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We Listen…NOT! September 25, 2006

Posted by 5 Wester in General Announcements, Observation Station.
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I’m usually out of the loop when it comes to corporate communication (thanks to the convenience of direct deposit), i.e., I usually don’t need to pick up my paycheck. It’s just good that somehow they managed to make it convenient for us by leaving our envelopes in our file folders at the nurses’ lounge after the nursing office closes.

You probably noticed that green sheet of paper tucked neatly behind your paystub. It’s an invitation to participate in the upcoming annual UHS Employee Survey (for 2006). Ah yes, I remember now, the kind of “confidential” survey that happens once a year that I did remember participating in.

If you’re like the rest of us, you probably glanced at that green sheet of paper and tossed it in the trash. On the other hand, if you’re one of them employees that take pride in what you do, you probably read the whole page and maybe consider actually participating in this survey.

As I read through the page I couldn’t help but wonder… “what ever happened to last year’s survey?”. Was it so “confidential” that they kept the results from us too, or maybe the results were just fabulous no improvements needed to be made.

There were indeed a few interesting points to this invitation which I’d like to share with you below…

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I like this. Who wouldn’t want to be in the best working environment? I’m sure 99% of you will agree, UHS is the place to be. Although like everything else in life, we can do better. I remember the first 3 months at work… frustration big time! Talking to a few of my colleagues did help…

Me: “How long have you been here?”

Nurse1: “3 years… one more year to go and I’m outta here! Don’t be hard on yourself, I was in the same boat you were… frustrated! But then I realise that nobody cared, so I stopped caring. It’s all the same, all talk, nothing happens. In the end, you take care of yourself!”

Me: “Yikes!”

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Yep! I know I can be proud of the quality of care because I give it! And if you don’t feel the same way about yourself, well… you got issues! 🙂 Seriously though, who doesn’t take pride in their work? I suppose the best indicator of quality health care services would have to come from the people we serve… our patients. I wonder if we had a patient satisfaction survey system in place. If there was one, I guess this is where we should focus on. I’m not about to be handing my patients a yellow sheet soliciting “service excellence” nominations. That would be too eerie, don’t you think?

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Wow! I’m blown away! This is really good. First up, everybody should participate. This will give us a better sample rate and thus better overall results for the survey. Second, honest and direct responses are usually dropped from the survey because it will throw off the curve (if you recall your statistics class, the extremes are discarded from the sample), therefore, discarding the input and feedback of those who are trully direct, and honest. Finally, the action planning process is something that I have yet to see. How do we actually participate in this “action planning process” (upper guys plan, lower guys follow, no input from us?). I’d really want to know. Do they sample those who give mostly 95% positive response? Or do they include the 5% that may be trully direct and honest, who probably have fresh ideas to spiffy up the joint. Beats me… but one thing I’ve learned in life that was a hard pill to swallow… “Faithful are the wounds of a friend; but the kisses of an enemy are deceitful”. In other words, beware of people that kiss your… “behind in the patient’s room, you have gotta know, that’s the way to go, patient’s on the bed, lmost to the ground, foot part down, what’s that sound?” (5 West Cider “Nurse and the MARs”), least we get caught with our pants down. By the way, what can we expect from them?

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To who?… $$$$$$ KaChing!$$$$$$

Listening without action is useless. Lets ACT!

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I’m a wireless Wonder!… part 2 September 14, 2006

Posted by 5 Wester in On Communication.
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Technology has definitely changed over the years and with that, a change of work style and attitude as well. This in itself would be another discussion we can get into, however, as promised from the first post, we shall explore what we can do to make things better at “our house”, i.e., 5 West. (Check out the recent comment by our good friend Ken, he did strike an important points which we will be discussing below).

As you go through life, you probably already know this fact… there is nothing new. Somehow, somewhere, someone has figured out how to do things efficiently… it’s just a matter of swallowing our pride, finding value in it, and adapting it to our practices.

Here’s a simple system regarding the phones which we did at Community Hospital of San Bernardino, and at Loma Linda University Hospital as well.

