Flying Fish

The hospital where I work has been conducting a series of seminars designed to enhance the patient and family experience at our facility. The effort is motivated by several factors. One is certainly to support the hospital’s mission as a place of care and comfort for the community. However, because health care is now very much a business, there are other, less altruistic reasons for doing so. In a competitive marketplace, the facility where patients and families feel most comfortable has the opportunity to take more of the market share of work. And the federal government is compiling data regarding customer satisfaction with health care facilities through the Consumer Assessment of Healthcare Providers and Systems Hospital Survey (H-CAHPS). The stated goals for the survey are for public reporting to enhance the transparency of care and provide incentives for hospitals to improve their performance. But the unspoken bottom line is that at some point in the future, scores will be used to modify reimbursement patterns. This concern makes it key for facilities and their employees to understand the H-CAPHS system and align themselves in such a way as to insure that scores are as high as possible.

So last month off I went to my scheduled session at 0730 (it sounds more important in military time) after working a particularly nasty night shift. Fortified with two cups of hot tea, I found a place in the back of the room where I figured I could hide when the lights went down and the Sandman stopped by for his imminent a visit. I was careful to choose a spot beneath an air conditioning vent as well, for I’ve learned over time that the sound of air blowing through the ductwork can mask all but the most sonorous respirations.

(This meeting-sleeping parallel is not new to me. During medical school, the daily Noon Conference was held in a large amphitheater with raised tiers surrounding a central dais. Each tier featured a continuous desk with a lowered skirt that extended along the perimeter of the tier facing the speaker. Behind the desks were swivel chairs attached to the table legs. What this meant in practice was that when the theater was full…which it always was because 1) attendance was required and 2) attendance was required…is that you could lay down on the floor on the uppermost tier and take a nap completely blocked from view by anyone except the three people sitting in the chairs just above your head. I took full advantage of this fact every day for the two months of my annual internal medicine rotation. This skill was not unnoticed by my classmates, who awarded me the “Rip Van Winkle” Award three years in a row. To date, I am the only repeat winner in the history of the school.)

The first order of business was to fill out a name sticker with the one word that describes how you felt at that very moment. Being a generally truthful sort, I wrote TIRED in large capital letters. Turns out that was the wrong answer, and I earned a reproach from the trainers who oozed early-morning glee in a pathologically perky manner. (I’m still working out exactly which organ exudes glee.) It turns out that the correct answer was HAPPY or ENTHUSED or BLESSED, and if I had been thinking I could have applied these words equally well. I was indeed HAPPY to be off shift, and ENTHUSED to be going home, and BLESSED by the fact that case management workers exist to find nursing homes for patients in the middle of the night.

The centerpiece of the presentation was motivational video that I’ve seen several times before. It’s been making the corporate rounds, so perhaps you have too. It’s the one about workers at the Pike Place Fish Market in Seattle who make a cold, nasty job into something fun by laughing, joking, shouting, and flinging fish into the air. The point of the video is that you choose your attitude towards you job. In theory, this works well. In practice, however, it’s a bit more difficult to pull off. During one of my stints as a bureauocrat we decided we would enhance our workplace by tossing file cabinets as a teamwork game. Windows were broken, alarms went off, and the local police did not seem like we had made their job any more fun. (I think they just chose the wrong attitude, but given that law enforcement officers can singlehandedly ruin my car insurance rates they can choose any attitude they want and it’s perfectly okay with me, sir or ma’am.)

The group was then invited to talk about ways they can make work fun. I apparently was called on to proffer a suggestion, and I must have said something. The truth is that I was so tired I have no idea if I did or not. I recall watching the fish soar through the rainy skies of the Pacific Northwest, and then I was seeing a packet of crackers in front of me just before a red squeezey trinket careened off my head. It must have been a “carrot-and-stick” sort of thing.

Another party favor I got to take home was a pre-printed card to remind me that “Kindness is Contagious.” Having been indoctrinated throughout medical training that contagious things ought to best be stamped out as quickly as possible, I’m still working through this concept. I also received some notecards that I’m supposed to give to someone when I see them do something of particular value to the health care team. I’ve already pre-written a few, such as “Thanks for graciously cleaning up that bodily fluid spill last night. Lord knows I wasn’t gonna touch that,’ and “I appreciate your kind and considerate help in cold-cocking the patient who came at me with a stick.”

In the end, a good time was had by all, and I was able to go home and rest with my free package of snack crackers and the soft plastic squeezy thing which the Residential Cat promptly took apart. Tomorrow before my shift I’m going down to Hull’s Fish Market and getting three pounds of mullet. If throwing one big fish around is good for morale, imagine the effect of forty smaller ones. It’s a way to spread the joy even farther. Especially if I hide them in various places where they won’t be found for a few days. Just think of what that’ll do for morale!