Christina's Considerations

Getting It Done: Strategies for Clinical & Financial Success

Dr. Ken Cohn is one of my virtual friends and like me, a writer and blogger.  He lives on the East Coast and at one time did live here in Santa Barbara, however the Internet has facilitated our connections and collaborations on topics of shared interest.  As in the case with some of my other virtual friends, I'm sure one day we will meet in person -- most likely at an ACHE Congress on Healthcare Leadership.

Last year his latest book Getting It Done was published.  He and his co-editor, Steve Fellows, have pulled lessons learned from some of the best and brightest in the healthcare profession on a broad range of topics. I enjoyed the stories, ideas and peaking inside a little unfamiliar territory.  Here are a few of the chapters and concepts that struck me.

Disaster Preparedness for Healthcare Professionals Important reminders:

• Disasters, like dragons, have long tails!
• You don't know what you don't know, but you could!  
• The best surge capacity response is not to have a surge!  
• It's all about big guys with big guns!  
• Has your CFO attended disaster training? Because, the answer is money!

Overcoming Rural Healthcare Challenges - The complexity that sometimes leads to the marginalization of rural hospitals and in many cases their one and only general surgeon.

Launching and Innovation Revolution in Healthcare - Great examples of breaking out of the old.  I especially like the red zones and Chocolate Cafe'!

Documentation as Destiny: A Tool for Survival  Why physician documentation is the key ingredient in the determination of payment.

Building a Functional Operating Room Culture  Hummm!!  I can see how the best candidate for OR medical director is "a retired surgeon or anesthesiologist who likes surgeons and has a background as a high school teacher with a degree in psychiatry."  This wonderful chapter also includes the quote "The best way to predict the future is to invent it." (Kay 1989)

Innovations to Address Disruptive Physician Behavior  Comprehensive approach and series of progressive interventions and ongoing monitoring, but don't forget docs aren't always the hospital's bully. Use this guidance to address them all for safe and high quality care.

Coaching Healthcare Teams to Improved Performance  Breakdowns in communication and poorly managed conflict drive suboptimal team performance and undermine the quality and safety of patient care.

 

Remembering Our Healthcare Veterans

I thought today would be a good day to remember our veterans who fight to save the lives of those fighting for our freedom.  My dad was a corpsman who worked in a naval hospital during the Vietnam War and I wrote about my tour of Midway's hospital ship last year.  

A few years ago, I also had the honor of touring the Field Medical Training Battalion at Camp Pendleton and their field hospital -- ER, OR, recovery and unit tents.  I took pictures and am shocked I can't seem to find a post about it on this blog.   As soon as I can find them, I'll add them to this post.

So, thank you to all of our military corpsman, doctors, nurses, pharmacists, administrators and other healthcare professionals!

The Doctors and Richard Simmons

The Doctors have been focused on exercise this month and I thought I'd share this video clip as a reminder to all doctors to have those conversations about weight and exercise with your patients.  I, too, also hope it helps inspire a few readers to get up and exercise. 

I don't watch The Doctors (too busy working), but I do love Richard Simmons and think I'll go for a walk now!!!

A few of the 13 secrets being revealed on the show are:

•  Gym membership not in the budget? Exercise at home using items you already have, including:
  • Tights (stockings) – Work shoulders, biceps and upper back by using tights just like resistance bands.
  • Paper Plate Push Ups – The increased resistance from a paper plate can amp up any workout.  Put plates under your hands and do a push-up; slide hands closer together and do another push-up; repeat.  Or, place plates under feet and do “mountain climbers” to work triceps and chest muscles.
• Fake a butter allergy! Even the healthiest veggies can be sabotaged by too much butter. If you’re dining out and worried the chef may not honor your request to remove butter, tell the server you have an allergy and save yourself from unnecessary saturated fats.
• Text a buddy!  Instead of keeping a food diary, try the “text accountability system” and text a friend what you eat each day. A friend may be able to better help maintain perspective on your diet.
• Ditch the mundane treadmill workouts. Challenge yourself with a water resistance course – Co-host Dr. Jim Sears shows viewers how an H20 boot camp can burn up to 600 calories/hour without the joint pain some experience in a regular workout.

