Friday, July 15, 2005

Do You Want Me To Biggie-Size That Rectal Tube For You, Sir?

Do you know what's wrong with the US health-care system? It was taken over by MBAs, meddling - again - in areas they know nothing about. They have implemented the "business model" of health-care, which is the most nonsensical way imaginable. Medicine never was, is not, should not be, and cannot be a business. It is an art, and a craft, and a higher calling, and a social service, with some science sprinkled in for good measure. One thing it is not is business.

But, because businessmen with their business attitudes took over the system, the inevitable happened. Hospitals are measured not by success in healing sick people, but by amount of money they earn. The patients are not treated as human beings in need of help but as - ah, heresy - "customers". How much more demeaning can it get? Here's an example:

Look at this article from The News & Observer from Jun 28, 2005:

If the public UNC Health Care system's earnings increase during the coming budget year, so could the fortunes of its chief executive, Dr. William L. Roper.

Under a proposed bonus program, Roper may receive an annual bonus of up to $130,000 -- about 30 percent of his annual base salary of $450,000 -- if the system hits financial targets. UNC Health Care also would have to score well on both patient and employee satisfaction under the program, which was developed by the health system but must be approved by the UNC Board of Governors.
Roper's proposed bonus, and other aspects of his pay, could be controversial among faculty and staff at UNC Health Care, which is in the midst of a reorganization that so far has included eliminating 200 positions.
Roper's bonus would be largely tied to operating income under the proposed program. Financial results would account for 60 percent of the total bonus; employee satisfaction and patient satisfaction each account for 20 percent of the total bonus.
For the chief executive to get the maximum bonus, UNC Hospitals would have to make operating income of nearly $13 million. UNC Physicians & Associates, the 800-doctor group that is also part of the health system, is expected to lose money but the system hopes to keep losses in check. It could lose as much as $3.1 million and Roper would still get the maximum bonus.

Hospital operating income could drop as low as $8.56 million and physician group losses could be as high as $4.6 million and a bonus would still be paid, though it would be a fraction of the maximum.

Patient satisfaction may prove a more elusive target. UNC would have to score in the top 10 percent among academic medical centers nationally for patient satisfaction for the maximum bonus to be paid. But during the budget year that ended June 30, 2004, UNC just barely scored high enough on patient satisfaction to be in the top 25 percent. McCall said patient satisfaction scores haven't changed much since then.

McCall said a performance bonus has been part of the chief executive pay package since the state officially established the UNC Health Care system in 1998. "No one has ever gotten the maximum," she said.

So, if the hospital improves, this rich white man gets a nice chunk of money. Ahhhemmm, .....but, excuse me, does he do diddly-squat in the hospital? Is he going to share his loot with people who actually work to improve the hospital scores (as ridiculous those scores are)? How about throwing a few bucks to each nurse, clerk and janitor, Roper?

Anyway, how is Mr.Businessman going to improve his hospital's scores on patient satisfaction, you may ask. Since he doesn't know shit about health-care, is he going to ask people who know, like, for instance the nurses at his hospital? Hell no. He is also Mr.Genius. He knows everything. Smart by birth, ya know. So, he is going to TELL the nurses how to behave!!!!

And what is he going to tell them? How are they to behave? Well, Mr.Brilliant came up with a set of phrases that nurses will have to use when addressing the patients. Yup, just like at McDonalds. Would you like a catheter with this?

So, Mr.McHealthcare forced all nurses to attend a seminar this morning to learn the phrases. I am not shittin' you. I have the print-out of the (typically atrocious MBA-style) PowerPoint presentation given to the nurses this morning. It is entitled "Great Expectations for Improving Customers Satisfaction". Did he hire Frank Luntz to come up with the name? It appears that Frankie is out of work, as I don't see his signature work in the current GOP Talking Points.

There are several pages here, each targeting a different situation, e.g., "admission", "when entering room", "nurse manager's daily rounds", "discharge discussion", "telephone etiquette" and "desk etiquette". Each page has a list of phrases, starting with 1."Hello Mr/Mrs______", 2. I'm [name] and I'm the nurse who'll .....", etc. and ends with the ubiqiutous "Is there anything else I can do for you?", and a list of "cues to remember".

But, the most revealing page is "responding to complaints". There is a table with "what not to say" column on the left and "a way to say it better" on the right. How about this example from the left column: "Oh, that doctor never calls back". Or this one: "The equipment around here never works right". Or this: "Well you know how this is, it's a state/teaching hospital..." Where did they come up with those examples, I wonder? From daily experience? So, they are going to do a better job by carefully shielding the "customers" from the truth. Hello?

Well, my wife works there and, yes, she went to this morning's "workshop". She works 12-hour night shifts all the time. She buys, with her own money, soap and shampoo for her patients. She brushes the patients' teeth to prevent infections from respiratory tubes (one of the leading causes of hospital-induced deaths), she wipes their asses, she holds their hands when they are dying, she hugs the bereaved family members. She is a fantastic nurse. And now, she is deeply insulted by Roper's phrase-list. She is incensed. So are all the other nurses. How does Mr.BicMac think he is going to attract and retain good nurses, I wonder.

Of course, this whole thing is going to backfire and explode in Mr.KnowItAll's face. Treating patients like customers (at McDonald's, no less) is going to make 'patient satisfaction score' sink even lower. The anger felt by nurses for this kind of treatment is going to lower the 'employee satisfaction' scores, too. I doubt he's going to be getting that fat bonus any time soon. Is he just dumb, or a self-important white male, or is he a Republican?

posted by Bora Zivkovic @ 7:33 PM | permalink | (2 comments) | Post a Comment | permalink