Sunday, February 27, 2011

No way to run a hospital

A friend reports on her recent experience in a New York City hospital, where her husband was undergoing a hernia repair.

They were about as un-user friendly as one could be. They called 5 times to tell him to come in between yesterday and today, all the time seeming to change the information. They gave him the wrong pick-up info to give me, so when I came up the K elevators to an empty reception area, I only figured it out by barging into the patient bay area where there was a lone nurse at the station. She told me to go back down and come up the A elevators. When I did, I couldn't find the recovery area (no signs) and had to ask somebody at the blood bank window, who pointed me to the right doors -- which were locked. You couldn't open them by pushing on the door release button and nobody answered the intercom.

So I called Sam on his cell phone, and he gave me to a nurse who couldn't seem to understand the problem: "The door is locked, can you please have some one let us in?" (There was another woman there trying to pick someone up by then.) "We're very busy right now." So we got in because some staff person opened the door with a card key and let us in, too. (He probably shouldn't have: How did he know who we were?). I felt badly for the other woman because she was old with a cane. The nurses couldn't seem to focus on talking to her, whereas they were suddenly wanting to help me.

And the elevators barely work and were crowded as hell. If we had put Sam in a wheelchair like they suggested, I think we would still be there. Of course he was walking slowly, having just had his abdomen repaired, so I basically had to body-check the elevator doors (and they were brutal) to get him in.


e-Patient Dave said...

So, let's name the hospital!

This isn't solving anything. Everyone who needs to be convinced there's a generic problem, already knows there is, so this post effectively just makes me feel more hopeless.:-)

Either the hospital management knows this is happening and isn't fixing it, or they don't know.

Do we need a Wikileaks for examples of disgusting hospital performance?

Paul Levy said...

Not my place to do so, as I promised the friend I would not include names.

e-Patient Dave said...

Sure, I wasn't expecting you to make that call. That's why I said "Let's," not "Hey you." :-)

I mean we, as a culture, as a society.

If this were a Best Buy store, there would be blogs about this stuff.

I recently helped a friend deal with the worst government employee I've ever met in my life. The employee was rude, insulting, uncooperative; I speculated that she could only survive because of some rule that said she couldn't be fired OR disciplined. In that case we went to my friend's state legislator, who found a cooperative employee - and agreed there was no point trying to do anything about the horrid one (who I assume continues to draw state pay and benefits).

Is there anyplace similar your friend can turn to get this taken care of?

Imagine: in that hospital's culture (pervasive disregard for doing things well and fixing problems that arise), what are the chances they're working to accidentally kill fewer people through medical errors?

Anyway, yeah, Paul, I was saying "Let's." If your friend's willing, that would be great; if not, of course I can't fault her.

Anonymous said...

Dave, I get your point; we need an easy way to report this stuff. We take the time to complain to friends but never get around to complaining to management.

I myself, after my mother's recent unsatisfactory hospitalization, never wrote the CEO like I planned. I ask myself why - didn't think it was bad enough? (any poor experience should be 'bad enough') Didn't think I had my documentation sufficiently in order (why should I need to?) Too lazy to find his/her name and address? (part of it) Worried it would affect her next time? (she has been back, but they are probably not organized enough to even make the connection!)

Maybe an email address for each hospital specifically dedicated to such complaints, with honest feedback from the hospital's investigation - not defensive under-rug-sweeping - would help. I don't know the answer since I'm obviously part of the problem, but I do think the expectation of no response/defensive response discourages us from even trying.

nonlocal MD

Christine said...

From Facebook:

We had a similar experience in LA at USC's flagship hospital. All the money was put in (incomprehensible) architecture, not in front line staff. Disregard for the young patient was mind-boggling. Raised hell to get a simple procedure. A few months later, they transplanted the wrong kidney into a patient.

Bart said...

From Facebook:

Re this snippet: "I felt badly for the other woman because she was old with a cane. The nurses couldn't seem to focus on talking to her, whereas they were suddenly wanting to help me."

