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.

 

 

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

Southern California HIMSS Annual Healthcare IT Conference

The Annual Healthcare IT Conference of the SoCal Chapter of HIMSS is coming up quickly on April 4th in Los Angeles.  It is a great networking and learning event for healthcare professionals, but it is also a wonderful opportunity to meet some of those who are new to the health IT workforce.

So check out the program agenda  and register today!  Highlights include:

• Jack Lewin, MD, CEO of the American College of Cardiology speaking on the State of the EHR Union: Where Are We?  Where Are We Going? When Will We Get There?
• How EHR Will Empower Patients and Family with Linda Macomber, Assistant Professor, School of Health and Human Services, National University and Clinical Reviewer/Juror, Certification Commission for Health Information Technology (CCHIT)
• Janet Marchibroda, MBA, Chair, Bipartisan Policy Center Health IT Initiative on Affordable Care Act’s Impact on Health IT: A Bipartisan Perspective
• A Health Information Exchange Update with California RHIO and HIE experts 
• Workshops:
  • Ambulatory EHR: Pros and Cons
  • Accountable Care Organizations/Patient Centered Medical Home
  • Career and Job Search Strategies

 

Hire People You Can Trust

The HBR blog has a post titled, Reward Value, Not Face Time and it brings me back around to the idea of managing a mobile workforce. I really do see more mobile healthcare workforces as an opportunity for hospital leaders to become more effective and efficient with the management of their limited and constrained resources.  

Like Tony, I too realized that the more autonomy I give people, the more confident and expert they became in their domains, the more ownership they took of their results and the happier they were at work.

I don't want to harp on this subject.  Instead, I'll just end by sharing a quote from the article that sums it all up perfectly.

The job of a leader or a manager, I've concluded, isn't to tell people how to get their jobs done, or when and where they do their best work. Rather, it's to free, fuel and inspire them to bring the best of themselves to work every day.

Tools Help Foster Communication Between Patients and Clinicians

I'm a big fan of the AHRQ's tools and have a new one to share.  I realize that some people aren't impressed by some of the tools, but overall I think that they are good -- and they are free.  If for no other reason, they will help stimulate ideas among providers who that then improve upon the resources they provide.

The latest tools are part of the “Questions Are the Answer,” a new public education initiative that encourages patients and their clinicians to engage in effective two-way communication to ensure safer care and better health outcomes.  An added benefit, or as we say in Louisiana a little "lagniappe" is the contribution improved safety and outcomes has on the patient experience.

To promote safer care and the importance of Patient Safety Awareness Week (March 4–10), AHRQ offers these free multimedia tools that health care providers can use with their patients:

• A 7-minute video featuring 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.
• A new 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.
• An interactive “Question Builder” tool that enables patients to create, prioritize and print a personalized list of questions based on their health condition.

For more information, go to www.ahrq.gov/questions. To request free copies of the DVD, brochure and notepad, email AHRQpubs@ahrq.hhs.gov or call 800–358–9295 and include the following reference numbers: DVD (AHRQ Pub. No. 10-(12)-0094-DVD); brochure (AHRQ Pub. No. 10(11)-0094-A; notepad (AHRQ Pub. No. 10(11)-0094-1).

  

 

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.

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.

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.

 

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

Social Media Risks

ECRI has a fairly comprehensive overview and guide on social media that includes some great advice for hospital and other provider human resource managers.  There is also an interesting bit of information related to passwords and data security (see page 15).  My favorites on HR include:

• Be careful with what you find while screening potential employees
• Exercise care before disciplining an employee for what they write on a social media post
• Current employees may one day be former employees so make sure you have educated them on social media and their HIPAA obligations

For those of you who like multimedia, check out the ECRI's video on the guide.

Engaging Staff with Social Media

The Nov/Dec 2011 issue of Healthcare Executive includes an article I wrote for the Satisfying Your Customers column, titled Engaging Staff with Social Media.  In the article I describe how successful leaders will prepare for the shifts occurring in the healthcare workplace; including the push for efficiency and new generations.  I also include a few examples of where social media is contributing to a more effective workplace in hospitals. 

Social media technologies are tools that can help increase customer, physician and employee satisfaction. I hope you will take the time to read the article and share your thoughts.

