Christina's Considerations

A Challenge of Ethics on Facebook

Ben Dillon has posted on a truly difficult ethical situation shares the story on GeoVoices. It involves a mom who blogs on the challenges of raising a child with a genetic defect and this naturally attracts a sympathetic following.  

The mom's posts include her disappointment over being told hospital nephrologists have denied a kidney transplant for her 3 y.o. daughter, because of her genetic defect - which is also known to cause mental retardation.  We don't know the actual reason for the denial, but the family believes it is because of the child's mental retardation and this is shared in the mom's blog posts and it ultimately made it's way to traditional media, including the Washington Times.

 

The result is that the hospital's Facebook wall now includes passionate pleas to reconsider the decision. Like Ben, I believe Children's Hospital of Philadelphia (CHOP) is appropriate in their handling of the social media aspects of this truly unfortunate situation.  It should be a guide to others.

• CHOP is carefully avoiding any discussion of the patient’s case or health situation and remains respectful of the opinions and feelings of everyone engaged in the discussion.
• They appear to be leaving all visitor posts on their page - the good and the uncomfortable.
• CHOP has issued a statement acknowledging that they are listening and reiterating their policies, values and history as relates to this issue. 
• CHOP and the family have issued a joint statement on Facebook as a result of the significant public interest.
• The organization is discussing the issue with the family offline.

 Let's all say a prayer for the child and her family!

Reach Out To Consumers, Measure & Control Your Domain

Not long ago, I read an article reporting that 1 in 5 Americans are using social media for healthcare information.  It made me wonder if hospitals are calculating their market share -that is, the portion of those info seekers in your service area(s) who are accessing online information sponsored by your organization, rather than that of a competitor or sites that may have questionable trustworthyness.

Then, over the weekend I picked up on a tweet about efforts to smack down ROI.  Basically, some in social media, not necessarily in healthcare, are promoting an anti-measurement agenda.  My feeling is that we in healthcare must measure our performance.  If it is important that we measure for evidence-based medicine, outcomes, patient satisfaction, compliance with regulations, improving quality and performance, managing risks, reporting, effective and efficient use of resources and more; then it is important that we measure the performance of our social media applications.

So this takes me to actually leveraging the technologies and learning to use social media in our healthcare environments and a couple of new resources that can help us all keep up with the rapidly evolving world of social media.

While at HIMSS last week, I came across two new social media white papers.  The first is the Health IT Social Media Primer from HL7 Standards.  It answers questions like "what do I need to know?" and "what should I tweet?", presents some important "how to" details and also reviews newer social media channels like Google+ and Quora (a question & answer forum). 

The second is a new white paper from the HIMSS Social Networking Work Group, Healthcare "Friending" Social Media:  What Is It, How Is It Used, and What Should I Do?  It also reviews recent social media developments, but I found the reference to there being 787 hospitals on Foursquare, but less that 10% having claimed their listing to be most interesting.  It reminds me of the teen patient who started a Facebook page in his childrens hospital's name, so he and the other patients could connect and support each other anytime.  

I was also happy to see that the HIMSS workgroup included the example an HIO delivering virtual education for electronic health information exchange (HIE).  And, I can't be more pleased that they also referenced my work. The topical review is publically available.

So, hospitals, do me a favor and:

• do reach out to the growing number of healthcare consumers searching for healthcare information from a trusted-source.
• do measure the performance and impact of your social media activities.
• don't let others control your domain name and brand.

Protecting Workers Against Violence is Worth the Cost

I was recently interviewed for an article in Healthcare Finance News about the cost of protecting workers against violence.  It came about because of a ANA survey  looking safety concerns in the workplace and the report that healthcare facilities are not doing enough to keep nurses safe.  While we often think of the hospital, workplace violence can, and does, also occur in nursing homes and ambulatory or private practice settings.

Healthcare worker violence is an issue related to security, which falls under the broader umbrella of hospital safety.  From a general standpoint, healthcare security is important, but competing priorities sometimes get in the way of organizations doing more to secure access to the facility or expend additional resources on training.  Most hospitals and some other healthcare settings do have security staff.  However, security staff can't be everywhere at once and just adding more isn't always the best answer.

The best person to identify when something isn't right (a safety or security risk) in their environment, is the person who works in that environment on a daily basis.  The result is that we must rely on employees and others in the organization to notice and report any suspicious behavior and to be more defensive in their contact with patients, families, visitors and even other staff.  Unfortunately, as an industry we have tried to create warm and inviting environments for the public and healthcare workers have historically been too caring and trusting.

