The “Nicely” Feedback Loop


The day you don’t want to be in the hospital is the day after a three-day weekend.  Over the Memorial Day weekend a skeletal staff will make sure that all your urgent needs are met—you will still get an MRI in the Emergency Department—but all the business-as-usual things will wait until Tuesday.  And then Tuesday comes, and watch out!

Here at Crouse Hospital I had so many meetings with so many people and got so tired that yesterday—Tuesday—I fell asleep at 7:45 p.m. so now, at 4:00 a.m., I am wide awake.  My first meeting yesterdat was with the unit nurse manager.  I told her how amazed I have been that this hospital could treat me so well when the last hospital treated me so badly—I had thought that all hospitals were alike—and then I identified two problems.

First, an aide who put my $3000 auto-BiPAP machine on the bedside table.  Then she added my $3000 laptop computer.  Then she added their $12.95 telephone, for which there was not room.  Then pieces of things started hitting the floor, I started yelling, and the aide said, “I won’t be talked to like this” and flounced out.

Second, a woman who had become addicted to pain meds decided to go off them cold-turkey, which put her in the Emergency Dept. and thence into the bed next to mine.  She was waiting for placement in a drug rehab program and had the courage to refuse a drug for the first time.  The nurse tried to talk her into taking it.  Good grief.  You shouldn’t be encouraging drug-seeking behavior in someone who is—kinda sorta—trying to change her lifestyle.

So the nurse manager (sorry, but I forget her name), looking solemn, said she would address the issues, then I was visited by Karen, supervisor of Care Management, i.e., discharge planning, who told me that there were four Karens in her department and I needed to talk to a different one.  I didn’t know how I got her in the first place.  I have been visited by a different care manager every day for four days and it’s getting me upset.  The fewer people I have to work with, the easier it is for me to address the issues.

Then Nancy Williams came.  Nancy is the director of Patient and Guest Relations and I had made her acquaintance after a problem in Crouse’s urgent care (a clerk had overstepped her bounds and done something wrong).  Nancy and I had a conversation that lasted more than an hour and covered a lot of topics.

In 2001, carrying a debt load of $91 million, Crouse Hospital filed for bankruptcy.  In 2004, Dr. Paul Kronenberg became the new president and CEO.  Dr. Kronenberg trained at Upstate Medical Center as an internist and had been Crouse’s chief medical officer for twenty years before taking the top position.  In fact, six of Crouse Hospital’s top eight executives were promoted from within.  I find this surprising because I would have expected that any company that went bankrupt would have to bring in outsiders to fix the problem.  It appears that all the top executives are new since the bankruptcy, so what do we have here?  A hospital that had the talent it needed but didn’t have it positioned effectively?  Now, apparently, they do, and Crouse Hospital is thriving.  It is variously reported to have 489 or 506 beds (and we won’t quibble about a 3% difference).

Derrek Suehs, who hails from Texas, is the chief quality officer and Nancy Williams tells me that he has taught the employees a simple test for evaluating the quality of the care they are delivering.  It is called the “Your Mama” test:  is the care you are providing good enough for your mother, or other dearly loved person?  Matt, the aide who cared for me kindly in the back of St. Joseph’s Hospital’s psychiatric unit, would have understood this.  He said, “I try to treat my patients like I would want my mother, wife or daughter to be treated.”  It’s also known as the Golden Rule.

My two best favorite physicians admitted at St. Joseph’s so that is where I went for decades of hospitalizations.  I didn’t like it but didn’t know it could be different.  Now I am finding a major difference between the provision of services at St. Joe’s and at Crouse, and I’m trying to figure out what makes the difference.  (I rejected Upstate Medical Center a long time ago.  It is my perception that the staff has the self-perception that they are there to train medical students, not treat patients—and it shows.)

So how do you change a corporate attitude?  Wegman’s grocery store chain wins top honors every year for being a really good place to work, which filters down to being a really good place to shop.  If the employees are happy then the customers will be happy—but it goes way beyond the employees being happy.  It is about the customers being treated with respect and courtesy, but Crouse goes beyond that to treating patients with kindness.

Kindness is non-quantifiable.  You can count the money, or the number of days a person is inpatient, or how many complaints get filed, but how do you measure kindness?  How do you set goals for that?

One day at St. Joe’s one nurse was checking my vital signs while I was talking to another nurse about something.  Distracted, I asked the vital-signs nurse to use a manual blood pressure cuff.  After my request, the nurse said, “Please.”  She presumed to instruct me—a wise person who was much older than she was—as if I was a child who needed to be taught my manners.  I wanted to slap her.  It was my perception that she was doing the job she was paid to do and “please” and “thank you” were not required—or earned.  I’d been there ten days and the nursing staff should have learned my blood pressure always had to be checked manually.

Here, right now at Crouse, it is 6:30 a.m.  Breakfast isn’t for two hours so I asked for coffee and juice.  The aide brought it—noting that another staffer had just made fresh coffee—and I spontaneously thanked her.  She treated me nicely so I treated her nicely.  Isn’t it amazing how that feedback loop works?

About annecwoodlen

I am a tenth generation American, descended from a family that has been working a farm that was deeded to us by William Penn. The country has changed around us but we have held true. I stand in my grandmother’s kitchen, look down the valley to her brother’s farm and see my great-great-great-great-great-grandmother Hannah standing on the porch. She is holding the baby, surrounded by four other children, and saying goodbye to her husband and oldest son who are going off to fight in the Revolutionary War. The war is twenty miles away and her husband will die fighting. We are not the Daughters of the American Revolution; we were its mothers. My father, Milton C. Woodlen, got his doctorate from Temple University in the 1940’s when—in his words—“a doctorate still meant something.” He became an education professor at West Chester State Teachers College, where my mother, Elizabeth Hope Copeland, had graduated. My mother raised four girls and one boy, of which I am the middle child. My parents are deceased and my siblings are estranged. My fiancé, Robert H. Dobrow, was a fighter pilot in the Marine Corps. In 1974, his plane crashed, his parachute did not open, and we buried him in a cemetery on Long Island. I could say a great deal about him, or nothing; there is no middle ground. I have loved other men; Bob was my soul mate. The single greatest determinate of who I am and what my life has been is that I inherited my father’s gene for bipolar disorder, type II. Associated with all bipolar disorders is executive dysfunction, a learning disability that interferes with the ability to sort and organize. Despite an I.Q. of 139, I failed twelve subjects and got expelled from high school and prep school. I attended Syracuse University and Onondaga Community College and got an associate’s degree after twenty-five years. I am nothing if not tenacious. Gifted with intelligence, constrained by disability, and compromised by depression, my employment was limited to entry level jobs. Being female in the 1960’s meant that I did office work—billing at the university library, calling out telegrams at Western Union, and filing papers at a law firm. During one decade, I worked at about a hundred different places as a temporary secretary. I worked for hospitals, banks, manufacturers and others, including the county government. I quit the District Attorney’s Office to manage a gas station; it was more honest work. After Bob’s death, I started taking antidepressants. Following doctor’s orders, I took them every day for twenty-six years. During that time, I attempted%2
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