Healthcare Talent Transformation

Transparent Healthcare – It’s Here: Get on the Bus or Get Runover

Jonena Relth, TBD Consulting

I’ve done some “unscientific” surveying of the issue of Transparency in Healthcare and was surprised by what I found. While we often blame the older docs of being inflexible and holding back in the transparency arena, I run across docs of all ages who know that healthcare delivery must change. There are the gutsy docs willing to put their heads above the fray and open themselves up to scrutiny by their peers and patients. They ask the hard questions, pressing for why we’re still teaching and practicing medicine the same way. They ask the question of why we don’t review our standard procedures using Lean methodologies to see how medical professionals can save time and money and improve patient care.

As with any change, there are those individuals that still need to be brought over to the “light side.”  Forgive my Star Wars analogy… There are still MANY doctors, old and young, who still have the “I went to medical school and thus know more than anyone else in the room. I like what I do now and don’t want healthcare to change – or at least don’t want my work to change.”

I don't have much advice for how to change the attitudes of the second group, except to:

• Keep the drums pounding…in a nice way of course. 
• Allow naysayers to stand back and watch the changes happening around them but not too long.  At some point, they will need to get on the bus, or the changes will pass them by.

Medical School Experiences that Show Leadership Transparency

Medical students experience both types of leadership: Transparent and Autocratic.  They see firsthand transparent leadership from some docs’ autocratic leadership from those docs unwilling to open up and flex, even a little, to allow the students learn from the docs’ personal experiences that would bring the subjects to life.  Yes, students are taught to memorize, assess quick, make quick decisions, but that's a different topic to address later.

As a trainer and teacher, I love to hear of times when professors share the good, the bad and the ugly with their students.  It’s from these real-life experiences that the “light bulbs” turn on around the room. These professors show a transparency that shows they are “real people” working at a complex job with many variables. It helps give the students a better idea of what practicing medicine will be like from them after their LONG training journey.

Don’t jump to conclusions here, I’m not suggesting breaking HIPAA laws, just doctors showing a bit of vulnerability.

Unfortunately, in medical school, the time is so short to teach the students all the theory and science needed to practice medicine, instructors in the classroom and hospital use an autocratic teaching style to get through as much of the content they can. There isn’t time to allow for much “self-discovery” or independent thinking. That will come later when they have more experience under their belts.

Signals that Change is Not Easy for MANY

In our EMR/EHR consultancy, we see the flexible doctors willing to attend training whenever it is convenient for the organization.  The inflexible doctors are the ones that still want to be trained one-on-one. My opinion is that these physicians don’t want "transparency" because they don't want others to know what they don’t know. It would bump them off their know-it-all pedestal and down with mortal men.  You can’t blame them.  I’m not being flip – honest.  No one wants to be treated by a doctor who they think doesn’t have all the answers and thus can’t cure them. Patients choose to be treated by docs they perceive to be “the” experts. What’s sad is that these same docs and patients are kidding themselves.  No one can know everything about every topic – even in their particular specialty.  A very skilled doctor may know more than the next 20 people, but new information is found every day and no one has the time to learn everything new every day and keep up with their patient load.

I have the utmost admiration for those who choose the medical field as their choice of profession. It is often a lonely, selfless job that keeps practitioners away from their families and forces them to trade “personal time” for being on call at night, weekends and holidays.  It is, however, time for all healthcare professionals to take a good look and accept that our world, our patients and healthcare delivery are changing. Hopefully more healthcare professionals will choose improved, transparent, care delivery by involving others, especially holding patients ultimately mutually accountable for our own care. 

It’s not a one-way street – patients need to change, as well.

The time is now that patients must start taking responsibility for how we treat our bodies and learn how they work. Ok, so in a perfect world, patients would know that "we are what we eat" and also know that we all need exercise and a will power to avoid things that harm our health.  If we do this, doctors will have a much easier time treating our illnesses and helping to make us healthier. Sounds logical to those of us "A" type personalities, but we have a long way to go to get here!

Please share your experiences with us about doctors – young and not so young – who are modeling transparent healthcare.  I know they are out there.  If you are a champion of transparent healthcare, please let us hear from you so we can learn from you!

Here’s a short list of my current transparent healthcare heroes. These docs are in the trenches speaking out for reforming healthcare delivery. They have all earned the right to be heard.

And folks, leadership is where it has to begin! 

