Friday, September 26, 2008
Wednesday, September 24, 2008
Sunday, September 21, 2008
Her first job is to get you to where you are going, and she does that very well. She is alert and aware of all the clients in her space and what they are waiting there for. Of the half-dozen services offered at this location, there was only one line, waiting to pay insurance. She helpfully redirected one client, "Don't worry, that line is not for you; travel is around the corner." Another time a case worker called a name with no response. Nicole checked with the couple at the display, and sure enough, they were the ones waiting to be called.
It was also obvious that she's a warm person who really likes people. We got talking because she noticed I was crocheting a "kickin'" scarf. She asked lots of questions. Nicolle is also plugged in to one of those cordless phones, so it was a little disconcerting to sort out who she was talking to. I suspect our new generation will get better at filtering out their freind's eatherial conversations. Anyways, we soon had a lively conversation going, interspersed with her helpful redirections for newcomers.
She tells a great story about her father in law, who lives in a tiny town in Sasktachewan. Somehow we got on the topic of drunk driving and how wrong it is. I mentioned that smart alcoholics drink close to home so they can get home afterwards without hurting anyone. Which is where her father in law comes in. He taught his pig to take him to the bar and back! They had a few old pigs on the property, over five hundred pounds. He would climb on the back of the pig and say "Bar", and the pig would walk to the bar. He'd tell the pig to "Stay" and he would stay. When the drinking night was over, he'd come out, flop on top of his pig and say "Home", and old pig would take him home.
Pig stories and all, Nicolle is an outstanding example of how a receptionist, who loves her job and loves people, can make a world of difference for new people coming through the door.
Saturday, September 20, 2008
I see her bright future. More and more her network of friends and mentors will take over, and I will recede as one of the centres of her life to a friendly morning star. I will always be in her constellation, always watching and cheering her on, but I will no longer be the centre.
When I called the displayed number back (which varied from her call-back number by one digit, by the way), I was put in to holding hell for about twenty minutes. I didn't dare hang up, because the pleasant automated voice reminded me of the dreaded consequences. I'd lose my place in the queue. So as my husband shouted conversational inanities at me over a Tim Horton's lunch, I listened in succession to health tips, elevator music, and dire warnings not to hang up. I offered to let my husband listen in to the helpful tips, but he declined.
The second failure was an automated message that came on every five minutes or so, advising me that they were experiencing a high number of calls and if I wished, I could "press one" to leave a message. After ten minutes, I gave that "1" a try. It doesn't work! So then I was stuck. Do I hang up and risk a longer wait in the future? I grimly stuck it out.
The receptionist at the general health line was unhelpful. She asked what the appointment was for. When I said I did not know, she told me I would have to wait for the lady to call me back again. (The horror of hours of hold flooded my imagination). In desperation, I mentioned that my doctor was hooking me up for diabetes training. Could this possibly be why they are calling? "Well then, I'll forward your call to Diabetes booking. If I lose the call, here's the number." I made her repeat it two times. She said it too fast to write or memorize.
What was doubly unfortunate is the receptionist bothered to explain how difficult it is to locate the right department, now that they have gone through a major reorganization. She detailed that for me, just in case I was unaware. Like that prig of a psychiatrist years ago, I got the sense she was trying to pull me in to her political reality.
It's not my fight, lady. I want out of hold hell, and I'd pretty please like to set up that appointment.
The woman who originally called me was delighted to hear from me. She was so pleasant and efficient I forgot to tell her that her original voice mail was unclear. But we got through the necessaries and I am booked for my appointment. It was disconcerting that the closest clinics for the Northeast are far West and Central.
Now I am envisioning several "mystery shopper" forms that people could complete to describe their own experience. I'd need one for waiting rooms, queues, and for automated phone systems.
Friday, September 19, 2008
It was not a good time. My son was a very depressed pre-teen. I dreaded the possibility that he was developing schizophrenia. It runs in the family, you see. Children's Services had started to get involved, and one of their first priorities was to assess his potential for suicide. Perfectly understandable. They wouldn't want to be held liable for a death while under their care. So they asked us to visit the above-named clinic to get assessed. So far so good.
