Scripting for Satisfaction

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Nurses Edition Commentary

Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN
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BurntOutDoc -

Thank you for sharing this. I've been using scripts like these for years.
My favourite is, "Welcome to the Emergency Department. Thank you for coming." They're the reason I have a job; I might as wall say thanks. I never miss an opportunity to say it even when I'm flying past a patient being rolled in on an ambulance stretcher.
Scripts are the reason that my colleagues and patients think I care and am passionate about my work. The reality is that I am as burnt out as a charcoal briquette. Despite this it is hard to completely hate what you do when you regularly smile and speak these words of welcome to our domain with sincerity.

Stephen S. -

Service apples and service oranges. The stated companies charge that much extra for the same made-in-china articles because customer pays that much extra for the service and clean environment. Those companies can afford extra personell dedicated to service. Walmart and McDonald's also have management courses and mottos, which do not make the customer service better because they rely on technology (Walmart's famous tracking system) to make up gaps in personnel. In the ER, more and more hospital and administrative and legal functions are crammed into the job of decreased people. The social demand we treat everyone in law makes us not an exclusive service, the increasing demands for documentation in laws like the new ICD10 codes or nevada law we check a script database for scripts written. The social demand on us results in us working sick often, which those retailers would not allow. Considering scripting ideas is interesting but there is no panacea in any part of medicine

Stephen S. -

I should've edited that better. "The social demand codified in law is that we treat everyone, so we are not an exclusive service unlike those high end retailers."

Sean G., M.D. -

I think any pre set phrases or commentary is ridiculous. Here is the formula: Be a nice person and care about others. Its that simple. There is no need to fake anything, and anyone who thinks that flies is severely underestimating your patients. Pts can tell the difference between genuine concern and catch phrases and such. My Er has a pt satisfaction score above 97% for both doctors and nurses consistently. As a dept manager or director you simply do not stand for people with a bad attitude. Most of the time our patients are there because they feel they need our help....I don't know about anyone else but I chose Medicine over business because I wanted to help people. So that sort of works out well. I think people often get a bad attitude when they jump to conclusions. For example a recent pt I saw at 3 am was a 2 y/o the nurse triaged as "bug bite". Some of the nurses were grumbling...I heard some whispered statements about...."What kind of mother drags their kid in the ER at 3 am for a bug bite?" Seems like a decent question...until you talk to the mom. She didnt bring him in for a "bug bite" she brought him in for redness and swelling to his leg she deemed an infected bug bite...she thought he might need antibiotics, since in the US u need an RX for abx and she knew the sooner you treat a cellulitis the better, she brought her child in at 3 am....in other words IMO she was a "good" mother....she did not care it was 3 am and she would rather be in bed, she noticed the swelling and indeed had seen many bug bites in her children she never went to the ER for because they normally didnt swell...this one was swollen and red, so she had a reasonable concern her son might need antibiotics. Realizing why she really signed in( and it wasnt for a simple bug bite) Its easy to see her as a worried mom who wanted help for her potentially sick child....I'll see that patient happily any time of day. If there are employees on your staff that are not nice people and are not motivated to help the patients you simply tell them they should probably work somewhere else. Its not that complicated. Yeah I know there are difficult patients...the migraines that come in repeatedly week after week and are allergic to everything but Dilaudid....but those people are sick too....and even if there only sickness is opiod dependance....isnt that bad enough? Would u trade places with them? I doubt any of us would, so if u see that recalcitrant ER pt demanding 4mg IM dilaudid because nothing else works....just remember u went into medicine to help people...and as a very wise and strikingly handsome man once said..."what you do matters".....

Noah R. -

I'm sorry but I hated this segment. I agree that scripts can be useful and use them myself. I am all for treating patients with respect and emphasizing communication.

But treating medicine as a service industry is wrong. Yes, lessons can be taken from the service industry and applied to medicine, but patients are not customers any more than hospitals are airplanes. The physician's job is to bring a person to health, not to satisfaction.

In the service industry what you sell matters. The goals of medicine are (or should be) entirely different. Do not conflate good service with good medicine. They are not the same and sometimes even incompatible with one another.

Sean G., M.D. -

I agree with you Noah I think I wrote something very similar on a previous episode. At that time I worked in an ED that had a very high percentage of "regulars" as it was the only game in town in a rural area of AZ. Then a terrible Admin took over that was all about the "Disney Land" Approach. They built a new hospital with a "Main St" which is apparently right out of Disney. The ER was constructed with no EM docs input. It consisted of "Pods" far removed from one another. All large single pt rooms far from the central nurses station. There thought was a nurse would man each pod and keep an eye on the pt, and the pts would feel more like they were in a hotel not a scary ER. Problem was the nurse wasnt even given a chair or a counter ....just a lap top with a pull out from the wall. Apparently the nurse was to stand in the middle of the 4 rooms by his or herself for 12 hours. Well ,,,,none of them did that...they had this weird need to connect with their co workers....so adding to that we had a massive central nurses station with granite counters, and halls you could drive an ambulance down with huge chandeliers...all the workers were completely isolated from the pts. Money was spent on the "looks" of the place and saved by cutting nurses and techs, paying bottom dollar(leading to experienced nurses leaving) and pt care suffered tremendously. The idiotic admin put a bunch of ipads in the wr....90% were gone in a week so they stopped that practice. Every room had a 55 inch LED tv(because we all no how wildly educational TV is and we wouldnt want anyone to have to spend a single moment of life with the bombardment of bull from advertisers and corporate news stations.Anyhow...bottom line was it was all about making the ER pt comfortable entertained and well fed...apparently they planned for them all to spend much of they day there...despite the mere 10% acuity rate. And stay they did....since there ER rooms were far nicer than most of their homes many signed in for the good food air conditioning and to have a nurse serve them and their family...and guess what? Pt care suffered because the goal was clearly making the pt happy not treating disease. With this set up ed thru put came to a crashing halt and pt wait times soared as the nurses were busy offering concierge service to the "lucky ones" that got rooms. Unfortunately due to the set up you could walk into your shift and see no pts anywhere...the place would look empty, but in fact there was a full house with a jammed WR. Of course demented elderly pts started being found unresponsive on the floor next to their beautiful isolated private beds because the nurse would spend a good portion of her shift elsewhere...getting food, coffee for the pt or ....my god no...talking to a coworker and the 5 star hotel set up was not conducive to treating sick people. It was great for the people that were there for the food cable tv and air condition...but the syncopal elderly pt...not so much. Yeah we are not running a vacation get away or a theme park....we are supposed to be practicing medicine...but that is what happens when big corporations take over the practice of medicine. I left, and thankfully I work in an ER that is run with actual delivery of good medical care in mind and not just serving cotton candy to pts.

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