Sunday, March 05, 2006

Dull is good.

The past week at work has been dull. Dull is good.

Status Migraine Guy is back, but he's calm and his pain is controlled. I don't know about you, but if I had a migraine that had run for two and a half weeks, I'd just chuck myself out the window and be done with it. I've only had one, but that one (and not a bad one, from what I hear) was plenty.

Our Customer Service Scores Tra-La are down for the months of December and January. This is a Big Deal to the management. Consequently, we're neither getting TEAM t-shirts this month (a good thing), and they're putting in place all sorts of bizarre procedures in order to improve Customer Service (a bad thing).

Part of the problem is that the CS scores are determined by questionnaires sent to the patients or the families after their stays. If somebody's either dead or gorked from a major brain injury, there's not a lot of hope that the person or people will find the time to fill out a thirty-question form, rating everything from the food to the cleaning staff on a scale of one to five. One would hope that they'd have better things to do.

Now, when you study mailed questionnaires in sociology class, it's assumed that a forty percent return rate is fantastic. Return rates normally run around 30%, with the majority of those surveys returned from people who have strong feelings--usually negative--about the subject being surveyed. Don't ask me why this is; I don't remember.

Anyway, if you cut the folks who can no longer read and write out of the survey pool, and remove a percentage of the families from that pool because they're taking care of Auntie Mae, you've smallified your return pool to those folks who were a) very sick at the time they came in, b) still have some memory of it, and c) care enough to return a 30-question form after rating things from 1 to 5.

Unfortunately for us, several of the people who returned their questionnaires have one or another type of dementia. One survey came back with three pages of single-spaced ranting attached; another had hand-written complaints about attempted kidnappings and abuse in the margins. There were others not as dramatic.

Those kind of affect the CS scores.

The amusing thing is that every member of Manglement with whom we nurses deal, from the lowliest charge to the uppermost uppity, has forgotten that crazy people skew results. Rather than throwing out three pages of paranoid rantings, they're basing practice changes on them.

Which basically boils down to "Keep your head down and give 'em whatever they want."

The floor nurses have given the new posters, training manuals, and inspiring speeches a collective shoulder shrug and are keeping on keeping on. If you have a patient who's convinced that the guys from the OR are going to kidnap her and sell her to white-slave traders, there's not a lot you can do (outside of, say, Haldol) to improve her Customer Service Experience.


PaedsRN said...

Ha! I vote for the Haldol, personally :) nice post.

Anonymous said...

I can only hope the last CS questionaire thing I filled out after a week long hospital stay was taken seriously. The nursing staff was absolutely fabulous, and I wanted their superiors to know it!

Anonymous said...

Yeah, our $$ back from the HMOs is dependent on these ^%$&^%$ surveys. I once got seriously flamed because I didn't speak Russian. She'd been promised a doc who spoke Russian & no one in my office did & she was irate. The last doc who spoke Russian left the group a decade ago. There is a Russian doc, in my specialty, one floor below, perhaps she got lost? But, no, despite my obviously Anglo name, I, and my entire office staff got flamed. And this impacted salaries. Grrrr!!!!!


Anonymous said...

but how long will the nurses really be able to keep on keeping on in spite of the efforts of Mgmt? i ask this as a 32yo nursing student, who is quite aware of both a personal low tolerance for Managerial Assholery and a systemic abundance of same. What am I thinking, I believe is the long and short of this comment, going into a profession where the PTB conduct themselves much like the restaurant managers that I've had to put up with while working my way through school?

Anonymous said...

I hear you, sister. I also work in medicine, and we recently had a (mandatory) meeting in which we were scolded b/c our patient satisfactions scores were lower the previous month. I was feeling bitchy, so asked how many people responded (I think less than 10%...also a mail-out survey). No one conducting the meeting could understand why these scores were meaningless, since the responding sample size is too low, and why variations of 1-2% per month are not statistically signifcant. They just told us to do better. Grrr.