A Patient’s Perspective: Hospital Surveys Miss the Mark
Mark's note: Mike Sporer has commented a few times on blog posts and I invited him to write this guest post after we exchanged some emails about his recent experience as a hospital patient.
I recently had a surgical procedure for a large kidney stone. During my home recovery, I expectedly received a survey by email asking me to rate my stay. The obvious thing I noticed about it? The entire survey focused on my interactions with staff.
My response was returning a blank survey with a comment; the survey's focus on personnel ignores the systems and processes in which hospital personnel must operate. I then outlined, in a letter to a hospital executive, my less than stellar interactions with the hospital system.
I'm what hospitals consider a “high-touch” patient. I have a progressive form of Muscular Dystrophy, leaving me using a wheelchair with limited us of my extremities. I transitioned to a wheelchair in 1998.
Here are some of the issues I saw and experienced:
Understaffing – During most shifts, hospital floors are grossly understaffed. At one time, the hospital industry utilized acuity levels for short-term staffing. This is no longer true. When the staff encounters a high-touch patient like me, their workload immediately increases with no hope for additional staffing. Overall patient care obviously suffers.
More time is spent on data collection than on patient touch. They seem to be missing the point; what matters is not how much data is collected, but how much relevant data.
All nurses and aides are trained in the use of Hoyer type lifts for patients with limited mobility. Using a bedpan is difficult given my musculature, so I use a Hoyer type device to toilet at home. In the hospital, after finally finding a portable Hoyer lift, the staff had difficulty finding a usable harness. The evening shift at the hospital then refused to use the device due to “safety concerns.” It wasn't until the next day, after the surgery, that I convinced staff to use the Hoyer.
Ten days prior to the actual surgery, a Nephrostomy tube was placed in my back with a urine drain bag. I was sent home with no instruction on the care of the site or cleaning parts of the device. A very dirty urine culture put me in the hospital two days before the surgery.
During my stay, both legs needed attention by wound care personnel due to edema. The order to do so was placed, but wound care never showed up during my entire stay.
Upon arrival, it was determined that I would benefit from a bariatric air bed. The bed arrived as I was being discharged.
Upon discharge, I received instruction on removing the Foley catheter and was told that my wife could remove it. I'm sure the goal was to shorten the hospital stay, but my wife isn't a health care professional and was a bit apprehensive about it. Although it isn't a difficult process, I ended up having a home health care nurse remove it.
Let me say that the surgical suite personnel, practices, and systems were outstanding, and I experienced positive results. The processes outside the surgical suite? Not so good.
The staff I encountered in this hospital were kind, caring, trained, and compassionate. However, they are were working under an oppressive environment caused by a broken system. Every problem I encountered could be avoided by a Lean mindset of continuous process improvement. Doing this requires that all personnel have a voice in improving systems and processes.
Instead, it seems they are dealing with top-down, command-and-control management who seemed more concerned with litigation than patient care. My experience with a nurse explaining that using a Hoyer device to move me was a “safety issue” speaks volumes. Hospital executives are, however, dealing with staggering regulations and a system centered around the insurance system.
Am I hopeful that the hospital system in America will improve? Hard question. Hospital care involves a “one size fits all” mentality for reimbursements. They operate under bureaucratic, top-down management, and they create an oppressive environment for employees. Many aspects must change to make sustainable improvements to hospitals.
I've been a practitioner of Lean processes for many years, and brought a Lean mindset to government operations while CFO/COO at a public career technical school. The same mindset applies to the nonprofits, retail stores, and service industries I've worked in. Bottom line? Lean is a culture. It's a mindset, not a toolset. Hospitals need to get on board, and we must advocate!
About me: I worked as CFO/COO in a career technical school, serve on several non-profit boards, and I am a practitioner of Continuous Process Improvement. Currently, I operate a management consulting company, www.empoweru1.com. We love working with small family-owned businesses and nonprofit organizations.
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What is interesting is how the level of care and processes in the operating room suite was at such a higher level than on the hospital floor. In the OR, it seemed as if everyone was fully engaged in the process. There was zero chaos. A home health nurse shed light on that. He simply said “the OR is where the hospital makes their money.” Enough said!
….this is a perfect example of why my parents say, “Don’t get sick” and they believe you go to the hospital to die.