The Customer is NEVER Right - A Nurse Practitioner's Perspective
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Transcript: Transforming Healthcare-A Pathway to Nursing Excellence (Hawaii)
















Transcript to  podium presentation each number corresponds to slide.

(1) Aloha and Mahalo for this opportunity as so many have labeled this content as irrelevant for healthcare workers. You will disagree.
 
Unfortunately, although passionate about this subject I do not possess the talent of presenting without reading. But without reading I risk leaving out essential points from a conversation that matters.
 



(2) Here are the Objectives:
1.   Participants will learn the history of healthcare service excellence.
 
2.   Participants will be made aware that the current path healthcare is being “taken down”, with regard to customer satisfaction, is NOT good for healthcare.
 
3.   Participants will appreciate that by putting healthcare and healthcare workers first and customer satisfaction to follow everything else will fall into place, to include customer retention and profits.
 
(3) Disclosures:
I will not be discussing any investigational and/or off-label use, UNLESS a healthcare worker pushing back is considered off-label. I do receive royalties from book sales but have no other financial relationships to disclose.
 





(4) Why a disclaimer? This is going to be a provocative presentation about the elephant in healthcare’s exam room. I hope to still have a job tomorrow.
 







Aside the introduction Let me tell you a bit more about myself (5)DA NURSE.
 
At 15, that was 1983, I enrolled in a vocational high school for a License Practical Nurse program. I was not a volunteer or a candy-stripe nurse but a nursing student responsible for patient care.
 




At 17 I joined the US Army to be a Combat Medic. After 10 years of active-duty I left the military to earn a Bachelor of Science in Nursing, right here at the (6) University of Hawaii-Manoa. Thirteen-years ago I earned degrees of a Nurse Practitioner and Clinical Nurse Specialist.
 
That bit of me to point out that I did not JUST wake up one morning and decide to be a nurse. Instead my desire to help others was early and I have been doing so for so long. And not just for a paycheck but as a volunteer as well.
 
Unfortunately, my LinkedIn profile shows that I have worked for more than 20 employers as a nurse practitioner. However, what that profile DOES NOT show is that my inability to stay employed was not because of incompetence, breach of duty, or negligence. Nor is it because of injury, disability, or death to a patient. Nor is it because of prejudice, alcohol, or drug addiction. Nor is it because I am unreliable, cannot be trusted or undermine those I work with. Nor is it because I lack compassion or do not care.
 
(7) I have worked for so many because I will NOT cater to EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS.
 
Why?
 






(8) I AM A NURSE!
 
I am not…a bellboy at your favorite resort looking for a tip…I am not a cashier at Chick-fil-A whose script it is, “My pleasure”…I am not a hospital’s CEO chasing satisfaction scores…and most DEFINITELY I am not anyone’s punching bag! Not to patients. Not to family. And not to administrators either. 




(9) That off my chest.
 
Like so many of you, I am a member of a time-honored profession and a patient advocate responsible to care for the sick, promote health, prevent illness and injury and maintain levels of health for others. It is also our responsibility to cultivate our profession and steer it in the right direction while placing patients’ reasonable concerns ahead of our personal convenience, pleasure, profit and safety without bias, stereotype or compromising the contributions of other healthcare workers.
 
(10) Because of that camaraderie I wrote the “The Customer is NEVER Right: A Nurse Practitioner’s Perspective”. I wrote it not as a disgruntled worker but because it is the story of so many in healthcare and a story that had to be told. 







(11) Not the never-ending story that we are burned out or hate what is in front of us but that we love what is behind us and that love is healthcare.
 
A story healthcare administrators dismiss as they rather follow than lead, claiming, “That’s what they are doing ‘up the street’ and so will we.” 





(12) None of them having the testicular fortitude to support us on their own, much less publically.
 
The book’s title is purposefully provocative. It not only points out that those who complained in the book were not right but more significant it screams that addressing patients as customers is NEVER right.
 



