Waiting feels like a waste of time and is intensely disliked by most people. I used to avoid the waiting area of the emergency centre like the plague, especially on busy days. At times it would feel like the patients in the waiting room has become an angry mob and I was uncomfortable just walking past. It’s like there is a “peer pressure” in waiting rooms and if one patient complains shouts or is rude it gives permission to others to join in.
As manager I had to deal with patient complaints and staff emotions after a busy day, staff was left feeling emotionally depleted after some shifts. Last week I attended staff meetings in different parts of an outpatient clinic. Their previously day was exceptionally busy and the staff expressed similar emotions. There was an increased burden to process more patients, files, scripts and exposure to what I would like to call “patient rage caused by waiting”.
Why the rage?
Hospitals are emotionally taxing environments. Visiting a hospital is stressful for patients and their family. Whilst waiting in line the patients may be in pain, they might’ve just received bad news about their condition; they might lack clarity about their condition or need to come back for more tests or results. They are required to join a variety of queues for different functions: registration, doctor consultation, tests, scripts, to make a follow-up appointment and so on.
Add in the length of some queues, poor communication on why they are waiting and duplicated work. Now add in the environment that is crowded, with poor ventilation, unsettling amounts of noise and limited signage of where to go next.
Truth is that patients spend a disproportionate amount of time waiting for that little value adding step and reason why they came to the facility, and then…it’s over in minutes. They might wait three hours for a repeat script. They might wait four hours to be attended to for ten minutes by an absent-minded doctor.
There is so much uncertainty of not knowing what is happening and when it’s happening that it is no wonder that the patients become agitated.
How patients demonstrate their agitation
Both verbal and non-verbal ways of demonstrating unhappiness are traumatic to the staff involved. Verbal rage includes speaking in a raised voice or making verbal threats and insults. Non-verbal rage may include glaring, rolled eyes or shaking the head. Emotions can evolve and escalate so basically if the patient’s agitation is not addressed constructively the more queues the patient joins in this emotional state, the more likely emotionally fallout are.
In a study done with Emergency Centre nurses in the USA 97% of nurses reported to have been victims of verbal abuse in the year preceding the study.
A study done in Japan took it one step further. Staff that reported verbal abuse was asked to complete a questionnaire designed to diagnose Post –traumatic stress disorder. The result: 21.3% scored positive for PTSD.
The patient is always right…Not
The buzz words the past few years have been patient centred care, quality care and the patient journey. Regrettably quality patient care and service delivery is associated with the idea that the patient is always right. This idea has resulted in excessive tolerance to be displayed towards patients that are misbehaving fuelling unrealistic expectations by the patients and perhaps creating a certain sense of entitlement.
There’s been this message that the patient’s emotional outbursts and verbal abuse of staff is the result of bad service practise. In one of the hospitals that I worked at we were consistently told that patient outbursts were due to us being lazy, that’s it root cause: lazy staff.
It creates pressure that you will end up in trouble for the patient’s behaviour. Frontline staff feels responsible for patient aggression and if only we did this or that; the patients would not have shouted at us. It is overwhelming and when you compare the emotions and if only’s with the three stage cycle of domestic violence, the similarities are scary.
Patient expectation is often unrealistic and a large part of frontline staff’s jobs revolves around managing expectations and fire fighting. It’s time to acknowledge that it may be unrealistic or hard to deal with. It also needs to be acknowledged that patients do step out of line.
Where is management?
Bishop et al (2005) did a study on violence in employment services. They demonstrated that although service providers experienced customer behaviour as violent, it was systematically denied by management who failed to acknowledge the behaviour as violent.
Hospital management owe it to the staff to provide a healthy and safe work environment. And perhaps on a busy day hospital management should support frontline staff by visiting patient waiting areas to speak with patients and check in on staff.
Yes to make it better for the patient. Yes the patient is important. Yes we should be patient centred.
However we need staff to care for patients, to feel compassionate and to pitch at work. The impact of a verbally abusive patient may linger long after the patient has left. Exposure to aggressive behaviour by patients has long-term psychological effects on staff including staff burnout, diminished job satisfaction, reduced self-esteem and morale.
This can increase absenteeism which creates a vicious cycle of more pressure on the remaining staff, high turnover of staff and a negative work space.
I’m not sure if there is any fixes to ultimately resolve waiting times and queues.
What I do know is that we need to think about the impact that our dysfunctional system has on staff retention and satisfaction.
I wish that I could find the right words to express that emotion felt by health workers, the sense of futility, regardless of how hard I work and try, they shout at me and then it’s my fault.
For too long in health care we have said that it’s ok if patients direct their rage at us. That it’s part of the job and that it’s something that staff on the floor just need to accept. You are seen as street savvy if you can cope with it. We need to change this thought process, now!
Bishop, V., Korczynski, M., Cohen L. The invisibility of violence: Constructing violence out of the job centre workplace in the UK. Work, Employment and Society, 19 (2005), pp. 583–602