Does the happiness of your caregiver
matter to your health?
One of the obvious, yet vexing truths about healthcare is
that it is a business. In fact, it is a highly complex and technical
operation that is uniquely delivered using 1:1 personal interactions in
intimate settings. There is precious little discussion about the fact
that people matter more in healthcare than technology or
So in a very real sense, your very life depends more on your
caregiver in this 1:1 intimate setting, than it does on the science or
technology that is being used. This is one lens through which we can view
the utter disaster that describes the relationships between the United States’
medical outcomes, our cost of healthcare and the paradox of the “most advanced
technology” in the world that is put to use in its delivery. What’s lost
is the enormous impact of the people delivering the service. In other
countries and cultures that have far less technology there seem to be better
outcomes. How can this be so?
In a retail environment, service quality is important to
loyalty, brand value and many drivers of bottom-line profit and growth.
Yet in retail, as in nearly every other industry, service quality does not
impact the very lives of customers.
distribution and preparation, and drug manufacturing (arguably a healthcare
related industry) may be notable exceptions. Aviation and some related
mass transportation industries may also be notable exceptions. We depend
on our “drivers” to keep us safe.
Yet impossibly we continue to treat healthcare delivery in many
ways, with the same “disconnect” and “third person separation” as retail
service industries when it comes to the relationship between quality of service
and the small things… such as life and death.
We exaggerate here because these are real issues that are
only now being addressed by law, mandate and accountability.
And that’s a wonderful new direction.
Before more good news, a few startling statistics:
leading causes of accidental death in the United States and Canada:
Auto accidents? Falls? Drowning? Good guesses. Those are up at
Coming in 1st place
however we find a surprising trio:
-Hospital acquired infections
That’s right. It's called "iatrogenic"causes. The very organizations tasked with saving lives are number 1 in the accidental
killing business. Above handguns. This is according to Medical News Today
, the National Safety Council and JAMA. This absurd paradox is misleading. Of course healthcare facilities and teams save lives and cure disease. But there are big risks that must be managed
aggressively. And they all come back to human error.
According to William Charney at Canadian
, systematic factors lead to most errors. “although
there are many causes for errors and hospital-acquired infections, I like to
look at the impact of people, process, and technology. And while technology can
clearly help, patient outcomes today are clearly driven by the quality of
people and process.”
What Charney is describing is the root of this new focus on
caregivers, and the bright spot in being able to create real improvement in
outcomes and reduction of errors and costs — “the quality of people
How is your caregiver treated on the
job? It should matter to you.
Of course we want all caregivers to be treated well by their
employers. Especially on the day we visit them. But is there more
to this than the difference between a sweet smile and a brusque attitude?
Is “bedside manner” a “nice to have” or is it vital? Think of it this
way: as Barbara Balik, Senior faculty member of the Institute for
Healthcare Improvement (IHI), puts it “we can only treat patients as
well as we treat one another.”
A 2009 Forum Group report titled “The Relationship between
Employee Satisfaction and Hospital Patient Experiences,” goes further by
finding that efforts to create higher employee satisfaction have a very
desirable outcome on patients, including increased patient satisfaction,
improved care quality, and increased patient loyalty.”
The report suggested that one effective way of meeting the
needs of employees, with the goal of ultimately satisfying patients, is
“viewing employees as internal customers.” Some people suggest that the tables should be
turned, and insist on hospital executives receiving their regular medical
treatment anonymously at their own facilities. That’s one way to have
executives alerted to the level of healthcare worker engagement and job
There are better, more positive ways. And new laws,
policies and mandates are driving this faster. Technology can help.
But first one more example of what may be a familiar
dilemma. Staffing. Or rather, staffing dysfunction.
Where’s my doctor? Where’s the
Have you ever wondered, while shivering in the paper gown in
the treatment room, why you have been left there for such a long time?
Have they forgotten about you? If you peek out the door into the hallway
there is nobody in sight. You were here half an hour early and sat in the
waiting room for 20 minutes past your appointment time. You will be late
back to work. Do they keep you naked and cold so you won’t wander around?.