(13) After writing the book I struggled with whether to publish it as once public there was no turning back. And likely the reason why so many balk, as anyone here could have written the same, but no one wants to be unemployed and I understand.
 






(14) My concerns were not critics but rather if I would forever hinder my opportunities in healthcare as the book is inflammatory towards the current system, those managing it and most concerning those offering the jobs.
 






In his “Day of Affirmation” speech in 1966 (15) Robert F. Kennedy said, “Few men are willing to brave the disapproval of their fellows, the censure of their colleagues, the wrath of their society. Moral courage is a rarer commodity than bravery in battle or great intelligence. Yet it is the one essential, vital quality for those who seek to change a world which yields most painfully to change.”
 
To that I will add, INTEGRITY is choosing your thoughts and actions based on values rather than personal gain or fears. With those two views in mind I took a deep breath and took on the challenge to take healthcare back. As a result here I am today—looking for work. Just kidding.
 
Kidding aside, I wish I could tell you this epiphany is transient and after being knocked down a few more times I will dust myself off and finally align myself with just being one in the crowd more looking away. 

(16) However, I have been with my guardian angel for a long time and she sees it differently. So here goes nothing…or as my guardian angel so frequently says, here goes EVERYTHING, AGAIN!
 







(17) Contrary to popular belief healthcare’s best-kept secret is not how much does the hospital CEO make. Instead, healthcare’s best-kept secret is that customer satisfaction scores are NOT about healthcare. And despite studies show there is no correlation between satisfaction scores and good healthcare satisfaction scores are the driving force healthcare workers must bow to.
 
A driving force without accomplishment I must add. Because despite all the money, time and effort invested satisfaction scores have not added anything to healthcare except an overwhelming amount of collateral damage.
 
Healthcare is a time-honored profession genuinely dedicated to helping others and OBLIGATED with saving lives and stomping out disease. Despite that heritage and DUTY healthcare has been cheapened, by any means necessary and at the cost of so much, into just another customer-driven service.
 
(18) However, healthcare is like no other industry, NONE! and…
-the only industry with patients
-the only industry with OUR waiting room

-the only industry where regardless of disposable income or time services are sought after and rendered
-the only industry whose workers maintain the public’s confidence year after year as the public has recognizes us as the most honest profession and with the greatest ethical standard of any industry
-most notable, healthcare is the only industry where workers go to battle for every “so-called customer” and when “so-called customers” succumbs—we cry for them as well…
 
…as the overwhelming numbers of patient experiences are rewarding, for both healthcare workers and patients.

(19) However, because of their sheer volume those positive experiences become blurs of one another and unless they are remarkably extraordinary their details are consigned to oblivion.
 
Yet, the melodramas of the complaining minority are permanently etched in our memories, some physically scarred. It is that misery and frustration which drags us down, as we must navigate, ALONE, that exhausting minefield just to stay safe and/or keep our jobs. Reason enough as to why so many leave healthcare and not fatigue as no one fatigues from helping others.
 
(20) How did we get here?
 










In the 1980s, healthcare administrators found themselves with a new frontier—(21) healthcare service excellence. Since, the belief has been that by increasing customer satisfaction healthcare’s quality and cost would improve. The strategy: Healthcare would learn how to deliver great service from the service industries. The blueprint: To take the ideas from all of the service industries, in particular their scripts and signage, and standardize them for healthcare workers with the... 


(22) ...IDIOT-OLOGY [sic] that healthcare workers were “just like waitresses”.
 
Thirty-plus years later and billions of dollars invested healthcare has nothing to show for that IDIOT-OLOGY [sic] except more expensive and inferior quality healthcare, a customer satisfaction needle that has not moved and most significant, a devastating trail of collateral damage that includes decreased access to healthcare, healthcare directed violence, an opioid abuse epidemic, thousands killed every year due to medical errors, and billions of dollars wasted just to name a few.
 
For the first half of those 30+ years a number of private companies did the rating, the most infamous of them Press Ganey. With the different company rating models both patients and healthcare organizations found the competing results to be confusing, unfair and failed in their intent to rate healthcare, shortcomings that lead those users to complain to politicians.
 