• Dr. Michael Koriwchak; Read one of Michael's blog posts: MD – Techy Doc Who Puts Patients’ Needs First
• Dr. Stephen C. Schimpff; Read one of Stephen's blog posts: Innovative Technologies Can Markedly Enhance Safety or check out his book: The Future of Health-Care Delivery: Why It Must Change and How It Will Affect You
• Dr. John Toussaint

Then there are the holdouts… but we’re working on ‘em! 

Jonena

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Transparency Inside and Outside Healthcare Walls - No one wants an "F"!

Transparency Inside and Outside Healthcare Walls – No one wants an “F”!

Jonena Relth, TBD Consulting

Promoting Transparency inside our walls:

How would you like your organization to be among the top 10 Places to Work?  Well, Fortune Magazine surveyed 259 firms and more than 277,000 employees to find out how they would rate their organization for management credibility, job satisfaction, camaraderie, pay and benefits, hiring practices, communication, recognition, and diversity, but only one healthcare company ended up in their top 10. 

The 10 most common answers were no surprise to any of us who follow transparent leadership methodologies, but my favorite “extra” was learning that one CEO posts his/her personal development plan for all employees to see and track results. 

This Leader ROCKS! (in my humble opinion...)

While the survey was aimed at all types of corporations, not necessarily healthcare, CHG Healthcare Services ranked third on the list of Best Companies to Work For. Wouldn’t it be great if several hospitals, especially those that have or are currently implementing Lean Healthcare, would be ranked in the top 10 for 2013?

To Read the Article: 100 Best Companies to Work For 

The facts are overwhelming that the most important asset we have is our employees and that all organizations should strive to hire the best candidates they can find to fill needed gaps. One process that is effective for building a best-in-class workforce is consciously hiring people who have skills and knowledge otherwise lacking in the organization - that of course includes hiring for IT and leadership expertise, as well.  By doing so, you build a solid company where everyone appreciates and learns from their peers and leaders.  It also fosters employee satifaction and patient satisfaction while grooming high potentials for leadership positions.

So healthcare leader, are you brave enough to post your personal development plan for all your employees and peers to see:

• What you don’t know now but are trying to learn? 
• How they are being led by someone who might not be as knowledgeable as they presumed?
• What you feel is important for you to become a better leader?

And, oh yeah…

• That you’re not perfect, all knowing, etc.?

Trust me, most leaders would be scared to death to let their employees and peers reach into their secret little minds and learn the real truth about them.  But folks, we need to step up to the plate and begin modeling transparent leadership so the people around us will feel free to do the same.

Once we all become transparent, we can begin the natural progression of everyone helping each other grow and our organizations and people will benefit socially, personally, professionally and financially. Can’t beat that! 

Promoting Transparency beyond our walls:

None of us wants the negative publicity of being linked to lack of transparency.  How is your organization rated for pricing transparency?  Patients want and deserve to know what they will be charged for procedures. As patients are becoming more informed, they are choosing to be treated at hospitals that willingly publish their fees. For healthcare organizations to be considered best in class, they need to swallow this poison pill and advertise their pricing.

You might want to read this article about Arizona state getting an “F” because price of services are hidden from the public: Arizona gets failing grade for healthcare transparency .  I have to believe that healthcare professionals in Arizona work hard to provide excellent patient care; but even so, their hospitals now have a definite black spot on their reputations.

Drum Roll Please:  Who will be the first person to step up and comment below:

• “Yes, I will post my personal development goals for my peers and employees to see.  I will begin the process of encouraging transparency within my healthcare organization.” 
• “Yes, we will change our pricing policies and post the cost of our services for easy access.”

I dare ya! Jonena

Suggested Reading:

Revolutionizing Healthcaare to Save Lives and Transform the Industry  By John Toussaint and Roger Gerard

 

TBD Consulting has a proven track record for ensuring staff and physician adoption of EMR/EHR system implementations as well as Lean Healthcare.

Drop by our EMR/EHR Clinical Transformation Group in LinkedIn to learn the latest news and opinions on electronic health records. 

Email Jonena or feel free to call our office today 602-263-1961. We'd love to hear from you!

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Do You Lead with Transparency or Power?

Is Obama Killing Healthcare?

Hal Alpiar, www.BusinessWorks.US

Doctors know where they've been, but they don't know where they're going! Today's medical professionals are strapped to a rudderless ship at sea that's being sucked into a raging storm.

