Guest Blogger: Chris Bonney

When decisions regarding facility design, patient flow, registration systems and other design, process or policy issues are made, who is sitting at the table as the voice of the customer? Who evaluates the impact of those decisions on the customer experience? Once again, I am pleased to offer the insights and perspectives of long-time colleague Chris Bonney on this topic.

Tracking the Eyes That Count

I was at a meeting of some architects recently. In demonstrating their capabilities, they showed how they'd solved a tough design problem on a hospital expansion project by clustering treatment rooms in a way that increased operational efficiency and reduced construction cost. Sounds like a win-win proposition, doesn't it?

Only nowhere in the process was there input from the patients who'll be using the facility. And therein was laid the foundation for what is likely to be a history of low patient satisfaction with this facility.

No one checked to see if patients would object to all those treatment room with their curtain doors facing the same public area. No one checked to see if patients would understand the confusing and blandly colored wayfinding signage necessary to navigate the facility's labyrinth of interior corridors, none of which have visual cues to set them apart from each other. They didn’t consider that older patients might need covered places to sit down every fifty yards or so as they walk in from the parking lot in the rain, or whether they’ll even find their way through the three poorly marked left turns necessary to get into the facility’s parking lot.

Navigating the health system is challenging enough for most people even when they have all their faculties. But add advancing age, declining eyesight and hearing and the stress of whatever condition brings them into your healthcare facility and you multiply the opportunities for confusion, anxiety, anger and failure.

Remember “Brubaker,” the movie where Robert Redford arrived undercover as a new prisoner to get a glimpse of life in the penitentiary he’d been hired to clean up? Put yourself in the patient’s shoes. Take a walk around your facility wearing a blindfold, wearing someone else’s eyeglasses, wearing earplugs or with a cast on your leg. Start out on the street where the bus lets people off, or at the farthest point in the parking lot. Do it in the daytime and at night. Do it in a wheelchair. Spend some time in each of your waiting rooms just listening. Pick a random ER patient and observe that patient through his or her entire stay at the hospital. Sit in a patient room and listen to the staff conversations outside.

After you’ve done all this, you might be surprised how different your impressions are from what they are now, and how many new ideas you’ll pick up. You could learn a lot from your customers.

Chris Bonney is president of Bonney & Company, a Virginia-based marketing research firm. He can be reached at 757-481-7030 or by e-mail at: chris@bonneyresearch.com

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.