I Am on the Side of the Health Care Professional

Just wanted to be clear about a previous post and troubling hospital experience that I described.

I firmly believe that we have a nation of health care professionals whose skills and intentions are not fully understood or implemented in our current system.

Ask a doctor how deeply the current payer system inhibits their use of knowledge and experience. And, take a closer look at why dedicated workers' morale is at issue.

There are great areas of innovation in our system however, and this is encouraging. Mass General's Benson-Henry Institute for Mind Body Medicine for example. http://www.mbmi.org/about/whoweare_staff.asp

I am no expert. That is the point. Let's work to allow the experts to practice, support younger minds to develop and patients to become more articulate and accountable.

This week's New England Journal of Medicine announcement that one is safer to have a heart attack in an airport or hotel rather than a hospital is an example of speed to react. Communication within hospitals is a major issue.

We cannot pretend that our system is "the best in the world" when it is not. The study focuses on equipment. Tools, whether they are technology based or mechanical are meant to carry out our intentions.

Communication and ease of transferring knowledge and information is fundamental. Electronic Medical Records require a significant cultural change and business transformation. While there is all this discussion regarding privacy, it was difficult to transfer the records of my wife's emergency stay in one hospital to her doctors and the hospital where the surgery occurred. Turns out to be a fax permission form that had no security really and a burdonsome process for action.

"Most hospitals rely on traditional defibrillators, which can be more cumbersome and time-consuming, and usually require a doctor. But newer defibrillators, which cost about $500 each and can be found in many airports and hotels, are much faster and easier to use. Because they are fully automated, the machine decides whether a shock is needed, and quickly administers it — so that anyone can use it quickly."

One article I read about this study suggests that Casinos are safer places to have a heart attack than a hospital. Casinos always communicate. They literally and figuratively almost always know where their money is at any time. It is no surprise that they can respond to a heart attack faster than a hospital can.

PS: The hospital where my wife had the surgery that seems to have resulted in a pneumonia called today to see how she is doing. Today is January 5th. The surgery was December 21st. They had no idea of what had occurred and how she needed to be treated at another hospital in emergency. In spite of having visited the surgeon several days ago and informing him on December 26th. Normally, this hospital calls one day after the surgery.

When I asked the surgeon if this kind of pneumonia was common during surgery he said "it is very common, well not very common".

My question to him is: How are you measuring what is common? You have not reported this to your hospital. Where is the data to support your response. What seems common to me, is lack of communication and consistent reporting of incidents.

New England Journal of Medicine heart attacks in hospitals

http://www.abcnews.go.com/WN/story?id=4080507&page=1

Why Hospitals Are Dangerous Places for Heart Attacks - Jan 3, 2008

Sal

It Always Hits Home

I have avoided this blog recently. The recent holiday season was difficult. With all the reading, research and personal experience regarding today's health care -- things hit hard over the last few weeks.

My wife, after having a fairly routine outpatient knee surgery on Dec. 21st, found herself on Dec. 23rd in an ambulance.

There is still confusion but the consensus seems to be that during the surgery she suffered pneumonia from what is called an aspiration.

The staff effort in the emergency room was diligent. There were other complications and they were able to sort out what was going on with expertise and understanding. However, I also had to work with them to make certain that they did not make quick assumptions to what might be a more complicated scenario.

Interesting, that when I apologized to the nurse for my assertiveness on arrival when I noticed a certain dismissive summary too quickly from two staff members, the nurse actually thanked me.

"I was proud of what you said to the admitting team. They needed to hear it and they will treat her differently now".

The short of it is that communication from this strong ER effort to other staff members was awful. Some verbatim that I heard.

"When I go to get the labs, sometimes I take the pictures myself because they are asleep up there" - Resident Doctor

"This used to be a really good hospital. It's not anymore" - Nurse

"That's not the right dosage. I am supposed to write that prescription" - Doctor upon discharge who had participated in the ER.

"We will keep her in the ER for as long as possible, because she will not get the same care once she goes upstairs (admitted)" - Nurse and long time employee

These are only a few of the morale, implementation and work routine hazards we experienced.

It goes deeper. Guarantees to connect and exchange information with my wife's primary doctors was never done.

I did find staff sleeping when they were on specific assignment to caring for the patient. Yet, there was never a question about the motivation or commitment of the health care workers. Something more dense is affecting their ability to perform.

We are all needing to help this situation.

