Does your hospital utilize the MIDAS+ program? If so, I’m sorry. I am empathetic and 1000% sorry. I freaking get it. MIDAS+ has to be one of the worst things that hospitals have utilized to “improve patient care”.
Let’s just start with the list of MIDAS issues I’ve had in the last year or so.
- Cussing in the hallway–not AT anyone, just in casual conversation. You know what I say to that? $%#& that! I am not 8 years old, nor is the person that reported me. I’d be happy to find them a tattle-tail to wear around though.
- A nurse reported me after she paged me at 3AM with the results of a UA that had actually resulted 12 hours prior. She wanted me to start antibiotics in an asymptomatic patient. She also didn’t want the education as to why it wasn’t actually necessary to call at 3AM about something this non-emergent, nor was I actually going to start any antibiotics in this patient at this time (no fever, no symptoms, no elevated WBC, no signs of sepsis…)
- Nurse complained because a family was upset when a patient was awake, agitated, and retching before she was extubated. The patient had been placed on a spontaneous breathing trial just 15 minutes prior, and I got paged twice within 10 minutes about the same issue. You know what is uncomfortable? Having a breathing tube down your throat. You know what’s even more uncomfortable? Needing a breathing tube when you’re not actually ready to be extubated and can’t breathe on your own.
- Nurse complained because I wasn’t nice when they called me at 2AM. There were times when I was taking anywhere from 12 to 108 hours of call in a row. I didn’t get to rest the next day or that night, but I still was expected to show up and take care of more patients, or operate, etc. Yet, I’m supposed to answer late night calls with a smile on my face at all hours with no repercussions for the nurse asking me a stupid question at 2AM.
My Experience with MIDAS
Our entire service get MIDAS reports all the time–for OR delays, for leaving patients in the OR when someone else is trying to die in the ICU or ER, for being frustrated when the right instruments or staff aren’t available, for attempting to educate nurses that simply don’t want to be educated at the bedside.
SUPPOSEDLY, the MIDAS system is a “non-punitive” thing in our system. Yet, if there are behavioral issues, they have to reviewed by our department chair and addressed with us directly. Sometimes we even have to provide a written response to some complaints. I’m not sure what happens on the other side, but here’s a good example of what might be occurring.
Mind you, a MIDAS report is not a quick and easy thing to do. The few times I have tried to report actual patient safety issues–the lab not giving FFP to a patient with an active head bleed (and not informing me), nurses allowing a chest tube to “fall out”, inappropriate transfers to our facility because our transfer center forces our hospitalists to accept everything (although we do not have every specialty available)–it has taken me minimum 15 minutes to complete.
Also, interestingly, the first time I made a MIDAS report on a nurse directly, the CNO showed up in my office the very next day. He had maybe shared a couple dozen words with me prior. I downloaded a mass of information about our service and our concerns when he decided to show up. Yet, I haven’t found the time to MIDAS a nurse again, and he hasn’t shown up in my office again. Coincidence?
What is MIDAS?
It is a system of anonymous, online/mobile reporting for healthcare workers to report “near misses” and patient safety concerns. It is supposed to collect data regarding such events in an objective fashion.
Even in our system notes, it is noted that it can be used to “implement corrective actions”. So, how does that translate to punitive? It’s essentially an anonymous tattle-tail tool. The REAL safety concerns, the REAL near misses–I don’t get feedback about those. I don’t know whats being done about them to make sure it doesn’t happen to another patient. Yet, I have to respond when I cussed in the hallway.
What is MIDAS doing to the healthcare team?
IMHO, it’s absolutely destroying the team atmosphere. It has created an us vs them mentality. It’s creating a toxic work environment for us all. Nurses vs physicians, lab techs vs nurses, radiology techs vs radiologists, etc, etc. It certainly seems like a punitive thing, and ever since it has been relied upon at our institution, there are more roadblocks to change. I’m not a “manager” so I don’t get to see the report side of things and the metrics it provides. Maybe there’s something it does well, but it certainly isn’t improving patient outcomes by helping us all to work together better.
What can we do better?
- Face to face, direct conversations about concerns. Anonymous reporting like the MIDAS system condones does little to rectify a situation. Especially when there are likely two different views of what happened.
- Administrators that understand bedside care–especially that provided by physicians. If they are so far removed from bedside care that they don’t understand alarm fatigue, overburden from excessive paging, then they will continue to make policies that are destructive to the ability to provide care.
- Physician ownership of the patient-physician relationship. Unfortunately, healthcare has been hijacked. For every physician, there are 16 administrators. That means there are 16 people interfering with the relationship that a physician is attempting to create with a patient. Therefore, physicians focus on administrator happiness more than patient happiness, or even their own.
- Pavlov’s Dog mentality. Animals do not respond to negative reinforcement nearly as well as they respond to positive reinforcement. Therefore, we need to raise up physicians when they doing good for patient care or when they do something good for nursing staff. We need nurses to know we think they are stars in their area/floor/clinics, so that others can model behavior after them. Yes, we need to work on the negatives. But if our only focus is negativity, then that is simply all we will continue to breed.
What do you think about “anonymous reporting” in healthcare? (Especially for small bedside things rather than true adverse events that are often already reported to a medical board or at least a peer review committee).
How do you communicate best when things go awry?