A loved one was recently hospitalized for surgery in a nearby town. During the experience there were several moments when I had to decide whether or not I would say something to nurses about hand washing and cleanliness. To my great surprise, I was too intimidated to say anything! The one time I did speak up went something like this:
• Hey, is that nurse filling my loved one’s water pitcher?
• She’s trying to make the water not too cold or hot, that’s good.
• Oh, no, she is letting the water run over her hands and into the pitcher! Should I say something?
• She’s probably going to dump out that water and fill it up with water her hands haven’t been in.
• Nope, she’s turning off the water. Do I say something?
• Me: “Hey, that water ran over your hands!”
• Nurse: “Don’t worry, I wash my hands all the time.”
• Me: “No, I don’t think we should take that chance.”
• Nurse: ‘I’m really hurt that you would think I’d do something like that.”
This was a personal seminal moment. I could not believe that after working with physicians and nurses in healthcare for 25 years that I would be intimidated about saying something about cleanliness. I was worried about the potential impact that my questioning would have on the care of my loved one. That made me hesitate about saying something until a situation came up where I could not keep quiet. I could not suppress my concern based on the possible impact to my loved one.
What about the nurse’s reaction? It was defensive, and she was telling me in essence “I can’t believe you’d question my decision-making.” In discussing the situation later with my husband (not the patient), he assured me that I had done the right thing. He asked me if I saw the waiter in a restaurant washing his hands at my table, would I then let him dip his hands in my soup?
This hospital experience was 99% wonderful. I thought the hospital paid excellent attention to the needs of the patient and the family. I thought it was clean, the caregivers were very good, and I would recommend the hospital. But the wall is still up about questioning at this hospital and probably every hospital across the US. It is a hard call to tell the professionals that they are doing something wrong. A cleanliness episode can happen so fast that you don’t have time to debate yourself about saying something.
How can we make it okay to question caregivers for the benefit of the patient?
Recent news stories about manager embezzlement give us all a black eye. What can managers do to limit their liability, and how can physicians protect the practice without managing the day-to-day operations themselves?
Here are nine suggestions:
- Perform a thorough background check before hiring a manager, and have your manager bonded.
- Have your bank statements sent to the physician’s home address and/or make sure the physician has the master access to the bank accounts online. Physicians, have a personal relationship with your practice banker and make time for a short meeting with them quarterly.
- Have the physician sign your practice checks. Each check should be attached to an invoice that lists the goods or service purchased. Do not order a rubber stamp of the doctor’s signature.
- Insist on a duplicate, numbered receipt book for staff to give receipts to patients for all over the counter payments.
- Have your insurance and patient checks sent to a lockbox.
- Make sure the manager takes time off – at least several weeks a year. Managers who are “too busy” or “can’t ever get away” are a red flag. The physician should review all mail during the manager’s vacation.
- Check the monthly credit card statement carefully before making the payment. Keep the card restricted to a relatively low limit to manage your liability. Do not pay practice bills routinely on the card to build frequent flyer miles as this makes it much easier for an employee to hide non-approved expenditures.
- Have a budget and make sure variances can be explained.
- Hire a CPA to review the books quarterly. Even if you do not need the services of a CPA for your statement reconciliation, taxes or partners distribution, hire one to review the expenses and receipts, and ensure that the retirement plan is being funded appropriately.
A qualified, ethical manager has nothing to hide and will thank you for following these nine rules. The rules protect the manager as well as the practice.
Photo credit: © Yuyang | Dreamstime.com
Generally, doctors either think it’s okay to be late (and usually are) OR they don’t think it’s okay to be late and only are in rare cases. That’s who they are as people, just like us, and it’s rare to be able to change them.
What I usually find is that certain patients are okay with doctors who are late, and will wait as long as it takes to see that doctor. Others will not wait, and therefore, will not return. I would let new patients know that the doctor takes his time with patients and that he often runs late and see if they can live with that. If that can’t, then they should be scheduled with another doctor or seek care elsewhere. If the doctor has a problem with that, he needs to know that a good practice manages patients’ expectations and that patients deserve to know that he typically does not run on time, and not have a surprise when they come to the practice.
One thing that is helpful is a very skilled nurse or assistant who keeps the doc on track so that he doesn’t run any later than necessary if he gets easily distracted.
I have seen some practices give patients beepers to page them when the doctor is ready so they don’t have to sit in the waiting room (especially with a sick child) any longer than necessary. You could also tell patients that someone will call them 20 minutes before their appointment – it’s hard to have someone keep track of this and do all the calling – but it might be worth it if it keeps the patients and the doctor happy.
Photo credit: © Torchdesigns | Dreamstime.com