Shortcomings that had been documented extensively in the literature, both professional and lay, as not only a bad and controversial idea, for a number of reasons, but more so that rating healthcare was a slippery slope. Despite the literature politicians and pundits believed rating healthcare could be consolidated and improved.
 
Not only did politicians and pundits ignore the literature. They also ignored the fact that healthcare administrators and pundits, then and still today, struggle to list a single benefit for healthcare from chasing after satisfaction scores, other than customer retention and profits.
 
And despite all of that, the literature sounding the alarm, the inability to list a single benefit, 30+ years of chasing satisfaction scores, and politicians and pundits acknowledging that healthcare is broke they pressed forward rationalizing that some tweaking of customer satisfaction ought to do the job.
 
No one ever considering that rating healthcare is the problem, as rating healthcare has been the one constant variable. And despite the already 30+ years of tweaking customer satisfaction nothing has improved.
 
What if the current healthcare system is not broke but instead as intended—focused on customer retention for profits and customer (23) satisfaction is just a ploy for those goals?
 







Regardless, politicians and pundits pressed on and as a result in 2006, in an attempt to consolidated and improve the rating of healthcare, (24) the Centers for Medicare and Medicaid Services implemented the federally mandated Hospital Consumer Assessment of Healthcare Providers and Systems, the slippery slope better known as HCAHPS.
 



(25) In 2012, HCAHPS, unlike the private rating systems, would wager against healthcare. The purpose: To offset the cost of the Affordable Care Act. How? Withholding Medicare reimbursements from organizations with less-than-stellar scores, actions that only undermine the survival of those organizations after unable to keep up with chasing after satisfaction scores. A distraction, because after being reimbursed at a lower rate a low-performer will rashly spend its money to correct the customer service inefficiencies rather than improving its product, healthcare. As a result a vicious cycle ensues of losing money, not fixing the problem but making it worse, closing their doors.
 
A lose-lose situation, as now those patients will have to go to (26) Elsewhere Medical Center, where overcrowding leads to deplorable circumstances and catastrophic outcomes, like increasing wait times, increasing treatment delays, increasing nursing workloads and increasing medical errors.
 




(27) Rating healthcare is NOT good for anyone, not for healthcare, not for healthcare workers and worse for patients. That alarm has been well documented and the collateral damage left behind is overwhelming yet no one is taking heed.
 
But don’t let me prep an area for a central line with betadine without JACHO, the American Nurses Association, the American Medical Association and the entire hospital staff, to include the unit clerks, to challenge that choice.
 
We have the planet’s greatest healthcare system and that is thanks to the men and women in our ranks as it is you who provides such great healthcare. Yet, healthcare in our nation is in crisis, a silent crisis as so many choose to look away.
 
This tolerated and largely ignored silent national crisis is not political as we only have healthcare’s submissive, altruistic and accommodating culture, and its obsession with customer satisfaction scores to blame. Not only did we follow the herd but we turned over the reins and since outsiders have taken healthcare in the wrong direction with their IDIOT-OLOGY [sic] that it is in the patient’s best interest.
 
(28) We got here because outsiders convinced healthcare administrators that in order for their organizations to remain in business they had to sell their soul or face closing their doors. Yet, here we are more than thirty years later and BILLIONS of dollars wasted with more expensive, less quality and decreased access to healthcare.
 
Outsiders used fear mongering to con healthcare administrators to turn on their own. Their two favored intimidations: First, that those who are complained about get sued the most, a truthful and well-documented fact.
 
However, those complained about being sued the most is a fact in every industry and in (29) every aspect of life as the unhappy try to find compensation for their so-called woes. Sadly, in healthcare a patient complaint causes MASS hysteria.
 
A question not asked that needs to be asked is, how many sentinel events those who are “POPULAR” cause? Because although not cited in statistics, we have all heard of that healthcare worker who has caused injury and even death but because “ADORED” that person is kept.
 