The clinic was fairly new at the time, and the waiting room was clean and modern, the colors soothing. My son and I were both given a long survey to complete where we were to check off all our fears and phobias. In my enthusiasm, I was probably more honest than I needed to be. Just because I skeedadle up the basement stairs at night because of the boogeyman who lives under there, doesn't mean I am a less capable adult. I've even been able to go up the stairs s-l-o-w-l-y, heart in my throat, daring the boogeyman to grab my ankles. I can override my overactive imagination with a dose of common sense.
I am absolutely fearless, on the other hand, when it comes to spiders, snakes, mice, wasps, bees, and all sorts of wiggly things. I'm just as likely to take hold of it to get a good look. My hubby has caught on to this facility, and has put me to good use, asking me calmly to "get rid of it" while he trembles like a schoolgirl.
Anyways, back to the "walk in clinic" intake process. My son and I fill out the forms and wait, patiently. We finally get to see the doctor, and he explains the presence of several interns as this is a teaching hospital. So far so good.
He tells me that he would not be doing an assessment, as my son was already scheduled to visit a premier child psychologist in the city. I got the sense the man did not want to provide a conflicting diagnosis. I get upset. I'd been asked to attend this clinic on the best advice of Children's Services. I don't want my son do die of suicide either. "So you tell me you will do nothing for me? That the forms in the waiting room, our hour wait, was for nothing?"
He tells me that Children's Services should not be using their service as some sort of clearing house. "I see." Near tears, I clammed up and left.
That experience left me with a burning conviction that conflicting agencies should never use the people coming through their door to make a point. What did that clinician expect me to do? Write my MLA? "Know for next time", if there ever were a next time? I was a mother in crisis, very near the breaking point myself. I needed help from the experts I was referred to. I did not need to be dragged in to a turf war.
It also made me wonder which sector of the mental health community that clinic intended to care for. Signs in the waiting room and notes on the application forms made it clear that they were not set up for crisis care or serious chronic mental illnesses. I tried to imagine my mother, while in full-blown manic phase, voluntarily attending weekly sessions at this pleasant clinic. They were also obviously not there to assist Children's Services in providing on-the-spot assessment of a client's risk for self harm. So who is left? The chronically depressed and the narcicissts? People with spider phobias?
Wednesday, September 17, 2008
The place is set up for profit. The architecture, the furnishings are all sleek and modern. Glass walls and chocolate walls sweep around in sleek curves, with little cubes to show off the merchandise. The cute little reception chairs were ordered in a perfect row. Instead of a coffee table, cushions. The fabric was worn in a spot and I couldn't help wonder, "Gosh, that fabric is going to be hard to match."
Anyways, the receptionist was pleasant enough. We had to lean close to talk. All those hard surfaces, and the space echoed with loud chatter. I asked her if it was like this all the time. "It comes and goes. Sometimes it is real quiet. When there's lots of people like now, yes, it is hard to hear." I make a mental note, "Put in some soft wall coverings." To the technician puffing air on to my eye, I complain about the absence of magazines. "Oh, but we have the big screen for that." What do you know. I completely missed the big screen on the wall, playing endless loops of instructional video on... you know what... the eye.
I'm not sure I am keen on all these instructional videos showing up all over the place. The Edmonton courthouse has the same thing. But I must say the courthouse video lady gives very practical advice. Advice that a live clerk of the court must repeat dozens of times a day. Most people (we hope) don't go to court that often. There's no way we could pick up all we need to know to keep ourselves straight, in the right place, and out of trouble in the short time we are there. I am grateful for the courthouse video lady. Though the courthouse is not so nearly as sleek and polished as that eyeglass store.
Should a public building pay as much attention to it's intake? What impression is it trying to build? Rather than prosperous, modern, and professional, what image is the intake office attempting to portray? Is it calm and efficiency? Or is it like the courthouse; authority and order? How does joe taxpayer feel about money being spent on a sleek and polished intake gallery?
The mental health clinic had patient artwork on the wall, which was very good. There was a great deal of random clutter, however, including the inevitable collection of ratty notices. Those notices, I swear, don't have nine lives. They are immortal. No-one ever reviews them or dares to take them down.