Some politicos would have us believe that the scandalous fifteen-thousand-page Obamacare program (and when, by the way, was the last time anyone you know read 15,000 pages of anything?!) need not be such a shocking insult to healthcare consumers because after all, it helps “less fortunate” people to get medical care.

Steamrollered through an inept Congress, Obamacare appears to have little if anything to do with the realities of healthcare. Instead, Obamacare hints at having everything to do with the crippling economic and personal freedom limitations brought on by the relentless White House pursuit of dictating increased government controls on American lives.

The end result? We will definitely end up with fewer competent physicians.

And those who remain will clearly not be providing adequate care –regardless of competency– because of the restrictions Obamacare piles on top of the restrictions already imposed on them that limit their ability to deliver meaningful health services.

But computerization is what tightens the noose around healthcare necks, some say. Not so. The mismanagement and misappropriation of administrative computerization advances by interfering and uninformed government misfits and ignorant insurance providers is what is at the root of today’s healthcare delivery shortcomings.

The de-humanizing of humanizing services is the characterization that uninformed and manipulative individuals, agencies, and organizations have wrought as they’ve twisted administrative computerization advances into shortcut invasions of patient and physician privacy. Have we lost even having thoughts of human dignity?

When “DOCTOR’S ORDERS” becomes “DOCTORS ORDERS” (as in orders issued to doctors by the White House) to conduct patient gun ownership surveys to build a bigger “Big-Brother-Watching” database universe designed to gain yet more government control, do you think this might possibly get just a bit in the way of doctors performing healthcare services?

Of course EMR (electronic medical records) and EHR (electronic health records) have succeeded at putting patient care over paper care. But are these important advances enough to be really helping doctors to know where they’re going?

And the Internet has fully armed healthcare consumers to be better prepared to understand and manage their own healthcare issues, to be more informed about diagnostics and treatments, and to work more productively with their doctors. But are these advances enough to be able to really help doctors to know where they’re going?

The whole lean organization, lean management fad (where did Quality Circles go?) may be a solution, but is not THE solution. It is simply a band-aid acknowledgement that things have gotten so bad, we can no longer afford for the physician to spare a minute or two extra with each patient and patient family to help heal, and help ensure and reassure a sense of well-being.

More dollars are saved. Care is more efficient. But –at the ultimate point of care– doctors don’t get to spend more time with their patients, so is this increased efficiency really enough to help doctors know where they’re going?

Being preoccupied with efficiency necessitates lower levels of individual healthcare delivery. And last time I looked, healthcare was a profession dedicated to individual care. Perhaps it’s time to redefine the word “care”? The bottom line is that doctors are literally trapped.

Adherence to rules and regulations designed to increase control over their skills and abilities to earn livings commensurate with their training and societal value is squashing the very lifeblood out of healthcare. And Obamacare will surface as the culprit when it’s too late to matter — unless enough small business owners and practice administrators and doctors start to make waves

. . . NOW.

Employee vs. Employer Choice of Physician Revisited: Additional Commentary on How Best to Incorporate Medical Tourism into Workers’ Compensation

Richard Krasner

Further research into the topic of Employee vs. Employer choice was prompted by a phone call I received over a week ago from an attorney in New York who handled workers’ compensation cases and is a consultant to carriers and businesses on workers’ compensation, group health and disability insurance, cost-containment, claims investigation and claim preparation. The call got me to think about what I had previously stated in my earlier post on the subject of employee vs. employer choice, and to my amazement, new research found that New York State allows employees, and not their employers, to choose the treating physician. I corrected my error in the original post, but decided that a further clarification and elaboration was needed.

Needless to say, when I came across a study by the Texas Department of Insurance comparing state workers’ compensation systems, I found more information, and decided to expound upon my previous writing. What I found was not just that there is employee vs. employer choice, but that choice of physician is determined by six additional categories. The first category is employee choice of physician. The second category is selection from a list prepared by the appropriate state agency. The third category is selection from a list maintained by the employer. The fourth category is employer choice. The fifth category is employer’s choice may be changed by state agency, and the final category is a after a specified period of time, choice falls to the employee.

As seen in Table 1, thirty states allow some form of employee choice of doctor, while twenty states allow some form of employer choice of doctor. This is important to bear in mind, for the purposes of incorporating medical tourism into workers’ compensation, as 60% of U.S. states allow employees to make the initial choice, and only 40% of U.S. states allow employers that choice, as seen in Figure 1, so that in order to incorporate medical tourism into workers’ compensation, it will be necessary to get employees to agree to it before getting their employers, or their employer’s carrier to do so.