First off, all the wireless phones would be at the nurses’ station. This was gathered by the off-going charge nurse (or resource person) before the previous shift was over. All of these phones are counted and fresh batteries installed while the old ones are being charged (see Ken’s post re: keeping ’em charged)

Then after the crazy reporting period, the clerk picks up assignment sheet and hands them to the charge/resource person so phone numbers can be included in the assignment sheet (this way, everybody had a phone and if one got missing, we have documentation on who had them). A copy of this is also given to the monitor techs so they can call the nurses directly should there be any significant change in the patient’s rhythm.

The charge/resource person would then hand these phones to the individual nurses (kinda like cops being issued their sidearms). The clerk then would write out the assignments on the big white board with the telephone numbers below each nurses’ name. (An added feature at Loma Linda University Hospital would be the nurses’ Polaroid photographs beside their names. This makes it easy for doctors, patients or family members to quickly identify the nurses assigned to their patients).

During the shift whenever a nurse gets a call, it is quickly transferred to the appropriate extension by the clerks since they also have the numbers written on the board. Whenever there is a change in rhythm, monitor techs have direct communication with the nurse.

Thirty minutes before the end of the shift, the charge/resource person calls on each nurse to surrender their phones for accounting. These phones are then counted and fresh batteries installed to get them ready for the next shift. The cycle then repeats itself for the incoming shift.

As you can see, this is a very simple system that could be put in place that would definitely enhance or speed up communication in “our house”, which is probably why MMC bought these phones in the first place. If you recall, improving communication is one of our top goals, and I believe it should be a priority everywhere.

One thing I failed to mention on the previous post “I’m a Wireless Wonder!” (my apologies Ken), is the fact that, when I was waiting for the MD to call me back, my phone number was posted under my name (a habit I picked up from CHSB and LLU Med Center), and that small white board by “Hot Rod’s” office, had my name and phone number on it too.

I suppose that in the rush of things, we revert back to our old ways and do what we’ve been used to doing (that’s me, guilty a charged! :)). Just take a look at that old phone above, and compare that with what we have now. Could you imagine what it would be like if we still had those things just because we did not want to change? And just like everything in life, the only thing permanent in this world is CHANGE.

Thin is in @ MMC! September 5, 2006

Posted by 5 Wester in On Service Excellence.
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For the last two nights, I’ve notice an alarming trend and I’m sure you’ve noticed it too. Just like peanut butter on a previous post “SERVICE EXCELLENCE in a bottle”, the epidemic has not only spread out to the nursing department, but to others as well.

Take for example our precious HOUSEKEEPING department or “ENVIRONMENTAL SERVICES” (fancy name ain’t it?).

If there was any one department that needs to have an army of soldiers ready to fight the battle, it should be them. I’m not so sure how much value our institution places on the housekeeping or environmental services, but I’m sure our valued patients and visitors will agree… once you come into the hospital you can’t help but notice the service they provide, i.e., stellar floors, clean bathrooms, emptied trash cans, immaculate nurses’ station and lounge, and quick service. I just wish they could be 100% consistent and reliable, however, I found out that they too suffer from the “thin is in” trend.

On one of my nightly tours of duty, I discovered that we only have 2 (two) environmental (friendly) services personnel (AKA housekeeping) covering the whole hospital. They are responsible for cleaning up rooms of patient’s dismissed or transferred, etc, among other things. For a hospital of this size I’m thinking, WOW… big savings right there (see the pig above… Do I hear a Ka-ching?!$$$).

Question: Are they able to perform such a feat with only 4 feet?

Answer: They can…but on who’s expense?

On ours obviously!

When was the last time you’d have to wait for a patient’s room to be cleaned just so you can transfer a patient to another floor? Or, when was the last time you delayed an admission because the room “isn’t clean yet”? When was the last time you had told environmental services that another room had to be cleaned, only to find out that she left after cleaning one room, then wait a couple more hours before they send someone back to take care of the other room?

We are only as strong as our weakest link, and I admire the dedication our environmental services people have, however, I think it’s about time we beef up and start the ball rolling. Like that fat pig above, we can’t sit here and do nothing about it, or else sooner or later… we might just get slaughtered!

