Trust is a Fragile Thing

Recently, I intercepted what could have been a travel disaster for me as I saw an airline attendant about to put the wrong shipping tag on my luggage. Fortunately, I was able to alert the attendant and make sure the right tag was used, ensuring that, when I arrived in Phoenix, my luggage would be there as well!

The attendant might simply have apologized for the almost-error and thanked me for catching it. Instead, she did something that I’m afraid many of us in healthcare also do from time to time: she made excuses. In this case, her excuse was that she had been up for over 24 hours. She said something like, “So, I’ve got to expect that I’m going to make some mistakes.”

Really? Well, gee! As a customer, I don’t want to expect that my service personnel are going to be making mistakes that affect me, and, frankly, I don’t care how much sleep they’ve had. For all I know, she had been out dancing the night away.

Having my luggage misdirected would be a problem, but not a life-threatening crisis. Still, this situation made me think of how many times nurses and other medical staff in healthcare must work long hours, under stressful conditions, and still be expected to perform at the top of their game. When they don’t, patients may be at risk—not just at risk of poor service, but at risk of poor and sometimes dangerously delivered clinical care.

The first solution to this problem, of course, occurs at the administrative level, ensuring that our staff members are not overburdened and are not required to work long hours that might negatively impact their performance. Airlines have tight regulations related to the number of hours pilots are permitted to work to ensure they are not too tired to function effectively. Perhaps healthcare can adopt some of these practices.

The issue I mentioned above is not so much the attendant was tired, but that she voiced out loud she should expect to make mistakes. What does that do for the customers’ confidence? Absolutely nothing. In fact, it erodes trust. It makes the customer feel on edge and vigilant for other mistakes.
In addition to working long hours, there are often many things that impact healthcare workers’ ability to be “on” while they’re at work.

  • You were up late with a sick child
  • You had a spat with your significant other before you left for work
  • You’re concerned about a friend or family member’s poor health

Any number of things can, and does, impact our personal lives negatively and cause us to make mistakes or perform ineffectively on the job, but it’s important we resist the temptation to share these personal situations with our customers. We may think we are just explaining the reason behind a mistake, but what the customer hears is an excuse that alerts them to be on the lookout for more shortcomings. They really don’t want to hear about our problems! In fact, as cold as this may sound, patients are really most concerned with their own wellbeing. And that is exactly how it should be. They are the ones who are scared and vulnerable. Don’t add to that vulnerability by saying things that will make them less confident in you, the organization, and the care that they should expect from you.

Here are some common things healthcare workers say to patients, and what the patient really hears:
“We’re short staffed.” The patient hears, “We don’t have time for you.”

“I’m so tired. I’m working a double.” The patient hears, “I’m not alert, so watch out for mistakes.”

“They don’t allow us to do that.” The patient hears, “Our administration doesn’t allow front-line staff to make decisions.”

“I’m required to review this with you.” The patient hears, “I don’t really want to do this, but I have to.”

Patients care about themselves and, for better or worse, being patient-centered means that’s what we need to care about too. We need to put aside our personal issues, concerns, worries, and excuses and filter our statements to make sure everything that comes out of our mouths in the presence of patients and families will instill their trust.

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