68) The Letter

October 24, 2006

El Milagro:
Diana stuck me today. I was able to walk right in and sit down at 4:10. Before I sat down I put my complaint letter in Herman’s mailbox and asked the junior social worker to take a copy to the administrator. Later in the evening, Susanne the Administrator stopped by my chair to say she got the letter and would be happy to talk to me about it after she has a chance to read it carefully. I said, “Okay”.

Tonight I got seated in the chair with the worst TV in the joint… is someone punishing me? As a complete surprise, several of the staff surreptitiously made comments indicating their support. So, evidently some of them are not completely behind the changes either, maybe because they won’t be getting out as earl as they used to either.

Here is part of the letter to the administration:

“Up until now I have considered your organization to be very client-centered and have used it as an example in presentations I do. I have said things like, 'El Milagro allows family members of patient to walk in and around the treatment center, which makes it seem much less ‘medical’ and patient/family friendly'. I had reported that staggering start times was a good idea because, unlike doctor’s offices where people have to wait for up to an hour to get in, you all tried to schedule people to come in every fifteen minutes (or so I thought based on my observations). I also have lauded your practice of working with each person to offer individualized diets and treatment regimens, based on a collaboration approach between patient and staff. This is very good practice and allows the patients and staff to have a friendly, supportive, and collaborative relationship. Now it seems that the new computers are dictating the relationship between staff and patient, and necessarily relationships will be less collaborative and supportive. I am afraid El Milagro will be more like the unfeeling and bureaucratic organizations that most of us are used to being at odds with in our struggle to deal with our medical challenges. If your concerns are related to your administrative (bureaucratic) needs, then I believe it would be more honest to just say so in your letter. Your ‘friendly manner’ in explaining your less patient-centered changes is somehow patronizing, since it is clear that these changes are not going to make our lives any easier, or better. If these changes are actually based on ‘patient safety’ then it would make more sense to explain exactly how patient safety is enhanced.
I hope that you will seriously consider that when you stay more client-centered then you do a better job of meeting your goals and objectives. In your letter you say that if we patients had a concern you were listening. I hope you are listening now.
In my conversation with Herman, he explained the difference between your new ‘three set and inflexible times’ approach and the ‘wave’ approach and how the wave approach can lead to people being late all the way through the day when one person is off. He continued that if all patients were like me that the wave approach works, but then said that change is needed because all patients are not like me. When he referred to ‘like me’ he clarified that I am on time, don’t quit treatment early, don’t have too many problems that cause treatment to go over time, and that basically I am a cooperative patient. So, partly the system is changing to satisfy the needs of problematic patients and punishing the good patients. That is not a best practice in any “patient-friendly” organization.
I would like to suggest you all consider a ‘modified wave’ approach that is structured around rewarding the patients that follow their regimen and are easy to work with. This could be accomplished by having staff identify who these dependable and compliant patients are and organize them into a subgroup of patients. Then the staff could assign these people to a group of chairs in rotation. For example, if there are 6 people per shift that meet the criteria, then 6 chairs would be identified as ‘wave’ chairs and these folks could be set on a 15 minute start time based on the time it takes staff to clear the chair for the next person. The procedure would reward us who are dependable and compliant clients and would set up a reward to motivate the other patients to work towards.
Also, most client-centered organizations establish client (patient) advisory committees whereby the administration can access client ideas and recommendations on an ad hoc basis, since the clients are intimately involved in the success or failure of the business. These committees should be involved in all levels of the administration of the organization, but especially those procedures and policies that have a direct impact on the users of the service. I would be happy to serve on such a committee if you decide that you want to be a “patient-friendly” organization.”

Notes: In at 74.5 and out at 72.0 Kg.

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