My Operation
I’m an expert now! Been there, done that. Recovering from ambulatory surgery at the hospital (H) most would consider the best in the DC area. The good news is that I survived! They didn’t make a fatal error in my care. On the other side, there were some customer service (CS) goofs, some quality of care (QC) issues, and some inefficiencies (E). I called to pre-register by phone. Three times. CS goof #1! The person who finally answered didn’t speak English well. CS goof #2: The public face of your institution--the clerk who registers surgery patients, can’t spell “inguinal hernia.” She also didn’t tell me when to arrive or where to go. I did find the “patient registration” desk where a clerk instructed me to wait for a second clerk who then collected all the information I had given over the phone two days ago. Sounds like two E problems.
“Go up to the second floor. If there’s no volunteer at the desk, find a nurse on 2 West.” This hits at least E and CS. If the volunteer is an integral part of the process, MAKE SURE THERE IS ONE! If not, put her to work somewhere else. I soon lost track of the number of people who came to see me. (E) One person could have done it all in about 5 minutes. One of these was the OR nurse. E. I realize this is a relevance issue for them, but she belongs in the OR. Let someone else get the patient ready. The PA repeated what my MD had done the week before, and not as well. E and QC.
In the OR, the anesthesiologist who was supposed to be taking care of me was off chinning with the nurses and oblivious to the fact that the local anesthetic was not quite adequate. (QC) The OR nurse asked the surgeon if he wanted antibiotics, and he said, “no.” Whoa!! That’s a NQF standard. Why is he allowed to say no? Another QC. Post op, no one asked me if I had pain (I did). The JCAHO requires this. QC. Of course, no one asked me if I wanted anything for pain (I did, but didn’t get it.)
When I left, they didn’t give me a survey or ask me if things went well. I guess they don’t care, and that would explain all the other items.
WHY does this happen! OK, these are small issues. No one died. But they are the canary in the coal mine. The E problems could be solved by reducing payments. AHRQ thinks that the other issues would improve by informing patients and giving them more choice. But I chose this place! The have good marks from HHS. Are there no places to get good healthcare in the US? Forget excellence--just satisfactory.
“Go up to the second floor. If there’s no volunteer at the desk, find a nurse on 2 West.” This hits at least E and CS. If the volunteer is an integral part of the process, MAKE SURE THERE IS ONE! If not, put her to work somewhere else. I soon lost track of the number of people who came to see me. (E) One person could have done it all in about 5 minutes. One of these was the OR nurse. E. I realize this is a relevance issue for them, but she belongs in the OR. Let someone else get the patient ready. The PA repeated what my MD had done the week before, and not as well. E and QC.
In the OR, the anesthesiologist who was supposed to be taking care of me was off chinning with the nurses and oblivious to the fact that the local anesthetic was not quite adequate. (QC) The OR nurse asked the surgeon if he wanted antibiotics, and he said, “no.” Whoa!! That’s a NQF standard. Why is he allowed to say no? Another QC. Post op, no one asked me if I had pain (I did). The JCAHO requires this. QC. Of course, no one asked me if I wanted anything for pain (I did, but didn’t get it.)
When I left, they didn’t give me a survey or ask me if things went well. I guess they don’t care, and that would explain all the other items.
WHY does this happen! OK, these are small issues. No one died. But they are the canary in the coal mine. The E problems could be solved by reducing payments. AHRQ thinks that the other issues would improve by informing patients and giving them more choice. But I chose this place! The have good marks from HHS. Are there no places to get good healthcare in the US? Forget excellence--just satisfactory.
Comments
Dr. Burney,
I was just reading your entry from June 8th. I think I can safely say that, yes, you can get good healthcare. I recently had surgery here in Milwaukee and I compared my experience to yours. Everyone was where they were supposed to be. I had one pre-op nurse who went to the extra effort of getting me a private pre=op room. My pain was well-managed. I received one survey before I left the hospital and another one in the mail about a week afterwards. I gave them very high marks, and now I think I should have gone higher. You've made me appreciate the quality of the care I received.
Posted by: Shannon Krause | June 29, 2006 09:55 AM
Dr. Burney -
I am glad you shared your story as I work in a healthcare quality improvement department so the items you noticed make me cringe at the lack of efficiency and quality. I have noticed many of the same items at some of my doctor visits. It does seem like they are small issues, but because they occur so often they collectively form large issues, and therefore incur large costs.
It is crucial for healthcare organizations to hear about patient experiences that display such blatant inefficiencies. Maybe collectively patients can make hospitals and clinics understand that no matter how much technology they have or how pretty their shiny new buildings are, receiving exceptionally poor, inefficient service does not make the high price tag worth it. Like Shannon's experience I have received quality healthcare, but I have not received healthcare that 'wowed' me. I do not find it acceptable in other industries to pay a high price for a product or service and not be 'wowed'. Healthcare consumers should not accept the current service quality they receive and I do not think they will for much longer. Your calls for high quality and efficiency are right on the mark.
Posted by: Jill Laeyendecker | July 6, 2006 03:35 PM
Shannon: Do you think you'd get the same quality of healthcare if you went back every day? I think the Hospital where I went provides good care now and then, but it's an accident. On the other hand, I'd place a large bet that Toyota produces excellent cars every time. And it's not an accident!
Posted by: Robert Burney MD | July 13, 2006 08:52 PM
Dr. Burney,
Quick question for you. Did you have an option or choice to where you had your surgery? Many times, as patients, we are directed to a location. Under my HMO, I do have a selection. I ask my surgeon- would you have surgery there? If the surgeon said no, I would look for the alternative location. Did a friend provide your surgery?
I work in an ASC and have to tell you that each staff member is here to serve the patient. Most complaints are about the surgeon or their offices. I am sorry your service was poor. Did you send them a note or talk with the Administrator about your care. If they don't know about, they can't fix it.
Every patient or customer has a responsibility to express their likes or dislikes when it comes to service. More often than not we hear the bad. Remember to comment or say thank you when you get the good.
Posted by: Josie Demrow | July 18, 2006 07:25 AM
Josie: Yes, I did have a choice, but I based my decision on imperfect information. Where does it say this hospital doesn't assess post op pain? This surgeon doesn't follow rules? Why should I send them a note! They didn't ask and thus are not interested.
Posted by: Robert Burney MD | July 20, 2006 09:50 PM