Reviewing the works of medical authors has been an enjoyable change of pace for me. While it did take me while to finish this latest book, it wasn’t for a lack of interest. Instead, it was needing to fit reading text into my schedule, rather than road-ready audio.
Dr. Alan Wyler, a neurosurgeon, was dead right on his newest medical thriller – Dead Wrong. It was full of mystery, suspense and a battle between good and evil, as well as, smart and not-so-smart, or perhaps, ego vs. a-bit-much-ego.
The setting is mostly in (or should I say “within”) a large academic medical center and there are plenty of peaks into the environment that some of us take for granted -- until we read about it in a fictional story. It also provides a bit of medical and technical education (I liked the stuff on X-ray/CT/MRI) and a bit of fantasy or futuristic science.
This book is certainly not a “chick” book, so men will like it along with women who don’t mind a bit of “man talk”. Anyone involved in medical ethics may find Dead Wrong stirring a bit of “what if” thinking and those with hospital security responsibilities will find some new ideas for their next facility risk assessment. There is also a great deal in this book for those who like to think about strategy and actions and/or counter actions.
But, perhaps most importantly (and costly) is that this story is a Risk Manager’s nightmare. It highlights the importance of really engaged patients, sound consent processes and enterprise-wide research oversight.
Share your thoughts about this or other books by Dr. Wyler by leaving a comment. Are there others of his I should read?
The holidays will soon be here and there may be the need for a little something for a family member, hostess or perhaps a gift for your boss or co-workers. Finding just the right thing can be challenging. However, if the recipient is a healthcare professional, embraces technology, is innovative and forward thinking, a book on social media and technologies might be just the thing you are looking for this holiday season. If so, consider one of the following two books by yours truly. The newest one, published by HIMSS is a collection of case studies and best practices. The second, is a high level overview of social tools published by ACHE.
If you have read either or both already, feel free to leave a comment with your feedback!
I recently set up a patient and family advisory council to address safety and quality concerns from the patient/family perspective. Creating an organizational structure that would fit within the culture of the organization has certainly been the easy part. We started with a six-month pilot and then evolved based-upon what we learned as we progressed through the process. However, this blog post isn't about that stuff. It is about what it like to sit in a room with patients and family members who want to share their experience to make it better for those who follow.
The first lesson is to prepare yourself to listenthat very first meeting. Emotions that have been simmering under a lid will finally come out and there may be a bit of splattering all over the walls. However, don't get defensive, don't try to explain why..... just listen. Before any really work to improve processes and quality can begin patients and their family caregivers need to have an opportunity to share their frustrations and know that someone who cares is listening. You may also see a little of this bleed into the second meeting, so don't panic. Gradually, the patients and family members will be ready to work toward shared goals.
The second lesson is to not be sosurprisedby the first lesson. Prepare leaders for the fact that it isn't just a "bitch" session, nor an example of how an advisory council was a big mistake in the first place. When there is no or ineffective communication with patients, the pressure will build and then it shoots out when there is finally an opportunity for release. Think of it as a hose with its nozzle finally opened.
The third lesson is to be prepared for some strong facilitation. All of that emotion needs to be managed and directed in a productive manner. It needs to be controlled so that everyone has a chance to be heard and weaknesses or gaps in processes identified. Re-direction and probing questions are two very important tools for gathering usable information.
The fourth lesson is to ensure there is follow-up and communication back to the advisors. Actually looking into making changes and implementing their suggestions will build trust and help keep the advisors engaged. Even if something can't be changed, because it violates a law, regulation or corporate policy, the fact that the idea was explored or the "reason why" explained will help keep advisors coming back.
The last lesson is to make sure you have real work for the advisors. The sharing of stories and talking will get old after a few meetings for both the advisors and staff. This is when the group is ready to transition to the real work of improving the quality, safety and experience of the healthcare. This workwill come from the key strategies that affect patients and from the stories the advisors share about their experiences. By listening, you will soon identify the work to be done by your patient and family advisory council.
Have you ever wondered which hospitals were the most social media friendly or how your organization compares with others? Or, have you wanted to benchmark your hosptial against peers, but didn't know where to find the data. Well, the list of Top 100 Hospitals for 2014 was recently released and it is a great starting point.
In this listing, only Facebook and Twitter stats were pulled to determine which hospitals are doing the best job of connecting with their patients through social media. Scores for each type of activity, with a total of 100 possible—50 for Facebook and 50 for Twitter were assigned.