The risks to employee (and patient) security and safety are continually evolving and expanding.  I believe our healthcare organizations must create policy that mandates reporting of any suspicious behavior, threats, and/or violence.  But, they should also create a culture where staff feel safe in doing so.  Organizations can also do more to educate their employees of the evolving risks and help them gain skills to identify risks and respond to difficult situations. 

As it relates to our patients (or their families), they are sicker than they have ever been before and unfortunately the ER is sometimes used as a dumping ground for individuals who belong in other settings.  We need to help our staff become better at identifying threatening behavior sooner and support them with response from other clinical or security staff.  Our organizations also have to develop strong relationships with law enforcement and other community leaders to address concerns as they arise.

As for the investment cost of security ... it is so much less than poor employee morale, high turnover and absenteeism rates, negative media coverage, investigations, fines, litigation, worker's compensation claims, and higher insurance costs. But, keep in mind that a balanced approach is best.

Another one of my posts that addresses the culture of safety and the CEO's role may also be of interest.

Health Literacy Resources for Pharmacies

The AHRQ has released resources to help hospitals address Pharmacy Health Literacy; the degree to which individuals are able to obtain, process, and understand basic health and medication information and pharmacy services needed to make appropriate health decisions. 

The tools present an opportunity for hospital pharmacies to improve their patient experiences and outcomes because:

• Only 12% of adults have proficient health literacy (e.g., can interpret the prescription label correctly).
• Medication errors are likely higher with patients with limited health literacy, as they are more likely to misinterpret the prescription label information and auxiliary labels.
• Studies document an association between low literacy and poor health outcomes.

This is important because:

• Pharmacists are responsible for making sure patients obtain the maximum positive health outcomes from their medications.
• Pharmacists care for patients with low to high education levels, low to high incomes, and multiple races of people; all of whom may have limited health literacy.
• Medication errors are likely higher with patients with limited health literacy.
• Studies document an association between low literacy and poor health outcomes.
• Pharmacists are one of the most accessible health care providers.
• Addressing literacy is an important quality improvement effort because it ties to an organization's HCAHPS scores and will ultimately impact reimbursement.

The Pharmacy Health Literacy resources include tools to address staff communications and conduct health literacy assessments using the Facilitator's Guide for Patient Focus Groups.  It also includes a Health Literacy Assessment Survey of pharmacy staff "How Health Literacy Friendly Are We?" for some self-reflection.  The staff survey covers an assessment of print materials, verbal communications and sensitivity to literacy.

Stage 2 Meaningful Use Has Arrived

The Notice of Proposed Rulemaking (NPRM) for Stage 2 meaningful use has been posted and it outlines the next stage of meaningful use for the Electronic Health Record (EHR) Incentive Programs, which are administered by CMS. 

The Office of the National Coordinator for Health Information Technology's (ONC's) NPRM was delivered to the Federal Register on February 22 at the same time as the CMS NPRM, and the policy is finalized. Additional news about the ONC proposed rule will be released once it is posted and the rules will publish on the same day.

CMS has developed a fact sheet to give providers an overview of the rule and how Stage 2 expands upon Stage 1 of meaningful use. 

I'm co-chair a workgroup for HIMSS to prepare comments related to governance issues in the NPRM. I'll also contribute to an American Telemedicine Association group review.  So, feel free to share any issues that you see. 

To learn more about meaningful use visit the CMS EHR Meaningful Use Overview web page.

HIMSS So Cal Healthcare IT Conference

Just as I'm getting ready to experience the big HIMSS Conference, the Southern California Chapter has released its agenda for their upcoming Healthcare IT Conference in Los Angeles.  

The conference is a great opportunity to hear from National and California leaders on HIEs, EHRs and Meaningful Use, wireless health IT applications, development of the HIT workforce and job search strategies, and accountable care organizations. It is also a perfect networking event.

I'm excited for the opportunity to return to my roots in Health IT and participate on the HIE panel. Register here to join us at the Center for Healthy Communities at the California Endowment near downtown Los Angeles on April 4, 2012 from 8am to 4pm.  I hope to see you there!

Caring for the healthcare givers!

Not long ago I posted on a shocking example of un-compassionate healthcare.  An agency employee made fun of and posted a picture of the patients medical records on his Facebook pages.  Worse, he refused to see is error or accept responsibility for violating the patient's rights and privacy.

