June 14, 2024

Story 3: Culture Isn’t a Buzzword

The hospital was a little better than the emergency room, but not much. My mom saw a steady stream of doctors, starting with the kidney specialist who was working on her sodium levels.

Because she had gotten an MRI and CT scan through the ER, she had visits from the doctors associated with all of the places the cancer had spread. By this time, Mom had perfected her death with dignity speech, so these visits were like stops at a drive-in fast-food window. No more than 3 minutes for each one. She would try to tell her story of how healthy she had always been and her decline since the cough started, but they were all in a hurry. Especially the hospitalist who was in charge of her case. His visits could be measured in seconds. When Mom asked a question, the look on his face was annoyance. The last time we saw him, she asked him a question, and he said, I don’t have time; I’ll get the nurse. Mom was trying to explain what she thought was an adverse reaction to one of the drugs they prescribed. I know these doctors are busy, but at least pretend to be interested.

The Oncologist reiterated that she had three to six months to live. He stayed the longest. He seemed like a nice guy who couldn’t bring himself to cut her off. The others didn’t have that problem. She would say that she elected not to treat anything and they would say ok and leave. My mom was sure she didn’t want to be sick from chemo, but what was dying with cancer going to be like? No one talked about what would happen without treatment of any kind.

She had cancer spots on her brain, and I literally chased the Neurologist out into the hall after one of the drive-bys to find out what to expect. She said the spots were small, and she didn’t expect them to have any cognitive impairment in the time she had left. A bit of good news.

We also faced specialization and staffing issues on the floor. She never had the same nurse or nursing assistant across the three days. I’m sure there is a good reason for scheduling this way, but it doesn’t make a good patient experience. Nurses couldn’t help with the restroom, and nursing assistants couldn’t help with the pain. It wasn’t the right person to ask for anything she asked for.  They all left to “let someone know.”  I’m pretty sure they don’t tell anyone; they figure the right person will eventually end up in the room.

My mom was a fall risk, so she was supposed to wait for help to the restroom, but my sister and I started to take her because of the wait times. No one seemed to care. One less thing for them to do. I wondered about the liability briefly, but seeing my mom uncomfortable wasn’t an option for us.

There was always a crowd at the nurse’s station looking at computer screens or joking with each other. You could see them visibly sigh when you interrupted them to ask for something. Some, and that may be an exaggeration, would respond to you. Others barely looked up from their computer screens and said, “They would get someone.”

The entire staff seemed disengaged, and no one cared about how this appeared to the patients. To add to the irony, the hospital was in the middle of an engagement-themed campaign, something to do with being a HERO. I knew about it because the computer screen in the room timed out the campaign messaging. The last thing that would come to mind from this experience was the word hero. It was just blah.

The one highlight was the palliative care and hospice teams. They were the opposite. They were very engaged and caring. They provided good information, answered their phones, and returned calls quickly. Since my mom didn’t want to treat her cancer, Palliative care took over her case and was focused on keeping her comfortable.

Lesson: Culture matters.

A few years back, one of my daughters was sick, and we went to Memorial Sloan Kettering Cancer Center. EVERYONE was engaged, from the security guard to the cafeteria checkout person. We were scared, but we knew we were in good hands. When you have confidence in the people caring for you, it trumps everything else. I don’t remember that much about the facilities at Sloan Kettering. It must have looked like every other hospital I’ve been in, but I remember the doctors, the nurses, the lab technicians, the security guard, and the cafeteria check-out person. They all seemed to know they had an important role to play in caring for patients and families during a very terrifying time in their lives.

If you or anyone you love has cancer, find out how to be seen by the teams at Memorial Sloan Kettering Cancer Center.

My Mom’s experience was not like the one we had at Sloan Kettering’s. Almost everyone—save Calvin and the Palliative and Hospice teams—appeared to me more focused on their workload than patient care.

Your teams have jobs, but do they understand their role in helping their customers accomplish their objectives? Would they say they run a press or help small businesses find customers? Would they say they are in customer service, or do they help nonprofits find and keep donors? Do you sell e-discovery services to law firms or help law firms successfully defend their clients? Do you pack up paychecks or help businesses ensure their employees have money to buy milk and diapers for their families?

Culture develops from a shared mission, processes that support the mission, and employees that honor the mission. Culture continues because you constantly inspect how your culture makes your customers and employees feel. If your culture doesn’t deliver to customers or employees what you promised them, it’s broken.

Understanding what your customer’s world looks like and feels like is how you build a culture that delivers on a promise to improve their situations. People at the hospital took vitals, gave medication, charted, and cleaned, but did any of them think about how those things were part of a bigger picture of my mom preparing to die? Maybe they did once, but they didn’t seem to now.

No one at the hospital was going to make my mom well, but their mission statement says they want to improve the health and well-being of their communities and bring good help to those in need. I think they should define “good help.” If they define it as performing duties, then they accomplished their objective. If they meant providing compassionate care, they fell short.

What’s your mission? How do your customers feel when they interact with your business? Is it transactional, as in they wanted to buy something and they did – or do they feel you are invested in their success?

Doing things right is about following rules, policies, procedures, and norms. Doing the right things is about aligning your objectives and values with those of your customers while you do your jobs.  When the two philosophies align, there’s no issue. But when they don’t, your customers are probably getting the short end of the stick.

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