On my first day of orientation they told me that MMC aims to be the “Ritz-Carlton” of health care. Call me an idealist, but I think we should re-evaluate our goals especially when a patient of mine (when I was just starting out) tells me that this is like “Motel 6”. There is a lot of things that go on at the “Ritz” that frankly, we don’t even come close. Sadly enough, we don’t even try, and even more so, nobody cares! If that was the case, I think it’s about time, we step up to the plate. How will anyone know what the “Ritz” is like, if they haven’t been there? I haven’t, have you? (Maybe our fat friend above has :)) Here’s an idea… how about we send the “employee of the month” for a one night all expense paid stay at the “Ritz”. Hopefully this will expose our people to what we are trying to achieve and bring back a piece of what is truly… “SERVICE EXCELLENCE!”

Sounds like a plan?

OPUS Day: The Saga Continues! September 1, 2006

Posted by 5 Wester in OPUS Clindoc Doc!.
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It’s been roughly 15 days since we’ve gone live and I guess we’re starting to adjust to the new technologies that came our way.

For one, most of us have developed our particular strategies and have successfully incorporated it into our usual routine. Some of us have even relocated to new “offices” and “sweet spots”, such as the back hall (by the fire hose), beside room 42 “Hot Rod’s new office – keep out!” :), particular patient’s rooms (one-on-oners) and parts of the nurses’ station. Change is good, however, with change comes new challenges and issues that we may have not considered.

Take for example, HIPAA.

I know JCAHO will not be around until (who knows when, year 2008?), however, practice makes perfect, as in the case of last year’s survey. I don’t know how inspectors will react to seeing those lively computer screens as they walk down the hallway with patient sensitive information jumpin’ right at them!

Sure, you’d have to be standing behind someone and looking over their shoulders, unless of course we can rationalize and say “It’s not that significant… it’s a non-issue!”. Well, if that was the case, so be it. However, there are a few things we can do to prevent this privacy issue from ever being a potential can of worms surveyors would love to pry open. Maybe we can position the screen in a way that’s not too visible to the public, i.e., screen facing the wall, or have hood covers on the sides. How about those fancy screen overlays where you can only view the screen from the front but blurs the views at an angle (similar to those license plate screens for your car)? I guess anything that appears to them as “good faith” effort to keep visual privacy in check, will sure put a stop to their prying and poking come survey time.

More work to fill in more time… yehey!

There is a natural phenomena that most of you probably already know, and that is, objects or activities tend to expand to fill up space. Have you ever noticed that regardless of how much your budget is, whether it be time or money, you will always end up spending all of it?

Case and point… vital signs.

Lets say it takes you about 20 minutes to do your vital signs, 10 minutes to take VS on all 10 patients, and 10 minutes to document them on paper (VS flowsheet and VS log). But now, thanks to technology, we document our vitals in just 3 minutes on computer. What happened to the extra 7 minutes? Well, here’s what happened… it expanded to 15 more minutes.

How?

Simple…

Three (3) minutes to document on computer, 5 minutes to document on the VS log, 5 minutes to document on the VS flowsheet on each patient’s chart, and 5 minutes to print everything out and stick ’em in the charts for a grand total of 18 minutes (more than the usual time).

Question: Why did we get a computer system in the first place?

Answer: Efficiency, i.e., streamline operation and reduce redundancy.

This doesn’t seem to be the case, however, because like we’ve been talking about, our activities expanded to fill in the time “saved”.

What could we do? NOTHING! Unless of course we sit down and doodle with our noodle, or at least have a voice out to corporate and give them some sort of feedback.

I guess it’s time to have a “user usability” forum where we (the users) are able to make positive suggestions and formulate procedures in order for us to use our time and technology more efficiently. Sure it’s going to be better in the long run, but don’t you think we can do it sooner than later? I’m sure we can come up with better procedures and ways to do things. After all, we’re the ones that do it everyday.

Don’t just comply, simplify! What do you say? 🙂