Christina's Considerations

A Culture of Safety in Hospitals and the CEO's Role

I prepared a handout for a recent HCESoCal educational/networking event and I'm sharing it here, because I really believe it is important for truly effective healthcare leaders.  

Quality and safety do rise out of the culture of the organization and ownership for creating it is the responsibility of the leadership team.  But, the CEO's desk is where the buck stops.  And, the governing body is reponsible for the oversight to ensure that the roles and responsiblities are carried out in accordance with their policy.

Core Organizational Infrastructure Components[i]

 A Culture of Safety

• Plans for Managing Risks and Maintaining a Safe and Secure Environment of Care (Hazardous Materials/Waste, Fire, Medical Equipment, Medical Gases, Utility Systems, etc)
• Collecting Information, Monitoring Conditions, Analyzing Issues and Improving the Environment of Care
• Integrated Patient Safety Program (National Patient Safety Goals, Staff Competency, Infection Control, etc)
• Emergency Management (Hazard Vulnerability Analysis, Emergency Operations Plan, Communications, Managing Resources/Security/Safety/Staff/Patients/ Volunteers/Utilities, &Testing/Exercises)
• Life Safety
• Communication (Between leaders and to those who need it, including staff, licensed independent practitioners, patients, families and external interested parties.)

The Healthcare Executive’s Role[ii]

Guide an organizational culture dedicated to improvement, focusing resources on the structures, processes and monitoring systems that will ensure patients receive the care they need without risk of harm.

Equip board with tools and information to provide appropriate oversight of the patient safety/quality strategy

• Involve the entire executive leadership team in the patient safety/quality strategy
• Engage the medical staff as meaningful partners in the development and implementation of the patient safety/quality strategy
• Develop processes to hear the voices of patients and families and applying their input in the design and improvement of care processes.
• Cascading a patient safety/quality orientation throughout the organization
• Develop a culture of improvement that includes an organization-wide commitment to continuous learning.
• Rigorously seek out and apply best practices.
• Provide open communication and demonstrate a commitment to transparency
• Adopt information systems that support the patient safety/quality strategy
• Encourage organizational involvement in voluntary collaborative

 [i] Joint Commission 2011 Acute Care Standards, Revised December 2010.

 [ii] The Healthcare Executive’s Role in Ensuring Quality and Patient Safety, ACHE Policy Statement, November 2008.

 

Feel free to download the actual Healthcare Safety Program Handout. 

Also check out the article The Patient Safety Team: Healthcare Executives Embrace Their Role, which highlights the impact that transparency is having on moving safety to the front burner. 

Affordable Care Act Videos Educate Consumers

The Robert Wood Johnson Foundation has a series of brief animated videos that address the key concepts of the Affordable Care Act (ACA).  These are really high level, concise and aimed at consumers.  Topics covered include:

• Insurance Exchanges
• Medicaid Expansion
• Medicare Part D Donut Hole
• Market Reforms
• Cost-Sharing

We still have a way to go to work out some of the details of implementation to reach these ideals.  In the meantime, these videos help explain the ACA and consumer responsibilities - because we all have a stake in this.

5 Basics for Any Hospital Social Media Plan

I was recently interviewed for an article in Beckers Hospital Review about the basics of any hospital social media plan.  There is so much to consider and the plan does need to evolve as time goes on, but the following are great as starting points.

1. Assess the hospital's readiness

2. Experiment

3. Start small and go slow

4. Create dialogue among disciplines

5. Monitor analytics

Oh, and if you are wondering.... a social media policy is a given!

If you are still wondering if hospitals should even use social media check out this white paper that includes a great list of applications by purpose.

 

NOLA Medical Surge

I spend a fair amount of time thinking about medical surge in Santa Barbara County, so I can't help but notice what other communities are doing when it comes to disaster planning and response.  

A game at the Superdome is certainly a good reason to bring out this medical surge unit and they are supported by at least 10 EMS/triage stations inside and outside of the dome.  NOLA does experience a high number of alcohol/drug related hospitalizations and I can only image how many occur in and around football games.  In addition, there are always routine emergency needs and the risks associated with a large number of people in an enclosed space.

If you like this kind of stuff, check out my post from this past summer that highlights the USS Midway's Hospital.

A Tale of Two CPOE Implementations

My latest article for HIT Exchange is on the subject of CPOE implementation. To review this and other articles on CPOE check out the digital edition of the September/October 2011 issue. 

 Tale of Two CPOE Deployments

Moving from Transaction to Engagement

Think of the nine characteristics of engagement systems described in this article along with health information technology.  Moving from Transaction to Engagement - R “Ray” Wang - Harvard Business Review.