So, last week I ran into a friend of mine who is the Executive Director of Adventures in Caring Foundation, a nonprofit organization that cultivates and teaches compassion in healthcare. Their volunteers visit hospital and nursing home patients and are often undergraduate students who will pursue a healthcare career. They also teach and train staff on delivering compassionate care and having those difficult conversations.

We discussed this shocking example of un-compassionate care and wondered if it is possible that this employee isn't managing their stress -- leading to poor judgement and actions.  In other words, is this employee letting the pressures of caregiving and life wear him down to the point that he exhibits self-destructive behaviors?

I'm especially interested in the thoughts of those of you in direct care roles, or who work and support caregivers.

Shift Bidding and Staffing the Unit

I had been seeing @MatthewBrowning on my TweetDeck and then realized we were on the HIMSS12 mHealth Meet the Bloggers panel together.  After our prep call, Matthew tweeted that he wanted to have a follow-up discussion because of some of our shared interests.  

Earlier this week, during our call, he described how he is using texting and microblogging technologies to help efficiently find nurses and other professionals to staff shifts.  Having seen nursing supervisors go through this daily pain first-hand, I can attest to the inefficiency of the process.  

In 2009/10 while writing my book I included staffing/shift bidding as one way of applying microblogging technologies for operational purpose.  Next week, @MatthewBrowning will demo YourNurseIsOn.com for me so I can actually see the idea in action.  And, this is what HIMSS is all about!

For more info review YNIO's Fact Sheet.

Californians’ Attitudes and Experiences with Death and Dying

A recent survey findings of Californians shows that patients and physicians not discussing end-of-life care.  Key findings include:

• About 80% of Californians said they would want to discuss end-of-life care with their physician if they had a serious illness.
• Only 7% said they have taken part in such a discussion, including only 13% of residents ages 65 and older.
• 82% of respondents said it is important to have their end-of-life wishes in writing, but only 23% have drafted such a plan.
• 70% of respondents said they would prefer to die at home, but only 32% have made such arrangements.
• About 66% of respondents said they would prefer a natural death if severely ill, and only 7% would want health providers to take all necessary measures to prolong their lives.
• 44% of those who recently had experienced the death of a loved one said the person's end-of-life care preferences had been followed completely by health care providers.

Dr. Gawande stated it perfectly in his New Yorker Article, "modern medicine is good at staving off death with aggressive interventions - and bad at knowing when to focus, instead, on improving the days that terminal patients have left."  

Healthcare leaders may also be interested in the ACHE policy on decisions near the end of life.

Social Recruiting Activity Report

A new report Social Recruiting Activity Report from Bullhorn examines the activities of recruiter use of social media for executive and job recruiting and it reveals that LinkedIn drives more views than Facebook and Twitter combined.  And, recruiters that post jobs on LinkedIn are likely to receive more applications (9 times more than Facebook and 3 times more than Twitter).  

Other interesting data includes:

• Median number of network connections per recruiter are 616 for LinkedIn, 245 for Facebook & 37 for Twitter
• Average number of connections added per week by network are 18.5 for LinkedIn, 3.1 for Twitter & 1.5 for Facebook
• It will take less time for recruiters to double their network size on Twitter (2.7 mos) & LinkedIn (7.6 mos) than Facebook (33.9 mos.)

The reports authors and I both believe we will see an increase in use of Facebook and Twitter over time, but it may be a bit slower for conservative healthcare leaders.  So, for now invest your time in LinkedIn.

For those of you who are considering or preparing for a career in health management, visit the resources on the ACHE webpage for students, those in transition and career counselors.

 

Mobile Governance

The executive summary of the HIMSS Mobile Technology Survey report had a somewhat alarming statistic -- only 38% of respondents noted that they have a mobile technology policy in place that regulates use of mobile devices and outlines the organization's mobile strategy.  I'm not so surprised, because it is a bit of déjà vu with social media policies. But, this does bring up the need for more attention by healthcare leaders to mobile governance.

While use and strategy are important, an organization's policy should also address data security and safeguards to minimize the risk of breaches and the release of PHI.  A recent study from CompTIA revealed that one-third of healthcare providers are already using mobile devices to access EHRs (and the PHI contained within).  And, not too surprisingly, another survey  found that medical residents are more like than established doctors to use smartphones for clinical purposes.

The result is an environment ripe for unintentional consequences. I addressed some mHealth governance and policy considerations in a previous post on tablets and revisit them here, as well.  