Myth? I do not know. What I do know is that a number of medical directors shared with me those stories when those directors told (30) me that life is unfair after they asked me to resign because of patient complaints. Yet, when I asked those directors as to why they kept individuals who’ve cause harm, more common than not, those same directors revealed that those with sentinel events are never on anyone’s complaint radar.
 
The second intimidation used, the all too common narrative that your hospital will close if patients badmouth your organization.
 
I am a nurse, not a businessperson, but when I researched the whys companies go out of business by far the most common cause was money. Now some will argue that poor customer service equals loss in revenue. Sure. However, I could not find a single business that closed their doors due to poor customer service.
 
(31) These are some of the biggest companies on the planet. Yet, in 2014, this article identified them as the worst in customer service.
 
Of course, these list vary as customer service is subjective and the reason as to why the difference between being perfectly satisfied and wanting the person back again cannot be improved on, as that difference cannot be measured, scripted, reduced variation or standardized. 


Those are not my words but the words of W. Edwards Deming, the father of statistics (32). That didn’t work. That’s not Deming but instead Lee Fred, a healthcare customer experience guru, repeating Deming words.
 
Now no one wants to be known for the worst customer service. OF COURSE NOT! And no one is suggesting that. However, do not force-feed me that line that poor customer service is the end all and why businesses fold.

(33) I get it, “Without data you’re just another opinion.” But what are we chasing after? For the difference of being perfect versus great or being perfectly satisfied versus wanting the person back again? Is there really a difference or is just semantics for another agenda? 






(33a) Because after all…“not everything that can be counted counts, and not everything that counts can be counted”, and even Deming agrees to that.
Again, the most common reason why businesses close is because of a lack of MONEY. That said, organizations that do not bring in enough money it is NOT because of poor customer service. I just showed you a list of some of the biggest companies on the planet despite having the worst customer service, not only in their industries but the worst customer service of all industries. Some are on there for eternity (34).

Instead, the most common reasons for lacking money are (1) poor business plans and/or (2) a product that is subpar to that of the competition.
 
As to the latter, regardless of industry, customer service is rarely a product but instead filler for a subpar product that falls short of the competition’s product. In other words, a great product stands on its own, without fluff or fillers, and products unable to do the same must rely on customer service or some other gimmick to make up for its failings.
 
(35) Of course there are organizations capable of both, great customer service and a product that stands alone. Many of them products from ambitious for-profit driven businesses. But even those businesses DO NOT side with customers over employees. My point, do not be fooled by the false narrative that customer service is the end all. Instead, put your best product forward. In healthcare that is the healthcare worker and not customer service as there is now 30+ years of chasing satisfaction scores without a single benefit but instead worse quality and more expensive healthcare.
 
Lastly, as to how we got here with regard to healthcare service excellence, the IDIOT-OLOGY [sic] that conflict between customer satisfaction and healthcare workers jeopardizes the administration’s goal of customer retention and profits. That being the second most guarded secret in healthcare as to WHY customer satisfaction scores are the driving force in healthcare. Reason as to why healthcare administrators side with customers over their very own and extensively vetted loyal employees.
 
An IDIOT-OLOGY [sic] that only leads to distrust, not just from the employee labeled a risk but from all in the organization, as ALL fear of being next if a patient complains.
 
(36) Now, as to what customer satisfaction can be credited with.
 









(37) “According to a 2009 Healthcare Advisory Board report, patient satisfaction scores have been stuck at about 82% for the past 10 years!”
 








(38) Not to mention those numbers are par for the course, as they seem to be the average as to how customers rate companies, regardless of industry.
 








(39) In Feb 2015, Rick Conlow, a customer experience guru, wrote “The great customer experience scam” where he stated, “You would think customer service should be getting better, with all of the surveys that are done and all of the new technology. Plus, there was the quality service revolution the last three decades [1990-2010]. Billions of dollars were spent. Right? Wrong!” (40)



 











It’s a scam Mr. Conlow wrote. Now I see why outsiders have taken their previous lack of ideas and repackaged them as the NEW and IMPROVED (41) Customer Experience. And guess who’s buying into it? Healthcare! Again! And as a result it will not be long before we no longer call patients customers or clients but will call them GUEST!
 
