Mail Call

It's the season for giving so I thought I'd share with you some of the feedback that readers have so generously e-mailed the past few months. You've had a lot to say--on everything from blogs to infectious disease to firing people. Most of it nice, some of it not, but all of it thought-provoking.

Last month, I addressed hospital-acquired infections in MRSA, MRSA Me by describing my personal experience and urging leaders to consider more rigorous screening protocols. I didn't intend to become a poster child for infectious disease but the e-mail I received in response to this post was overwhelming. I read countless stories of patient safety breakdowns and received numerous invitations to join "survivor" networks and write about my story. For an event that's supposed to be rare and unusual, there sure are a lot of medical error survivors out there.

"I had a post op infection after an ankle replacement. . .and guess what, MRSA. You and I are some of the lucky ones. I only spent three and half months at home not able to work and needed to keep my foot elevated, two extra hospital admissions and another surgery. My first week back to work, I met a woman who lost her leg due to a hospital acquired infection--MRSA. The following day, I was at a meeting at the Joint Commission in Chicago and met a woman whose 24-year-old son survived a horrific parachuting accident only to die a couple of months later of a hospital-acquired infection," wrote Linda Kenney, President and Executive Director of Medically Induced Trauma Support Services (MITSS), an organization formed to support patients, families and clinicians affected by medical errors.

On the flip side, I was surprised by how many readers e-mailed asking what MRSA was. I can only hope these readers aren't too deeply imbedded in healthcare (but now I'll be sure to link to the definition).

Believe it or not, I always appreciate readers who take the time to criticize me--especially those who write not just to be nitpicky but in a way that is truly beneficial to readers. For example, Jeanine Thomas, president of the MRSA Survivors Network, pointed out that I was inaccurate in saying that Illinois hospitals are required to screen only ICU patients. "The law mandates (I wrote the bill and initiated it) that all ICU and at-risk patients must be screened upon admission," Thomas wrote. Suzanne Henry, Campaign Organizer for the Stop Hospital Infections Campaign at Consumers Union, provided this link to a compilation of all states' hospital infection reporting laws.

Bad Press in late November discussed the long-term impact of medical errors on disease management and patient-driven care. One of my favorite responses to this column came through our new user-friendly Web site.

"The public appears convinced that physicians and hospitals are incompetent and dangerous, so I have a proposition in the form of an experiment. Every physician and hospital will shut down for three weeks, after which time the public can decide whether they were better off with us or without us. If they decide they are better off without us, we will admit our shortcomings and find other ways to make a living. If they decide they are better off with us, we will come back to work on the condition that they pay us what we're worth and show a little respect."

This is one of my favorites not because it is particularly informative but because it highlights far better than I ever could some of the challenges leaders face when trying to implement change and overcome tired thinking. I can only hope this view is the exception rather than the rule.

Another reader wrote: "Why in the world would you take your parents to a hospital for a mammogram or a colonoscopy? People who are not sick should not take up space in a place for sick people. The risks for infection make it a poor choice when there are adequate outpatient facilities available." He makes a point, of course, but not everyone in America has access to a multitude of outpatient specialty clinics. In rural Maine where my parents live, the local hospital is a one-stop shop for all services--both inpatient and out.

Fire Away, my column on weeding out underperformers, wasn't quite as infectious a topic as medical errors but it did elicit some good feedback.

Healthcare consultant Mary Malone wrote: "I have been working with healthcare organizations for more than 20 years--mostly in the area of improving patient experiences and leadership. Without fail, the organizations that most quickly embrace the idea that low-performers (however defined) must either improve or leave are the ones that have greatest success. However, the number of leaders (at all levels) who don't deal with this issue in a timely manner is astonishing to me."

And, last but not least, a healthcare leader in Texas summed up the importance of effective employee evaluations far better than I could: "I too have been in multiple leadership positions ranging from inpatient and ambulatory nursing management settings, COO/Risk Manager of a large multi-specialty clinic, to hospital CEO. Disciplinary action is never easy, but unfortunately, as your article highlights, is sometimes necessary for the good of other employees and the organization, not to mention the patients served by these staff members or organizations. If a low performer sucks the life out of those with whom he or she works, it can have a negative impact on the patients cared for by other staff members. Low employee morale, indifference, absenteeism, and turnover may be symptoms that this is happening, as well as lowered patient satisfaction ratings or evidence of patients seeking care elsewhere."

"While some may feel that employee termination is a failure of leadership to adequately mentor or develop staff members, not every employee is a model of decorum. The '20/80 rule' (20 percent of your staff take up 80 percent of your time) sometimes rings true more often than leaders would like to see. For employees falling into this category, you may well alienate other productive employees by focusing attention, time and money in the wrong direction. This does not mean these folks are a lost cause, however, and sometimes a termination of employment or disciplinary action can turn someone around. I have seen members move on (either by their own volition or by being fired), or disciplined, who have become highly productive members in a new organization or in a different setting. Leaders should keep this in mind when dealing with less productive employees."

Thanks for all your feedback this year. HealthLeaders Media Corner Office won't publish next Friday, but I look forward to hearing from more of you in 2008. Happy holidays!