A letter to a hospital CEO prompts a couple of responses.
by Joe Goldstein, R.Ph.
Reprinted below is a letter I sent to the CEO of an area hospital, with excerpts of the replies I have received. Neither of the two response letters were from the CEO, but were from a direct report.
March 14, 2018
I received a survey this week from —-, and that’s what has prompted this letter, which I’ve wanted to send for quite some time. I have much to say about the hospital and its people.
First, I have made several trips to — and have spent many days and nights there. Twenty-eight years ago my youngest child was born there. I’m no stranger to the hospital. That being said, let’s share some observations.
Most of the people who work there genuinely care about the patients. I can overlook an occasional request being delayed, or put on the back burner. The staff is not there to satisfy my whims. They are there to take care of my needs. They do that well. I’m usually very critical of the care I receive. I have been a registered pharmacist for 42 years, and spent most of that in direct patient care in the community. I’ve published two books; a third is being formatted, and I’m writing a fourth. I also manage a healthcare blog.
The people at —- occasionally make mistakes. They are human. Incorrect drugs and doses are sometimes passed. The food service is not always efficient. But the care is usually more than adequate. — suffers from the same syndrome that plagues all health care: everything is at the will and pleasure of the physician.
You can have the most efficient staff, but a physician arriving late sets the tone for the patient, who believes the clinician is never at fault. I have personally been involved in an hour-long surgical delay because an Irresistible Force met an Immovable Object. And to be fair, the physician has to care for multiple patients. As I used to tell my pharmacy patients who wanted their orders NOW: someone is first, and someone is last, and the rest of us are somewhere in the middle.
Are my procedures begun when scheduled? That’s unlikely. Am I given my meds exactly every six hours? It would surprise me if it were so. It’s impossible to anticipate how unexpected circumstances will affect routines and schedules. Sudden erratic heart rhythms ruin schedules. Unexpected vomiting can spoil your day, as can incontinence.
So let me bottom-line it for you. In all these years I have had one major personnel complaint. I had a radiology technician fail to offer me a lead shield for a couple of x-rays. I didn’t say anything to the technician, but I did tell my nurse. I assume this technician was re-educated.
I do have a criticism of the physical plant. Your parking situation is appalling, especially at the Emergency Department. I have made several trips to the ED for issues with my foot, both acute and chronic. I have had to park at the bottom of the hill and walk up and down it, in all weather conditions. I once asked the transport department to bring me to my car at the bottom of the hill, and was refused. The reason given was that she was not allowed to leave the hospital.
The triage and treatment rooms in the ED are in sad shape. Look at the floors. Some have cracked flooring, which is a breeding ground for bacteria. Treatment rooms may have debris and fluids from previous patients on the floor. I have found the conditions to be unsightly, unsanitary, and unsafe.
Lastly, I want to comment about the amount of paper generated. Each time I have had any treatment in the ED, I have had papers generated explaining the drugs I have been given—and the drugs I have not been given! Imagine my horror when I began to read these generic explanations of several drugs that are used in emergency medicine, and knew I had been given one drug listed on the three pages I was handed. Grab a copy of these pages and read the first couple of paragraphs. It sounds like the patient received all the drugs listed. I understand that this is given for compliance purposes, but it should be either better tailored, or have a strong disclaimer. At the very least, the nurse should give a better explanation on discharge.
But the big issue in hospitals also is at —-: staffing. Staffing is inadequate. We all know it. The vomiting child, or incontinent elder, or the middle-aged man who develops atrial fibrillation are all patients who need extra care, who take nurses and support staff away from other patients who also need care. There are only so many hours in an 8-hour shift, and the work needs to get done. Nurses and other staff who are dedicated professionals may seem brusque or uncaring, because they have tasks to perform and deadlines that must be met. They also would like to have, and deserve, lives outside the hospital. Staffing, patient ratios—we’ve heard it all. Everybody talks about the weather, but nobody does anything about it.
I’ve really only scratched the surface here. The hospital faces many challenges, including an indigent population, a multi-cultural population, corporate mandates, and the need for efficiency and profit. It hasn’t yet reached the point where it impacts patient care—my care. Please don’t let it. And I will let you know if it does. Thanks.
The first response came just two weeks later, and was essentially an acknowledgement of my letter. The important part of the one-page response was:
“Please be assured that the comments expressed in your letter are currently being reviewed by the appropriate department directors. You will receive a written response with the outcome of this investigation and any improvements to be made within 30 days of our receipt of your correspondence.” It was signed by the Patient Relations Manager of the Quality and Patient Safety Department. And to her credit, she included full contact information and invited me to share any additional concerns or information with her.
The next letter was dated just a few days later. This one was a page and a half, from the same representative. She began by thanking me for my original letter, and said she had shared my positive observations and comments with the department leadership team to remind them that good care is meaningful to patients and their families. She went on to say that my concerns were shared with various department heads. The parking situation was brought to the attention of the Senior Director of Facilities and Support Services, as well as the Security Department. Mine was apparently not a lone voice in the wilderness. She assured me that Security personnel were now making daily rounds to assure available parking for patients. This has been an ongoing issue there.
The Director of Facilities and the Nursing Director of Emergency Services are now working to “…schedule more frequent, deep cleanings of the Emergency Department exam rooms.” Cleanliness is a top priority, she said, and has been somewhat challenging due to high patient volume. The Nursing Director will be educating her staff on providing a better explanation of the paperwork each patient receives upon discharge, and the documentation will be reviewed to see if the amount of paper can be decreased, and made easier for patients to understand. I will suggest including a pharmacy team member on that review committee.
I do intend to follow-up these letters with a personal phone call, and perhaps a visit or two to help point things out. My concerns about the food service were not mentioned, and I will address those soon. Those issues could have serious negative effects on health.
It’s important to give feedback to healthcare facilities that serve your needs. This goes for all businesses in which you find genuine opportunities for improvement, or glaring deficiencies. Please be sure to also tell them about the good things you have seen there. People who do their jobs well, and who go beyond their basic requirements, deserve to get a pat on the back. Also, it shows you’re not just a whiner and complainer.
Don’t be intimidated because these offices and hospitals dispense healthcare. Cracked floors and unclean surfaces are unacceptable and unsafe in any environment. Whether they are serving hamburgers or monitoring your heart rate, they should be happy to answer your questions and listen to your observations. If they don’t, take it the next level, which is to the local municipal, state, or federal governing authorities. You have to be willing to advocate for yourself. Unless you’re unable, don’t expect others to do it for you. If you have difficulty expressing yourself, or are physically incapable of doing so, get someone to help you. Make your voice heard. We all deserve, and should demand, medical offices and facilities that are clean; uncompromising, patient-focused care and service; and information that is given clearly, and is understood and explained to our satisfaction. We should accept nothing less.