Sunday, September 14, 2008
In this incident, I was attending one of my son's psychiactric appointments. It can't be the easiest job in the world to run the front counter for a mental health clinic. It's got to rack right up there with the counter clerks at Money Mart. Harried from before and within, it's got to be an unrewarding job. I could read all of this in the few minutes we had our encounter. I stood less than a foot from the bulletproof glass. She was hunched over and gave me the barest eye contact. It was as if she dearly hoped I had no reason to be there and that I would quickly leave. Behind her, a half-dozen workers were chatting it up.
I told her I was to meet my son at his appointment. I had his name but not the name of his worker. This was a problem, apparently, as her brow furled. She started flipping through her work pad and looking at the computer screen. She asked if I had the worker's name and I said that my son refers to him only as his "therapist". The crowd behind her desk suddenly burst out laughing and left. Was it my comment or some other private funny? In any case, I was not impressed. As the counter clerk continued to shuffle through her papers, I pulled out my Blackberry and called my son on his cell phone. It turns out he was in his therapist's office, and his name was Jim. I relayed this key bit of information. Then I found out my son was on a different floor. I asked if there was a different reception on that floor, and left.
Where my behavior was not the best was that I remained cool and professional. Probably I don't like being eyed as a potential mental patient. Also, I am hypersensitive to how I am treated at counters, and I have a low tolerance for inefficiency. That girl at the front desk should have all the information at her fingertips to do her job well. She didn't, and I was annoyed. She didn't want me to be there, so I was annoyed. What is unfortunate, is she could not know that my annoyance was not at all personal. It was no reflection on her, personally.
Except, darnit, she acts as if she is afraid of her own clients. Her body language screams, "Get me out of here". She flinched when I approached the counter, "Oh, no. Here comes another one." She never knows if the client is going to be kind or frantic. Frantic for the mentally ill can escalate all the way up to calling the paddy wagon.
There was a paddy wagon parked outside the facility that day.
I wonder if there is an unpleasant encounter that escalates to the paddy wagon, if the counter clerk could be spelled off to get a mental break and a chance to recover.
It seems to me that it would help to elevate her floor so that, when seated, she would be eye-to-eye with the client when they approach. I'm thinking this height can be non-threatening if done right. The Pike Place counter is quite high. Would it help also to deepen the counter so that the distance between the client and the glass were more like two and a half feet? I think that is the Canadian cultural norm for appropriate distance. Also, the space behind her should not be open for random social gatherings. It is distracting for both the clerk and the supplicant.
And finally, she needs to be frequently told the value of her job, and be given all the tools to do it. She should be the most informed person in that clinic. If there are two mental health counters in that building, they should have information about each of their appointments that day as well.
What is the great thing that she adds to these people's day? Reassurance that they are heard, and that their concerns are being taken seriously. She can help a mentally ill person feel at peace. On the random days when the paddy wagon gets called anyways, it's not her fault.
Wednesday, September 10, 2008
This incident happened several years ago at a Superstore pharmacy, about the same time they came out with that two-station system; receiving and shipping. I started out poorly. I went to the wrong counter. When I got to the the receiving end the clerk helpfully advised that it would be a half-hour wait to pick up my order. I thought, fine, I am in a store, I will do my shopping and come back in thirty minutes. This surely would be a plus, as I don't have to stand around waiting for my order.
When I came back thirty minutes later, there was a line of frustrated customers. After watching the line for a few minutes, I understood why. None of the orders were ready. The pharmacy, besides putting in the entry and exit stations, had instituted a new system. Each order had it's own little basket. So far so good. Those baskets could be in any of a dozen locations. Very, very, bad.
As the clerk received each person in line, she bustled around in the back, checking each of the dozen locations in turn. It was worst for the woman directly in front of me. The clerk came back to the woman in front of me a couple times and told me she could not find the order. Finally she told the woman they were out of stock of the particular medication and she would have to come back.
After seeing what happened to that poor woman, I decided to take a stand. I had my turn with the counter clerk and told her I was cancelling my order, could I please have my prescription back. Her eyes went wide and she disappeared in the back .... for twenty minutes.
She came back with my order. The pharmacist, on hearing my request to cancel, rushed my order instead. They were nearly out of stock of my medication, so they only filled the prescription partially. I would have to come back for the rest.
I was angry. Not only was I required to wait much longer than promised, but my specific request to cancel the order was ignored. I assumed they preferred the days' profit over a small embarrassment. I left and never returned. They can keep the partial order on file forever for all I care.