 

 

Patient Care in a Crisis

By now, many of my regular blog followers should have figured out I'm a girl from New Orleans and I also have a specific interest in emergency preparedness and disaster planning, especially for hospitals.  Once again, I get to post about something that blends several interests.

I received a link to the premier issue of the enhanced digital magazine Security Management . It includes an article, Patient Care in a Crisis, that looks at the decisions healthcare providers made in New Orleans in 2005 when Hurricane Katrina came ashore. It explores issues, such as, security and the choice between shelter-in-place and hospital evacuation.  The lessons learned and information shared will certainly be of value to those readers with an interest in disaster planning and preparedness.  One fact that I did not know before this article was that 35% of the dead bodies recovered after Katrina were found in hospitals.

However, the interactive nature of this eMagazine with embeded short video clips, podcast and an expandable digital map of the U.S. with the number of staffed hospital beds available for all U.S. Zip Codes will be especially interesting to those of you who enjoy new media and emerging technologies. The more interactive nature of this digital magazine does enhance the reader's experience.  

For those of you who like apps, you may also be interested in the article that follows on Life Safety Apps.  It also includes interactive presentation of content.

The digital issue and healthcare feature is available publicly for the month of May - so check it out soon!

Health IT ROI - Value to the Enterprise and Patient

Building Out Your Health IT ROI - The Value to the Enterprise and the Patient This latest article for HIMSS Clinical Informatics Insights explores how enterprise portals can help hospitals tie disparate systems together, so that the data and information already being collected can be used (meaningfully).  Going beyond the typical departmental information systems, it also addresses the accommodation of non-traditional Health IT technologies, such as, remote monitoring, telemedicine and social networking technologies.

Social Media in Healthcare Infographic

Via: PowerDMS

Appropriate Use of Social Media and Social Networking in Medical Practice

The Federation of State Medical Boards has released Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice. It addressed the physician-patient relationship, professional and ethical standards and provides recommendations for state medical boards to consider in educating their licensees on the proper use of social media and social networking websites.

The following recommendations are also included:

• Physicians should only have online interaction with patients when discussing the patient’s medical treatment within the physician-patient relationship – and these interactions should never occur on personal social networking or social media websites.
• Patient privacy and confidentiality must be protected at all times, especially on social media and social networking websites. Although physicians may discuss their experiences in non-clinical settings, they should never provide any information that could be used to identify patients.
• Physicians should be aware that any information they post on a social networking site may be disseminated to a larger audience, and that what they say may be taken out of context or remain publicly available online in perpetuity.

One study in JAMA found that 92% of state medical boards in the United States have received reports of violations of online professionalism, so this guidance is really a bit overdue.  But, I'm glad both the boards and licensed physicians now have some clearly defined expectations and guidelines for moving forward.

For all of my nursing followers, similar guidance is also available in a previous post.

Telemedicine: A Public Service Announcement

If you are like me and feel we need to start educating consumers on the power of telemedicine, then please share this video.  It was created by my friends at @CTELTweets, so let them know what you think!

 

Social Media and the Patient Experience

I'm currently working with a healthcare system and one piece of the project is to incorporate social media into the patient experience.  There are truly innovative opportunities to apply the technologies to solve operational, care and support challenges across the continuum from the worried well through pre-treatment, treatment and post-treatment.  It has been exciting to talk with staff about their specific needs and matching technologies that will help accomplish the job.

I've shared examples of these over the years in my blog posts, book and articles (see left column).  Some of my early favorites are outlined as my best practice examples.  All it takes is a little imagination, thinking thought the purpose, goals and processes and building in the appropriate management structure.

Once you get beyond the initial thinking and planning, consider these 4 social media strategies to build patient loyalty by engaging consumers in two-way conversations. 

• Incorporate humor
• Integrate your social media channels
• Keep the budget low
• Tie Social Media to Service Lines

 

NLRB Report on Social Media Cases

The Acting General Counsel of the National Labor Relations Board released a second report  on outcome investigations involving social media that were submitted by regional offices and it underscores two main points:

• Employer policies should not be so sweeping that they prohibit the kinds of activity protected by federal labor law, such as the discussion of wages or working conditions among employees.
• An employee’s comments on social media are generally not protected if they are mere gripes not made in relation to group activity among employees.