Despite the customer satisfaction needle not moving and ALL the collateral damage left behind the common hounding from outsiders is that “…the train has left the station…so either get on or be left behind as customer satisfaction scores is where healthcare is headed”. Sadly, no one opposing that groupthinking despite the train is headed on a collision course as the IDIOT-OLOGY [sic] of accommodating the EXPECTATIONS of a few is not sustainable. 

(42) Something healthcare administrators are WELL AWARE OF but only privately do they mumble that the numbers do not match up.
 








None having the testicular fortitude to stand their ground and push back so they bow and keep throwing money at the status quo. (43)
 
Preying on healthcare’s submissive, altruistic and accommodating culture outsiders have been able to herd healthcare to their desire. And will continue to force-feed healthcare the Kool-Aid that has gotten us where we are today.
 


Kool-Aid healthcare administrators then (44) regurgitate as scripts and signage, standard uniforms, valet services, and luxurious lobbies, to name a few, as being in the patient’s best interest. And those of us who decline to be force-fed are dismissed.
 
No one, not even the patients themselves, has the patient’s best interest in mind than those of us caring for the patient. One reason the public appreciates our honesty and ethical standards, an honor that excludes administrators and outsiders, and righteously so.
 
Again, healthcare is a time-honored profession trusted with saving lives and stomping out disease and must NEVER be cheapened just to accommodate a few.
 
(45) On that note, to those drinking the Kool-Aid, do us all a favor, quit writing articles and self-help books that tell us that our frustration is because we are experiencing what you have labeled “compassion fatigue”. 







(46) When instead the reason so many leave healthcare is because of frustration with a system that treats us as doormats for others to walk all over and wipe their feet on us as well.
 
Again, since the 1980s the belief has been that by increasing customer satisfaction healthcare’s quality and cost would improve. Instead, we got more expensive and inferior quality and decreased access to healthcare.
 
Why? Because rather focus on variables that would improve the quality and cost of healthcare, such as outcomes and the safety of healthcare workers and patients satisfaction surveys focus on wait times, pain management, housekeeping, and communication skills, none of which improve the quality or cost of healthcare.
 
Not to mention, IDIOT-OLOGIES [sic] that have done nothing for healthcare but (47) incite a survival of the fittest race that pins us against our treasured colleagues who are helping others as well. Treasured colleagues healthcare administrators have so disgracefully labeled as “THE COMPETITION UP THE STREET”.
 




(48) Another bad idea, aside rating healthcare, is satisfaction based pay, as normal human behavior tempts us. Because if I am going to get paid based on high satisfaction scores, not to mention keep my job, than I will pander to that IDIOT-OLOGY [sic] of needless admissions, diagnostics, procedures and medicines.
 




(49) In 2011, the Centers for Medicare and Medicaid Services paid out $226 BILLION on overtreatments that did not benefit anyone.
 
How much of that wasted on unnecessary admissions, diagnostics, medications or procedures JUST to satisfy patients who say, “I have insurance…” Or patients who believe that every sneeze is swine flu, every headache is a tumor, that their bronchitis is cancer, that their stomach flu is Ebola, that grandma would benefit from a four-day weekend admission or any other list of reasons JUST to avoid complaints or threats from patients? (50) Pandering is not advocacy.
 
Making matters worse, rather discounting those as fraud, waste and abuse healthcare pundits have labeled those inconsistencies as no-brainers. That being the need to avoid patient complaints at any cost and by any means necessary, regardless if those accommodations are inappropriate or wasteful, and why healthcare workers are told to (51) BOW and not challenge extravagant expectations.
 













Because of that we are NOT to discuss topics like smoking, alcohol, drug abuse, obesity, non-compliance and other unhealthy choices unless related to the current visit as (52) those concerns might upset patients according to administrators.
 






