Please tell me how this is right?!?!

  1. I work for a large univeristy hospital that also has several branches throughout the metroplex. There has been a huge push for patient satisfaction over the past 9 months. Scores are based on surveys completed on discharge and then also a survey mailed to patients at home following discharge. Currently scores are in the low to mid 80's. The goal is greater than 95%. We had a presentation in March on what the expectations were of the staff to insure that patient satisfaction improves and we were expected to sign a form saying that we were committed to just that. The major push was to have the patients be rounded on each hour. The even hours by the nurses and the odd hours by the techs and the purpose of that was to anticipate the patient's needs. We were also to imply with our words, actions and attitude that "we have time". The patients are visited by the supervisors to evaluate how things are going (I'm not sure what all the patients are asked during this time).

    On Tuesday we were presentated with a hospital wide program that ranks each staff member as a high, medium or low performer based on carrying out the commitment of improving patient satsfaction. This ranking has nothing to do with patient care, critical thinking and so on. Bad attitudes, gossiping and backstabbing are within consideration to the ranking. The superivsors will meet with each staff member. The order will be high, medium and low in the hope that by talking to the high performers first they will have a positive influence on the rest. The low performers will be given a choice to basically shape up or ship out. My manager says that even some of the most experienced nurses will be faced with that decision.

    What do you think of this?

    Here's what I think. I think that it is extremely childish and extreme. I can't believe that a group of educated adults put this program together. I feel like it doesn't value nurses and techs and recognize that we are human beings. I also am feeling like I don't even want to work for this healthcare system anymore.
    I really enjoy the people that I work with and they types of patients that we have. I even sometimes enjoy the workload We as a whole work pretty well together. I'm just dissappointed that we have to go through this and it is an added stress to an already stressful job. I'm further upset that we do not have an advocate.
    I'm going to try to let this blow over because I don't see how it is going to effectively work. But the list has already been determined and it is expected that each staff member will be spoken to before January. "Nothing says Happy Holidays more than You Are A Low Performer"
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  2. 58 Comments

  3. by   Tweety
    So who does the ranking?

    Doesn't sound like a good idea to me. Did they copy it from another hospital or just invent it?

    We have to the "I have the time" thing too.

    I would simply look at it as another part of the evaluation. They've added "customer service" to our evaluation too and fortunately I got high marks because it's my strength. I hear complaints from patients about the same nurses with bad attitudes and some people though technically performing their job for years, have the personality and customer service skills of a toad, perhaps it is a good idea to call them on it. But I guess I'd rather have a battleaxe with good critical thinking and clinical skills than someone with good customer service skills. Be nice to have a well-rounded nurse though.

    I guess it sounds like I'm on the fence.

    I think customer service at the expense of employee service and satisfaction is a bad idea.

    Good luck with this.
  4. by   nursemaa
    Hospitals have to compete with each other nowdays to because often people can choose where to go. And the fact is that people will choose a hospital that gives a caring, calm, and healing impression.

    I tend to hire more on attitude than skills, because skills can be taught but it's almost impossible to change someone's attitude towards work and their patients. But Tweety is right, you need a blend. I also round on patients and ask them for their perception of the care, and if there's anything we could do better to help them.

    The fact is, whether we like it or not, customer service standards are not going to go away. Most of it just boils down to being nice to our patients, and leaving them with the impression that you really care about their needs, and that you are there to help them get through this hospitalization.

    It takes little time to smile, introduce yourself and ask "how may I help you?". It also doesn't take alot of time or effort to leave them with the impression that you have time for them. And if you ask them if there's anything else you can do before you leave the room, chances are the call light won't go on so often. So I think the things we're being asked to do in terms of service are not outlandish or difficult. Obviously, because many nurses, who are just as busy as the rest of us, have excellent skills at communicating this way.

    Oh and by the way, these methods come from Quint Studer, who is the guru of service excellence for hospitals. He doesn't recommend customer service at the expense of employee satisfaction, in fact he recommends making sure there is good equipment for doing their job, making sure to recognize and thank staff who have provided excellent care, and rounding often on staff to support and assess their satisfaction, and to solicit their ideas for improving the workplace. He is very supportive of meeting staff needs so that they can meet their patient's needs. But he does say that people who are still harsh and uncaring with patients may have to go....
  5. by   midwife2b
    Oh and by the way, these methods come from Quint Studer, who is the guru of service excellence for hospitals. He doesn't recommend customer service at the expense of employee satisfaction, in fact he recommends making sure there is good equipment for doing their job, making sure to recognize and thank staff who have provided excellent care, and rounding often on staff to support and assess their satisfaction, and to solicit their ideas for improving the workplace. He is very supportive of meeting staff needs so that they can meet their patient's needs. But he does say that people who are still harsh and uncaring with patients may have to go....

