Thursday, March 24, 2005

What fucking planet are you fuckers fucking from, anyhow?

Or, Performance Improvement, Management-Style

We had a MANDATORY SEMINAR this week on performance improvement. The PI guidelines were written up by management (read: those with little or no patient contact) and presented to us in PowerPoint form (read: we had the handout read to us) or in skit form.

One of the best parts was this: (bear with me...)

A very short, morbidly obese patient had come in for some treatment or other and had had problems with the bed in the room being too high even when it was lowered as far as it would go. He'd also had problems with the toilet seat being too high for him to sit on, as it had a riser. A riser, for those who don't work in hospitals, is a large plastic device used to raise the seat of the toilet high enough so that hip-replacement patients don't have to squat to poop.

These problems had apparently gone unfixed for several days, leading to aggravation and frustration on the part of the patient. I get this, and sympathize, having dealt with it myself in the past. However, management's solutions were to a) take the riser off of the toilet, and b) provide a stool for the patient to stand on so he could get into bed unassisted.

There're only two problems with this approach: a) The toilet risers are permanently installed on toilets in a percentage of rooms and cannot be removed and replaced with a regular seat. Nobody seems to have thought of this and moved the guy to another room. B) Stools for patient use are strictly forbidden under hospital policy. We on the neuro/ortho unit have to sneak them into patients' rooms in order to provide people with extra inches. As far as I know, there is *one* stool in the entire hospital, hidden in our supply room.

The PI skit focused on how to validate the patient's feelings and solve his problems. It was performed by two people who apparently operated in total ignorance of hospital policy and technical reality.

Need I mention that the MANDATORY SEMINAR was held at 0730? For half an hour? And that was the only time of day it was offered? So that day-shift nurses had to leave the floor at the busiest time of day, and night-shifters had to lose an hour of sleep?

So I left my patients in the capable hands of my overworked charge nurse for 30 minutes in order to prove that I was committed to patient care.

Teamwork, by the way, is an essential part of this PI initiative. In order to facilitate teamwork, each floor manager is going to post a list of people who've gotten props from the patients on a monthly basis.

Uh. It doesn't matter if I pray with a patient, talk to her for forty-five minutes, or get many compliments from family members. All of those things, by the by, have happened in the last seven shifts. What matters to management is if those patients fill out a piece of paper. I feel idiotic saying to a woman who's just cried on my shoulder, "Hey, I know you're in a rough spot, but would you mind filling out this questionnaire to let my boss know I'm doing a good job?"

I'm not (and I'm sure this is shocking) good at self-promotion. Guess it's time to go back to work with the attitude of loving the job for its own sake.

In other news

It really sucks when you tell a friend that you have to lose 25 pounds, on doctor's orders, and she doesn't say, "Oh, you look great as you are. That doctor's blowing smoke."

Guess it's time to go do some situps.

Goal: size 8 by April 24th. We'll see how this goes.

10 comments:

me said...

Oh. My. God. I'm totally cracking up over here given that I AM one of the people on the management side and the same kinds of stuff drives me insane...esp. the power point thing -- it is not meant to be a SCRIPT...it's an AID for Pete's sake. In all seriousness, though, your insight is really useful.

Also...I have to drop some poundage myself...you can't possibly be that overweight...I'm rootin' for you!

me said...

Oh. My. God. I'm totally cracking up over here given that I AM one of the people on the management side and the same kinds of stuff drives me insane...esp. the power point thing -- it is not meant to be a SCRIPT...it's an AID for Pete's sake. In all seriousness, though, your insight is really useful.

Also...I have to drop some poundage myself...you can't possibly be that overweight...I'm rootin' for you!

Anonymous said...

Great post! I do sympathize with the nursing staff. A couple of years ago I was in the hospital with a severe kidney infection and learned all about what you guys have to put up with. I'm lying there in bed with a 105 temp and the nurse is telling me as she is putting on a blue wristband that I am on level blue. She pointed to a chart on the wall with different colored squares. Level blue means that I am supposed to leave my bed rails up.
And if I'm anywhere else in the hospital and they see my blue wristband they will know I'm on level blue. All I could think of at the time was that I must truly be delirious. Surely this nurse could have simply told me to leave the bed rails up, did I really need a blue wristband which matched a blue square on the wall? Once the fever went down I noticed that the blue wristband was there, and that I had not been delirious--just another performance improvement project at its finest.

L

DisappearingJohn said...

I also am laughing about your performance improvement scenerio. Our policies are all based on improving our Press-Ganey scores, to the point we have a "customer service" person who rounds each day and interviews patients using a script, reminding patients that we "want to make sure they are very satisfied with their care", and "very satisfied with ...." (add the typical areas of the survey). You say "very satisfied" 8 times per patient in the script, all in an attempt to get the highest Press-Ganey ratings ("very satisfied" is the highest rating for each question on the survey)

And good luck on the 25 pounds... You'll get darn little sympathy from me on that one, though...

John

DisappearingJohn said...

I also am laughing about your performance improvement scenerio. Our policies are all based on improving our Press-Ganey scores, to the point we have a "customer service" person who rounds each day and interviews patients using a script, reminding patients that we "want to make sure they are very satisfied with their care", and "very satisfied with ...." (add the typical areas of the survey). You say "very satisfied" 8 times per patient in the script, all in an attempt to get the highest Press-Ganey ratings ("very satisfied" is the highest rating for each question on the survey)

And good luck on the 25 pounds... You'll get darn little sympathy from me on that one, though...

John

DisappearingJohn said...

I swear, I only hit "submit" once..

Anonymous said...

Too funny! I am so damn sick of scripting and Press,Ganey that I could scream! I can so relate to your posts. And I am sorry, but they are PATIENTS, not CUSTOMERS!!

Anonymous said...

Too funny! I am so damn sick of scripting and Press,Ganey that I could scream! I can so relate to your posts. And I am sorry, but they are PATIENTS, not CUSTOMERS!!

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Anonymous said...

Press Ganey is turning medicine into a cult. Just drink the Koolaid and all will be well. It is a tool by non medical personal used to brainwash those involved in patient care. It's a great technique, probably first used by the Nazis.