I caution you from challenging those so-called no-brainers as ethical dilemmas or immoral misjudgments. As I very well know that any healthcare worker not drinking the customer is always right Kool-Aid will lose that argument and likely their job as well. As I KNOW that administrators have already made up their minds, before addressing the issue with you, that you are a greater risk than a benefit to the organization. As their groupthinking only permits them to see it one way—that you are wrong and nothing else matters. How do I know? Been there. Done that. (53) Wrote a book about it. 

However, after the fact of course, (54) I only wish I had the foresight of a bolder title, like MAKE HEALTHCARE GREAT AGAIN!
 








That aside, the mentioned WASTE does not include the BILLIONS lost as a result of healthcare directed violence. (55) A violence that has become more frequent, more brazen and more violent. And our professional and government organizations have nothing to offer except “feel good” policies that are IMPOTENT as they purposely fall short as to not offend patients or families. 




Despite those policies (56) reports from victims of violence continue to be greatly underreported.
 









Why? Because the first thing administrators ask is, “What did you do to piss off that patient?” Reason enough as to why (57) “Healthcare workplace violence is an underreported, ubiquitous, and persistent problem that has been tolerated and largely ignored.”
 





(58) After assaulted by a customer a taxi driver posted a video of the assault online and within the week that video was viewed by 2.5 million launching a debate about the safety of taxi drivers.








(59) Yet, despite statistics show healthcare workers are assaulted 4 to 5 times more often than taxi drivers in urban areas (60) this video of nurses being assaulted by a patient has barely gotten 1/5 the views in more than two years since the incident.
 





Healthcare pundits tell us that healthcare directed violence is a rare occurrence and at the hands of the demented, psychotic or those under the influence of alcohol and/or drugs. Yet, the experience of many in healthcare has been that healthcare directed violence is more common than not. And more common than not it is NOT at the hands of those listed but instead of those who did not get what they wanted, tired of waiting, missed their honey-bunny, thought it was too noisy at the nurse’s station or whatever flavor of the week it is.
 
(61) Isn’t it sad the industry on the forefront of fighting domestic violence finds itself in an abusive relationship, to include justifying the violence and siding with the actions of those who are abusive towards us?
 




(62) On top of all that, as if not enough, studies have not only shown there is no correlation between satisfaction scores and good healthcare. But they have also shown that the most satisfied patients not only spend the most on healthcare but they are most likely to be admitted and most likely to die.
 
Interestingly, UC-Davis, a pillar of healthcare research, is not able to convince anyone despite their study included over (62) 50,000 charts.


Yet, healthcare administrators take at face value the private customer service consultants’ claim (63) that they only need 30 responses in order to reach a “meaningful conclusion” with regard to customer satisfaction scores.
 
Well then, I too can reach a “meaningful conclusion” by extrapolating from the 30+ years of healthcare chasing satisfactions scores. And that conclusion is, there is not much to be gained from wasting millions just to sway a few to anyone’s side, not to mention the collateral damage left behind from doing so. Especially since a few from your side will likely go to their side as that is the normal cyclic trend of customers, in every industry. Some you gain and some you lose. 

(64) As disclosed by the American Customer Satisfaction Index of the last 21 years.
 
Think of all the money, time and energy wasted and the collateral damage left behind just to gain some here and some there. Not to mention, whom are we undermining and stealing patients from? But from our treasure colleagues who are trying to help others as well.
 
As healthcare workers, is that the train we want to be on?
 
Those are but a few of the collateral damage I speak of and the true reasons as to why so many have left healthcare rather the proposed “compassion fatigue”.
 
(65) Is taking healthcare back possible? Absolutely!
 









Plagiarizing Albert Einstein, (66) “healthcare will not be destroyed by those who take it down the wrong tracks but by those who watch them without doing anything.”
 







That said, I caution you, as most healthcare administrators were recruited from clinical backgrounds after they showed interest in looking after and doing good for their clinical colleagues. Sadly, over time, (67) after crossing to the dark side, those naïve torchbearers find themselves siding more with their NEW administration colleagues than their FORMER clinical associates.
 