I share this because I'm not sure how many of my readers even saw the first report  (Wonder if they tweeted it!).  In this report there were/was:

• Four cases involving employees’ use of Facebook where the Division found that the employees were engaged in "protected concerted activity" because they were discussing terms and conditions of employment with fellow employees. In five other cases involving Facebook or Twitter posts, the Division found that the activity was not protected. 
• One case where it was determined that a union engaged in unlawful coercive conduct when it videotaped interviews with employees at a nonunion jobsite about their immigration status and posted an edited version on YouTube and the Local Union’s Facebook page. 
• Five cases where some provisions of employers’ social media policies were found to be unlawfully overly-broad and an additional case involved an employer’s lawful policy restricting its employees’ contact with the media.

These cases aren't limited to healthcare, but they will be helpful as your organization's human resource department monitors it's policies with the rapidly evolving new media.  For more, visit a related post on social media risks.

By the way, does your organization's social media policy address managers "recommending" employees on LinkedIn?  Can you think of reasons why it should?

 

I am the patient experience!

What a great few days of learning it has been here at The Beryl Patient Experience Conference.  The video below sets the stage for how we healthcare workers are the patient experience.  Below the video are some key quotes/thoughts from the last couple of days.

• Empathy and compassion were key themes!
• Will Boomers push for combined physician and hospital bills - so they can understand better?
• Physicians weren't really trained to deal with patient fears!
• Decrease perceived wait time just by asking waiting ED patients, "How is your pain?" or "How is the wait?"
• It's not about meeting patient expectations, it is about exceeding them!
• The culture is driven by management systems and priorities... not workers or values.  What gets your leader's attention?
• Reshape expectations - as far upstream as you can!
• Healthcare is not a service industry, it is an "experience" industry.  The emotion (pain, stress, suffering) and mask of tragedy!
• A exceptional experience is magic, not a script!
• Happy employees make happy patients!
• Focus on what can't be measured - from Deming actually.
• Empathy, then the broken record.
• The strategy for engaging physicians is to:
  • engage as partners in planning the patient experience,
  • help them build their skills, and
  • develop and support physicians as coaches and team players.
• We need more courageous conversations in healthcare!
• The hospital is in the safety/security level of Maslow's Hierarchy.
• Check out the Critical Care Family Assistance Program guidelines from the American College of Chest Physicians

Patient Engagement & Their Experience: The Virtual Touch Points

My new collegues at Tower seem to like the fact that I envision and write about the application of technologies to improve the work that has to get done in hospitals.  Since my work is now focused on re-defining patient experiences across all touch points (physical and virtual), we created a paper that highlights opportunities to engage consumers and patients using technologies for an enhanced web experience.

Patient Engagement and Their Experience: The Virtual Touch Points was prepared just in time for this week's Patient Experience Conference and it ties my long-term passion for improving care for the benefit of our patients to the role of information technology.  

The paper explores the drivers for transforming the way healthcare organizations engage consumers, patients and their families and the web-based opportunities across the continuum of care from pre-admission through post treatment follow-up and across all departments.  It describes how virtual engagement can enhance patient experiences and satisfaction with provider encounters.  It also highlights the role of key technologies, such as, enterprise portals, social media, mobile applications, business intelligence and telehealth.

According to our CEO, Sue Sutton, RN, PhD, “It is important to address the needs of patients where they are in their experience and tie disparate information systems together to present a seamless interaction for patients and their family caregivers.  Providing access to self-management tools and creating opportunities to help enhance their encounters with the system contributes to more engaged and accountable patients.”

The team at Tower has helped expand my view of technology applications, which we all agree, is an important strategy to enhancing today’s patient experiences, as well as, contributing to more efficient business and care processes, better outcomes and lower costs.

Trusted Source: Certified Medical Apps and Products

Not long ago I referenced Continua in an interview about securing and optimizing iPads and don't believe I've included them in a blog post.  So, it is probably a good time to share a little more information.