Figure 1 – Pct. of Employee/Employer Choice

Table 1 – State-by-State Comparison of Statutory Provisions Relating to Choice of  Treating Doctor

Source: Texas Department of Insurance, Workers’ Compensation Research Group, Comparison of State Workers’ Compensation Systems, 2004.

Note: * If an employer and/or insurance carrier has a managed care arrangement for workers’ compensation, then injured workers are required to choose a treating doctor from within the employer’s or carrier’s network.

Note: ** If employer has designated at least two Health Care Organizations (HCOs), then the timeframe that an employer has to choose the treating doctor is normally extended.

Broken down even further into the three categories mentioned above for employee choice, as well as for employer choice, 24 states allow employee to have initial choice, which represents 80% of all states that allow employee choice. Four states allow the employee to select from a list prepared by the state agency, which is 13% of all thirty states, and three states allow employees to choose from a list maintained by their employer, which is 10% of all the employee choice states, as seen in Figure 2.

Figure 2 – Pct. of Employee Choice Categories

Ten states allow employers to choose the treating physician. Three states allow the employer’s choice to be changed by the state agency, and seven states allow the employee choice of doctor after a specified period of time has elapsed. As shown in Figure 3, half of the twenty states that allow employer choice, or 50%, allow for initial employer choice. The other 50% is split between states that allow the state agency to change the employer’s choice (35%), and the states that allow the employee to choose after a specified period of time (15%).

Figure 3 – Pct. of Employer Choice

To further complicate the matter, one state in the employee choice category, yet unknown, allows the employee to choice their treating doctor if they can prove that they or a family member has a record of previous treatment with a particular doctor. As shown in Table 1, five states allow workers to choose their doctor if the employer or carrier does not have a managed care plan; otherwise they have to choose from within the network. Seventeen of the employee choice states have unlimited choice of treating doctor, but are not ascertained in the report.

It would appear that in order to incorporate medical tourism into workers’ compensation, it would be useful for any facilitator or other entity such as an employer or carrier, to carefully read the statutes in each state they are conducting business in and have considerable workers’ compensation claims that might benefit from the lower surgical cost and quality issues medical tourism affords. To not do so would be foolish, and would create a great deal of confusion and doubt as to the whole efficacy of medical tourism, which would be a terrible mistake for the employee, his employer and the insurance carrier.

Richard Krasner has worked in the Insurance and Risk Management industry for more than 30 years in New York, Florida and Texas in the Claims and Risk Management spheres, primarily in Workers’ Compensation Claims, Auto No-Fault and Property & Casualty Claims Administration and Claims Management. He has experience in Risk and Insurance Business Analysis, Risk Management Information Systems, and Insurance Data Processing and Data Management. Received my Master’s in Health Administration (MHA) degree from Florida Atlantic University in Boca Raton, Florida in December 2011. I am looking for new opportunities that will utilize my previous experience and MHA degree. I am available for speaking engagements and am willing to travel. Contact Richard or read Richard's blog.

Health Wonk Review - Insightful Nuggets

Another great edition of Health Wonk Review: Thanks to the Disease Management Care Blog for hosting.

Don't miss Jonena's addition to the HWR. Gone are the days when American medicine was ranked head and shoulders above ALL other healthcare systems around the world. One only needs to watch the up-tick on medical tourism to see that there is a plethora of qualified healthcare providers beyond our borders.  EMRs and EHRs are the US healthcare system’s way of dipping their toes into 2013. We MUST go beyond getting our toes wet. We need to implement change methodologies and Lean tools and processes that will guide all healthcare employees - clinical and non-clinical alike - to participate in and take responsibility for continuous process improvements within their spear of influence. Read the entire post.

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Health Wonk Review - Valentine's Day Edition: Here's Your Heart!

US Hospitals Look Out: Global Healthcare Industry is Booming!

US Hospitals Look Out: Global Healthcare Industry is Booming!

Jonena Relth, TBD Consulting

Change is Difficult - More for Some than Others

Lately, I've been participating in Lean healthcare discussions on LinkedIn.  It's interesting to see how the electricity in the convo causes the arm hair to stand up on the "uninitiated" who still believe that Lean methodologies was/is intended only for manufacturing and it simply doesn't fit with their concepts of healthcare delivery. 