While other social media platforms are important to note, their focus was on the two most common and widely used in medical communication. To see who made the list and their rank, go to http://nursejournal.org/articles/top-100-most-social-media-friendly-hospitals-for-2014/#sthash.xcRAhbt6.dpuf
Lately I've seen a few people questioning what patient engagement really is and asking if the term is over used. It makes me think about how shallow they must be. Then on LinkedIn I came across a simple quote that is a perfect answer to this question and it comes from Mr. Ben Franklin.
Now, for those of you who don't work with patients, it also applies to physician, employee, co-worker, volunteer, supervisor/leadership, and public engagement.
Over the years I've contributed articles to several publications, and often repeatedly, because we have built up a mutually beneficial relationship. As a writer, I think any of them will tell you I produce on time and the continuing invites seem to indicated my writing skills are good and there is something to what I have to say.
The latest of these partnerships is Multibriefs and my contributions to newsletters for several healthcare administration associations. (Perhaps you are a member of one of the associations and have already seen one of these articles.) One result of writing for someone else is that it cuts into the time I have for my own blog... thus you may have noticed recent infrequent posts.
By sharing links to my first four articles for Multibriefs, I hope that I will continue to maintain your interest until I re-balance and can acclimate to my new obligations. I also believe each has the possibility to stimulate some new ideas.
Every now and then I like to deviate from healthcare. Louisiana is usually my favorite deviation, but today it is the flag and Robin Williams interpretation of it. This post is a great reminder for all Americans, as well as, a tribute to the wonderful mind of a very funny man who also seemed to have a warm heart.
I recently saw this video on Facebook and have to share it on my blog. It is a humorous example of our need to attend to how healthcare professionals present themselves and the patient experience. It also highlights the need for self-advocacy by patients - that is to speak up and take actions to ensure one's safety.
This is for all of my friends and family in the Great State of Louisiana! Yes, people in Louisiana are generally happy. They are a bit laissez faire and let things take their natural course, just as the Mississippi river does. How can it not be a place of happy people when a common saying is "le bon tempe roule" or let the good times roll!
Lately I've been thinking about the fact that I'm not blogging as much. But really, I don't believe I'm blogging less.... just differently and on new channels. In the old days (2005 to 2011ish) my blog was my primary social media outlet and my other social media channels were supplementary and supportive. However, the times and technologies have changed and my toolbox has evolved.
I'm busy... so a tweet here or posting an image on Pinterest there is so much easier and faster than setting up a weblog post. As a result, my "collection" of digital content is now diversified across multiple platforms and better organized and this has helped me to actually expand my collections. The best example of this is my healthcare infographic collection on Pinterest. Another is my Twitter stream of all of those interesting bits of news and articles that really aren't worthy of a full blog post. An then there is my engagement with the people with whom I have actual professional relationships on Linked In. I'm also on Foursquare, but that is really only for me -- finding places when I travel or to see what people think about my clients.
As I reflect on my blog and other social media channels, I realize I need to do a better job of integrating all of my tools on my blogging platform to make it much more robust and a more accurate reflection of my social activities. Widgets will help with this and perhaps there are some better ones since I last looked.
What does this all mean? I think it means that we can expect our strategies to change overtime as the technologies evolve and help us increase our efficiency and effectiveness. I think we also need to recognize as we consider our metrics that less might actually be more --- because it is only different. This all points to the importance of annual reflection and its contribution to improvement - in our focus, strategies, tactics, measurement and performance.
So, when was the last time you reflected on your social activities? What are you waiting for?
For months I've been listening to books for leisure, but with this latest I'm back on to my professional interests. However, this one is also personal.
If you are involved in hospital, sub acute or SNF leadership or active with ethics, disaster planning or emergency preparedness in your healthcare organization, you need to read this book. You also need to read this book if you are a physician... or nurse.
During and after these five days at the hospital I know as Baptist (my dad worked in Central Supply and Purchasing many, many moons ago) there was great pain, suffering and difficult decisions. From hearing all of the "evidence" I must say it was all due to poor planning and unengaged leadership at the top. The lack of strong leadership lead to delays in response and recovery and scenarios that placed hospital employees in difficult positions.
I know, I wasn't there! However, several places along the way I know I would have made different decisions. For one, if I were CEO/COO/CFO I would have been present, continually assessing the situation and adjusting plans accordingly. I would NOT have just sat around and waited for the "government" to come and bail me out.
This book comes down to the ethical decisions that take place during emergencies and disasters including intentionally ending a life. It goes beyond the hospital staff to also include the community and political response and highlights the importance of having the most difficult conversations before disaster strikes
If you have read the book, do you believe each of key patients mentioned in this book were treated in a manner that would be deemed acceptable? Would you have been proud of these results had you been the hospital CEO? I think we can, and have, done better! Lets learn from the mistakes and not repeat them!