So, the adage “The customer is always right” remains king. Why? When in no other circumstances is anyone else always right. My parents are not always right. My friends are not always right. My siblings are not always right. My grandparents were not always right. My colleagues are not always right. Our professors were not always right. And as much as I hate to admit it even I am not always right. So why? Why should anyone accept that the customer is always right?
 
(68) That said, to those paying attention, you might have noticed I did not say that my guardian angel is not always right.
 








(69) Some think I am a customer service subject matter expert but I am far from such expertise and much less interested.
 
What I am a subject matter expert on is patient complaints. As I have more patient complaints than any healthcare worker on the planet. That’s not bragging, as anyone who is job hunting will tell you how painful job hunting is. Nonetheless, because of my expertise with patient complaints I will tell you that complaints come from those with hidden agendas and grandiose beliefs and expectations all extending from entitlement issues.
 
Being the patient complaint guru, if I can add anything of value to the conversation it would be that although drug seekers might raise hell in your clinic, emergency department or floors contrary to popular belief, they rarely, if ever, submit complains. Drug seekers are not patients they are addicts and the last thing they want is to be banned from their next fix or income.
 
In no manner am I suggesting drug seekers get a pass but note that bad things happen to bad people too so be careful with dismissing drug seekers. I would also add, don’t blame drug seekers for low satisfaction scores, as the problem isn’t the drug seekers or the low scores but the consequences of low scores. And for that you must look at those interpreting the numbers, healthcare administrators.
 
This conversation is not because of patients complaining but about the administration’s knee-jerk reactions and sequel JUST because a patient complained.
 
(70) We cannot change what we refuse to confront and in order to make healthcare great again we must remove the blinders that tolerate this ignored and shameful silent national crisis that insults healthcare workers and patients and also puts them in harms way.
 





In order to accomplish this seismic paradigm shift (71) we must surround ourselves with those who are bold and on the same mission as us.
 








How? In 2013, the federal government announced a college rating system to withhold billions of dollars in federal student aid money from low performing colleges. Sound familiar? (72) That college ranking system discarded after college leaders, unlike healthcare, stood their ground and pushed back citing the misguided rating system was “uncharacteristically clueless, quite wrongheaded, oversimplified to the point that it actually misleads and prioritized moneymaking.”
All predictable and have been actualized in healthcare, not only with HCAHPS but with the private rating systems before as well. Yet, healthcare pundits missed those and instead bent over to accept the idiot-ologies [sic] of outsiders, not once but twice. OR, did healthcare pundits see those moneymaking opportunities and WHY they sold their souls.
By no means am I suggesting that patients cannot or should not complain as they are only venting their frustrations, anxieties and feelings of powerlessness.


(73) However, when inappropriate they must leave because the culture of any organization is shaped by the worst behavior tolerated.
 








(74) The literature is inundated with articles that list a plethora of reasons as to why rating healthcare is a slippery slope yet no one is interested.
 








Albert Einstein warned us, (75) “We cannot solve our problems by using the same kind of thinking we used when we created them.”
 








(76) Meaning, we must rid ourselves of traditional thinking to create the future. We MUST no longer NURTURE this mistake of rating healthcare JUST because we spent a lot of money, time, and effort making the mistake.
 
For this insanity to end we must (76) deflate everything customer service to nothing more than a byproduct of healthcare rather its driving force.
 
Unfortunately, and where the burden lays, (76) healthcare is in desperate need of leadership as most healthcare administrators are not leaders but managers who merely facilitate policy between subordinates and superiors.
 
Healthcare needs change agents willing to go against the grain, even if alone. A direction that (76) endorses healthcare workers as valuable and trustworthy, supports our collaboration and professionalism and recognizes us as the good-doers over concerns patients may take their business elsewhere.
 
I have no knowledge what healthcare organizations spend to sway patients to their facilities. What I do know is whatever that monetary value is they would benefit most, to include improving the cost and quality of healthcare, if they spent it on their workers. As successful companies, in a number of industries, have shown that workers-first is a profitable reality.
 
