Yesterday, I accompanied a friend to her cancer treatment. I witnessed something that highlights the fact that all employees in a hospital need to be briefed on that hospital’s service expectations. This may seem obvious, except that I have confronted a lot of managers in a lot of hospitals who have argued that, since their staff is not patient-facing, any training on (or even focus on) patient experience is not worth the time and effort. Even if they might concede some value, they will still prioritize other things above that training and give some version of the “now is not a good time” excuse. This is frustrating because everyone in a hospital is either patient-facing or supporting someone who is patient-facing.
Before I continue, I know that there will be some who say that to a hammer, everything is a nail. I care about PX, so clearly everything has a PX component. They are, of course, right when they say this, but it is not the ‘gotcha moment’ that they think it is. Every encounter in a hospital includes (a) an employee, (b) resources, and (c) patients/family members. If you can think of something that doesn’t, please hold forth in the comments section. By definition, then, everything that happens in healthcare involves HR/staffing issues, financial issues, and patient experience issues. Not all are equally important in any situation and each of these can have a different flavor or impact. Staffing, for example, might include issues of licensure or where those staff are located and not just a sheer number of warm bodies. If you insist that all things have a financial or staffing component, you should also realize that they have a patient perspective as well.
Yesterday, in my role as transpo as well as patient advocate, I ran an escort mission bringing B to her infusion appointment. For those that don’t know, often before a patient receives chemotherapy, there is lab work done to make sure that there is nothing wrong that would suggest the chemo not be done that day. So, we showed up for her lab at 0800. From there she would go to the infusion room and after additional paperwork, she would start getting the drugs at 0830. Yesterday, instead of thirty minutes, seventy-five minutes elapsed with B waiting in her chair before a nurse came over and said, “I am sorry for the delay, but apparently lab is super-backed-up and so we don’t have your lab results yet.” (About fifteen to twenty minutes later, the results dropped and the drugs were started.)
After the nurse’s update, B expressed three things that were telling. First was a concern over how the delay was going to affect me. She was worried that the chemo was already going to take about two hours, so this extra delay might cut into my other plans. I assured her that everything was fine and this wasn’t going to interfere with my day. The second was a concern over the lab itself. She said that she hoped that the lab wouldn’t screw anything up as they were backlogged and scambling.1 It is not hard for someone to imagine that anyone rushing around could possibly to cut corners or miss a detail or adopt a “good enough” mentality in an effort to work faster. To be clear, I am NOT saying that this was happening. I am merely explaining how the patient filled the gaps in their knowledge with their assumptions. Third, she was also feeling a bit “less than.” She was here once a week for years and yet she was clearly being bumped by something that was deemed more important than her. She has a 35-minute one-way commute to the oncology center, and even though she has been here multiple times, it seemed like they thought her time was less valuable.2
Had I been wearing my “patient experience” hat instead of my “patient advocate” hat, I might have had a word with the nurse in private about using more positive words and giving more detail, like how much longer this was expected to take. The problem with this conversation, though, is that the nurse is likely to tell me that she doesn’t know what is happening in the lab. She doesn’t know if someone called in sick3 or if a machine is being serviced or if everyone in the hospital got their blood drawn at 8am. She is even likely to be a bit defensive. She might throw lab under the bus, saying that she has no idea what is going on over there. To that I have two responses.
First, B doesn’t care why there is a back-up in lab. She only wants to know how long it might take, so she can make allowances in her schedule. She also wants to know that this won’t affect the quality of work being done in the lab. That is all. She doesn’t need anyone’s head on a pike; she only wants useful information.
Second, given that all patients waiting to start treatment want the same answers, not knowing the issue in lab is not a suitable defense. If you don’t know what the delay is, or how long the wait will be, or if it is because of a mechanical issue and certain tests need to be couriered to another facility, you should find out because you will be asked by patients. While this may throw shade at the clinic nurses, I tell this story primarily to highlight that the lab is supporting patient-facing staff. They should be providing this information without being asked. They should have a process in place to notify staff when delays occur and provide broad information on what the delay’s impact will be on patients.