This, in my opinion, is a classic example that shines a light on the fact that change is more difficult for some folks to swallow than it is for others. Many healthcare professionals just don't want the culture to change from a top-down, autocratic, name and blame, do-as-you're-told environment to Lean healthcare -- a culture that has as its foundations:

• Customer Focus (Patient/Customer Needs met)
• Respect for People
• Collaboration
• Gemba Walks and
• Standardized Work

Medical Tourism is a Reality folks! 

Gone are the days when American medicine was ranked head and shoulders above ALL other healthcare systems around the world. Our healthcare delivery is no longer considered to be the:

• ONE AND ONLY
• BEST ANYWHERE
• ONLY HOSPITALS RICH PEOPLE FLOCK TO FOR CARE 

This is a hard nut to swallow, but we need to start chewing and get to swallowing if we're going to make the US Healthcare System best again. Our people deserve it.  For heaven's sake, we live in America, the land of opportunity!

One only needs to watch the up-tick on medical tourism to see that there is a plethora of qualified healthcare providers beyond our borders. US medical schools are training docs, who after perfecting their skills, move back to their homelands to provide medical care at a fraction of the cost of the US. Many of the countries such as Thailand have some of the most sophisticated hospital systems in the world with highly trained physicians and medical staff who are happy to treat whomever they can.

Use of Technology is Way Behind Other Industries

It's also no secret that by staying in a world of paper charts until recently, healthcare workers are not as adept at computer skills as compared to people with similar responsibilities and pay in non-healthcare. 

Honestly, it's been decades since we had to train someone how to use a compuer mouse -- except in healthcare.

I guess if you shoe horses or give swimming lessons for a living, you might not know how to use a computer.  But wait, you'd still want to make appointments and save your customers' contact data!  Yep, you'd want to be proficient in Gmail, Outlook or other email/calendar program -- and you'd definitely need to navigate the page with a mouse!

So Where Does Lean Healthcare Fit into the Equation?

EMRs and EHRs are healthcare's way of dipping their toes into 2013. We MUST go beyond getting our toes wet and implement change methodologies, tools and processes that will guide all healthcare employees - clinical and non-clinical alike - to participate in and take responsibility for continuous process improvements within their spear of influence.

There are many process improvement techniques, but I'll put my money on Lean healthcare to eliminate obstacles preventing hospitals, provider offices, pharmacies, medical equipment manufacturers, software companies, etc., from providing best-in-class healthcare.  Lean is simple, but not easy to implement because people cling to the comfortable ways of the past. The addage, "If it's not broke, don't fix it," MUST be eliminated from our memory banks.

If embraced by all, Lean methodologies eliminate issues as vast as out-of-date technology systems, worker frustration and errors and oversights that can increase patient safety risks. Some "fixes" are complex, but lean methodology strives to find well-thought-out improvements that can be implemented quickly and without costing a fortune, if at all possible -- thus the name Lean. 

Our overarching goal should be put patients first, cut out waste, eliminate tasks that don't add value to the patient and ultimately lower the cost of healthcare delivery so we can compete in the global marketplace.

I can't think of a better goal than that, can you? 

Please let me and our readers hear from you -- I truly welcome comments! Conversation is the best way for us to learn from each other.

Jonena

TBD Consulting has a proven track record for ensuring staff and physician adoption of EMR/EHR system implementations as well as Lean Healthcare. Whether you need assistance to create a training department or organizational change department, help your existing training organization meet the needs of the ongoing changes, or simply need "extra hands" to meet your deadlines or ROI goals, please contact Jonena. She and her qualified staff are here to assist you with your organizational development, coaching and training initiatives.

Drop by our EMR/EHR Clinical Transformation Group in LinkedIn to learn the latest news and opinions on electronic health records. 

Or feel free to call our office today 602-263-1961. We'd love to hear from you!

Lean Healthcare Could have Prevented Errors this Cancer Patient Endured

Republished with permission. Article by Marshall Allen. ProPublica, Jan. 9, 2013, 2:43 p.m.

"For Dr. Elaine Goodman, the strongest lessons in patient safety didn’t come from her training. They came from her mother’s death.

Goodman had just finished her first year of medical school when she found herself spending months at the bedside of her 63-year-old mom, who was battling breast cancer in the hospital.

One morning she arrived to find her mother’s face and hands bloodied. Hallucinating and disoriented, her mom had yanked the cranial staples inserted during a recent procedure from her head.