    Since Studer's program was instituted in our facilities patient, staff, and physician satisfaction have all increased. The equipment issue, recognition, and idea gathering have been the biggest improvers in all overall satisfaction. I had a hard time with this customer service program initially (are we going to a Burger King mentality?) but basically it boils down to treating everyone in a respectful, nice, appropriate way, and delivering tools to make that happen.
  6. by   meownsmile
    OH i think this is speading like the flu. My facility has a "committee" now forming getting ready to put policies inplace. Those with attitudes will be let go if performance doesnt get better.
    Yes they are using the survey model. Some company compiles these results and gives a percentage overall based on the size of your facilities compared to others your size and probly charges an arm and leg for the results.

    Ok a couple posting since i first set this response. My question, you can smile, and do the little things for a patient as much as you are able. Give the rest of the staff smiles, and thank-yous,, and yes at some point it helps,, but.. at what point does the staff have to accept the idea that the facility is paying huge amounts for these "workshops" and huge amounts to these companies doing these "surveys" and the facility expects them NOT to have hard feelings when they dont get reasonable raises?
    Somehow i think they are cuttin off their nose to spite their face by paying to send all the managers off on a weekend to a "getaway" to learn how to tell their staff thank-you. Whats that say?

    I guess what i mean,, is if management would set an example what they expect staff to,, staff may not have such a hard time doing it. And they may not have to PAY someone to teach management that.
    Attitudes roll downhill,, same way everything else does.
    Last edit by meownsmile on Nov 24, '05
  7. by   gauge14iv
    The problems with this Studer model ensue when facilities choose to leave pieces out - the staff satisfaction for example. The Studer model is an all or nothing - meaning that if the facility isnt going to deliver THEIR end of the bargain - keeping staff happy with the appropriate resources and tools to do their jobs - then patients aren't going to be happy either.

    A facility cannot just adopt the patient satisfaction piece and expect that to work - they have to be willing to do the rest too.
  8. by   nursemaa
    Quote from meownsmile
    I guess what i mean,, is if management would set an example what they expect staff to,, staff may not have such a hard time doing it. And they may not have to PAY someone to teach management that.
    Attitudes roll downhill,, same way everything else does.
    Well, you are abosolutely right! Studer also states that the customer service attitude must begin with managment, and training starts there. Management is taught how to round on patients and staff, tools that help improve the work environment, and strategies to ensure that patients leave satisfied with their care. So it's not just teaching them to say thank-you, there's much more. If the organization doesn't start the program at the top, it will fail.

    Just as some staff need training in these skills, so do some managers. Workshops help to teach those skills, and to teach management how to effectively support and coach their staff.
  9. by   wookiee
    Customer Satisfaction has become the biggest buzz word in the industry, and for important reasons, bottom line profit. If the patient is not happy, they now have the choice to take their business elsewhere, and the hospitals are seeing this happen on a daily basis.

    Where I run into a problem with the whole thing is that it is the only buzz work in many hospitals, and all the rest of the issues are left on the side of the road so to speak. I personally am from the old school where you first take care of the ones that provide the "Customer Service" namely the Nursing staff. It is sort of like the old saying "If Momma ain't happy, nobody's happy". I see it this way, a happy nurse is a good nurse (for the most part), whose patients are then in turn happy with the care that they are recieving, then you get your good ratings.

    Pressuring staff by impossing sombody elses standards is not going to make for a better and happier place for the patients, what will however is to take steps to make for a better work environment, ie better staffing and patient ratios, at least adiquate equipment that functions most of the time, and par levels that reflect the supply needs on the floor.

    Knowing the strength's and weaknesses of staff is important, but to catagorize them in performance levels is only going to make them even more unhappy with where they work and in turn make the patient satisfaction ratings go into the cellar.

    If I were to ever have or see a floor manager, or anyone from management come up to a staff member and give them an "at-a-boy", you did a great job with patient so and so, I think I would be a canidate for the CCU.

    Rather than harrass staff to provide better customer service, it would be my suggestion for management to attend classes on how to empower their staff, how to make their staff feel like more of a team, rather than to single them out for lack of being happy.

    What the heck ever happened to Employee Satisfaction anyway?