Continua is a pioneer in establishing industry standards and security for interoperable connected health technologies such as smart phones, gateways and remote monitoring devices. They were established established six years ago with the mission to empower information-driven health management and facilitate the incorporation of health and wellness into the day-to-day lives of consumer.  Their 250 members represent companies from around the world; including Intel, Microsoft, IBM, GE Healthcare, and Cisco.

The risk manager in me recommends that apps be downloaded from trusted sources, so I was really pleased to learn that they are certifying medical apps, as well as, devices and services for personal health management and healthcare delivery. Their certification is granted to technologies that meet their guidelines and to date, 45 diverse products have been certified.  This includes weight scales, glucometers, and blood pressure monitors.  Their first Apple mobile solution enables developers to build custom health applications and connect with other certified personal health devices and facilitates integration with various interoperable servers to relay health information.

While there is no absolute protection, this is a good start!

 

Liking, following, linking, tagging, stumbling: social media is changing the nature of health-related interactions

Earlier this year I was invited by the eHealth Initiative to participate in a focus group for PwC Health Research Institute's newly released report entitled, “Social media likes healthcare: From marketing to social business.”  It included both consumer and industry surveys.

The report finds that social media activity by hospitals, health insurers and pharmaceutical companies is miniscule compared to the activity on community sites. While eight in 10 healthcare companies (as tracked by HRI during a sample one-week period) had a presence on various social media sites, community sites had 24 times more social media activity than corporate sites.

Highlights from the consumer survey found:

• One-third of consumers now use social media sites such as Facebook, Twitter, YouTube and online forums for health-related matters, including seeking medical information, tracking and sharing symptoms, and broadcasting how they feel about doctors, drugs, treatments, medical devices and health plans.

• When asked how information found through social media would affect their health decisions, 45% of consumers said it would affect their decision to get a second opinion; 41% said it would affect their choice of a specific doctor, hospital or medical facility; 34 % said it would affect their decision about taking a certain medication; and 32 % said it would affect their choice of a health insurance plan.

• As is the case more broadly, young adults are leading the social media healthcare charge. More than 80 % of individuals between the ages of 18 and 24 said they were likely to share health information through social media channels and nearly 90 % said they would trust information they found there. By comparison, less than half (45%) of individuals between the ages of 45 and 64 said they were likely to share health information via social media. But, keep in mind that 45% is a really big group of aging Boomers.

• Sixty-one percent of consumer respondents are likely to trust information posted by providers, and 41% are likely to share with providers via social media, compared to 37% trusting information posted by a drug company, and 28% likely to share information with a drug company.

Findings from the surveyed eHealth Initiative members include:

• Eighty-two percent said their organization’s social media efforts are managed by marketing/communications. Few organizations said their IT departments and digital teams owned social media strategies.

• One-half said they are concerned about how to integrate social media data into business strategy and processes. 

As I often advise, it is important to include a social media strategy in your hospital's plans for engaging patients and consumers.  The plan should include a balance of engagement on community and corporate sites, as well as, promote innovation for applying the technologies as solutions to clinical challenges.

Helping Patients Communicate More Effectively About their Health

I'm much more involved in patient engagement these days, so I'm really pleased to share some tools that will help patients communicate more effectively about their health.  We know that when patients become more actively involved in their own health, there’s a much stronger likelihood their health outcomes will be better.

"Questions are the Answer,” is a new public education initiative from the U.S. Agency for Healthcare Research and Quality (AHRQ), encourageing patients to have more effective two-way communication with their doctors and other clinicians.  The Questions website includes free educational tools for providers to use with their patients:

• A 7-minute video featuring real-life patients and clinicians who give firsthand accounts on the importance of asking questions and sharing information – this tool is ideal for a patient waiting room area and can be set to run on a continuous loop.  I'd also recommend adding the videos to your virtual patient waiting room (aka website or patient portal) with other resources.
• A brochure, titled “Be More Involved in Your Health Care: Tips for Patients,” that offers helpful suggestions to follow before, during and after a medical visit.
• Notepads to help patients prioritize the top three questions they wish to ask during their medical appointment.

 

Clinicians can request a free supply of these materials by calling AHRQ at 1-800-358-9295 or sending an email to AHRQpubs@ahrq.hhs.gov.

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