After spending nine hours in the emergency department with abdominal pain (Part 1, Process Improvement), and then being admitted as an inpatient in a noisy ward (Part 2, It Is What It Is), I was starting to feel low and that things were spiraling out of my control. So, I requested a visit from the hospital chaplain. I was in need of spiritual help in addition to the antibiotics.
The chaplain showed up the next day and stayed with me for 45 minutes or so. This visit was a moment in time and perhaps the most valuable 45 minutes I’ve ever spent. From the start of the encounter and with a warm smile, what followed were a series of open-ended questions and topics to consider. They ranged from, “How are you?” (meant in a broader sense than “what is your pain scale rating from 1 to 10?”) to “What are you worried about?” and ”What is truly important?”
Process Improvement: Be open to experiences, support and ideas from other quadrants. Turn off filters and negative thinking.
I was transferred to a single-patient room. You would think that sleep would improve—but nay! The beeps and squawks of alarms dominated the atmosphere there, too. IV changes and vital sign readings continued every few hours. Sleep, which is so essential to well-being, is not to be had as an inpatient. This is a serious shortcoming of our hospitals and method of healthcare delivery. It is a delicate balance between being attentive and present, so that important status changes are not missed. But lack of rest is unhealthful by definition.
Noncontact, smart-sensor, and cable-free monitoring is within our grasp. This has the potential to decrease or entirely avoid the disruption of noninvasive blood pressure and vital sign data collection and arousal from sleep. Silent alarms and audible alarm elimination in the hospital is an attainable goal that will help the patient get to better.
My boss came to visit me more than once. It is difficult to be professional when laying in bed in a hospital gown with a four-day scraggly beard, a bed bath instead of a shower, bed hair, and a fuzzy brain from lack of sleep, pain, and concerns.
“Take the time to heal,” said my supervisor, a straight shooter. “We will cover your work load and it is not your concern until you are ready to come back to work.”
I suspected this was the case, but to hear him articulate the words was a relief. I did remain in contact with a daily update and progress report. Each day came with the disappointing conclusion that discharge would not be determined until the next day. The flowers and balloons that showed up toward the end of my stay was an additional confirmation that my colleagues and coworkers were a part of my support network.
Process Improvement: Always wear clean attire, comb your hair, and brush your teeth. You never know when someone important will show up.
As a long-time biomed, I know about medical equipment, and specifically service repair, performance verification testing, and use cases. My infusion pump followed me everywhere. It’s curious how the impact of what I normally do as a routine suddenly became personal. Would the pump deliver the antibiotics at the correct rate? What if there was an in-line bubble or obstruction? Was this particular device both “safe and effective” as mandated by the FDA and a standard in our industry? You can can bet I checked the inspection sticker date—it was current.
As it turned out, I had an infiltrated IV line. This is routine. IV’s typically only last two-or-three days and then a new IV site is needed. The pump is designed to detect an obstruction, (e.g., low flow rate and increased back pressure). But in my case, the pump did not alarm. I noticed the issue when my arm became painful and I saw blood in the IV tubing. I summoned my nurse, who attempted to start a new site. While she did everything correctly, she was unable to canalize my vein. A call was made to the “crisis nurse.” That’s an older term for the floating resource of an experienced, senior nurse. A few minutes later, “pop.” The line was established.
Process Improvement: The results of your work have an impact on others, family, friends or yourself.
While in the hospital, I received phone calls, text messages, in-person visits, cards, flowers, hugs, and a blanket. These were so important! I was buoyed up mentally, physically, and spiritually. This was a diversion to my state of illness and pain, but I also needed to guard against over visiting and fatigue in sending up-dates or receiving calls at inopportune times.
Process Improvement: Friendship in moderation is penicillin for the soul.
Finally, good news!
“You are looking much better this morning!” my resident said during morning rounds. “Your white cell count is down and you have much less pain response and the swelling has decreased since yesterday. I’m going to recommend discharge today but need approval from the attending physician.”
The grin on my face must have looked like a sunrise. The process of patient discharge is far from simple. There are home-care plans and orders, prescriptions, dietary restrictions, and inclusions to be checked off. It takes time. In my case, it was four hours between notification and pick up at curbside. I was ready to go home.
Process Improvement: Prepare ahead of time what can be staged. Use technology or forms or applications to streamline processes at critical times.
Certain brands are synonymous with stellar customer service. The difference between the Ritz-Carlton and Red Roof Inn, or Nordstrom’s and Old Navy, is also apparent in how they deliver goods and services. Top brands do the following:
- The customer is the focus. They listen to their customers and attempt and anticipate needs
- They set expectations (overt) and then deliver on the commitment (service level agreement).
- Return patronage is a shared goal.The brand carries an understood element of quality and trust.
- Service recovery, when needed, is offered without hesitation.
- The “team” supports the individual as well as the individual support the team.
- Staff are selected for their knowledge, skill, and demeanor. Training is a norm.
- Employees smile and genuinely like their jobs.
- Rooms, architecture, physical buildings are clean, bright and uncluttered.
- There exists an aura of professionalism and competence.
Did I have a “peak” customer experience during my hospitalization?
Well, yes and no. The members of my medical team were all extremely competent, knowledgeable, and articulate. They not only explained what was going on, but why and what was coming next. Similarly, nurses, and ancillary staff were present when needed, listened to what I had to say and, were genuinely engaged with my care.
The disappointing parts: the inefficiency, delays, missed communication, and lapses in attention that I already mentioned in greater detail.
The big question is… “Would I recommend this hospital to a friend?”
Eben Kermit is a biomedical engineering supervisor at Stanford Health Care in Palo Alto, CA.