Another time, a stethoscope fell on her mom’s face and gave her a black eye. She suffered frequent falls and preventable side effects from drugs. And she narrowly missed having an unnecessary brain operation and getting an incorrect drug.

“It was really eye opening for me to see the reality of how difficult it was to keep her safe in the hospital,” Goodman said. “It’s not enough just to have caring, qualified people to keep the patient safe.”

Goodman believes the incidents hastened the decline of her mother, who died in 2008 after six months in the hospital. A Harvard Medical School grad, Goodman is now a second-year resident in internal medicine and primary care at Brigham and Women’s Hospital in Boston.

Goodman shared her story after completing our Provider Questionnaire [1], part of our ongoing reporting on patient safety [2]. ProPublica confirmed details of her mother’s story with one of the

physicians who treated her and by reviewing her records. This interview with Goodman has been edited for clarity and length.

What did your experience with your mom teach you about medicine?

The hospital she was in is a nationally ranked hospital near Seattle. It wasn’t that we felt the place was not up to snuff or not capable of providing good care. But I hadn’t realized how hard it is to keep a complicated patient safe in the hospital. The harm is rarely caused by actual negligence. The vast majority of cases involve a lot of people doing fairly reasonable things, and somehow something just falls through the cracks.

One day my mom fell out of bed in middle of the night. They had bed alarms to notify nurse if a patient starts to fall out of bed. But there’s also a chair alarm, and the nurses showed us that there were only enough electric outlets for one alarm at a time, and the alarms had identical cords – making it hard for the nurses to tell which alarm was plugged in. The day my mom fell, the wrong alarm was plugged in.

There are lots of easy solutions to this. They could make the cords different. Or they could have two outlets, so both could be plugged in. I certainly hadn’t thought about that as a medical student, but all of a sudden it became the most important thing in my day when my mom was in the hospital.

Medication errors were frequent. My mom was on a seizure medication that needed the dose adjusted according to her nutritional status. The physicians probably knew this, but with all the handoffs, a new doctor would come in, see the drug level was low in her blood – and without carefully observing her nutrition – and then up the dose. She was being accidentally overdosed on the medication which caused her to sleep for days. As somebody who has a life expectancy on the order of months, those days were very important to us.

The biggest error related to her chemotherapy, which was administered by a device straight into the fluid of her brain. They’d give her the chemo about once a week, and it was supposed to last an entire week. One weekend her normal oncologist wasn’t on so the covering physician administered the chemo. About a week later her normal oncologist came to us in tears. She’d discovered that her colleague had not administered the right chemotherapy drug, and the type she’d received had only lasted a day, not a week. My mom had effectively gone for a week without getting any treatment. For her this probably didn’t change her life expectancy drastically, but it probably changed it a little bit. But this event itself was really terrifying. It had the potential to make a huge difference in the life expectancy of other patients.

How did the hospital doctors and officials respond?

We [family] had a lot of conversations with the hospital administrators about what they were going to do about such a big medication error. We arranged to become members of the hospital’s patient safety committee. That got us involved in a way that made us feel they were addressing it.

On the committee I watched how the hospital addressed the error. It turned out the drug that had been incorrectly administered had a name that was almost identical to the name of the correct drug, and the labels were almost identical. Plus, the hospital did not have a pharmacist who had specific

expertise in chemotherapeutics. It was a case that illustrated what they call the “Swiss cheese model” for how errors occur. All the holes just line up and then the mistake is made. There were no good systems in place to make sure that if somebody didn’t catch it, there was some hard stop to keep this from happening.

The hospital ended up hiring a new chemotherapy pharmacist, training the nurses and changing how the chemotherapy drugs were ordered and labeled.

What do you see as the causes of ongoing patient safety problems?

Complexity. There are exponentially more treatments, medications and technologies now compared to a few decades ago. We also have so many different ways patients are insured, different facilities they’re staying in and various aspects to their care. There are so many layers to manage.

There’s also a huge problem with overbooking our physicians and medical staff. The patient volume is high, and they’re in and out of the hospital more quickly. The demands on a physician’s time are incredible. Physicians are constantly multitasking — being paged all the time, distracted, working long hours — with no time to sleep. The list goes on and on.

And yet the emphasis is on the individual doctor taking care of all the issues. You take these caring, smart individuals and put them in a situation where they’re overtired with too many demands on their time, and they’re supposed to double check themselves and make sure nothing slips through the cracks. Frankly there aren’t enough hours in the day to make sure you do all of that. You also don’t have the mental bandwidth to do it.