• Explore the availability of mobile technologies in their environment (and ecosystem) to identify any risks.
• Determine whether the risks can be managed -- allowing patients, employees, providers and others to realize the value and benefits offered by application of the new technology.  
• Balance usability, preferences, security, & budgetary concerns
• Explore mobile security and mitigation considerations then develop and clearly communicate the organization's policies. (specific policy considerations are detailed in the full post)

Beyond EHRs and other data systems, more and more doctors are engaging with patients through social media platforms - which are hard to separate from mobile devices. And, any healthcare professional can easily use apps to upload PHI - think DropBox!  This points to the importance of including social media considerations in your review of mobile technologies.  It is also another friendly reminder for those of you who haven't already created your organization's social media policy; to do so.

 

Social Media: Doesn't Fix a Poor Recruiting Strategy

I love this blog post from Alan at Human Capital Institute titled Social Medical Will Not Make Up for a Poor Recruiting Strategy.  Social media (simply a tool) also can't and won't make up for a poor marketing, outreach, communication, engagement, or any other strategy.

The post does recommend that you identify the following for creating an effective recruiting strategy.

• What – what is the ultimate goal? For example: hire 8 accounting staff
• Why – Is there a skills gap that needs filling? Is the company expanding and in need of more staff? Why is this important to the organization?
• Who – Who does this involve? The hiring manager, the recruiter, and the desired candidates (define experience, compensation range, etc.).
• Where – Where will these new hires work (corporate office, telecommuting)? Where do desired candidates exist? (cities, colleges, competitors, etc.)
• When – What time constraints are there for this hiring project? When will these hires be completed?
• How – What are the cost/personnel restraints? What methods are most likely to attract the talent needed (e.g. should we create a talent community via social media to attract these candidates? Are there existing professional communities, blogs, Facebook groups we can exploit?

 And, no strategy is complete without understanding the risks!

Managing the Mobile Workforce

Mobile Health (mHealth) also involves managing the mobile workforce, but I don't often hear this administrative function being discussed.  In our efforts to increase access and the quality of healthcare and reduce costs we are moving beyond COWs (computers on wheels) and leveraging and adopting more mobile technologies, such as, tablets and smartphones.  So, lets see what kind of discussion this blog post will generate.

A few months ago I read the book Managing the Mobile Workforce and appreciate the guidance on leading, building and sustaining virtual teams.  I was especially happy to see a couple of examples drawn from healthcare environments. One of these examples caught me a bit by surprise.  It involved looking at employees who spend most of their workday out of any office (or nursing station) and on the units attending to patients.  Or those in ancillary and support roles who move from department to department or drive between clinics or other sites throughout their workday. 

My first question is have we, as healthcare leaders, really thought about the new workforce paradigm and our ability to communicate with and supervise workers who are increasingly on the move during the day?

I do believe that effective healthcare leaders will begin to recognize the strategic value of more flexible work arrangements and this will include virtual and remote workers.  Telemedicine technologies are facilitating access to clinicians at a distance and remote coders and IT support are becoming more popular.  But, there are other functions that can easily be performed from a distance with today's technology -- at least a portion of the time.  Traditionally, hosptials and other providers have expanded their real estate to house these workers, rather than turning to "telecommuting" arrangements.  

My second question is are healthcare leaders beginning to recognize that mobility can actually increase productivity and will they follow other industries who are turning to remote and virtual workers to stay competitive?  If so, have they really thought through how to develop motivated and engaged virtual teams?

A new, more mobile workforce in healthcare will also require thought about the type of person needed to fill the job that needs to be accomplished.  And, it will require that supervisors learn strategies to train, support, motivate and manage the performance of teams that include both onsite and remote workers.

My third question is do healthcare supervisors and managers recognize the importance of trust and how to build it with workers across vast distances?

A final question focuses in on the technologies that are improving our ability to even consider the idea of expanding the remote and virtual workforce.

Do healthcare managers, especially high-level ones, know what the tools can do, and what their limitations are, so they can manage their teams more effectively?  

 

In December, I came across 5 considerations for hiring remote workers and I believe they are an ideal starting point for healthcare leaders who are beginning to reflect on mobility in their workforce.  These five considerations set the foundation for starting to create your organization's strategy for managing a mobile workforce.

1. Create Common Goals

2. Set Individual Goals and Expectations

3. Develop Trust and Accountability

4. Overcome Isolation

5. Plan Regular Communications