Christina's Considerations

Disruptive Behaviors in Healthcare Environments

I'd like to suggest that one important piece of health reform is the elimination of disruptive behaviors by healthcare professionals, because it ties in directly with transparency, adverse outcomes (quality & safety) and cost(s).  We need to educate and hold all of our leaders accountable for eliminating the barriers to dealing with unprofessional behaviors -- especially the politics.

The Studer Group has researched the impact of disruptive behavior by healthcare professionals and included an insert in the 2009 report on the Best Places to Work in Healthcare titled Creating Great Places to Work by Eliminating Disruptive Behaviors.   I've written a little on my experience at Speaking up, Staying put or Getting out  and the Joint Commission has two new leadership standards dealing with disruptive behavior.  Lets bring it all out in the open and deal with it so we can move on with the real work at hand - improving the quality and safety of care while reducing the cost.

H1N1 Public Service Announcements: California

The California Hospital Association has released some PSAs on H1N1 for children and adults in English and Spanish.  The PSAs feature hospital emergency room physicians who describe the typical symptoms of the H1N1 flu virus, as well as the warning signs of a more severe case of the illness.

Below is the adult English PSA.  Please visit the CHA website at http://www.calhospital.org/h1n1spots for the others..

  

 

Workplace Health and Wellness: H1N1

I've been monitoring the traffic to my posts and am happy to report that there are more searches for information related to "business" and "workplace".   Please visit my last post on business and workplace responsibilities.

I've posted on my concerns about obesity a few times (one example) and now it seems it is a high risk condition for the H1N1 flu.  This could be due to the existence of other chronic conditions like diabetes, or perhaps compromised lung function is increasing the risk of respiratory distress.

Even though the strain isn't so severe, be prepared for the impact on your business and encourage your employees to stay home and rest if sick.  They should call their doctor and/or go to the hospital if they are vomiting or have difficulty breathing.

Just having the flu isn't a reason to go to the emergency room!

Be aware and prepare at home and work!

Macro trends in possible healthcare legislation?

Mark Frisse shares his thoughts about some possible macro trends in healthcare legislation and I agree that these are needed and likely.  I especially believe there needs to be more dialog and a closer link between payer intermediaries and decisions at the point of care.  Too many layers and being too far removed increases the risk of undesirable outcomes.

The trends:

1. A shift from plan exclusion of pre-existing illness to controlling expenditures of covered members
2. Rising health care costs
3. More dialog between payer intermediaries and decisions at the point of care
4. More capitation and risk relationships with providers
5. More dynamic provider networks based on a variant of social networks and preferences
6. A shift in the delivery of health care services from physician-based practices to networks of clinicians with varying skills practicing in a wider range of accessible settings
7. A shift in "ROI" from short-term return to long-term value
8. A shifting responsibility from intermediaries to individuals
9. Administrative simplification
10. Pricing and quality transparency

How 'bout them Saints?

I've been watching Manning quarterbacks for many years and really enjoy the games of the two younger ones.  However, when it comes to a Manning vs. the New Orleans Saints, I'll always choose the latter.

We are off to a great season with today's win!

Do hospitals need to enter the world of social media?

I've been following Tony and Hospital Impact for several years now and it is great to see he is having success with the contributor format.  One of his contributors posted on whether hospitals need to enter the world of social media and I'm sharing it because it is yet one more voice on the subject and a nice example.

For those of you who want an example of what people are posting about the hospitals in their community visit the link to GWU Hospital Horrible.  I wonder if GWU knows about the post! 

Most Severe Cases of H1N1

The SBCPHD has a new press release that includes some stats I'd like to share.

• Over half (58%) of the 26 Santa Barbara County residents hospitalized with complications of H1N1 since late June were younger than 19 years old and 75% of those placed in intensive care units due to H1N1 complications were 16 or younger.  To date, the only death in the County has been a teenager with multiple medical conditions.
• Pregnant women are at increased risk of complications and death from the H1N1 flu and nationally, over 25% of pregnant women who were hospitalized for H1N1 flu have died.  Although the actual number is relatively small (28 as of 10/1/09) the concern is great.

