Transcript to STTI Vancouver, BC podium presentation (15 minutes) each number corresponds to slide.
(1) Thank you for
this opportunity as so many have labeled this content as irrelevant for healthcare
workers. You will disagree. Instead, you will find this a conversation that
matters and that needs to be had.
(2) Raise your hands, who remembers The VIEW, a TV show, dismissing
Miss Colorado USA, a nurse, as wearing a costume and borrowing a stethoscope?
(3) Raise your hands, who heard that on 13 May 2017 a nurse was kidnapped,
brutally tortured and savagely raped while at work caring for others?
Keep those two in mind during this
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.
(6) This is going to be a
provocative presentation about the elephant in healthcare’s exam room
no one is talking about. (7) I hope to still have a job
tomorrow. 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.
(8) I have worked for so
many because I will NOT bow to EXAGGERATED
UNREALISTIC EMOTIONAL EXPECTATIONS.
And despite warned and given an explanation. I
(9) 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
families. 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
and NOT anyone else’s to cultivate our profession and steer it in the right
direction without compromising healthcare workers or patients.
(10) Healthcare’s best-kept secret
is NOT how much does the hospital CEO make but that customer
satisfaction scores are NOT about
healthcare and instead EXCLUSIVELY about
customer retention FOR profits.
Studies showing 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
but leave behind 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.
(11) However, healthcare is like no other industry, NONE, and:
industry with patients
industry with our waiting room
industry where regardless of disposable income services are sought after and
-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…
(12) …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—(13) healthcare service
excellence. Since, the belief has been that by increasing customer
satisfaction healthcare’s quality and cost would improve. The
strategy: (14) 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”.
(15) 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.
(16) The collateral damage.
centers unable to keep up with the competition closing their doors leading to
circumstances and catastrophic outcomes ELSEWHERE
because of increased census, wait times, treatment delays, nursing workloads
and medical errors.
In 2011, the (17) Centers for Medicare
and Medicaid Services paid out $226
BILLION on overtreatments that did not benefit anyone. How much of that just to
avoid patient complaints?
WASTE that does not include the hundreds of millions WASTED on luxurious lobbies and valet
(18) WASTE that keeps us
from HIRING sufficient nurses to
have safe nurse:patient ratios.
(19) 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.
(20) “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. 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.
(22) 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?
(23) 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
(24) 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.” (25) NONE having the testicular fortitude of going at it alone.
(26) I ONLY wish I had thought of
a bolder title, like (27) 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.
(28) 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.
(29) Is taking healthcare back possible? Absolutely!
Albert Einstein, (30) “Healthcare will not be destroyed by those who take it down the wrong tracks but by those
who watch them without doing anything.” (31) To take healthcare back and end this ignored and shameful silent national
crisis that insults healthcare workers and patients we must surround ourselves
with those who are bold and on the same mission as us.
(32) 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.”
(33) 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.
(34) But don’t let me borrow a stethoscope for the whole planet
to come unglued. Who cares whose stethoscope it is? The View proving the public has no
idea what we do. Yet, we are asking the public to rate us.
Albert Einstein warned
us, (35) “We cannot solve our problems by using the same kind of thinking we used
when we created them.”
(36.1) Meaning, we must rid ourselves of traditional thinking to create the future.
For this insanity to end we must (36.2) deflate everything
customer service to nothing more
than a byproduct of healthcare rather its driving force.
(36.3) Healthcare needs change agents willing to go in a new direction, even if ALONE! A direction that (36.4) promotes healthcare workers as valuable and trustworthy over concerns patients may take their business elsewhere.
(36.5) By no means am I suggesting patients cannot complain as they
are simply venting their frustrations, anxieties and feelings of powerlessness.
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? 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 (36.6) 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.
(36.7) 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.
(36.8) 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 (36.9) patients are customers, clients, or guest. They are NOT!
They are patients, ill or injured, and ONLY
healthcare has patients!
(37) 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!” (38) Because picking your battles is a position of convenience. As anyone
who has fought any battle will tell you how inconvenient that is.
(39) 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, unsafe
nurse:patient ratios and placating to those who make demands on us... (40) 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.
(41) I know that I am not alone in these thoughts and why I ask, don’t judge my words. Judge my intent.
(42) Thank you for
your time, the attention and the opportunity.