Healthcare Talent Transformation

Courtesy Extended is Courtesy Appreciated

Aka: When to face the patient during the exam when EMR/EHR is in the mix

Posted by: Jonena Relth, President and Leadership Evangelist, TBD Consulting

 

Patients appreciate it and feel valued when their physicians review their chart BEFORE entering the exam room.  By doing so, physicians are demonstrating that they value the patients individually and are not just going from room to room ticking off another patient's ailments.  Physicians should come into the room prepared to meet with their patient and interact personally.  If during the visit, he/she needs to look something up on the EMR/EHR chart, that is certainly acceptable, but it is optimal for physicians to be SITTING not standing next to their patients so the patient can see at least the side of his/her face while the computer is being used. 

Positioning the computer at table height next to the exam table eliminates the barrier of not looking eye to eye with the patient, which is what they want. I have a dear friend who is a retired vascular surgeon and he told me years ago that to operate on a patient, he only needed to read the charts.  However, by getting to know the patient, sitting next to him, listening and answering all his questions, the interaction reassured the patient and built trust between the two of them. His patients that had his undivided, face-to-face time often had quicker and easier recovery times than those he wasn't able to meet with personally.  A positive, trusting frame of mind is strong medicine!

This is a time of transition with electronic charting, and the office visit culture is changing which calls for compromise on both the part of patients and physicians.  For the most efficient use of the EMR/EHR, it should be perfectly acceptable for a physician to type notes during a visit AFTER the patient and physician have talked and or the exam is completed.  The physician should NEVER have his/her back to their patient as it sends a loud and clear message to the patient, "Using rude manners with you does not matter when you are in MY exam room."  This is not the right message to send.  Studies have shown that one of the primary complaints physicians have with using EMR/EHR is the decreased face time with their patients.  Believe me, patients want that face time too!

And one last note:  Have you ever attended a "meeting" where you had to sit while someone else read their notes in front of you to refresh their memory of the reason for the meeting?  I'm guessing we all have experienced this and it is just plain rude.  For the physician to review the patient chart before entering the exam room is just plain courtesy.  The logistics of the computer placement is just a matter of keeping the goal in mind -- physicians do what they do because they want to help/cure their patients' illnesses.  To do that requires face time.

*********************

TBD partners with our healthcare clients to create organizational development solutions that drive bottom-line results.  We focus on improving performance management, employee engagement and process effectiveness.  Click here to learn more about TBD's healthcare solutions.   You'll be glad you did!  602-263-1961

Process or People Issue? You Be the Judge!

Posted by: Jonena Relth, President and Leadership Evangelist, TBD Consulting

Isn't it interesting how much easier it is to tell someone how to do something out of their comfort zone than it is to do yourself? I'm in that dilemma now.  As a patient advocate for others, it's easy for me to take notes and ask questions of providers.  But now I find myself in the position of the patient and last week I got nervous and scared during a consult, didn't take notes and was embarrassed to ask the provider to explain things I didn't understand.  What happened to that Type A, go-to gal?  She crumbled and walked out of the appointment with more questions than she had when she went in.

Shame on me!  I'm a founding member of the Society for Participatory Medicine and believe with all my heart that it takes two: me (the patient) and my doctor (the provider) to solve my medical issues. But I'm just like so many patients that when posed with a very serious issue, we lose our balance, fall back into the chair and listen with half an ear - - the other half is somewhere in space trying to block out the inevitable bad news.

So what did I do next?  Well, I regained my composure the next day and called the provider's office and asked to speak with the physician. The receptionist forwarded me to the physician's voice mail where I left a short, but to the point message:  I'm scared. What are the next steps in my treatment?  Response: No call back, so I just worried over the weekend.

And next?  I called the provider again on Monday.  A different assistant gladly took a message and told me she would hand it to the physician when she came out of the treatment room with another patient.   Responses:  No call back, so I continued worrying until the next day.

Today is Tuesday.  Feeling a bit frustrated and angry, I held my temper and called the provider a third time.  A third assistant took my message that I was scared and wanted to speak to the physician.  It's 3:00 pm and still no call back.

Trust me; I will get my answer, even if it means driving to the provider's office and sitting in the lobby until the physician comes out to speak with me.  I will be polite, but firm.  This is an office that normally provides wonderful patient care and exemplary customer services, but obviously, something is terribly wrong.  My point of sharing this is that the average patient would scream and yell at the front desk staff or else go to the phone book and find another provider.  Either action will damage the provider's reputation and possibly hurt the patient.

As a performance consultant, my gut says: "Gap in the process."  I (the patient) say, "Who cares if it's people or process, I need help!" I'll give it one more try before I call UCLA Medical Center for another opinion.  What would you do?

Part of the Solution: Understand the Workflow

Posted by: Peggy Salvatore

Last Friday, The New York Academy of Sciences and Columbia University’s Center for Advanced Information Management partnered to present a conference, “Electronic Health Records: Where Do We Go From Here?” The room was populated by physicians, academics and people with blended medical and professional degrees from sectors like IT, government, policy, and business.  The seekers had come to find out what the people leading the charge could tell them about where health IT is going and how we’ll get there.

One of the issues is how to best integrate hardware and software into the clinical practice environment so, instead of being intrusive, it is organic. Over time and with many implementations used by increasingly tech-savvy clinicians, IT applications that work with the environment will emerge. Until then, vendors are installing equipment and designing software with varying degrees of compatibility with the provider’s worksite.

By staying through all the sessions despite a major snowstorm bearing down on the East Coast, I heard some great discussion at the end of the day around workflow optimization. The question under consideration by researchers:  how is workflow analysis used in the design and implementation of health IT in the clinical environment?

Two items from this presentation were particularly noteworthy:

1. Time and motion studies, which are research and time-intensive, have proven to be no more applicable to the real world than focus groups of clinicians and non-clinicians when analyzing workflow, and
2. There are workflow and time-and-motion studies being conducted but most of these researchers do not know each other, are not aware of each other’s results, and their work product is not commonly available to the people who need it most – those designing the systems and software.

One audience participant raised the possibility that perhaps the researchers who are conducting the workflow analyses and time-and-motion studies might consider banking their findings in a common repository to be available to IT professionals.

In such an expensive and disruptive process as IT integration, it could be very valuable for designers and developers to have access to some of the best thinking on clinical information system workflow analysis as they build our IT infrastructure that is used at the point of impact – where the doctor meets the patient.

[Blogger’s Note: One of the notable aspects of the conference was the venue: it was held in the NYAS Conference Center in World Trade Center 7, the only of the three WTC buildings decimated on 9-11-01 to be rebuilt so far. I had visited the site before, but had not been inside the new building. It is simple and stunning. As you enter, you are greeted by a running marquee several feet high commemorating 9-11. The city blocks around the WTC site are ringed with bumper-to-bumper NYPD cars, and a massive men-in-blue presence working hard to keep people feeling safe on the premises.]