1. Design for sense and response.

2. Address massive social scale.

3. Foster conversation.

4. Utilize a multitude of media styles for user experience.

5. Deliver speed in real time.

6. Reach to multi-channel networks. 

7. Factor in new types of information management.

8. Apply a richer social orientation. 

9. Rely on smarter intelligence. 

I've spoken about how I see social media technologies being integrated into EHRs; especially to address some of the meaningful use criteria.  So it should be no surprise that I agree with Professor Wang that experiential and personal fulfillment systems will power the next waves of innovation.

Mobile Medical Applications Survey

The latest HIMSS Vantage Point survey is on the subject of mobile medical applications.  I find the listing of areas in which clinicians use apps  to be reaffirming of my recent comments on the best hospital apps in an article.  

I am a bit surprised that 34% of respondents said there is too much regulation.  I'm not sure I agree with this statement, at least not yet.  This is such an early point in the evolution and we do need to exercise care and cautious application, especially when use of the apps effects diagnosis and treatment decisions.

I do believe the FDA and others are working to improve the approval processes.  So, the risk manager in me would say we have the appropriate level of regulation.

Rural Hospitals Behind the IT Curve

A study published in the Journal of Rural Health finds that rural hospitals lag behind urban institutions in nearly every measure of meaningful use; and the differences are particularly large and significant for CAHs.

CAHs are especially challenged by the meaningful use incentive system, because:

• investments are evaluated and subsidies determined after adoption. This means CAHs must accept up-front financial risk which may be particularly difficult for large expenditures.
• the subsidy amount may be low for relatively small expenditures, which are more common in smaller hospitals. 
• subsidies are based on observable costs, so CAHs will receive no support for their intangible costs (eg, workflow disruption).

Data presented includes:

• only 4 of the measures examined have been met by a majority of rural hospitals: electronic recording of patient demographics and electronic access to lab reports, radiology reports, and radiology images. 
• 5 % of rural hospitals and only 3% of CAH could demonstrate meaningful use of an electronic health records system as required by the Center for Medicare and Medicaid Services' (CMS) criteria. 

As we all know, just having health information technology (HIT) or an electronic health record (EHR) doesn't mean we automatically have meaningful use.  Therefore, implementations at rural hospitals will require leaders to identify someone in the facility who can navigate the technology, fully apply it in the patient care environment and share their learnings with others to bring the clinicians along toward meaningful use.

 

Mobile Medical Applications Survey

The latest HIMSS Vantage Point survey is on the subject of mobile medical applications.  I find the listing of areas in which clinicians use apps  to be reaffirming of my recent comments on the best hospital apps in an article.  

I am a bit surprised that 34% of respondents said there is too much regulation.  I'm not sure I agree with this statement, at least not yet.  This is such an early point in the evolution and we do need to exercise care and cautious application, especially when use of the apps effects diagnosis and treatment decisions.

I do believe the FDA and others are working to improve the approval processes.  So, the risk manager in me would say we have the appropriate level of regulation.

Preventing Surgical Fires

The U.S. Department of Health and Human Services’ Food and Drug Administration (FDA) and its partners have launched an initiative and website to increase awareness of factors that contribute to surgical fires, to disseminate surgical fire prevention tools, and to promote the adoption of risk reduction practices throughout the health care community. Resources and tools  available for hospitals, surgery centers and other providers include posters, checklists, educational videos and information for patients.

Physicians and HICS

Here is a nice blending of two of my worlds. This YouTube video (social media) is a great training tool for physicians who may be called upon to fill a hospital incident command system (HICS) role (disaster preparedness & response), such as, the medical/technical specialists.  If you experience challenges getting your physicians to your hospital's training, or just want a different tool to reinforce of key points, consider this video.

 

Thanks Stanford Hospital and Clinics and Lucile Packard Children's Hospital!

 

Social Media Trolls and Customer Unlikes

I came across a couple of blog posts that address some of the more uncomfortable social media issues, so this post goes along with my firm belief that we should always explore the good, the bad and the ugly. Because, that is how we can truly improve!

Ragan's Healthcare Communication News brings us a really good guide on responding to ill-tempered trolls who hide behind anonmity to make online attacks at others.  Think about it... would some of these people use the same words and tone if they were speaking to our face or if we could identify them?  Probably not.  

The Huffington Post believes this is just the way it is, but I'm one of those who believes we should mature and put our names and virtual faces to our comments.  Otherwise, I can't really trust what the person leaving the comment is sharing - and this goes for overly good or bad comments.  As for ugly, there isn't really a need for this.

The second post comes to us from the Harvard Business Review Blog Network and is about social breakups.  Brands are flocking to engage with consumers on social media, but some have missed the point about engagement and building virtual relationships. Too many brands are confusing their social media campaigns with just another billboard opportunity to throw information out.  They will soon find they are being dumped by consumers who aren't interested in the noise and flood of irrelevant and uninteresting information.

