Wednesday, August 29, 2012

Welcome to Acronym Hospital

Acronyms are, of course, wildly popular in health care.  I don't think the job would be nearly as much fun without them.  "Medical speak" is cumbersome and the average person usually doesn't know everything we are talking about even if we use the actual language.  It can be confusing for people in health care as well, but there are some basic acronyms that people are expected to know like in the first 10 minutes of their training.  Take Wednesday, for example; surprise, surprise.  She overheard Eeyore tell me that she had just put a patient in treatment room 2 with SOB.  This is one of the biggest jokes in health care since it means "shortness of breath", rather a garbage term for someone with any complaint ranging from cough / man cold to pulmonary edema.   Wednesday was aghast that Eeyore was so rude to refer to someone as a Son of a Bitch.  Right.  Bonehead.

At some point hospital administration jumped on the Acronym bandwagon.  Where I work not a week goes wherein the Suits in Charge of Stupid Shit does not devise a new set of "catchy" phrases to go along with their latest so-called motivational agenda.  SPIRIT and CARE are two of the latest to hit the hospital.  The Suits apparently spent months on those with little else to do after the massive reduction in force.  Then they wonder why their employee surveys suck.

It didn't take Kate and I months, but rather minutes to come up with new meaning for SPIRIT.

S  squirrels....'nuff said
P  plenty of Percocet for all!
I  if it is difficult, we might do it.  Impossible?  Fu*k it.
R  really??!! Your prescription for narcotics was lost / stolen / thrown away / eaten by wild dogs??
I  if assholes could fly, this place would be an airport
T  totally allergic to tylenol, tramadol and toradol.  But the dilalalalala stuff works purty gud.

Suits spend seemingly endless hours in useless meetings to try to devise work- arounds  to improve satisfaction scores.  They don't seem to get that better support of the nurses would reap ten-fold rewards in that arena.  They are not getting that people who genuinely believe that their management cares fu*k-all about them are not in the greatest position to be institutional cheerleaders.  Plus we know they think we are stupid and don't remember stuff.  Like, in this electronic age, why are you still doing employee mailers?  Stamps add up.  Or the cafeteria closes at 5 PM, now 2 hours earlier which says "screw you" to the evening shift.

Honestly, we just don't care about your so-called "Service Recovery" acronyms.  We spend lots of time enjoying making fun of them, though.  Same goes for "Key Words at Key Times", which will be tomorrows topic of conversation.

Service Recovery employs the HEART acronym.  It stands for HEAR the patient, EMPATHIZE, APOLOGIZE, RESPOND, and THANK them.  Seriously.  The following is an example of how we, as nurses, are expected to respond to rude behavior from patients and families.

"I understand that you are upset.  I know how frustrating this must be for you, and I will do everything I can to get you into a room as soon as possible.   I apologize for the long wait, but I promise you will get the same careful, comprehensive exam and care when it is your turn.  Thank you for choosing our health care organization"

Seems like a good idea on paper, but in actual fact it pulls nurses away from the bedside and rewards bad behavior.  Monkeys then copy that bad behavior so it is a losing battle to employ that kind of psychology.

So,  to put some perspective on this scenario, imagine that you are are a patient sitting in the packed waiting room with abdominal pain, a febrile child with an earache, or a deep laceration.  You are a reasonable person with reasonable expectations and expect that you may have to wait.  As a reasonable human being you *get* that other individuals may be sicker than you are, have life threatening illness, and might require more intervention thus stretching our limited resources.  So keeping my little speech in mind, now imagine that I am responding to a highly negative verbal assault, shouted in your presence or that of your young child.  You could not be aware that this individual has dozens of visits for the Holy Trinity of Chronic Pain Complaints, nebulous injury with severe pain requiring narcotics, and an affinity for being disruptive.

"This is bullshit!  I have been waiting 30 minutes!  I'm going to talk to my lawyer if I don't get some answers and see a doctor!  What is the name and number or your supervisor!  All you people do is give me the runaround!  I have real pain issues!  I'm leaving"

As a patient who is being reasonable, playing by the rules and waiting your turn, are you going to put up with my decision to reward this type of behavior by immediately taking him into a room?  No, you are going to be pissed unless you are one of those parents who tries to calmly explain to their 2 year old who is banging the dog on the head with a hammer why it is a bad idea to hit Fido on the head.

Instead I say something like "Ok, sir have a nice day there.  I'm calling the police"

Many thank me for my own brand of service recovery, tell me they appreciate the way I handle it, or simply applaud.

Thank you very much; the bullshit has left the building.