The same goes for compensating us for JUST satisfying patients when a greater return on investment would be if we were compensated for outcomes, the safety of healthcare workers and patients, and not running up the bill. Those are win-win scenarios.
 
Healthcare is much bigger than any complaint and why complaints need not be feared as (76) the intent of those who complain is not to get anyone fired but an opportunity to vent.
 
Disagreement is not a hate crime or a crime at all. Nor is it a lack of caring or compassion. Who of us is absent of disagreement with those we love most? However, in healthcare, where we attempt to preserve the quality of life and prevent the loss of life, it is customer service complaints that are the end all.
 
Placating is not advocacy and rather placate to customer satisfaction scores healthcare needs and would benefit most if we placed all our energy, time and money on (76) clinical outcomes, those responsible for those outcomes, and the safety of healthcare workers and patients.
 
Because not only have we not moved the needle with regard to customer satisfaction scores but when the dust settles following a patient’s tantrum that is behavior you would NOT accept at home from loved ones. And why I get a chuckle when some suggest we treat patients as if they were family. Healthcare administrators would not accept that behavior at home either. Yet, they want us to accept that venomous behavior from those we are helping.
 
(76) I say dismiss those who annoy us. Dismiss the rude. The entitled. The abusive. The demanding. Those who tread on us and those who have taken us down the wrong tracks. By dismissing those who annoy us it frees us to focus on those who value, trust and appreciate us for the care we give. On this we must stand in solidarity and not waiver otherwise those who annoy us will not change their behavior as long as they can find tolerance elsewhere.
 
DO NOT confuse accommodating or appeasing with advocacy as indulging those who make unreasonable demands on us not only leads to running up the bill but it leaves us vulnerable too.
 
(76) Instead, we must side with loyal employees and coworkers over outsiders, the petulant, unreasonable, angry, demanding and those who tread on us for us not submitting to their EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS. This is not about us versus patients but about convincing patients that we are looking out for their best interest and if they desire our help they must stand with us. If they decline they must leave because intimidating us until they get what they want is manipulative and not what we are here for as it only divides healthcare workers trying to help others.
 
Lastly, we must get rid of the IDIOT-OLOGY [sic] that got us here in the first place. (76) We must NEVER see the ill or injured as customers, clients, or guest but as the patients they are, ill or injured.
 
(77) I am well aware of the wrath when we do not drink the Kool-Aid. Yet, when administrators say to me, “You better pick your battles wisely, Mister!” My answer, “I have!”








(78) Because picking your battles is a position of convenience, as anyone who has fought any battle will tell you how inconvenient that is and it is that inconvenience and sacrifice which gives worth to the battle.
 






(79) Plagiarizing Mother Theresa, “I alone cannot change healthcare, but I can cast a stone across the waters to create many ripples.”









In order to take healthcare back and steer it in the right direction, where healthcare and healthcare workers come first, and away from idiotic scripts and signage, standard uniforms, valet services, luxurious lobbies, and placating to those who make demands on us or tread on us (80) we need companions. Not to take part but to take over, across healthcare, standing in solidarity, as the time for conversation has LONG passed. Now it is time for accomplishments NOT more accommodations. Anything short of that results not in fatigue but in frustration as no one fatigues from helping others.
 
(81) I know that I am not alone in these thoughts and why I ask, don’t judge my words. Judge my intent. To those interested, I will send you a PDF copy of the book if you LIKE the book’s Facebook page and message me.
 






(82) Mahalo for your time, attention and the opportunity.
 
Questions?
 

 

 














References:
 
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Papa, A., & Venella, J. (2013). Workplace violence in healthcare. The Online Journal of Issues in Nursing. Retrieved from http://www.medscape.com/viewarticle/807943_3
 
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Scheinfeld, A. (2014, June 2). 5 things your nurse wants you to know (but can never tell you). Nursetogether.com. Retrieved from http://www.nursetogether.com/5-things-your-nurse-wants-you-to-know-but
 
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