23 January 2020, I wrote about how a medical support assistant (MSA) was negatively influencing communication between my primary care provider and myself. Today, I discovered the Department of Veterans Affairs – Office of the Inspector General (VA-OIG) is reporting the same problems in several other VA Medical Centers across the country. One veteran waited 36-calendar days for a positive test result notification; yet, because there were no “adverse patient events as a result,” the lack of communication is not considered an issue. Another example involves a patient and do not resuscitate (DNR) orders, along with family concerns and end-of-life home hospice care. The VA physician/hospitalist in charge had four incidents raising concerns the VA-OIG investigated, where the need to improve communication is the problem with no solution, support, or quality controls.
I guarantee, if there is a 36-day lag in a positive test result notification to me, there would be an adverse patient reaction. While the VA-OIG made communication recommendations, I would bet dollars to doughnuts that the problems in communicating remain a significant customer service issue. Why, because the majority of comprehensive inspections the VA-OIG conducts include failures in communication, and the amount of communications issues resemble bunny rabbits in a field with no predators.
The “I-Care” customer service program at the VA reports the following in every I-Care class:
“How we treat veterans today determines if the veterans choose the VA tomorrow.”
On the I-Care Patient Experience Map, how communication is used influences how the veteran feels about choosing the VA for their needs. Yet, the VA continues to communicate like the veteran has no choice, no options, and does not matter. Here are some communication tips, tailored specifically to the VA; may they find application quickly in VA customer operations.
- The VA claims that the primary care provider, the nurse, the MSA, and the patient are a healthcare team. If this is the case, then the first step in improving communication is a technical fix opening as many channels of two-directional communication as possible. Including email, voicemail, text messaging, telephone, fax, and instant messaging. If the patient has all these channels, and they do; why can’t the nurse, the doctor, and the MSA use all the same technology to communicate?
- The VA has improved on this issue, but there is considerable improvement still to make; when test results come out, copy the patient on the results, automatically. But, where the patient’s results are concerned, explain the results. Have the nurse or a physician assistant write some comments about the results, before sending them onto the patient. Currently, I receive bloodwork results and have to Google/Bing my way through the results and guess when discussing the results with my spouse. I received bloodwork results from UNM, the results came in digitally to my email box, with hyperlinks to explanations by doctors in the UNM system. I received X-Ray and MRI results that claimed “all normal;” this does not tell me anything and increases the problems in understanding what was observed in the X-Ray and MRI.
- Face-to-face customer service is a skill that requires training, quality assurance, and monitoring. Yet, the MSA’s at the VA, who do the most customer influencing communication, are not trained, monitored, or quality assured. The result, patients are treated horribly or are treated amazingly well, based solely upon the individual. Unfortunately, the leadership in charge of customer service are often the worst offenders for poor customer service. This must change; implementing a quality assurance program is not difficult, or expensive, and provided the quality assurance does not become the stick to beat people into submission, will provide positive fruit. But, everyone who communicates with a veteran needs training and needs methods for improvement.
- Stop active listening as the standard for communication. In a hospital environment, especially, the standard should be reflective listening to achieve mutual understanding. Active listening skills can be faked, thus inhibiting proper communication. As an example, review the physician hospitalist who was able to fake care for patients sufficiently to fool the VA-OIG, but the patients and their families were left without feeling they had communicated sufficiently to act with confidence.
- “I-Care” is a good program; why has it not become the standard for all customer interactions? There is no reason for this program to not be a mandatory baseline standard of employee behavior from Secretary Wilkie to the newest new hire. Yet, hospital directors can dismiss “I-Care,” refuse to implement “I-Care,” and disregard “I-Care.” To grow the “I-Care” culture, every employee needs to onboard and commit; where is this being insisted upon?
Too often, the root cause analysis is either poor communication as the issue, or a substantial sub-issue; yet, even with the insistence of the VA-OIG, communication failures remain. No more! The VA must implement “I-Care” for every employee, implement a quality assurance program for communication, hold communication training, and design communication goals for every classification of employee. Most importantly, every single leader must exemplify the customer standards they want to see in their employees. There are no valid excuses for failing to communicate!
© 2020 M. Dave Salisbury
All Rights Reserved
The images used herein were obtained in the public domain, this author holds no copyright to the images displayed.