PX training cannot be one-size-fits-all. This is what makes it difficult to execute consistently across a hospital or system. I remember once, addressing an audience in North Carolina. I pointed at a random person in the crowd and asked him about what he did to address the patients in his work-life. He responded, “Nothing. I am the Chief Financial Officer.” The room broke out in laughter, as did I. But I then said that no one in the hospital probably has more emotional conversations with patients than those employees in billing. What training did his team have in delivering on the patient experience? While they got training on how to deal with irate patients and they had scripting to assist with patients needing financial assistance, he said that they didn’t get any broad patient experience training. I said that we would fix that. To the audience I said it was just my luck to pick the CFO out of a room heavy with clinical staff but that it highlighted the fact that PX was not just a clinical thing. Everyone in the room either supported patient-facing staff or at least occasionally talked with patients, either in the cafeteria, on the phone, or even IRL4 in the grocery store or PTA meeting.
Supporting patient-facing staff is patient-facing
I have talked to a number of non-clinical staff about the patient experience, and they often will bemoan the fact that, since they have minimal patient interaction, most of how patients perceive them is filtered through someone else, usually a nurse. This is true, but it applies to everyone in a hospital. Every staff member has their behavior presaged by someone else. The ED nurses will tell a patient about the inpatient nurses. The day-shift will talk about the night-shift. Nurses will comment about doctors. In every one of those moments, there is an opportunity to fill that information gap with confidence and assurance or anxiety and fear. In my story, perception of the lab is being established by the nurses. Since that nurse is the person we see, they are likely to be the recipients of the roses when things go well and arrows when things don’t. Less obvious is that they are also a spokesperson for the lab. This is important not just for the nurse to understand, but for the lab to understand.
These folks need training focused on how to support those who are patient-facing and often actively so, with the patient staring at the nurse while they are on the phone. If you want your team to be presented in a good light, then it is your responsibility to provide the spokesperson with the right information. If you are not distributing useful information to help patients understand what is going on, and, by extension help the clinic as well (should they start juggling their schedule or rescheduling people given how long these sessions take), then don’t be surprised if they are not presenting you in the most flattering light. The reputation of most staff is filtered through the nurses. Make sure that they are aware of your commitment to delivering quality food, or making quick repairs, or being friendly and attentive in cleaning.
Kinda patient-facing is patient-facing
As anyone how has worked on the phones know, connecting with someone telephonically is more difficult than doing so in-person. There are fewer nonverbal cues so the ones that are present, like tone of voice and pauses in conversation, are magnified. I have also had people, like in billing or pre-authorization, say that they “mostly” are not patient-facing. This generally means that they don’t talk to patients as a matter of course, but occasionally, a patient will find their extension or ¡qué lástima! willbe forwarded to their extension. This can be worse for all involved. The patient is likely engaged in a series of seventeen-second conversations followed by being put on hold and transferred to another person, which means the person answering the phone is arriving at a conversation that the patient is already in the middle of. So, every question the financial person asks is a repeat of a question already answered five times before and therefore evidence that no one is really listening to them.
These folks need PX training, but it really needs to be specialized to their environment. They need to understand the specific medium of a telephone call. This is a skill that seems fast-fading with the advent of asynchronous conversations like email and texting as well as the transition to video calls for internal meetings. They also need the level-setting skills, so that they can effectively come into a conversation without inadvertently antagonizing the other party with repetitive questions or statements.
It is easy to shuffle service needs and training to the bottom of the deck, because they feel less germane to your department’s work. But remember that just as you give staffing and finance focus with your decision-making, the patient’s experience should be in the conversation as well.
1Note that B inserted “scrambling.” The nurse didn’t say that. But also note that assuming that the lab was a flurry of activity, with people trying to do three things at once is a reasonable embroidery to the story.
2Also note that the nurse said nothing about being bumped or something taking priority. Again, this is filling in the gaps with assumptions.
3I know that there is a considerable debate about whether the phrase is “called in sick” or “called out sick” so before you roast me in the comments for my choice, please know that you really have better things to do with your day.
4In real life, as the kids say. Because, as you know, I am with it and down with young people these days. No cap; I got the rizz.
PX Matters with Joseph Snipp 
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