    Wookiee
    Just one big dumb hairy ape!
  10. by   tencat
    My question is, what criteria makes one a 'low' performer? Is one a low performer if you don't run to get coffee for the family of a patient when you have five other patients who need care? Are you a low performer because a family member wants to yell at you about some aspect of care, and you don't stand there and smile and take the abuse? These manager-types need to remember, as has been said, that happy customers are the result of happy workers. If your workers are feeling dumped on and unappreciated, it's going to affect the whole system. Expecting someone to keep working just for the satisfaction of knowing that the job is 'special' perpetuates the myth that one must sacrifice all to be a good caretaker to others. Noble idea, yes, but most of us are not Mother Teresa, and that expectation is totally ridiculous.
  11. by   snowfreeze
    At the same time an employer wants to increase "customer satisfaction" they need to understand employee comfort also or the customer will never feel comfortable.
  12. by   Daytonite
    having been in management when hospitals went to this kind of thing i can tell you exactly what is going on based on what you have written.

    first of all, your hospital is wanting to make a definite stand within the medical community that the doctors (and the patients) should consider coming to your hospital for their hospitalization and other healthcare services. the more patients your hospital gets under it's roof, the more money they will have coming in. you can thank medicare for creating payment programs that have pretty much whittled payment for healthcare services down to the absolute nubs. it is forcing hospitals to budget every single dollar they spend very, very carefully so they don't go belly up.

    secondly, patient satisfaction (or customer satisfaction) while sounding disdainful to a lot of nursing staff is a very real world answer to increasing the number of patients coming to a facility for their health care needs. the retail industry, in particular, has long been aware that offering courteous, friendly customer service increases their sales. healthcare has become a retail item, believe it or not. in some markets (cities) people have a choice of facilities they can be patients in. your hospital has decided they want that business. one of the things they are focusing on that directly affects you nurses is customer satisfaction. there are a number of companies that do customer satisfaction studies for healthcare facilities. i can't think of the names of them, but these surveys can be accessed through your state chapter of the american hospital association. consumers in the know actually look at these reports to chose hospitals they are going to go to! we looked at them when we were looking for a cancer center for my mother's treatment.

    third, the thing i know something about is that disciplinary action is probably being built into this program your hospital is undertaking. you may not have been told that, but i smell it. that fact that they had you all sign a form that you were committed to it gives personnel proof that you understood and were made aware that "high performance" was going to be expected. don't be surprised if you are all introduced to some sort of evaluation tool (form) that assesses your level of "performance". you will probably be told about that in your individual meetings with your supervisor. as you said, "the low performers will be given a choice to basically shape up or ship out." i'm going to suggest to you (because i saw this done in one facility i worked) that customers and employees are going to be able to report those who have bad attitudes, promote gossip and chaos, backstab, are snotty and nasty, deliberately sabotage the work of others, refuse to be part of the team effort, etc. your hospital is going to get rid of these employees. first, they are going to give them the opportunity to shape up. this, then, gives the hospital complete legitimacy to fire them it they do not follow these additional performance standards.

    we can laugh, sneer and poke all the fun over this we want, but most hospitals that do this are looking to get rid of their lousy, bad attituded employees despite whatever level of training and expertise they have. and that is going to include the doctors as well. this program they are instituting is going to give them the power they need to do that. in most places it's difficult to fire an employee who just has a bad attitude, but not under the program your hospital is putting into operation. this is serious, so please take it seriously. snap at someone in another department on the telephone and they can write you up for it and you could well find yourself fired over it if the hospital can show you have a pattern of this kind of behavior. it only takes two or more reports against you and you are out the door. bad attitudes, gossiping and backstabbing are very hard issues to discipline employees on as they don't really involve your actually job duties. now, your supervisors are being given a way to address these issues with a program that has some bite to it. where i worked it was mostly us managers who filled out these reporting forms, but we also made them available to all the staff although most never filled any out unless another employee insulted them in such a way that it made them angry enough to want to report them.

    you are going to have to smile, be courteous at all times and have a positive attitude. for those who can't do that--bye-bye. and, under this program, it won't be that hard for the hospital to do. hospitals are huge employers now and as such can demand this of all it's employees, including the nurses. so, watch what you say and do. you are now going to be expected to give superb customer service. if you make a mistake at least do it with a smile and have a positive attitude about correcting your mistake. that is how you survive under this kind of regime. you have to look at it this way. otherwise--there's the door. you can either go willing or they will have (and have probably planned for) a way to fire you.

    in one of the facilities i worked, the employees nicknamed our mandatory seminars on this "charm school". we got a nicely produced booklet explaining the program to us as well as signed the paper. however, let me tell you that in the 15 or 20 years this program has been in operation at that hospital, the hospital services there have grown by leaps and bounds while several other hospitals in the same local area have gone to the dogs and one had to close its doors. the business people who consult with administrators and advise how these customer service programs be set up know what they are doing. and, like any other business, the bottom line is always profit. that profit will be used to buy better equipment, enlarge the facility and perhaps, even increase your salary. if you want to work for a place that isn't interested in the bottom line, go work for the government, military or some volunteer group. remember that we do live in a capitalistic society. this is one of the prices that we have to pay for that. you don't have to like it, but at least keep it to yourself. if i were you i wouldn't openly dis this program at work as you will surely end up on the chopping block.