What were some of the mistakes in this encounter, and how could the pharmacy have improved them? I've ordered the pharmacy errors from most important to least important.
- There was no respect for the customer by the pharmacist. My specific request was bypassed for the sake of interests (profit) that were not my own. I never got to see the pharmacist face-to-face to tell him so myself. He never found out that he permanently lost a regular customer because of his neglect. His vision was appallingly short-sighted. In his interest on not losing a single sale, he permanently lost a customer.
- The counter clerk was neither empowered to make changes or properly oriented to the new system. She was confused, rushed, and utterly intimidated.
- The process sucked. The two counter system is appropriately efficient, and the individual baskets work well. However, there were too many stations where the orders could stack up. There should have been only three. Receiving, filling, and completed. Maybe four. There always seems to be a stack of orders that are picked up days later.
- The intake clerk really did not know how long orders would take. She gave the same answer to all, "thirty minutes". This may be petty, but I hate being misinformed.
- There was no accommodation for newbies. Could they have taken my order at the shipping counter and advised me "for next time"? Perhaps not, but I thought I would mention it. As small as the incident seems, a petitioner is always in the vulnerable position. Don't make us feel any more stupid than we already feel.
Well, that's that. Wouldn't it be great if we had "mystery shopper" questionnaires and customer service cards at places like this? Those of us who speak up would have a place to protest. Rather than resort to sharing our experience by word of mouth and blog.
My list for the holidays. The white-tail deer don't count as birds, but it was pretty cool to see them in the Kootenays and Montana. On the trip I saw the following birds to add to my lifetime list:
- Canada Geese
- Red-Tailed Hawks
All but the hawks are all flocking to fly south for the fall. The hawks waited patiently on fence-posts for unwary gophers. I won't count the terns and gulls yet because I'm not sure which ones I saw.
Tuesday, September 9, 2008
On my return from holidays the other day, my granddaughter rushed in to my arms to greet me. "I have bad news,"
"I know, the fish died."
"No, it's something else. I broke your skipping rope. Shea and I were playing and..."
"Don't worry, it's a thing. It's just a thing. Never worry about just things."
She smiled and ran back.
What price can I put on that?
Monday, September 8, 2008
- What is the psychology that drives the experience...that makes it either unpleasant and demeaning, or significant and helpful?
- The first contact (receptionist) and the intake worker must be empowered. There's no point in fixing the mechanics of intake, if the people responsible for finalizing the action are miserable.
- Reviewing the process itself. How many handoffs are there? How much work is put in to verifying, keying? What is the optimum intake criteria for the action? Are we asking too much, too little? Auditors, what do they want to see?
For the rest of this entry, I'll talk about issue one - the primal psychology. These are just ideas. I would like to confirm them against behavioral research. I am coming to realize the way we react to various situtations in our civilized world, has more to do with how our stone-age ancestors would have reacted in an equivalent situation. We aren't so far away from our ancestors as we would like to believe. It's like civilization has given us a veneer, but we are the same primitive construction beneath. So what did drive our ancestors? From Pinker's list, he suggests that we are hard-wired for complex social interactions. We've always been social beings. It seems to me we would have always had the need to negotiate a needed service from a stranger. It becomes a problem if we have nothing to barter. If we have nothing to offer, we beg.
The image that comes to mind of begging is a subservient wolf grovelling with the alpha dog. He'll crawl on his belly, mewling, puppy-like. He'll lick the lips of the alpha. In every way he will try to appear harmless. How does the alpha dog react to this behavior? It seems the successful alpha will be benevolent most of the time. He won't make the subservient dog grovel for extended periods of time.
Getting back to people, what happens to us if we are required to grovel for extended periods of time? Does resentment build? Is there a breaking point, where the subservient stops trying, and becomes a hostile threat to the group?
Another analogy that comes to mind is the petition to the king. It seems that the same behavior applies as described above. Success may depend on the petitioner's ability to appeal to the benevolence of the leader. A complicating factor might be an intermediary, or a gate-keeper, who decides who gets access to the King. Biblical examples are Haman in the book of Ruth, and Absalom who undermined his own father-King when petitioners came to see him (2 Samuel 15:2-6).