Another blog post that includes a few great workplace examples is list of 20 hospitals with inspiring social media strategies. 

Candy Stripers and Junior Volunteers

I've posted on the subject of volunteers, young people working in hospitals and those considering a career in healthcare administration, previously.  However, this last week, I've been specifically researching Candy Stripers, who are sometimes referred to as Junior Volunteers.

Candy Stripers at Doctors Memorial Hospital, FL

I'd love to here your thoughts or stories about the youngest of our hospital workforce!  If you prefer something more personal, send me an email: Christina {at} cthielst {dot} com

I'm thinking I should also start researching the Pink Ladies, too!

ACP Ethics Manual on Social Media, Catastrophes, and More

The American College of Physicians has released an update to its Ethics Manual and new or expanded sections include, among others, confidentiality and electronic health records, health system catastrophes, boundaries and privacy, social media and online professionalism.  I really appreciate the manual and have pulled out a few key points based upon the topics I cover often on this blog.

• Communication through email or other electronic means can supplement face-to-face encounters; however, it must be done under appropriate guidelines. Issuance of a prescription or other forms of treatment, based only on an online questionnaire or phone-based consultation, does not constitute an acceptable standard of care. (Exception: on-call situations) (pg 75)

• Shifting principles guide the patient-physician relationship during catastrophes and physicians need to be prepared for decision making and the just delivery of healthcare. (pg 80)

• Physicians who use online media, such as social networks, blogs, and video sites, should be aware of the potential to blur social and professional boundaries.  They therefore must be careful to extend standards for maintaining professional relationships and confidentiality from the the clinic to the online setting.  Physicians must remain cognizant of the privacy settings for secure messaging and recording of patient-physician interactions, as well as, online networks and media and should maintain a professional demeanor in accounts that could be viewed by patients or the public. (pg 81)

 

 All Changes to the Manual since the 2005 (fifth) edition

Report on Hospital Acquired Infection in CA Released

Healthcare-associated infection data on all hospitals in Califorinia has been released by the California Department of Public Health (CDPH).  This means anyone can see the nosocomial infection rates of their local hospital by unit.  But, I urge some caution among consumers with comparing rates of different hospitals and units. Instead, this data should be used to prepare questions and for a discussion with your physician or the hospital.  Hospitals may be interested in using this data to benchmark themselves against other hospitals.

Healthcare-associated infections (HAIs) are infections that patients develop during the course of receiving healthcare treatment for other conditions. They can happen following treatment in healthcare facilities including hospitals as well as outpatient surgery centers, dialysis centers, long-term care facilities such as nursing homes, rehabilitation centers, and community clinics. They can also occur during the course of treatment at home. They can be caused by a wide variety of common and unusual bacteria, fungi, and viruses.

HAIs are the most common complication of hospital care, occurring in approximately one in every 20 patients. The following HAIs occurring in hospitalized patients are required to be reported to the CDPH by all California general acute care hospitals:

• Central-line associated bloodstream infections;
• Clostridium difficile infections;
• Methicillin-resistant Staphylococcus aureus (bloodstream)
• vancomycin-resistant Enterococcus (bloodstream)
• Surgical site infections

Data is also available on a couple of hospital practices that that contribute to a reduction in HAI rates and length-of-stay.

• Central-line insertion practices 
• Staff influenza vaccination rate 

 

 

Gartner Worldwide IT Spending Forecast

I participated in this morning's Gartner Worldwide IT Spending Forecast.  Gartner, the technology research giant, brought together some wonderful speakers who shared information that I feel is important to healthcare -- especially at this moment in time.  The issues will have major revenue implications for vendors (perhaps leading to service changes) and could delay current and planned IT initiatives (EHR adoption, HIE, etc) of healthcare organizations.

The floods in Thailand in October of 2011 severely impacted fabrication facilities and this has lead to a shortage of hard drives. It is predicted that it will take at least until the 3rd or 4th quarter of 2012 for the industry to get back to meeting demand.  There is some uncertainty about this timeline.

