The Customer is NEVER Right - A Nurse Practitioner's Perspective
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Transcript: Patient Safety Conference: Nurses Resuscitating Healthcare (DC)

Transcript to  podium presentation each number corresponds to slide.

(1) Thank you for this opportunity. While customer satisfaction in healthcare is not nurse to patient ratios both are HUGE problems in healthcare no one wants to address. And why you, the brave, are here. To start a conversation that matters.

(2) To those who think you are too small to make a difference, a bit of wisdom, try sleeping with a mosquito.

(3) Objectives:
1.   Participants will be made aware that the current path healthcare is being “taken down” is NOT good for healthcare, healthcare workers or patients.
2.   Participants will appreciate that by putting healthcare and healthcare workers first everything else will fall into place, to include customer retention, profits, and, most significant, a safe workplace.
(4) 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.

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

(6) As I have worked for more than 30 employers as a nurse practitioner in the last 15 years. NOT because of incompetence, breach of duty, or negligence. Not because of injury, disability, or death to a patient. Not because of prejudice, alcohol, or drug addiction. Not because I am unreliable, cannot be trusted or undermine those I work with. And not because I do not care or lack compassion.

(7) I have worked for so many because I will NOT bow to EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS. And despite warned and given an explanation. I PERSIST!

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.
Like you, I am a patient advocate and a member of a time-honored profession responsible to care for the sick, promote health, prevent illness and injury and maintain levels of health for others. It is our responsibility, NOT anyone else’s, to cultivate our profession and steer it in the right direction without compromising healthcare workers or patients.
(9) Healthcare’s best-kept secret is that customer satisfaction scores are NOT about healthcare but about customer retention FOR profits. As studies show there is no correlation between satisfaction scores and good healthcare. Yet, satisfaction scores are the driving force of healthcare.
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 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.
(10) 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 recognized us as the most honest profession and with the greatest ethical standard of any industry
-most significant, 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…
(11) …as the overwhelming number of patient experiences are rewarding for both healthcare workers and patients.
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.
How did we get here?In the 1980s, healthcare administrators found a new frontier—(12) healthcare service excellence. Since, the belief has been that by increasing customer satisfaction healthcare’s quality and cost would improve.

The strategy: (13) Healthcare would learn how to deliver great service from the service industries by taking their ideas and standardizing them for healthcare workers with the IDIOT-OLOGY [sic] that healthcare workers are “just like waitresses”, today, some of us in costumes, borrowing stethoscopes.

(14) Thirty-plus years and billions of dollars invested healthcare has nothing to show for that IDIOT-ology [sic].
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.
(15) What collateral damage?
Healthcare centers unable to keep up with the competition closing their doors leading to overcrowding, deplorable circumstances and catastrophic outcomes elsewhere because of increased wait times, treatment delays, nursing workloads and medical errors.

In 2011, the (16) Centers for Medicare and Medicaid Services paid out $226 BILLION on overtreatments that did not benefit anyone.
WASTE that does not include the hundreds of millions WASTED on luxurious lobbies and valet services.

(17) WASTE that keeps us from having safe nurse:patient ratios.

(18) (VIDEO) WASTE that does not include the BILLIONS lost to healthcare directed violence. 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.

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

(20) Healthcare pundits tell us that healthcare directed violence is a rare occurrence at the hands of the demented, psychotic, or those under the influence of alcohol and/or drugs. I say it is more common than not. And more common than not it is NOT from those listed but instead from those who did not get what they wanted, tired of waiting, missed their honey-bunny, thought it was too noisy at the nurses’ station or whatever flavor of the week it is.

(21) 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 those who are abusive towards us?

(22) All for what? As studies show 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. Those are but a sample of the overwhelming collateral damage left behind.

(23) I wrote “The Customer is NEVER Right: A Nurse Practitioner’s Perspective” not as a disgruntled worker but because it is the story of healthcare; where healthcare administrators rather follow than lead, claiming, “That is what others are doing ‘up the street’ and so will we.”

