June 14, 2024

Story 4: Uniforms, Quacking, and the Kind of Employees Who Notice Things

Once my mom’s sodium levels returned to normal, the hospital discharged her to a Rehabilitation facility to hopefully get some strength back.

One of the many drive-by visits we received in the hospital was from the patient advocate. She gave me a list of rehab facilities and asked me to check off the ones I wanted her to try. They all had ratings, so I picked the ones with the highest ratings closest to where my sister and I lived.

After three days, the hospitalist showed up at 1:00 PM for approximately 90 seconds to say he was discharging my mom. I mentioned in an earlier post that my mom attempted to ask him about a side effect she had experienced due to the morphine she was now being prescribed. He told her he didn’t have time to discuss it but would send a nurse in to speak to her. I think a nurse did come by, but she didn’t offer answers, and the staff seemed to be in full “get her out of here” mode.

The rehab facilities I had checked on the list and researched online didn’t have rooms available. The Patient Advocate suggested another location close to my sister’s home, so I agreed. This was my worst decision as my mom’s advocate and possibly my entire life.  My mom wanted to get out of the hospital; I knew she couldn’t go home, and the hospital wouldn’t send us to a bad place, right? WRONG.

This place was a disaster from the moment we arrived until my mom left for assisted living. I am not exaggerating to say this facility was seriously deficient in management practices, culture, medical knowledge, and all processes used to run the place, and most of the employees were incompetent.

If you are in Richmond, please email me, and I will be happy to share the name of this facility so you can steer clear should you need a rehabilitation facility in the future.

Things went wrong immediately. The hospital arranged for a medical transport from the hospital to the facility. They arrived at approximately 4:30 PM.  My mom was buddled, moved to a gurney, and then to the ambulance as I followed behind in my car.  I wish I remembered the name of this group because the three-person team explained things clearly, was courteous to my mom, and transported her comfortably to the rehab facility.

I was a minute or so behind the ambulance. I saw it parked in front of one of the buildings, pulled into a parking spot, and joined the two of the drivers inside. One stayed behind with my mom in the ambulance. When I walked in, the two drivers were talking to a woman, and I knew something was wrong just by looking at the body language.

I approached the group, which included a woman in professional clothes (not scrubs) who appeared to be with the facility.  She told them she didn’t know anything about a new patient and kept repeating, “Nobody told me,” and “I don’t know anything about this.” Within seconds, these thoughts went through my head:

·      Mom in the back of the ambulance

·      It’s now after 5, so the chances of the patient advocate still being at the hospital will not be good.

·      The drivers weren’t getting anywhere.

·      I was going to have to figure this out fast.

I approached the group, explained that I was the daughter of their new patient, and gave her my mom’s name and the names of the hospital and patient advocate who arranged for the admission. This gal (a huge jerk) turned her back on me, threw her hands into the air, and said, “I don’t know anything about this,” and walked away.

I asked if we could try to figure out what was going on as my mom was in an ambulance in front of her building. She briefly looked over her shoulder, repeated she “wasn’t aware of any new patient” and didn’t know what I expected her to do and she threw in a “nobody ever tells me anything” for good measure.

My mind is still going a mile a minute now with these thoughts:

1)   Do the drivers have any recommendations?

2)   Should I have them drive my mom to my house and figure it out from there?

3)   That would be a lot for my mom, who was already exhausted.

4)   I need to call the hospital immediately if there is any hope of catching someone who can help sort the situation out.

5)   Mom is going to get concerned if she stays out in the ambulance for longer than expected, so I had better go tell her what’s going on.

I took out my phone and started dialing the hospital. As expected, it went to voice mail, so I was trying to zero out and get to the switchboard when two people wearing scrubs noticed the situation and walked up. The administrator was about 30 feet from me, still exclaiming that she didn’t know what people expected her to do when no one told her anything.

The two gals in scrubs told us we were at the wrong building and needed to go back out to the entrance and make a right instead of a left to reach the rehab part of the facility. We were at the independent living building.  Problem solved.

Why hadn’t the first gal figured this out? She was more invested in what she felt was a slight against her by some unknown administrator who didn’t tell her something than she was in patient care. Also, she might just be a bitch. She should be fired for one or both reasons.

The drivers returned to the ambulance and moved my mom to the other building. They were ready for her, and we moved her into her room. It was dinner time, and the nurse who had admitted her suggested we go to the dining room for dinner.

The word dinner is a stretch. It was a bologna sandwich and pasta salad. My mom ate half of the sandwich and some of the salad. I introduced my mom to the others at the table, hoping she could make friends while there.  That, too, would prove to be a stretch.