You’re trapped. Waiting. You can’t check email because your cell phone
gets no reception in the building. You hear a voice in the hallway and
open the door to ask “where’s my doctor? Where’s the shift nurse?”
All you get is a shrug.
This matters a lot more than you think.
Where staffing is inadequate, the potential for medical
error actually increases. William Charney’s review of the scientific literature
has found a direct link between medical error and infection. For each
additional patient over-assigned to an RN, the risk of death increases by 7
percent for all patients. Patients in a hospital with a 1:8 nurse–patient ratio
have a 31 percent greater risk of dying than patients in hospitals with a 1:4
nurse–patient ratio 1. (For non-math majors that means
understaffed healthcare organizations make more mistakes, and that means
increased risk to patients--- you and me)
Penny-wise and pound foolish
compromises in shift scheduling and staffing levels
Longer shifts have become popular over the last several
years. They can save payroll expense. However they also create a
higher rate of medical error. “Physicians-in-training who are
scheduled to work long hours make 36 percent more serious medical errors with
five times as many serious diagnostic errors. Fatigue-related error data is
plentiful in the scientific literature. Fatigue-related preventable adverse
events associated with death of a patient increased by +/- 300 percent in
interns working more than five extended-duration shifts per month.”
The takeaway there: If you seen an intern--- send him
or her away to get some sleep.
The good news- accountability is
driving real focus on quality and engagement
The Affordable Care Act, also known as “ObamaCare” makes pay
for performance the law of the land
Hospital Value Based Purchasing Program
. This puts billions of dollars
of medical reimbursements into play at healthcare delivery organizations.
And it’s not something that Congress or The States are likely to be able to
avoid or repeal. Like it or not, we all have to live with its rules.
As healthcare organizations are coming to understand, 1%
(growing to 2%+) of all Medicare reimbursements are being withheld for
consideration under pay for performance.
is being defined as patient satisfaction, improved outcomes and overall better
quality of service delivery. But how do healthcare organizations
improve? What are the drivers and measurement basis? What are the
benchmarks and predictors? Those are just a few of the questions asked by
healthcare executives today.
The relationship between caregiver engagement, satisfaction
and working conditions, and the quality of outcomes is no longer in question
for the healthcare industry. Caregiver engagement drives outcomes and
patient satisfaction. This is the direct link and the key insight that
healthcare organizations are coming to understand. And now it’s directly
linked to financial payments.
The great news is that this is much easier to impact these
factors of care than acquiring multi-million dollar treatment devices or
waiting for new vaccines or DNA treatments or advances in disease management.
By comparison, it’s ridiculously simple and
inexpensive. But it’s not something that has been aggressively and
mindfully managed, monitored and turned into action, policy and benchmarks.
Again, lots of great news.
New mobile services like the NursesCount service and the
companion service PatientCount (from the company WorkersCount) provide
immediate insights into service quality, identification of problematic
processes, and service areas, and turn them into actionable insights and
benchmarks for leaders to see daily, in real-time.
The NursesCount and PatientCount services change the game by
delivering the first healthcare-specific worker sentiment measurement service,
delivered on mobile devices. These services move measurement and management of
engagement from a yearly or periodic basis to a daily basis. The friendly
mobile application asks employees two simple questions each day: how do you
feel about your life at work today and a question of the day.
The value to employees comes from seeing daily the results
for their organization (as well as peer group across the industry). For
healthcare managers, results are summarized into dashboards showing aggregate
sentiment changes over time and comparing sentiment and questions of day to
benchmark data. This way executives and managers can quickly discern where
improvement is needed, and where actions and initiatives are working.
In conclusion, the answer to the original question of “Does
the happiness of your caregiver matter to your health?” --yes
So the next time you visit your healthcare organization’s
facility, take a look around and try to get a sense as to whether things seem
“happy” or “sad” – and if the people you encounter seem overworked, cranky and
disengaged, or if they seem positive, happy and engaged.
If things don’t “feel” so great, consider making a change to
another healthcare provider.
Your very life could depend on it.
What's your view about this in your organization? Join the conversation at our LinkedIn Group