Can’t Get No Satisfaction

I went to a Patient Satisfaction Committee meeting a few months ago and never went again because it was pathetic. Sad to relate but our largely inner-city Emergency Department has been tooling along with satisfaction scores in the low thirty percents and, as reimbursement is at stake, the hospital has become somewhat hysterical about satisfying the customers. At first they implemented something called “AIDET.”

AIDET, for those of you who don’t know, is a bad joke concocted by a bunch of grifters at the Studer Group and sold to gullible hospital administrators as a formula to make patients happier. It is an expensive acronym that describes what is really nothing more than common sense politeness and it enjoins us to Acknowledge, Introduce, tell the Duration of a the visit, Explain, and Thank the patient.

The hospital spent good money on this system and the clipboardeurs strutted like petty Napoleons conducting the many seminars and classes required before the big “Roll-out,” a day that when it finally arrived was greeted with the fanfare we usually associate with launching a fucking aircraft carrier. Banners and Posters everywhere, naturally, as the party faithful expressed their love for Big Brother and the atmosphere was decidedly oppressive, almost Stalinesque.

The medical staff were exempted from the training. Since dissent is not tolerated at my hospital the administration is very careful about offending the doctors, most of whom have legs, are doing the town a favor by working at the hospital, and can get jobs elsewhere pretty quickly. Nothing worse than carrying your clipboard into a meeting and being laughed at by a bunch of doctors.

They never consulted the Emergency Physicians about the thirty-minute wait-time guarantee for the same reason.

So the big roll-out came and nothing. Nada. The patients don’t care. The hospital is still understaffed, still filthy, still has a primitive laboratory that cannot get the results of simple labs in a timely manner, and still has long wait-times.

Additionally, when two-thirds of your patients are looking for narcotics, work notes, or miracle cures to mild, self-limiting illnesses there is nothing that will satisfy them but capitulation or divine intervention. I could double the satisfaction scores by simply giving everybody a complementary thirty-days of Percocet or a Z-pack for everything but so far the administration had not asked us to do this, at least not overtly.

So I went to the meeting and although I was treated politely I was as welcome as your crazy Uncle Milt who is not allowed to live within 600 yards of elementary schools. The Facilitator listened politely to what I had to say but only because she didn’t have the guts to interrupt a physician when he was making sense. Every other rational suggestion made by people to whom the administration should listen before hiring the Studer Pirates was summarily dismissed as non-feasable. Having shot their wad on crazy corporate psycho-bable apparently there is no money to hire a few extra nurses, buy some portable blood testing equipment like they have at the local Urgent Care, or even get a janitor to make a high-speed reconnaissance pass through the Emergency Department at night.

As to suggestions that perhaps the paperwork burden has become too heavy; so heavy in fact that the nurses literally spend three-quarters of their time documenting the irrelevant minutia of patient care, and that patient care would be enhanced if the focus were really on the patients and not paper…well…this was greeted with the disdain you would expect from a person whose entire job revolves around checkboxes and forms.

But this is typical of medical corporate culture and our sad, ruined society at large. The real problems in our Emergency Department are over-crowding, the horrific paperwork burden, primitive equipment, shoddy ancillary services, and a malignant and vindictive culture. These problems require decisive action and money to solve, two things that are impossible to wrest from the grasp of the kakistocracy so they will go ahead blame the staff for the problems (because the underlying premise of AIDET is that the staff suck) and throw some weak-sauce, ineffectual corporate duckspeak at them.

But that was yesterday. When the satisfaction scores continued to wriggle around in the bottom of the toilet they decided to only survey admitted patients (who are generally very happy about their visit) and mirabile dictu, the scores almost doubled.

The underlying premise of AIDET is to ignore real problems and blame the staff who could solve all of the corporation’s problems if they weren’t so mean to the patients.  There may be some potential for incremental improvement by using AIDET in a well-run, otherwise solid hospital but all the propaganda in the world can’t fix a cruddy hospital (or a country, for that matter).