By the way, on the discussion at the end I believe a team should make the needed decisions on a case by case basis weighing the resources available and the risks. I also believe patients and families deserve an opportunity to contribute.
A few days ago, I tweeted yet another example of the ugly in healthcare social media. Once again, hospital employees accessed protected patient information and actually provided it to an ex-boyfriend. Result: the patient is now suing her ex-boyfriend and staff (including one nurse) at the hospital where she was being treated for a sexually transmitted disease after details in her records were placed on a Facebook page - Team No Hoes.
Then my husband sends me the story of an anesthesiologist who was, among other things, sexting and texting during surgical procedures. He has been suspended by his state medical commission because his preoccupations compromised patient safety.
I've posted on this a few times 2012 , 2013 to highlight the risks so that countermeasures may be implemented. This doesn't even include my list of examples I use in my presentations. My goal is to one day run out of this news to report.
The idea of a gun violence restraining order is being proposed in wake of the recent killings just off the UCSB campus and the warning signs that were fully recognized too late. The idea is that family and friends could seek a restraining order from a judge in an effort to potentially prevent violent individuals from buying or keeping guns. The judge, upon examination of all evidence and consideration of factors indicating risk of self harm or harm to others, would then sign an order temporarily stopping an individual from buying or possessing a firearm - and periodically reassess. This decision would create a clear path of action for police and judicial authorities to search for and confiscate weapons if they believe individuals could be a threat to themselves or others.
I have worked in healthcare for 35 years and some portion of this has been in acute psychiatric hospitals and consulting to community mental health providers. During this time, I've had to navigate the fine line between HIPAA/patient rights/laws and interventions in situations where there was only a perceived risk for escalation. After this most recent event I wondered if it was time to revisit the 5150 criteria of danger to self, danger to others or gravely disabled.
I do recognize that individuals who are truly intent on doing harm to others or themselves will likely be successful - ultimately. Thus, in some cases we must accept, learn from and move forward from unfortunate events. However, there are times when we could have done more - but public policy stood in the way. Each time these recent events and the investigations unfolded, we identifed missed opportunities to intervene and change the course that lead to death and destruction of lives.
Some Background Contributing to the Current Enviroment
During the Reagan Administration the mental health system changed dramatically. The vision was to de-institutionalize and provide services in local communities. It was a good idea, but unfortunately funding for the envisioned community supports did not materialize and community mental health is still trying to catch up.
During the Managed Care squeeze of the mid-1990's, benefits for psychiatric and chemical dependency (often self-medication of underlying psychiatric issues) coverage were slashed and denials for care from insurance companies were the norm. Parity (with medical care) was a huge debatable issue and still is a bit of a challenge today.
As a society, we don't lock people up as in the past and we have evolved, better understand, don't fear mental illness and respect individual freedoms. However, the evolution of the care delivery system needed to support mentally ill individuals hasn't kept up.
Role of Family (and Friend) Caregivers
We have been living with the regulations for involuntary holds for some time now. Unfortunately, too often family and friends have concerns and "suspiscions" and we say we are sorry but they "don't meet the criteria". Additionally, without some indication of risk at the moment, law enforcement is limited in their ability to look deeper into the situation.
In the medical world, we are recognizing the important role family caregivers have on helping the patient recover, minimize the risk of relapse, comply with their treatment plan and stay healthy. Families have always had this role with their mentally ill loved ones, but again public policy sometimes leaves them feeling helpless when they know in their heart and soul that things are really bad. Healthcare providers must be able to listen and act.
It is time to revisit the 5150 hold criteria and the triggers that demonstrate compliance and/or consider new approaches such as the gun violence restraining order described above. Either way, we do need to put a bit more faith into the insight that family and friends are trying to express. We must collect information from those closest to the patient and with all of the information make a more informed decision about the need for a 5150 or other intervention. We must also provide protections against HIPAA violations and address provider fears of violation so that professionals feel more comfortable speaking up and sharing relevant information when they have legitimate concerns.
I don't want want to limit our efforts to guns, because if you are mentally ill and dangerous, you will find a way to secure the tool(s) needed to carry out your plan -- guns, knives, cars, bombs, planes, screaming fire/bomb in a confined and crowded space or otherwise. This is about identifying those at risk for escalation and carrying out plans to destroy others and themselves and limiting their options to secure tools of destruction. Having said this, relying on acute psychiatric hospitalization before being placed on the list preventing the purchase/possession of a gun isn't enough when the pressures (especially reimbursement/payment) greatly limit hospitalization.
Continuing as we have means we need to recognize that it isn't a matter of if another one of these potentially preventable events will happen, but when, where and how. Please let me know what you think!