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"I am struggling so much with how healthcare is changing. I can't say or post publicly what I know and what I see without getting fired. ... But it is not all about the care of patients anymore." - Family Practice Medical Receptionist
"I am a nurse and have been for 30 years. I recently went back to school to study art. I am burnt out. Not from my patients, but from the administration. They make decisions that adversely impact staff and patient alike and I am simply burnt out." - Registered Nurse
"I didn't think they would pick me to speak. I am considered a troublemaker in my hospital." - Physician Assistant
These are three quotes from many recent conversations sharing the same theme: People with power to make decisions that affect staff, patients and the healthcare delivery system are not listening to those who are working on the frontlines of healthcare.
The first quote (from a medical receptionist in a primary care practice) was in response to one of my earlier blog posts and shared with me covertly so that the leadership of the hospital system that recently bought her practice, as well as the leadership of her practice would not know she had done so. We eventually connected over Skype and she shared more details.
"Tom, the local hospital has bought our practice (in its effort to create an ACO). Decisions are now all centralized at the highest level and no one is looking out for the patients. Productivity quotas are continuing to drive behaviors (and even more so). The focus on more and more visits and more and more procedures to meet revenue goals rules the day. The patients and families being impacted are an afterthought (never mind in the center aka patient-centered care)."
Physicians have since left her practice and no one made sure patients were informed or provided with options.
"And only now after receiving many patient complaints are we being told to try to fix the damage. But it is too late. We have lost the trust of these patients. They feel abandoned. Leadership is removed and isn't listening to us on the frontlines and patients and families are being harmed. I am not valued and I am counting the days until I can leave this job."
The second quote came from a happenstance meeting earlier this week. As my wife and I managed our yard sale a woman came up to us and asked: "Do you have any art supplies?" She then proceeded to share how she has opted to follow her other passion (art) because the hospital leaders where she worked cut the nurse-to-patient ratios to levels below what is safe, made decisions based on drivers other than the drive to provide quality care, and made decisions without listening to the frontline staff who witnessed firsthand the adverse affects on staff and patients. The harm these decisions are doing to patients is scary (no wonder hospital errors occur in one-third of all hospital admissions, according to an April 2011 study in Health Affairs). And it's sad that the system has lost another seasoned, caring nurse who is passionate about patient safety and yet silenced by her hospital leadership.
The third quote above was from an amazing physician assistant who is silenced in her own hospital and considered a "troublemaker" because she dared to address emergency room overutilization. Her hospital leadership had opted to throw more and more money at the problem (thus wasting limited financial resources) rather than listen to those on the frontlines who hold great nuggets of wisdom and want to help. Only in a forum outside of her hospital were her voice and amazing successes recognized and honored.
We continue to take for granted our most cherished resources (our frontline staff). These people are in the know, they are passionate, they care, and they are the ones who are most connected to our patients. These people must be heard if we are to truly improve the care we provide to patients and families while also managing our limited resources more effectively.
To all healthcare leaders ... I beseech you ... listen to your frontline staff, engage them, learn from them and honor them.
To all frontline staff ... please continue to "manage up" and tell your stories. Please continue to share. And if your organization's healthcare leaders won't listen ... please tell your stories to me ... I will.
Thomas H. Dahlborg, M.S.M., is Vice President for Strategy and Project Director for the National Initiative for Children's Healthcare Quality (NICHQ), where he focuses on improving child health and well-being.
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