H1N1 Most Severe Press Release H1N1 Most Severe Press Release -- Spanish

Please prepare to limit the risk to your family by being aware of the symptoms outlined and taking steps to reduce the risk of exposure.  If you do get sick, call your doctor or a clinic. 

Po boy's & Muffuletta's

Leidenheimer has been making bread for po boy's and muffuletta's since 1896 in New Orleans and I've been missing their french and muffuletta bread.  So, I went online and found their site and want to share a little lagniappe with my readers.  In addition to being able to purchase these two unique breads, you can also download a Po boy Screen Saver.  What I don't understand is why the po boy's are not dressed!

I just can't imaging eating a soft shell crab or oyster po boy that isn't dressed!  Can you?

Where Healthcare Workers Work

Hospitals and Health Networks Magazine had a great diagram and article summarizing where healthcare workers work in their September 2009 issue.    I'm sharing it here because it also demonstrates the communication needs that we hope to address with health information exchanges. 

Think of the patient who visits their family physician and is referred to a surgeon for an outpatient surgery and is referred to the hospital for further treatment based on some pathology findings.  At discharge the patient is referred back to the surgeon and family physician for follow-up care and to a home health program, or possibly a skilled nursing facility, for support during their ongoing recovery period. 

It will be really great when each of these providers can easily access the patient's records without waiting for the copy service or courier to deliver constantly changing paper records to multiple sites.

Santa Barbara County H1N1 Information Line

If you live or work in Santa Barbara County and have questions about H1N1 flu (swine flu) you can call the Public Health Department Information Line (1 888 722-6358) and speak with a nurse in English or Spanish.  For more information about the information line or to review or post the press releases go to:

2009-10-07 H1N1 phone line

2009-10-07 H1N1 phone line (Spanish)

H1N1 Flu (Swine) and Santa Barbara County

We had our first death from H1N1 flu this week here in Santa Barbara County -- an adolescent girl with complicating factors.  I've also noticed a lot of traffic to my recent posts on H1N1 Awareness and Prevention Materials and Educational Materials for Teens and Young Adults. 

While the traffic to these posts is great, I'm not seeing much traffic to my posts on Is your business prepared for the 2009 flu season or Business Preparation for a Possible H1N1 Outbreak.  Given a recent conversation, I suspect that my community's businesses (especially small ones) will not be a prepared to respond to the impact of a significant H1N1 event.  And, this may be true for your community, as well.

Hospitals and other healthcare and first responders have been preparing for months, but we still need the business community to help keep our local and national infrastructure moving forward.  We have chosen a capitalist economy, so that means we can't expect the government to be there to provide all of the services we now receive from businesses this flu season.  Just as we expect our government and healthcare communities to prepare, we should also be expecting our business leaders to fulfill their responsibility to prepare for disruptions and minimize the risk of an adverse impact on our daily lives. 

Hospitals and healthcare providers will only be able to accommodate the expected surges if the business community understands the importance of their role and is prepared to take definitive steps to continue to providing essential services, equipment and products needed for daily living. 

My recommendation:  ask the businesses you frequent and your business partners how they have prepared for a significant H1N1 event.  If they don't have an answer, prepare to obtain your food and essential supplies and services from businesses that have a plan.

Health 2.0: Social Media Book for Administrators

I'm on jury duty and missing the Health 2.0 Conference in San Francisco and wish all of the attendees stimulating conversation and a great conference!

As an update, my book on use of social media in healthcare is undergoing a round of revisions now that it is in production.  The book provides an overview of the various forms of social media and social networking tools and their application in healthcare environments and offers a review of best practices from around the US.  It will be published by Health Administration Press and is necessary reading for any hospital administrator and others in the C-suite.

If you want to learn more, feel free to leave a comment or contact me via email

Cross-Enterprise Document Sharing and PHRs

My writings are sometimes cited in the work of others in an effort to build upon our collective knowledge.  The most recent example is a study titled Using Cross-Enterprise Document Sharing protocol to build the prototype of Personal Health Record Systemby researchers from the National Yang-Ming University. 

The authors believe the idea behind a PHR is that the individual should take care of his or her physical condition, rather than leaving it to healthcare providers.  The paper seems to start a conversation and I'm interested in what my readers have to say about the study.