Doing the Safety Hustle at Carondelet Health

Forget those boring safety brochures (who reads them, anyway). Carondelet Health rounded up the team to do the Safety Hustle.

The Brand Value Proposition: Real or Scripted?

Yesterday I spoke with a nurse who called to tell me a 'funny story.' She had just left a mandatory staff meeting where the nurses, secretaries, nursing assistants and others on her unit were called together to talk about the hospital's brand.

At the meeting she learned that the health system where she works wasn’t stacking up when it came to patient satisfaction scores. Which is concerning, considering that they are consistently recognized on Top 100 lists and are a Magnet hospital, to boot. So throughout the organization, work teams and units were being called together to learn that the hospital’s brand stood for ‘excellent patient care’ and that a comprehensive initiative was being undertaken to improve HCAHPS ratings.

At first, she told me, everyone nodded their heads. “Great,” a colleague said, “we’ve got a lot of ideas for how we can provide better care.” Recommendations eagerly popped out -- such as better collaboration and communication between the ER and the unit to create seamless hand-offs during the admission process, adjusting staffing to provide more support during the labor-intensive periods when new admits come on the unit, and assuring adequate supplies so that nurse could stay at the patient bedside rather than wander around the building to find basic patient care necessities.

Another nurse brought up concerns about four separate patient safety issues and suggested they discuss how those could be avoided in the future. “But wait,” says the meeting chair, “we’re not here today to talk about patient safety, we here to fix our patient satisfaction scores.”

My friend reported that she then noticed the managers and speakers at the front of the room shaking their heads as each suggestion from the floor was raised. “We can’t do that at this time.” “The ER will never change their practice regarding transfers.” “This isn’t what we’re here to do today.”

So what was the point of the meeting? To be instructed in the art of scripting. “Hello, Mrs. Jones, here at (anonymous) hospital, we’re committed to excellent patient care.” “I hope you found your care excellent.” “Is there anything else I can do for you for your care to be excellent?” And so on.

The whole theory, of course, being that the more they drop the word “excellent” within patient earshot, the more likely patients are to check off the “excellent” box on the satisfaction score sheet.

The rest of the shift, she reported, the nursing staff would jab and make comments to each other such as "I'm sorry to be three hours late giving you your meds tonight because the order was confused - but we give excellent patient care."

Now I have to believe that this was not the intent of the initiative, nor the intended outcome of the meeting, but something seriously got lost in translation. When the nursing team hears that it’s the patient satisfaction score and not the patient care that needs improving – well, I’m not laughing.

How to Lose a Nurse

The call to nursing came the summer my 15 year old daughter had a leg injury that landed her a desk job in a Nicaraguan clinic during a church mission trip to Vida Joven in the mountains north of Managua. Instead of joining her fellow teens in camp activities (made difficult enough even without a leg in a cast by the weather, terrain and primitive conditions), she joined a group of doctors and nurses that set up a temporary clinic to provide medical care to people in neighboring villages. Families, often towing five or six shoeless children, walked as far as ten miles to see the American doctors and receive much needed medical treatment for ailments ranging from intestinal parasites to skin fungus to respiratory impairments caused by sleeping in enclosed tarp huts where kerosene is burned to warm the chilly mountain air. Babies with birth defects, children suffering from malnutrition, young men with malaria, diarrhea, festering cuts – curses of the poor in developing countries.

My daughter spoke Spanish well enough to facilitate conversations between the doctors, nurses and patients. And she was put to work dispensing medications – everyday drugs we take for granted but precious to those that suffer while waiting months and months for the clinic to come to Vida Joven. She came home that summer eyes wide opened by the abject poverty of the people living in the western Hemisphere’s second poorest country.

She went back to Nicaragua every summer of her high school years, taking on greater responsibilities in the medical clinic and growing in the conviction that nursing was what she wanted to do. Back at home she searched for a university with a nursing program. She spent spring breaks and summers off building an orphanage in Boliva, nursing at a hospital for women and children with AIDS in Kenya, volunteering at a clinic in La Paz. One day she said to me, “Mom, I was born to be a nurse. I just didn’t know it until now.” Now being the day she came across a tiny rain-soaked boy of four or five stooped and shivering under a tree in Nicaragua – shoeless, hungry, sick. Something clicked for her. And six years later here she is – RN, BSN.

Last night she called me – distressed, angry – wanting to quit her hospital job of just one year after spending another twelve hour shift trying to care for too many critical patients with too few staff, missing supplies, inoperable equipment and physicians that don’t return calls when their own patients are heading south. Concerns tumbled out. The evening she couldn’t get the doctor or charge nurse to believe that her patient was septic (he was). The day that she held tight to a hypothermic patient using her own body warmth to try and raise the woman’s temperature because there were no warming blankets on the unit and no one to search for any. The night just six months out of school when she was the senior nurse on the floor. The critical care patients admitted to med/surg beds without the monitoring equipment or staff to keep them alive. The psych patient admission that punched her in the face. That one shift when the unit had twice the staff (‘don’t get excited,’ said the charge nurse, ‘it’s the show for JCAHO’), the next day when they were all gone. The countless meetings where nurses were invited to share their concerns and ideas. The weeks that ensued where nothing changed.

Her panic was palpable; seated in the fear that her patients are in harm’s way of a system that is just plain broken. And I heard what she wasn’t saying out loud.

That even in the jungles near Matagalpa, even in the slums of Nairobi, even in the makeshift clinics where a handful of professionals and a dozen suitcases of medical supplies somehow divide like fishes and loaves – she never felt as powerless or worried for the safety of her patients as she does in this nationally-ranked, Magnet-designated hospital.

And that breaks my heart.