I introduced myself to the team on duty, ensured they had my contact information, helped my mom get ready for bed, and tucked her in before leaving. I was planning to supplement the food if the bologna sandwich indicated what she would be served, but otherwise, I was hopeful that now we were in the right location, things would be ok. I was very, very wrong.

My sister and I split the days so that someone was with Mom most of the time she was awake. We often needed to ask questions or inquire about medicine or procedures like showers. It was extremely difficult to know who was in charge, and no one volunteered to tell us. It was like they had been told not to escalate anything to anybody.

There appeared to be one RN who was in charge of the certified nursing assistants and med techs. She only worked during the day, which meant anything that happened during the night or on weekends had to be communicated via voicemails that were rarely returned.

The staff wore various scrubs and crocks, stained ill-fitting t-shirts, and various head attire. None of the uniforms were “uniform,” which made me worry that it was indicative of their patient care, which was a correct assumption. Like the gal the first day, no one seemed to know anything except that they weren’t being given the information needed to do their jobs.

They also weren’t trained. My mom called me in the middle of the first night, saying that the staff didn’t know how to help her get to the bathroom. They did not know the proper lift procedure. My mom had been a nurse and a caregiver in her last few years of work, so she knew the proper lift procedures. The staff didn’t.

My mom started getting out of bed and into a wheelchair and wheeling herself to the bathroom. We were terrified she would fall again, but when she rang the bell for assistance, it could take anywhere from 20 minutes to a couple of hours before someone came. When they got to the room, the main focus was ensuring the call light was turned off before they did anything else. I would think to myself, it’s been on since I got here two hours ago, so why are you in such a hurry to turn it off now?

One night, I was with my mom in the dining room. We were waiting at a table with three other residents, and a couple of workers were on their break just a few feet away. They were complaining loudly about their manager and using foul language. They either didn’t notice the residents sitting there or didn’t care what they heard. Both are unacceptable.

On multiple occasions, I watched the staff prepare meal trays to take to the rooms of people who couldn’t get to the dining room. The food would come out and go on the trays, and then they would spend 15 minutes pouring drinks and placing silverware. The food had to be ice cold by the time they delivered it to the rooms. Why not do the silverware and cups first, then add the food when it’s hot and head to the rooms?

Watching them, it felt like they were trained specifically on how to do something and not given the leeway to make changes based on the timing of the food’s arrival. I thought to myself, would they really get in trouble if they reordered the procedure? I doubted that, as no one seemed to pay attention. So, either they didn’t care enough to notice they should reorder their procedure to ensure the food stayed hot, or they didn’t realize it. Are they being told to do something in a specific order or to deliver the food to the patients with the right utensils as quickly as possible? It’s the difference between doing the right things and doing things right.

They often ran out of coffee in the mornings. My mom looked forward to her coffee, and when they ran out, she was disappointed. It was brought over from the main dining room in another building in one carafe. I asked if they could get more. The person serving said “no”. I suggested they ask for two carafes; she looked at me like I spoke Dutch. That seemed like a very easy fix to me. Were they not fixing it because no one told the main kitchen staff they were running out, or was only one carafe available? Either way, no one cared about the patients having their coffee.  I left a message for the director, but it was never returned. I started bringing coffee when I came in the mornings.

They delivered the beverages to the rooms in Styrofoam cups that easily tipped over and held only about 8 oz of water. On the second day, I noticed that George, another patient in a motorized wheelchair, couldn’t get close enough to the water machine to fill his giant cup with water, so I asked if he wanted a refill. He was super grateful. I started filling it every day when I arrived to see my mom.  The staff saw me doing it, but they didn’t ask why or thank me for doing it. Did they see that he couldn’t get close to the machine?

My mom was getting morphine for her pain. In the beginning, it was one dose at 9 PM that would help her go to sleep. After four days, she was addicted to that dose of morphine at 9 PM, so when they didn’t come, she would get agitated, and her breathing would become more labored. It is difficult to give medicine to a bunch of patients at exactly 9 PM, so we wouldn’t get worried until they were behind by 45 minutes to an hour.  When it got close to being an hour late, I would go down to the nurse’s desk to remind them to get it. On one of those trips, I walked by the med tech at the medicine cart, who was watching videos on her phone, propped up on the cart, and eating her dinner. This was a problem on so many levels. Was she late with the medications because she was distracted by her videos and dinner? Why was she eating over the medicine cart at all? Why not go sit in the now-empty dining room to eat? Didn’t anyone else who worked there notice the potential for a mistake from the med tech watching videos and dispensing medication simultaneously? Was this individual so stupid that she didn’t understand the ramifications of someone reporting this procedure, or did she not care?