Since we are on the subject, I also want to throw in some personal branding advice because I've already dumped one LinkedIn connection and am about to dump two others.  The reason, too much, irrelevant and un-interesting information being sent out as LinkedIn updates.  My guess is that these individuals have their Tweets also going out as LinkedIn updates.  The result is I can't see what my other connections are up to because my tweet deck is full of noise from a few.  Since I can't shut of their updates and still be friends, they may soon find themselves as being dumped.  (And, one is suppose to be a social media "guru"!)

My advice is to be considerate and thoughtful when you are setting up your social media settings, otherwise you put your virtual reputation at risk.  Remember, managing your in-person and virtual reputation is a must.

And one more thing...  :)

For those of you who have stuck with me as this turned into a vent, I share some perhaps really important social media risk management advice.  If you are a provider, be very careful placing offers to promote your services on Groupon or even FourSquare. Fierce had an article not long ago on how deep discounts on clinical services could create some anti kickback troubles for physicians, hospitals and other providers.  I think a discount in the gift shop or dining room is a great thing, but beyond that ... speak to your attorney first.

Social Media and the CEO

I've received Chief Executive Magazine for a few years and have seen a few articles about social media and networking.  But today, they sent me their new white paper, CEO's Guide to Socal Media: What Every CEO Needs to Know about Social Media.

It is a really great overview for any CEO, including those who are responsible for healthcare organizations. (But, hopefully you are also reading my book.) If you only read one part, read #1 Internal communication and private social networks.  Maybe this will help some of you adopt more flexible work schedules and allow some employees to leverage today's technology to work remotely - at least part of the time.

I also agree that we are starting to see a shift from "social media" to "social business".  In our case, that means "social healthcare".  So read on and leave a comment with what you think about this white paper.

You may also be interested in their papers on the cloud and mobility - both interrelated with social media.

Rural Healthcare: Increasing Access to Physicians and Technology

In August, the Obama Administration announced a new jobs initiative for rural America that includes investments focused on increasing access to capital, job training and health care services.  Healthcare leaders with an interest in increasing rural access to physicians and technology will want to watch as this initiative is rolled out.

• Increasing Physician Recruitment at Critical Access Hospitals: HHS will issue guidance to expand eligibility for the National Health Service Corps loan repayment program so that Critical Access Hospitals (those with 25 beds or fewer) can use these loans to recruit new physicians. This program will help more than 1,300 CAHs across the country recruit needed staff.  The addition of one primary care physician in a rural community generates approximately $1.5 million in annual revenue and creates 23 jobs annually.  The average CAH creates 107 jobs and generates $4.8 million in payroll annually.

• Expanding Health Information Technology (IT) in Rural America: USDA and HHS will sign an agreement linking rural hospitals and clinicians to existing capital loan programs that enable them to purchase software and hardware needed to implement health information technology (HIT). Under current conditions, rural health care providers face challenges in harnessing the benefits of HIT due to limited access to capital and workforce challenges.  Rural hospitals tend to have lower financial operating margins and limited capital to make the investments needed to purchase hardware, software and other equipment. 

I guess one of my first questions is whether this initiative will help facilitate access to specialist physicians via telemedicine.

Social Media and the Nurse

The ANA has come out with their Principles for Social Networking and the Nurse and also taken it a step further by creating a Toolkit with materials to help educate staff.  If you are a nursing leader, I recommend getting a copy and incorporating it into your organization's policies and guidelines.  

The principles are important to any nurse, so I also recommend using the toolkit to educate nurses, students and the organization's leadership.

I also read The Dos and Don’ts of Social Media for Nurses at Nurse Zone and think Jennifer has some good advice.

 

Update: 1/20/12

The NCSBN has also released new social media resources and guidance for nurses.

A Nurses Guide to Social Media

Brochure

California Society of Healthcare Attorneys

In a few weeks, I'll be attending the annual California Society of Healthcare Attorneys Fall Seminar and speaking on Social Media.  That means I'll have an opportunity to ask questions and even plant some ideas in their minds.

If any of my readers have a question that you would love to ask a healthcare attorney about social media legal issues, or you want me to carry a message to them, please leave a post here.  The session will be interactive, so I look forward to sharing anything I learn back here on my blog.

If you are interested in attending, visit the Society's site for program information or the brochure.

If you are interested in what little information I've found on the subject, visit my earlier post Social Media:  Law and Risk.  I also have links to a great ethical discussion on Bloggers and Social Media Risks

Critical Care 24/7

I've been fortunate to have learned so much about telemedicine over the last several months and see value in its application in multiple healthcare settings.  Health Management Technology invited me to share my thoughts on the subject of telemedicine and I chose to highlight the value with two high volume and potentially high cost conditions - sepsis and stroke.

Critical Care 24/7  will hopefully spark interest thought in by healthcare leaders who may be challenged with these patients.  

Thank you Dr. Rogove for helping me to understand the value of staff access to intensivists via telemedicine for more aggressive treatment of sepsis.

eMagazine version.