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.
will be made aware that the current path healthcare is being “taken down” is
NOT good for healthcare, healthcare workers or patients.
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.
I will not be discussing any investigational and/or off-label
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
(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!
(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.
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
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:
industry with patients
industry with our waiting room
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
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.
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].
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?
centers unable to keep up with the competition closing their doors leading to
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
(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?”
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
(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... (26) MAKE HEALTHCARE GREAT AGAIN!
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!
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
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.