This means:

• There will be storage and server component shortages.  Storage will not be cheap and providers will need to be efficient.
• Virtualization (the cloud) may be a more affordable option.
• We can expect longer lead times for delivery, backlogs and double ordering of products.
• We can expect an increase in costs over the short term (re-assess those budget projections you made last year)

One lesson that comes from this situation is to have multiple geographic locations for the manufacturing of components to help prevent business disasters like this one.  In this case all of our (the world's) eggs (hard drives) are manufactured in one basket (Thailand).

PC and software spending is down due to the downturn in the economy.  But, there was one bit of good news that I pulled from the discussion on software.  Spending on software (tools) for collaboration is increasing.  Companies are investing in technologies that will help them stay competitive and this means tools that will help their employees collaborate will reduce the need to bring on additional people. 

Now, I've been seeing this in other industries and have started to see it trickle into healthcare.  With health reform upon us, I hope my friends in the hospital start thinking a little more out of the box and how they too can leverage collaborative tools (aka social media) to improve efficiency and effectiveness in the workplace.

When Agnes' stroke hit, acting FAST saved her life

My work with the Telestroke Initiative has given me an opportunity to learn a great deal about stroke care and to know some of the people at the National Stroke Association.  In the process, I've also heard about some stories that hit really close to home (in the hospital).

One is of Agnes, a stroke unit nurse manager, who on February 10, 2009 went from being the stroke nurse to a stroke patient without warning.  She is a 35-year nursing veteran and a key nursing advocate and partner in establishing the hospital's stroke unit.  Her stroke occurred while relieving one of her nurses for meal break in her hospital's stroke unit.

In honor of each of my friends who care for stroke patients, I want to share the warning signs of stroke with my readers.

 

Hospital Leadership

I'm a student, educator and practitioner of leadership.  Hummm, wonder if practitioner is the right word...  Anyway, I like the article in today's issue of Beckers Healthcare Leadership: 7 Adjectives to Describe the Best Hospital Executives and the list they came up with to describe those who excel.

1. Visionary
2. Nimble
3. Out-of-the-box Thinker
4. Technology Savvy
5. Business minded
6. Relationship oriented
7. Life-long Learners

These do describe me (from self-reflection and heard from others).  Do they describe you, or the leaders in your facility/organization?  I hope so!

12 Ways to Health Holiday Song

The CDC's 12 Way to Health song is great for any holiday gathering!  Play the song, set to the tune of the 12 Days of Christmas, during school or office parties.  It is especially appropriate for use by hospitals and other provider environments. 

Best Health Blogs of 2011 Nominee

Healthline is having a contest to identify the best health blogs of 2011 and Christina's Considerations is one of their nominees.  Right now I'm listed as #11 and don't know that I'll win, but I'd at least like to make a good showing.  To vote you will need to sign into your Twitter or Facebook account.

If you are a fan, vote for me today!

Healthline

A Cat Out of the Bag!

I finally let a cat out of the bag for the world to see for an article about women and maternity leave.  It was a long time ago, but the feelings of being laid off after just returning from maternity leave remain in my memory.

My boss had made the comment about the few female CEOs in the company not having children at home almost two years earlier when I informed him I was getting married.  I do believe his intention, as a mentor, was to make sure I recognized the reality of the day.  I appreciated his concern.

I always had to fight against the current to accomplish my goals and just saw what lay ahead as one more challenge and another opportunity to prove my determination -- that I could "have my cake and eat it too." The reality was that my industry or company wasn't ready for me, or others like me.

At the time of my layoff, the environment was that we were having to re-invent the organization to survive through the tsunami of managed care.  (This was at a time when managed care wanted new moms out of the hospital fast. I had been asked what time I planned to leave the hospital just seven hours after delivering my daughter. Legislation later required a more appropriate length of stay.) 

I could understand the need to eliminate my position at that hospital, given the continual decline in census due to managed care. What I can't understand or even explain, is why my company, one I had worked for over many years, did not try in the slightest to find another position for me -- even in another area of the country.  Maybe it was the fact that the "Columbian's" were in charge.  Or perhaps, as my boss had cautioned, because I had just had a baby.

My boss continued to be a source of recommendations and referrals to opportunities, but the company let me down.  Now that the "Columbians" are gone, it seems that perhaps the company has evolved. Hopefully, others haven't or won't share this experience. 

 

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. 

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.