And finally, besides the application of complex social interactions, the queue, or line, appears to trigger our primal instinct to protect our "territory" or earned space in line. It is deeply offensive to jump the line. The entire line may jump on a line-breaker, exerting extreme social pressure to conform. I am sure you can think of dozens of examples.
Besides line-jumping, the whole experience of waiting in line for an indeterminate period is stressful. The line-holder has very little status other than his placement in the line. Very often the receptionist or intake worker has no status in the organization either. Both may fiercely maintain any dignity that is offered him. The intake worker's greatest power comes from their near godlike ability to accept or reject based on the rules. The worker's intimate knowledge of the rules, (and the line-holder's ignorance of them) results in a social dance that, for the ignorant, can be humiliating and highly discouraging.
Could this result in the socially inept being denied services they rightfully deserve? Aren't these same people the ones who most desperately need the help? How do we break through the process to allow status to all the participants - intake workers and petitioners alike - so that they can meet on common ground?
The social dynamics of human-to-human contact is so much better. Meeting and conversing with a friend, having them understand you, and receiving needed help, isn't that so much more satisfying than the dynamics of petitioner-granter? It seems to me that the status of both the petitioner and the intake worker has to be raised and acknowledged first, before we can have this kind of significant dialogue.
Tuesday, September 2, 2008
- Intuitive mechanics
- Intuitive biology
- Mental maps for large territories
- Habitat selection
- Danger, including the emotions of fear and caution, phobias
- Food: what is good to eat
- Contamination, including the emotion of disgust
- Monitoring current well-being, including the emotions of happiness and sadness, contentment and restlessness
- Intuitive psychology
- Mental Rolodex: database of individuals, with blanks for kinship, status or rank, history of exchange of favors, and inherent skills and strengths. (Could this explain the popularity of Facebook?)
- Justice: sense of rights, obligations, and deserts, including the emotions of anger and revenge.
- Kinship, including nepotism and allocations of parenting effort.
- Mating, including the feelings of sexual attraction, love, and intentions of fidelity and desertion.
A great colleague of mine retired this week. He goes back to school to take philosophy. His dream is to resolve the issue of choice over death. Can we choose our own passing, and how can those we love make the best choice for us? Shold they make that choice? He smiles like a chipmunk every time he talks of his retirement. His parting words to me is to not delay in making my own plans.
Now, my own retirement is over a dozen years away, but I've been a good girl and gone for the training. The trainers were excellent. Their first great gift is that they convinced me that, financially, we will be just fine. They also convinced me that I need a vision, mission, and a plan if I am to enjoy retirement. What is my dream?
To make it easier for people in queues. Start an advocacy and consulting non-profit group that helps people get through the intake process as humanely as possible. We should be able to do this without stuffy waiting rooms, sweaty lines, take-a-numbers, triplicate forms, harried receptionists, and surly intake workers. One wonders sometimes if they make it so hard just to keep the numbers low?
You see, I dread the queues in my own future. Pharmacies. Hospitals. Disability applications. Insurance claims. I fear I will become one of the faceless masses, that pairs of dead eyes will stare past as rough hands stamp, "Rejected".
How do we make the whole experience more humanizing? Why can't intake be like Pike Place Fish, where they make everyone's day? For a few moments, there is genuine contact. And we earn this great connection over fish! http://www.pikeplacefish.com/
Anyways, that's my dream. All the things I want to do will take years to set in motion. But I've got the years. And the talent for making it better.
Monday, September 1, 2008
That's my conclusion after thinking deeply on Romeo Dallaire's message when he came to talk to us all (on June 20, 2008?). Here's another book for me to try,
"James Orbinski's An Imperfect Offering: Humanitarian Action in the Twenty-First Century. Orbinski, the Canadian physician who served for more than a decade with Medecins Sans Frontieres (MSF), took his darkest journey into the abyss of human suffering during the Rwandan genocide, when hundreds of victims overwhelmed his Kigali clinic. It was there, as he desperately sought to staunch the wounds of a woman raped and then mutilated in the most unspeakable fashion, that he came closest to despair. It was this patient who, holding his arm, said "ummera - sha" -- "courage, my friend" -- and sent him on to help other patients while she awaited death. Her quiet, selfless compassion guided him through many more horrific experiences." - Salt Spring News http://www.saltspringnews.com/index.php?name=News&catid=&topic=6&allstories=1