How did your experience change the way you practice medicine?

It changed how I view interacting with families. Last year I was an intern here at Brigham and Women’s. I was working extremely long hours and getting hundreds of pages I had to respond to. When I’d get a page that said a family wanted to talk, sometimes my heart would sink. I was tired, hungry and had other patients to attend to. It’s terrible. But you can get to a place where if someone asks you one extra question you’re just going to snap. That’s another example of burnout or being overworked.

When I was first in the hospital with my mom I tried not to ask too many questions. I didn’t want to be labeled “difficult,” or as the daughter in med school who thinks she can dictate decisions. As a result my mom’s care got worse. I realized that we family members had a lot to offer, especially in terms of handoffs between physicians. Sometimes the only person who’s been present is a family member. In one case with my mom, a radiologist had picked a chemo drug he thought was best and later I saw a nurse begin to administer a different chemotherapy drug in response to his order. I questioned the nurse. The nurse was kind of annoyed, but she called the radiologist and then administered the correct drug.

What did you learn about patient safety as a medical student?

We had some lectures peppered throughout the curriculum. No patient safety course, but we had talks here and there. I went to med school because I was passionate about science and care, so the patient safety topics weren’t the most exciting. They were about organizational structure and felt more like business school than medical school.

I would have been more attuned to this problem if the instruction had been tied to individual patients. When I came back to medical school [after caring for her mother], I did a patient safety elective – which was a new thing at the time – where students sit in on committees that are reviewing adverse events. Reviewing those cases made it easy for me to imagine myself as a physician who missed something important while caring for a patient.

What’s one way medical providers can reduce the number of patients who suffer harm?

Sometimes errors are not even tracked. When I returned to medical school after my mom’s death, I found that there was no way for medical students to report an error. There was an error reporting system, but the medical students did not have a login for it. Myself and a couple other physicians in the patient safety elective helped get that changed.

And when errors are reported, the response is not always constructive. I filed an error report a few days ago about a medication event. Most people responded well, but a few emails I got showed some people were not happy being involved in an error report. We’re not all the way there yet. People are still prone to taking these things as personal failings instead of thinking about the system. We need to move away from a culture of saying ‘error reporting is done to be punitive’ to ‘it’s everyone’s job to error report to make the system safer.’

We need to build a culture of patient safety. That means removing the stigma from patient safety and error reporting so we can collect data about errors and learn how we can fix things. That’s better than not knowing the scope of the problem because people are afraid to talk about it."

EMR/EHR - Pay twice - why?

Jonena Relth, TBD Consulting

EMR/EHR systems purchased and implemented without the efficient workflows and training is a waste of money. 

 "We can save training expenses by..."

If a vendor or employee tells you that they can provide training that consists of generic screens that come with the system - - turn tail and RUN.  Medical professionals are intelligent and very busy folks - not to mention expensive.  First off, no one has the time or inclination to be trained on something they won't use or that doesn't fit into their "world."  To add to this, many medical professionals do not have a strong computer  background and thus many folks won't be able to tie the generic training to the customized system workflows and screens they will be required to use after the system goes live.  It should go without sayin', but once again I emphasize:  If you don't train the ACTUAL processes (screens included), people will not have the skills and knowledge needed to efficiently and accurately use the system for many months -- if ever.

Pay twice - why?

If you only provide generic training that doesn't mirror the actual work, you will need to retain the "slower learners" and provide superusers at the beck and call of all users for many months, if not forever.  Rework and retraining is very expensive and a waste of time, energy and money.  So, I guess the adage for this should really be: "Go cheap now and pay twice as much or more!"

Another puzzle piece to successful system use:  

To ensure buy-in from all users, be sure to involve clinicians and physicians in the whole process.  Not doing so will result in a costly change imitative that is not embraced by the users.  Medical professionals know how they do their jobs without the new system.  With guidance, medical staff can work with training professionals to build workflows to guide a system design that includes new, more efficient workflows intertwined with the system for each user group. 

The result will ultimately result in an excellent system, customized training and improved patient care. Those are our ultimate goals, are they not?

Jonena

TBD Consulting has a proven track record for ensuring staff and physician adoption of EMR/EHR system implementations. Whether you need assistance to create a training department, help your existing training organization meet the needs of the ongoing changes, or simply need "extra hands" to meet your deadlines or ROI goals, please contact Jonena. She and her qualified staff are here to assist you with your organizational development, coaching and training initiatives.

