What This Blog is About

A long time mentor and friend, Cicely Berry, often says: "all we do comes from our need to survive".

Cis is the Voice Director of The Royal Shakespeare Company. Her profound work and deep appreciation of the human spirit has affected diverse communities all over the world.

Will take you to my current work.

This blog is dedicated to the belief that the overall health of a community or organization is a clear reflection of their ability to communicate.

"Cada cabeza es un mundo" - Cuban proverb

"Every head is a world"

Thursday, January 24, 2008

Back to the Hospital

I am looking to health care institutions that have a bias for change.

My wife had to return to the hospital a second and third time since December 23rd.
A different hospital than the first visit.

Bottom line:

Once again, expert and dedicated emergency room staff. However, they suffer from staffing issues, payer requirements and slow to evolve - EMR (electronic medical records).

The patients suffer as well.

1. My wife's medication in the ER was delayed by what seemed at least 2 hours. Reason: The nurse in charge had left. The nurse attending my wife had been recruited from the cardiac floor because of the ER being understaffed. The cardiac floor is not on the same computer platform as the ER. The attending nurse could not work the program. There may be legal reasons for the cardiac to be separated. However, this arrangement did not work when we needed it to work.

2. After waiting 12 hours or more to be admitted, my wife went to a room after midnight. The ER nurse (who had volunteered to stay for extra hours), simply took her to the room herself. There was no one available to transport her. Having been sleep deprived for days, part of the reason for admitting Maggie was to help her to get rest. She wound up in a room with a woman in a state of dementia who yelled and talked, rarely stopping, and had been doing so for days.

3. Medications that were ordered and confirmed 4 times in the ER were not ready or indicated when she was admitted twelve hours later. Not one meal served to her in all her stay reflected the "lactose intolerant" indication that was critical to maintaining her much needed calorie intake.

This is a very good hospital in NYC. Their medical staff is outstanding. Information flow and the the need for a business model change are clear.

ERs are businesses. This particular hospital has been mandated by its Board of Directors to break even this year. They see the need for a business model change - ( I think they do).

"They spent 3 million dollars on software upgrades this year. Why can't I connect on the same platform. I don't even know how to access the vitals from the ER triage which is down the hall" - My memory of what the cardiac nurse told me during her frustration working in the ER. "I can't do my work".

Some hospitals are innovating with EMR and integrating patient information across the board. From patient management, the doctor and the payer to create a more efficient and successful hospital stay. These hospitals are trying to do something that is not conventional in health care today. To share information, accountability and be more inclusive in an effort to work differently and achieve better results. Look for those hospitals. It will pay off when you need them.

In business, we have learned the hard way, to understand usability testing, tool development based on what communities of practice need, and when to challenge the best advice of consultant applications.

Emergency care is a business.

Here's an interesting article on businesses and health care. It's not necessarily on point directly for what I have been discussing. However, it's obvious, that hospitals cannot do this alone. That re-engineering is a concept that must be dynamic in this arena. Without communication and stuck in silo and specialty practice behaviors, the incentive to communicate is not always there.


Health care and communication. The continuing issue.

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