    your comment that "i also am feeling like i don't even want to work for this healthcare system anymore" is one of the kinds of responses this program is designed to elicit from someone who doesn't want to comply. they are counting on some people like you who will save them from doing their dirty work and just walk away. others will fight against it tooth and claw to no avail--they will be fired, for expressing negativity to this new program if nothing else. and, please, i'm not meaning to be harsh to you, but if you quit it won't matter. new employees will be hired and their hiring will be based on a commitment to these performance standards. they will commit to it because they want the job. eventually, everyone left will be committed to this program. are you prepared to give up your job at a place you sound like you have liked working at? can it be so hard for you to follow this new plan which is going to make your working conditions better in the long run? if not, then i guess you know what you have to do, don't you? this is not going to blow over. your hospital administration put down big bucks to hire and contract with the consulting firm who has designed this performance program for them. it is not going to go away. there is nothing you or even a group of you is going to be able to do to stop it. the next few months are going to be painful if you stay on because you are going to see some people you think of as friends leaving or being put out the door. change is hard on everyone because of it's uncertain nature. but, let me point out that one of the things nurses deal with more than most other professions is change. so, we have it in us to survive something like this. i would predict that one of the first firings or exits is going to be someone in management. they are usually the first to go if they don't show a committment to the program because they have to sell it to the rest of the employees.

    by the way, the timing for introducing this program was not done randomly. it is the holidays and people are less likely to up and make a drastic change in their employment during this time of the year. this was factored into the overall plan that was developed. employees are more likely to accept something like this being shoved down their throats when they are facing holiday expenses. the hospital has been told that right off the bat they may lose a fair number of employees, so starting the program around this time of the year limits those numbers a bit. these consultants who develop these programs are very, very smart.
  13. by   NRSKarenRN
    Quote from tencat
    my question is, what criteria makes one a 'low' performer?
    high-middle-low performer conversations

    quint studer explains how to have conversations with high, middle, and low-performing conversations in the august 05 issue of hfm magazine, a publication of the healthcare financial management association.

    basically, high performers are people who bring solutions. middle performers can identify the problem but may lack the experience or selfconfidence to bring solutions. low performers tend to blame others for the problem. they act like renters instead of owners....

    many healthcare organization leaders are spending 80 percent of their time on the 5 percent of employees who are not meeting expectations...

    indeed, when leaders tolerate low performers, they are drained of energy that could be better spent inspiring the middle- and high-performing employees who drive long-term sustainable results in an organization. in any change initiative, an organization eventually hits a psychological “wall,” where high and middle performers perceive the performance gap between themselves and low performers as unfair. they slow down, pace themselves, and results slow down with them, negatively affecting the entire organization.

    once that occurs, leaders lose faith in their organization’s ability to create and sustain long-term gains and turn to a new “program of the month.” the real solution to moving organizational performance long-term lies with employees: using specific conversations to re-recruit high performers, develop middle performers, and hold low performers accountable (“it’s up or out!”).

    inevitably, this solution creates an uncomfortable gap as low performers become more isolated from better-performing employees. low performers improve or leave, which unlocks the full potential of the organization as it moves over the wall toward peak performance...

    Quote from tweety
    so who does the ranking?
    department manager.

    informally each manager already knows or learns if new who are self starters (high performers), staff that need support/guidance (middle performers) and those that need "an eye kept on them" (low performer).

    it's not fair to any organization, especially to other employees to have an established employee that constantly needs to be reminded how to do the job! set clear expectations, mentor employee to meet goals with time lines and provide support/re-education where needed. if realistic goals (same for all employees across board) are not met, then employee is really choosing not to be an employee and is let go.

    many nurses and aides have posted here what a morale drag it is when one employee constantly manges to evade not doing work. remember story when new manager had "good rn" arrive 30-45 min late to work repeatedly despite being counseled? staff appreciated when rn finally let go as affecting morale of whole team---that's what quint studer is talking about here.
  14. by   NRSKarenRN
    Quote from gauge14iv
    The problems with this Studer model ensue when facilities choose to leave pieces out - the staff satisfaction for example. The Studer model is an all or nothing - meaning that if the facility isnt going to deliver THEIR end of the bargain - keeping staff happy with the appropriate resources and tools to do their jobs - then patients aren't going to be happy either.

    A facility cannot just adopt the patient satisfaction piece and expect that to work - they have to be willing to do the rest too.
    :yeahthat:


    Staff need to hold Senior Management accountable. If they are not proviing "customer service" to employees, employees have a right to request meetings to discuss their concerns. Many work issues resolve around "unfilled expectiations" just airing exactly what these expectations are on both sides helps clear the air. This is not about getting raises, but about building a culture where two way honest discussions of how to best improve work environment for employees and patients will move your organization forward.

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