Corporate Office 602-263-1961. Email Jonena today!

Lean Strategies Improve Healthcare Delivery while Lowering Costs

Jonena Relth, TBD Consulting

I'm encouraged to see healthcare leaders looking beyond the ways they have always done things in the past to implementing innovative solutions such as Lean to curb the industry's skyrocketing costs, poor quality, nursing shortages and employee dissatisfaction— all symptoms of deeper problems inherent in the system itself.

These forward-looking healthcare providers have realized the financial and moral imperatives for improving quality and safety and eliminating waste as strategies for responding to their pressing challenges.

Lean Healthcare (adapted from the Toyota Production System) is not just for manufacturing or another short-term fix: it’s a way to transform an entire organization into a safe and high-quality, high-performing healthcare delivery system. If implemented property, it can be the "how to" for managing change and creating continuous improvement.

Lean Healthcare is used to eliminate obstacles that prevent organizations from providing best-in-class healthcare by eliminating issues as vast as out-of-date technology systems, worker frustration and errors and oversights that can increase patient safety risks. Some "fixes" are complex, but lean methodology strives to find well-thought-out improvements that can be implemented quickly and
without costing a fortune, if at all possible -- thus the name Lean.

As a leader, it makes sense to at least research whether your organization would embrace the methodology and sustained results derived from lean implementation.

Take a peek and give me a call if you'd like to see how lean strategies can help your organization improve your care delivery while lowering your costs.

Jonena

TBD Consulting has a proven track record for ensuring staff and physician adoption of EMR/EHR system implementations as well as overall process improvements. Whether you need assistance to create a Training Department or Lean Academy, or help your existing training organization meet the communication needs of the ongoing changes, or simply need "extra hands" to meet your deadlines or ROI goals, please contact Jonena. She and her qualified staff are here to assist you with your organizational development, coaching and training initiatives.

Corporate Office 602-263-1961    Email Jonena today!

Supervising Adults

Kel Mohror

Dr. Michael Koriwchak, in a October 5, 2012 blog post titled "The Naiveté of mHealth," describes a situation where mHealth fails utterly in the post-hospitalization care of a congestive heart failure (CHF) patient.

Our CHF patient is discharged from the hospital all tuned up with appropriate medications, diet and smart phone remote monitoring using a CHF app.  The monitoring app works well at first, feeding him periodic words of encouragement and reminders to take his meds, record his vital signs, weigh himself, etc. 

After several days of his phone going off constantly with all the reminders, alert fatigue sets in.   After ignoring the alarms for a few days he gets fed up and shuts the CHF application
off.  The monitoring network detects the data interruption, and a provider calls the patient. At first the contact with a real human helps, but after several calls alert fatigue strikes again. Our patient recognizes the caller ID and stops answering.

 In the meantime he tires of his medication regimen and diet restrictions and succumbs to the urge to scarf down some pizza and beer with some potato chips for dessert.  His smart phone isn't smart enough to change his behavior. The salt and fluid load makes his heart failure worse. In the middle of the night he wakes up short of breath and calls 911.  Back to the hospital he goes.

I wonder at what point do we, as a society, regain expectations of accepting the consequences of ignorance? When "adult supervision" of adults becomes standard practice in many walks of life such as healthcare or teaching (where a teacher bullies a teenager for wearing a political tee-shirt which the teacher likens to the KKK!), those being supervised cannot be coddled, but rather must be penalized. 

Whether the consequence is termination of vocation or of life, that is what the teacher or patient chose, knowing full-well what her / his behavior could lead to.

If a patient, upon leaving the hospital "all tuned up with appropriate medications, diet and smart phone remote monitoring using a CHF app," chooses to behave in ways that surely put her / him on the path to readmission, perhaps the re-admit should be denied.

If a patient prefers foods and sedentary ways over "field-proven" discharge instructions, why should the medical and nursing knowledge, expertise, time and hospital resources be wasted on a re-admit who clearly chooses comfort and what is easy over what is "medically necessary" to live? Can't those professional and material resouces be better used for healing a similar patient who "lives" the discharge guidance and regains health over time?

Choosing to ignore "the rules" has consequences- a speeding ticket and higher insurance costs, an accident from "running" a red light, and higher morbidity due to "not liking" the therapeutic regimen.

 Society can no longer afford to reward unhealthy behaviors with "do whatever it takes" healthcare.