As Lean Healthcare professionals we are all aware that value is defined by the customer. Often it is not until we can truly see our work through the eyes of the patient that we understand what is value-add and what is waste in our work. The subject and author of the following story wished to remain anonymous. She has been employed in the healthcare quality field for over 30 years, facilitating and leading process improvement for almost 15 years. She holds Lean Certification through ASQ/SME and teaches classes in Lean Healthcare. During the last 19 months, she has focused on improving the patient’s experience by looking at patient touch points. As you read the scenario below, try to put yourself in the shoes of the patient or the patient’s sister, daughter or son and experience the healthcare processes as they would experience them.
At the end of July 2014, I was diagnosed with breast cancer.
The dreaded “C” word came after an abnormal mammogram, two additional mammograms, an MRI, a needle biopsy and a surgical consult. I was assigned a “navigator” who made it all happen within 33 days from the 1st abnormal mammogram until surgery to remove the cancer. Having had some previous experience with healthcare, I suspect the navigator helped to overcome some potential process failures in scheduling.
On the day of outpatient surgery I was instructed to arrive at 6:30 a.m. for a needle placement at 8:00 a.m. followed by surgery at 12:30 p.m. I wondered why it was necessary to be there 90 minutes before the procedure, especially since nothing much seemed to be happening. After time in pre-op, I was transported to radiology. Then the peri-op nurse entered the radiology suite to attach my arm band. He appeared embarrassed that he hadn’t attached it earlier.
After the needle placement, I waited 4 ½ hours until my surgery. With a needle in my breast, I was experiencing great discomfort. What was I to do? Why were the two procedures scheduled so far apart? I later learned this scheduling met the needs of the radiologist. I wondered if he or she would enjoy sitting around for four-and-a-half hours stuck with a needle. It was bad enough to try to deal with this diagnosis, and for my daughter to sit around in the pre-op holding area with me.
After surgery, I was scheduled for 21 daily radiation treatments. During this time, when I arrived in the waiting room the receptionists greeted me some days, but often did not even acknowledge me with eye contact, a hello or a smile. I really did not want to be there and it felt as if I was part of the juggling act they had to deal with between greeting patients and families and dealing with patients, insurance companies and physician offices on the phone. Didn’t they know that a friendly hello would have meant the world to me? The same people who rarely greeted me when I arrived, frequently said, “Goodbye, hon” when I left. How was it I was now the familiar “hon” when I left?
At the introductory meeting for treatment, the nurse asked me to view an eight year old video on breast cancer and radiation therapy. The patient education room had out of date information on the shelves, the pamphlets were helter-skelter, there were empty boxes scattered on the floor, and it was not at all oriented to patients. I had been told that the hospital had the most up to date equipment and personnel.
In the back waiting area, I was to disrobe and put my clothes in a locker. I found the lockers didn’t lock, so personal belongings weren’t secure, and I sometimes had to share a locker with another patient. There were newly built lockers, but I was told there were no keys for them. The bathroom door didn’t appear to lock, and I was always fearful someone would walk in on me.
The nurse ushered me back and said, “Now, what is your name and what are you here for?” She checked her paperwork and asked, “Are you Nancy?” (I am not.) Obviously, the paperwork must have been for someone else.
The facility could not provide a secure location for my belongings or my privacy and they did not even know who I was; how could I trust that they could prevent the return of the cancer?
The first time I saw a physician (not my own radiation oncologist), I was told this cancer was no big deal. Really? Any cancer is my body is a big deal.
One day I was running late for my treatment, so I did not answer my cell phone as I was driving. I arrived on time only to learn the radiology computer system was down and my early morning radiation therapy appointment was delayed. Another patient was scheduled at the same time in a different room and she had left her home too early to receive the message. After learning of the need to reschedule her treatment, she repeatedly expressed to me her concerns about the time she would have to take off work and grumbled that it was only fair that the hospital pay for her time and gas.
During my treatments, I couldn’t help but think about all the other patients experiencing exactly the same thing I was. I shared my observations with the manager, director and my physician. They were surprised that people weren’t doing what they were told to do (greet patients when they entered), that these little things were so bothersome and I was told, “It is so much better than it was. But facilities department doesn’t respond when called.” The manager told me it was painful to hear my observations, because they had been working on so many things to try to make improvements.
After the treatments were completed, I saw my medical oncologist who said I did great with this “garden variety cancer.” I objected and asked him never to use “garden variety” and cancer in the same sentence again. My life had changed because of this diagnosis, and I wanted him to recognize it…I needed his empathy.
Are these big things or little things? Is it lack of knowledge, lack of interest, lack of mindfulness or do they just not care? My observation was that I was an imposition in a world that made sense only to them. They did not see me as a person; I was the work they had to do on that day.
When I received my bill, I was surprised to see that the hospital bill for services was $39,924.25. My insurance company had a contractual credit adjustment of $32,635.20. Working in healthcare, I had always heard our CFO review the contractual adjustments of 70%, 80% or more during the monthly budget performance review, but I hadn’t seen what it means to the patient. After I understood the bill, I shook my head, chuckled, and considered the waste…for the people calculating it, the people explaining it and the patients who try to understand it.
So as you read this story imagining that you are the patient or the patient’s daughter or son, how does this experience measure up? Is it good enough for you, your mother or your sister?
Clinically, her care was technically appropriate and she has an excellent prognosis. As her colleague and friend, I hope her story disturbs you as it did me. The work we do is important because of the people we touch. What can we do different today, so the next story is not told like this one?
Today’s blog was written by Maureen Sullivan, senior manager at HPP.
Maureen has over 28 years of healthcare experience in clinical nursing, management and quality leadership. As a registered nurse, Maureen’s clinical experience is in medical-surgical nursing with progressive responsibilities in nursing management at the front line, middle management, and administrative levels.
Maureen has a bachelor of science in nursing with an emphasis in healthcare management from Metropolitan State College in Denver, Colorado. Maureen achieved certification from the National Association for Healthcare Quality as a certified professional in healthcare quality (CPHQ).