Saturday, March 24, 2012

The Disneyfication of Nursing?

A recent article on describes efforts by hospitals to offer specialized training to nurses in customer service and courtesy. According to some reports, many hospitals are hiring outside consultants in order to boost customer satisfaction surveys in response to Medicare's new ruling that they will begin basing a small percentage of payments to hospitals in accordance with facilities' "patient experience" scores.

Disney and Healthcare

One company offering these types of trainings for hospitals is the Disney Corporation, under the auspices of its "Building a Culture of Healthcare Excellence" program.

With mandates such as using a patient's name at least three times during a shift and actual "scripts" for nurse-patient interactions, fears are being raised that a "Disneyfication" (my word) of nursing care will cause patients to actually feel that nurses are less sincere in their communication. I use the word "Disneyfication" since Disney is renowned for teaching its theme park employees (all known as "cast members") to interact with visitors in a scripted and uniform manner which some can feel is disingenuous and fake.

The "Stepford Nurse"

While consumer/patient satisfaction should certainly be a primary concern for hospital administrators and workers (we are, after all, there to serve our patients), explicitly manipulating and scripting nurse-patient interaction into a potentially insincere and robotic expression of "concern" and customer service may indeed be counter-productive. If nurses in an institution begin addressing patients with eerily similar vocabulary and turns of phrase, patients will certainly pick up on this trend and make a mental note tinged with suspicion. To wit, in the above-mentioned article, one nurse in Massachusetts complained that using such a communication style at work made her feel like a "Stepford nurse", robotic and insincere.

Ask the Nurses

If hospital administrators and bean counters want to see improvements in their Medicare patient experience scores, perhaps instead of turning to Disney and other companies, they should actually be turning to the trusted professionals upon whom they rely for positive patient experiences----nurses. And in my judgment, it is healthy and happy nurses who will deliver the best care and communicate most effectively with patients, not nurses who work mandatory overtime and are leaned upon by administration and management to do the impossible day after day without adequate compensation.

In order to increase patient satisfaction scores, nurses should be fully integrated into the process of developing strategies to improve such scores. Among those discussing ways to increase patient satisfaction, I have heard many suggestions and initiatives, including:
  • Having nurses sit down in patients' rooms in order to increase a sense that the nurse has time to actually listen to the patient
  • Mandating hourly nursing rounds on every patient
  • Having nurses receive report from the outgoing shift at the bedside so that patients can take part in report (this could be quite a time management issue during shift change)
Whatever strategies are implemented in order to improve patient experience and satisfaction scores, scripting mandated ways of speaking with patients is not the most effective way to achieve this aim. Having a nurse call a patient by name at least three times per hour may be achievable, but this always runs the risk of a nurse overdoing it and sounding more like a used car salesman than a healthcare provider.

It should be recognized that patients will see through the subterfuge, and while a patient wants to be addressed in a friendly and professional manner, the Disney approach may prove to be somewhat heavy handed. (And once we start calling hospital employees "cast members", we may as well just turn on the TV and watch a medical drama on network television.)

Nurse Satisfaction is Equal in Importance

Nurses know how to deliver quality care and address patients in a friendly, inquisitive and respectful manner. If some nurses are surly, impersonal or unfriendly with patients, one can rest assured that the majority behave thus due to mandatory overtime, work-related stress, high nurse-patient ratios, and other negative work conditions. While nurses should never allow their feelings about their work conditions or workload to "leak" out into their interactions with patients, it's human nature to do so and we can understand the inherent dynamics that would lead certain nurses to behave in such a manner. Unhappy nurses will often treat patients in unhappy ways, and while this is clearly unacceptable, scripting alone will not change the inherent calculus of the situation.

If administrators want nurses to buy into improving patient satisfaction scores, then nurse satisfaction scores should also be seriously (and simultaneously) considered. Hearts, flowers, teddy bears and free lunches during Nurses' Week are lovely, but true support for nurses is more than an annual fete that's quickly forgotten as nurse-patient ratios rise and mandatory overtime turns nurses into zombies.

To support nurses---truly support nurses---and commit to their job satisfaction is a laudable and intelligent undertaking for any facility, and I have no doubt that patient satisfaction only naturally increases in concert with the satisfaction of nurses and other healthcare providers.

Hospital administrators and managers ignore the needs and happiness of nurses at their peril, but those facilities that embrace the notion that increasingly satisfied nurses lead to improved patient satisfaction will discover the gold mine that happy nurses can truly be.


Unknown said...

Well said Keith. And "The Stepford Nurse" appears to be the desired outcome for admin. Once again, this is an initiative devised without nurse input. An all too common practice. No consideration for sincerity, but rather a focus on promoting a Disney-like illusion. Quite strange and revealing is the fact that this would be the approach rather than starting the process at it's core, by changing the cause of lacking patient interaction.

Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

Yes, Perg. Illusion over sincerity is right. I was shocked by this initiative but really should not be. Authentic communication starts in the heart, and these types of initiatives miss the heart altogether.

Anonymous said...

More concerning to me is that this goal is to keep patients happy, not healthy. Does this mean we can't discuss the topics they might not want to hear for fear of a bad review. Don't suggest they don't NEED morphine every hour or they will say they were mistreated. Heaven forbid we strongly encourage them to get out of bed. Often what is in our best interest is not the easiest choice. I feel it is my job to help patients understand this, but it doesn't always make them happy.

Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

Excellent point, Anonymous. Yes, trying to keep them happy could indeed make us choose to alter care in order to facilitate a better patient satisfaction score. It's a slippery slope, and you make some very salient points. Thanks for chiming in on this very important conversation.