On the Wednesday before Thanksgiving, I had the early shift, and my sister was doing the bedtime routine. About 9:30 PM, my sister called to say that the staff was saying there was no order for morphine. My sister tried to explain that there was an order but wasn’t getting anywhere, so she called me.

I’m going to give you this exchange in dialog form:

Kate: My sister tells me you won’t give my mom her morphine. Can you tell me why?

Med Tech: I don’t have an order for it.

Kate: She has had a dose at 9:00 PM every night since arriving.

Med Tech: No, she hasn’t.

Kate: (trying to problem solve) Is it listed by its generic name on the chart?

Med Tech: Starts reading a list of medications that she can’t pronounce, which, three weeks into this, I knew how to pronounce.

Kate: I’ve been there when a med tech gave it to her.

Med Tech: Then they were giving it to her without an order.

Kate: You realize that morphine is a controlled substance, and if a member of the staff were giving it to her without an order, which I have witnessed, they would be breaking the law, right?

Med Tech: I don’t know what you want me to do. There isn’t an order for it.

Kate: Can you call the doctor on call?

Med Tech: No, I’m not allowed.

Kate: This isn’t the only situation in your facility’s history where a patient has needed a new or changed prescription at night.  There has to be a way to get the doctor.

MedTech: I can write a note in the doctor’s book.

Kate: When will the doctor see the book?

Med Tech: The Monday after Thanksgiving when he returns from the holiday.

Kate: That’s absurd. That would be five days, and there must be a procedure for notifying the doctor before five days.

Med Tech: I’m not allowed to call the doctor.

Kate: What can you do?

Med Tech: I can call the head nurse and tell her.

Kate: Let’s do that then.

I get off the phone and call the Palliative Care team who prescribed the morphine in hopes that they can help. The doctor on call returned my message within 3 minutes. As I was explaining the situation, my sister texted that they were giving Mom the morphine now, and Mom thought I was a wizard.

So many things are wrong here.  A med tech who cannot pronounce the medications? Shouldn’t you be able to read and say the medication you are dispensing?  Do you know what you are giving your patients? Do you not realize the absurdity of telling someone who is in pain that nothing can be done for five days? You had an escalation process to call the nurse but didn’t offer it until I asked you repeatedly for a solution. What was the goal, to fix the problem or to wait until I gave up? What the heck happens to patients who don’t have an advocate 24 x 7?

Lesson 1: Uniforms

If you provide uniforms to your team, you do so because you want people to know who your employees are. You also want your employees to be proud of their company. Dirty, stained, ill-fitting, and ragged uniforms do the exact opposite. They make your customers wonder about your attention to detail and if your brand will deliver on its promise. Stains happen, but if you don’t care, your employees won’t care. Employees who don’t notice their uniforms aren’t living up to your brand probably don’t care about the experience they deliver to your customers. If you are an owner who thinks uniforms are important for your brand, then be prepared to replace uniforms when they are stained, tattered, or don’t fit anymore. It’s a small investment, but it will demonstrate to your customers that you care about the way your company is perceived and to your employees that you want them to be proud of where they work. If you are a manager, dress the part. Your customers will feel like they are talking to someone in authority, setting the stage for problem resolution.

If you have a dress code, enforce it. If you don’t, what is the point?

Lesson 2: Stop Quacking

When a customer is upset, they don’t want to hear what you can’t do. They want you to fix their problem. If the words, “that’s not our process”, or “I’m not allowed” come out of your team’s mouth, it will exacerbate the situation.

Train your employees on how to respond to issues. Train them to demonstrate empathy, ask the right questions, get the facts of the situation, and share what they will do next to resolve the issue. Teach them to know when a situation has exceeded their ability to fix it so they know when to engage you or your senior management team. Never just quack policy back to a customer; it will make them crazy.

Lesson 3: Hire Perceptive People

You want employees to notice things. They should notice when your processes don’t work for a customer and try to tailor one that can. You want them to notice when a customer is unhappy and intercede.

You don’t want employees who don’t notice when a wheelchair can’t get close enough to an ice and water dispenser to use it. You want them to notice when you only have half a cup of coffee left to give to a patient and look for alternatives. You want them to notice that when you keep delivering cold food, patients don’t eat it and seek a solution.

I’ve often thought part of an in-person interview should be a staged situation in the lobby. The candidate arrives and announces they are there for the interview. The front desk person leaves to find the interviewing manager and doesn’t come back purposefully. A fake customer walks in to find no one at the front desk. Does the candidate get up and try to find someone to help, or do they sit there and watch as the decoy customer waits and becomes impatient? If they get up and try to find a human to help; they are probably a keeper.

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