(24) None having the testicular fortitude of going at it alone.

Since writing the book, (25) I wish I had thought of a bolder title, like...

This tolerated and largely ignored silent national crisis is not political as we only have healthcare’s submissive, altruistic and accommodating culture to blame.

(27) 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’s in the patient’s best interest.

(28) Is taking healthcare back possible? Absolutely!

Plagiarizing Albert Einstein, (29) “healthcare will not be destroyed by those who take it down the wrong tracks but by those who watch them without doing anything.”

(30) To take healthcare back we must surround ourselves with those who are bold and on the same mission as us to end this ignored and shameful silent national crisis that insults healthcare workers and patients.

(31) In his Day of Affirmation speech, in 1966, Robert F. Kennedy said, “Few 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.”

(32) The literature is inundated with articles that list a plethora of reasons as to why rating healthcare is unfavorable for healthcare, healthcare workers and patients. Yet, no one is interested. But don’t let me prep for a central line placement with betadine without JACHO, the American Nurses Association, the American Medical Association and the entire hospital staff, to include the unit clerks, from challenging that choice.

(33) The View did not only wake a sleeping giant. They proved the public has NO idea what we do. Yet we are asking them, the public, to rate us.

Albert Einstein warned us, (34) “We cannot solve our problems by using the same kind of thinking we used when we created them.”

(35.1) Meaning, we must rid ourselves of traditional thinking to create the future.
For this insanity to end we must (35.2) deflate everything customer service to nothing more than a byproduct of healthcare rather its driving force.
(35.3) Healthcare needs change agents willing to go in a new direction, even if ALONE!

A direction that (35.4) promotes healthcare workers as valuable and trustworthy over concerns patients may take their business elsewhere.
(35.5) By no means am I suggesting patients cannot complain as they are only venting their frustrations, anxieties and feelings of powerlessness.
Disagreement is not a hate crime or a crime at all either. Nor is it a lack of caring or compassion. Who of us is absent of disagreement with those we love most? Yet, 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.
Rather placate to customer satisfaction scores, healthcare would benefit most, if we placed all our energy, time and money on (35.6) clinical outcomes and the safety of healthcare workers and patients.
A patient’s tantrum is behavior you and healthcare administrators would NOT accept at home. Yet, healthcare administrators want us to accept that venomous behavior from those we are helping.
(35.7) I say dismiss those who annoy us. Dismiss the rude. The entitled. The abusive. The demanding. 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.
(35.8) To Make Healthcare Great Again we must stand in solidarity and side with loyal employees and coworkers over outsiders, the petulant, unreasonable, angry, demanding and those who tread on us.
DO NOT confuse placating with advocacy as indulging those who make unreasonable demands leaves us vulnerable.
Lastly, we must get rid of the IDIOT-ology [sic] that (35.9) patients are customers, clients, or guest. They are NOT! They are patients, ill or injured.
(36) I am well aware of the wrath when we do not drink the Kool-aide. Yet, when administrators say to me, “You better pick your battles wisely, Mister!” My answer, “I have!”

(37) Because picking your battles is a position of convenience. As anyone who has fought any battle will tell you how inconvenient that is.

(38) Plagiarizing Mother Theresa, “I alone cannot change healthcare, but I can cast a stone across the waters to create many ripples.” 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, 1:8 nurse:patient ratios and placating to those who make demands on us...

(39) ...we need companions. NOT to take part but to take over. Anything short of that results not in fatigue but in frustration as no one fatigues from helping others.

The take away point, nurse:patient ratios negatively SAVE money while money is WASTED on customer satisfaction. Both with HUGE cost and risk to healthcare, healthcare workers and patients. Yet administrators are NOT troubled by those facts. And why (40) RESISTANCE is needed to MAKE HEALTHCARE GREAT AGAIN!

I know that I am not alone in these thoughts and why I ask, don’t judge my words. Judge my intent.

(41) Thank you for your time, the attention and the opportunity.


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