Sal

Incentives & What They Can Encourage

The reimbursement system “tolerates and even financially rewards poor performance by hospitals that fail to prevent hospital-acquired complications,'’ write the report’s authors, Dr. Heidi Wald and Dr. Andrew Kramer, health care policy researchers at the University of Colorado at Denver. - December 19, 2007, NY Times Making Hospitals Pay for Their Mistakes

http://well.blogs.nytimes.com/2007/12/19/making-hospitals-pay-for-their-mistakes/

In our work place we do not often think of incentives as something connected to fundamental issues. They often become clever or simplistic solutions to what are truly fragmented apparent issues instead of deeper needs.

This article sites specific examples of how incentives in hospitals may actually create harm. It is worth looking at for an understanding of a more pervasive issue. The above url will also give you some blog responses that disagree and some that do not.

The article suggests that in most businesses, such reward for poor performance does not occur. However, I suggest that hospitals as businesses are presently emanating many other business models. And, that the use of incentives in many companies today (often driven by an outdated mentality), deserve a closer look.

Once again, health care, the well-being of an organization and its ability to communicate are connected for all of us.

Sal

Designing the 'Care' into Health Care

"Improving the user experience could inspire people to tap into the system more regularly to help stave off more serious illness"

This article comes from an interesting perspective. Taking a look at what the patient is looking for from a designer's perspective. User centric needs is a subject that e-business advocates have understood for years now. Interesting to see the same fundamental logic put to a discussion of health care. Worth reading.

"To a designer's eye, efficiently providing for a basic need is indeed the fundamental issue. But it should be possible to go beyond rudimentary solutions to achieve the overall objective of a healthy population by also addressing an essential question: What does the individual want and need from the experience of health care?"

http://www.businessweek.com/innovate/content/nov2007/id20071121_967757.htm

Communicating Today & A Personal Note

"The application of technology has reduced differences among the productivity of transformational and transactional employees, but huge inconsistencies persist in the productivity of high-value tacit ones. Improving it is more about increasing their effectiveness for instance, by focusing them on interactions that create value and ensuring that they have the right information and context than about efficiency. Technology tools that promote tacit interactions, such as wikis, virtual team environments, and videoconferencing, may become no less ubiquitous than computers are now. As companies learn to use these tools, they will develop managerial innovations smarter and faster ways for individuals and teams to create value through interactions that will be difficult for their rivals to replicate. Companies in sectors such as health care and banking are already moving down this road". -

Eight business technology trends to watch

James M. Manyika, Roger P. Roberts, and Kara L. Sprague

December 2007, McKinsey Quarterly

This observation from the McKinsey authors is certainly true as they advise executives to understand that "Technology alone is rarely the key to unlocking economic value: companies create real wealth when they combine technology with new ways of doing business".

Technology is meant to carry out our intentions and that requires our ability to communicate clearly. In health care, a complicated world of the urgent and the measured use of skill and expertise, too much today gets in the way of connecting peoples' abilities and peoples' needs.

I have written before of my brilliant uncle, the business man and social innovator. Just before Thanksgiving, on the evening of his 97th birthday, he died. Still brilliant and provocative and knowing. His pacemaker replacement had been successful but with some complications. Painfully, I will always believe that a major complication was the contractual relationship that the facilitating hospitals had to complete the surgery and aftercare. He just stayed in the hospital too long with too much transportation from one place to another for simple tasks to be performed.

Communicating in today's world often means implementing at the same time. For my great great uncle, this was something he clearly understood.

Sal

Communication Today & A Personal Note

Walking On Eggshells

It's not uncommon in dysfunctional families to hear the phrase "it's like walking on eggshells" used to describe the difficulties of communicating with one or more family members who tend to control or even terrorize free exchange.

Sometimes, its subtle and sometimes, the process is brutal. However, feeling that the truth is dangerous or painful, rather than expected, permeates the everyday wellness of everyone involved.

In today's workplace, where there is assertion of being global, diverse and inclusive, there is often an undercurrent questioning of what is really true.

Sensing that geo-political references and "other influences" may actually be driving certain organizational behaviors today, tend to put unspoken pressures on people. We work to achieve objectives and don't always feel able (free) to talk about what's on our minds.

Now this may seem dramatic. But is it? In a world economy, driven by network centric information, brokered by players who have sometimes obscure value chain relationships, where are the places to speak freely?

Issues like outsourcing are often spoken about as inhibitors and conversely, as natural growth patterns by the same organizations when they need to define or defend decisions accordingly.

Confusion, as part of a working strategy, is not so unusual.

Walking on eggshells. It's something that people practice in places they don't quite trust -- yet don't feel ready to leave.

So, they learn to live with it and walk gently.

Does this sound familiar to you?