Get ready. I anticipated and tried hard to solve this problem when my mom was ICU intubated and Dad, then 83 and completely lucid/competent, albeit shocked (everyone thought he'd go first) was her proxy. Of course he wore hearing aids. Of course *every* provider/staffer couldn't be inconvenienced to reposition themselves closer to him in order to enable their patient's proxy to best hear them. I took to positioning myself very near dad's ear to that in talking to me they were talking to him.

BTW, I learned that it's a cognitive disconnect to pose a question and ask the respondent to reply to someone else (me the inquisitive, Dad the proxy). Not to blame respondents for this; I think it's just an unnatural thing to pull off (one would have to have the sense of an actor or the sensitivity of -- a caregiver.

Kathy said...

From Facebook:

At a recent AARP meeting, an elderly (at least late 80s) told me about a recent hospitalization. Her greatest concern was that she got someone else's medications for 3 days because their chart got clipped onto hers in the ER on admission. (????..this is just crazY!). But she also had a roommate who was deaf, completely deaf. The staff yelled at her at the top of their lungs, which of course was absolutely crazy as well, because she was DEAF!

So this elderly lady said "that hospital ought to have white boards to communicate with deaf people! Yelling didn't do any good because my roommate was deaf!") I asked if she ever suggested that, and she said "No, nobody would pay attention to me if I did!"

Barry Carol said...

If this happened to me or a family member, I would have written to the hospital’s CEO and to the appropriate state agency that regulates hospitals. I’ve written to CEO’s on other (non-medical) issues a few times over the years. My experience is that the letters get routed to appropriate people within the organization and I always got a response that addressed the issue. As a former hospital CEO, perhaps Paul could give us some insight into how he and his people handled complaint letters, as opposed to testimonials. that came to his office. How do other hospital CEO’s deal with complaints, as far as you know?

Paul Levy said...

It was pretty straightforward, Barry. A member of my staff or a Patients Relations staff member would investigate the complaint and get back to the person with (1) an apology; (2) a description of how we think we did wrong; and (3) a remedial plan to minimize the chance it would happen to someone else. If it involved a matter relating to medical choices, it would often be referred to our Health Care Quality group, and, if a policy or rule change was needed, to our Medical Executive Committee.

All complaints were logged in and tracked through to completion.

I think you would find that most hospitals have a similar mechanism; but, when in doubt, write to the CEO.

Anonymous said...

So take this one for what it is worth as a non-medical professional ...

I just (last month) went through a hernia repair in a Boston area hospital, and it was amazing. The facility, the people, the care ...

Understanding that this is not the forum to single out performance, good or bad, how does one who is uninitiated to such things (as I am) get the "real story" on facilities that are chronic in their poor care to avoid what is detailed in the story?

On first blush it would seem that all are not for the same level of transparency or respect as is commonplace (and warmly appreciated) by those here.

Paul Levy said...

The simple answer is that you cannot find useful information of this sort anywhere. So, you are left to rely on anecdotes from friends and associates.

Mary Ellen Mannix,MRPE said...

Why do we (globally speaking) continue to be more afraid of naming facilities then fear the errors that result from the continued lack of transparency in medicine?

Anonymous said...

This post and the next one about Winchester inspired me to write that letter to the CEO of my mom's hospital after all. Do you think I could find his email address? On the hospital website there were only phone #'s for all the administration, and they were all the same ; the main hospital number!

On the parent corporation's website there were - phone #'s. Except for a 'form' I could fill out with name and address, my email address, and a box to check concerning what my comment was about. They 'hope' to respond within 2 business days.

One of the things I always admired about Paul was that his hospital email address was right out there for the taking - and as some of you know, he answered his emails personally.

One has to 'want' to receive feedback; and it's clear who does and who doesn't.

Oh - and Dave, this is Inova Loudoun hospital, part of Inova, the largest hospital system in Northern Virginia, who have successfully lobbied to keep out all competitors except 2 small hospitals.

nonlocal MD

Becky said...

Following two hospitalizations, my husband completed the inpatient hospitalization customer satisfaction surveys. After each, we called in to request a meeting with the quality control division (the phone number was listed in the survey request letter. The pre-recorded answering machine message was non other than the hospital CEO). No one returned our phone calls. Our concerns were serious; including stopping a medication error.

Their lack of action, speaks volumes to their culture. And they failed to diagnosis my husband.

There is a customer satisfaction survey, but what about a visitor experience questionnaire? The smartest CEO, Paul, would benefit from hearing the visitor experience;like your recent experience.

I brought a friend to treatment at a hospital I had never been to before. Each treatment was in excess of two hours, so I went prepared with a new book to read. The thing is, I never read more than a couple of pages a day. You see, there were other family members sharing the waiting room with me. In those conversations, I learned who the most compassionate doctors and nurses were on the floor, why patients left other health systems and transferred to this tiny hospital, what made their journey easier to bare. I came away from that experience thinking, that I wish there was a way to challenge CEOs to dress like they were getting ready to rake leaves on an autumn day and spend time sitting in waiting rooms with visitors. They would find out (very rapidly) what makes their institution shine, the failures of other facilities and areas that they could improve on.

At this hospital, each doctor and nurse would say hello and acknowledge you when they passed by you in the hallway or cafeteria. If you are a patient (or supporting a patient as a visitor) that small act of kindness, can make a difference during your time there.

I did ask if there was a visitor feedback form so that I could share the positive experience of visiting their hospital for the first time. There was not.

If there are CEOs reading this post - here's my challenge: try it. Spend time in your waiting rooms with chronically ill patients and visitors (sit in their seats). Listen. Learn. Improve. Share the experience with your staff. Celebrate your successes.

Anonymous said...

e-Patient Dave has it right the first time: Wikileaks for healthcare. I've watched the hospital QI movement grow, with a radiation of entities for every disease and every part of the country. There are many places to store this information, including a CEO's desk. But that is all it has been: storage. First, and perhaps a little second-order problem solving.

Since the first IOM report, there have been calls for an anonymous error log for providers, such as found in the airline industry. Medicine has demonstrated that it will not step up to the plate until patients and families drag them there. Build it and they will come. First, to make sure they are not on display, but later, when it is apparent that the public isn't going to abandon the conversation, they will join. There will be new leaders among providers who will create opportunities for themselves and their institutions by early adoption and use. With the rapid changes in the healthcare environment, soon few providers and institutions will be able to afford NOT to pay attention to a centralized source of reporting.

At no time has the technology been cheaper to facilitate this, and the social networks exist to collaborate and disseminate such a site's existence and aid in its improvement. A little organization by region and type of error/harm, and perhaps reporting source. Classification models exist, disease-specific experiments exist. And the hospitals and providers who become part of the conversation early, by participating in being transparent about problems, get the biggest reward of appealing to the public as working in the best interest of all.

We can keep going about this piecemeal, but that is what the conversations and solutions will look like. Who is ready to take this on?

Anonymous said...


Provide details, please.
Who will submit errors to this log - providers,patients or both? Who has access to it in the airline industry, and who should have access in your proposed log?
How would it remain anonymous, or should it?
Do you have any references regarding the calls for such a log? I've missed that conversation.

And what does "classification models exist, disease specific experiments exist" mean exactly?

I am not criticizing; just interested how this could be implemented. I believe a patient-oriented organization would have to take it on, not a governmental entity - IHI?

nonlocal MD

Anonymous said...

If there are problems with getting the hospital to listen, and writing the CEO doesn't work (which it should), then shouldn't your next stop be the local news? PR is important to revenue, hit em where it hurts, and things should change.

76 Degrees in San Diego said...

I agree that the nicest thing would have been to direct her to the CEO.....but here is a place for these kinds of observations:
the hyperlink is on the first page...

Susannah said...

Hi all, glad to see this post got some good discussion. I am the person that sent Paul the "rant" about my experience retrieving my husband, and I will be writing an email to the CEO as soon as I get a moment to breathe, probably next weekend? I do agree that we should take these sort of issues to the source, rather than just venting to our friends. Other than that, do we really want to start a sort of "Rate my Professors" website for hospitals? Not sure, without a Wikipedia style editing and monitoring system if it would be more than a bitching session. But I am open to thinking about it (if somebody else does the work, of coures, hahaha). Anyway thank you for your input and if anything interesting happens I will be sure to report back.