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Top 12 Healthcare Buzzwords for 2012

 |  By cclark@healthleadersmedia.com  
   January 03, 2012

Originally published December 27, 2011.

This year's crop of healthcare buzzwords and catchphrases includes a handful of terms that are really oxymorons. By oxymoron, of course, we mean one of the words or phrases in the expression contradicts the rest. But if you think about it, that's the very theme of health reform today.

Innovators are looking at their systems and turning them upside down, contradicting old assumptions and turning volume-based care and payment systems into long-term wellness programs. Payment systems are now based on quality metrics and accountability for months and years after the initial visit.

It's a paradox: Doctors and hospitals must work harder so the patient needs them less and costs go down. Certainly, the lingo must adapt.

Last year's lexicon picks was one of our most popular articles, so we know you can't wait to see this year's list:

1.Palliative intensive care. Palliative care is generally perceived as comfort care with morphine or other diligent pain relief regimens to ease the dying process, along with more counseling for loved ones to understand what's happening and accept it. But intensive or critical care means pulling out all the stops, doing everything possible, to keep patients alive.

Now, providers are combining the two. It is said that 30% of all hospital in-patient deaths occur in the intensive care unit, so why not introduce palliative care systems much earlier?

The idea increasingly being implemented within hospitals is to bring the patient and family together with palliative care professionals, when the patient's condition is appropriate, in a much more concerted and structured way than has been the ICU routine.

2. Cultural DNA. Again the contradiction. DNA is something we're born with, it can't be changed with a shift in culture.

But changing an organization's cultural DNA is an expression that increasingly resonates among quality leaders. With this phrase, they're trying to convey the idea that if leaders of a healthcare organization walk the walk and talk the talk, their behavior will gradually osmose into everyday practice.

3. Change fatigue. People get tired mainly when routines stay the same, day in and day out, right? Not necessarily. We've been hearing healthcare providers talk about a new kind of fatigue, one brought on by too much change too fast.

Now, many commercial health plan and federal healthcare programs are encouraging innovation, requiring that hospitals, clinics, and physician practices test new ways of doing old procedures. There's change in leadership, areas of responsibility, accelerated workload and expectations, and requirements for new skills and training in people who may not be prepared for it or want it.

Some providers have expressed frustration with this "new flavor of the month" attitude. Now managers are trying to find productive ways to make these transitions, so there is enough stability and constancy mixed in to prevent change fatigue.

4. Accountable care skimping. In the Medicare Shared Saving Program's final rule released in October, the word "skimp" comes up four times.

Officials for the Centers for Medicare & Medicaid Services used the word to address a concern that when physicians in accountable care organizations are paid to avoid unnecessary expenses, they may—unconsciously or not—avoid necessary expenses for their patients. Heaven forbid, they may "skimp on care."

Here are a few quotes from the rule:

"Comment: Several commenters expressed concern about unintended
negative consequences related to the quality measures and patients' role in
improving quality of care outcomes. A number of commenters were concerned that ACOs might skimp or delay in providing specialty care, particularly high cost services or those not available within the ACO."

And, "Other commenters expressed concern that specialty care and care for those with disabilities might be negatively affected by the lack of specialty measures or incentives to skimp on necessary care."

The rule continues:

"Response: We believe that the final set of measures is appropriately focused and measures care furnished by a variety of providers including specialists, nurses, and nurse practitioners. We also believe the issue of including specialty providers who furnish primary care services is addressed in the two-step beneficiary assignment methodology discussed in section II.E of this final rule. We also agree that monitoring is necessary to ensure providers do not skimp on care or avoid at-risk beneficiaries."

5. Positive deviance or disruptive innovation. In healthcare settings, these two phrases, which have different origins and meanings, can be used to express the same idea. They implies a strategy in which providers look at peers—be they controversial individuals or entire institutions—that function differently, but still achieve excellent results.

One example of positive deviance comes from Michael Edmond, MD, chairman of infectious diseases at Virginia Commonwealth University, who eschews conventional wisdom that hospitals should perform active surveillance with testing to prevent hospital-acquired MRSA infections. Instead, he bucked that trend in favor of hand-washing and other universal precautions such as catheter insertion bundles. He got his infection rates down without using expensive testing and without having to put colonized patients into isolation.

Disruptive innovation is a similar idea. A concept originally proffered by Harvard professor Clayton Christensen, disruptive innovation can mean advancing healthcare quality through a wide range of new ideas: the use of payment incentives, transparency, retail clinics, comparative effectiveness research, and the use of social networks.

6. Essential benefits. In a bulletin released in December, the Obama administration has said that it wants state legislatures—not the federal government—to decide what will and what won't be required for coverage by health exchange programs, as long as benefits include some provisions in each of 10 categories specified under the Patient Protection and Affordable Care Act.

The 10 are: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse disorder services including behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services including oral and vision care.

By allowing states flexibility in how each defines essential benefits, what is considered an "essential" drug or service in one state won't be declared one in another, perhaps more conservative or budget-challenged climate.

Look for this phrase to be extremely controversial. Many consumer advocates are already questioning whether the Department of Health and Human Services is fulfilling the PPACA mandate which says, "the Secretary shall define the essential health benefits" and "ensure that such essential health benefits reflect an appropriate balance among the categories...so that benefits are not unduly weighted toward any category."

 

7. Day 31. With hospital Medicare payment penalties for higher rates of 30-day readmissions and 30-day mortality on the horizon, some healthcare providers are quietly wondering what their healthcare systems might look like on Day 31.

Will repeat patients who perhaps should have been hospitalized on Day 29 have their readmissions postponed a few more hours or placed into observation? Might an arguably preventable death that is now inevitable be postponed one or two more days? Certainly Medicare auditors will be watching.

8. Getting to genba (or gemba). Okay, not exactly a new phrase but we predict much more frequent use of this Lean-derived expression in virtually all aspects of healthcare. Anyone with "chief" in his or her title will be compelled to leave the safety of the office and go to genba, a Japanese word meaning the place where crucial work takes place.

It may mean that a hospital CEO will view the patient's discharge process, or a nurse manager will go to a patient's home to see how preventive care is provided there. It may mean a physician whose patients are frequently
readmitted through the emergency room will go to that ED to watch the next time the patient falls.

The idea is that by going to where the work actually happens, costs may be reduced, care could be streamlined, and patient care might very well improve.

9. Gamification. In a column earlier this year, our former tech editor Gienna Shaw described one possible way to ensure patient compliance and improve health literacy:

"Developers are banking on techniques like 'gamification' (a horrible word to describe health-related web sites that have game-like interfaces and qualities) as a way to get folks to learn about their health and use their healthcare data to improve it," she wrote.

Think of an iPhone app that lets one notify, or even compete with, friends on Twitter or Facebook how far and fast everyone ran today on the treadmill. There might be games in glucose checks for diabetics. Calorie counters may not just log in the day's tally, but also show with a pinball machine interface whether those meals hit all the food groups.

Game on.

10. Engagement. As in physician engagement, board of directors engagement, c-suite engagement, and patient engagement. It's not exactly a new phrase, but the increased frequency of its use in healthcare settings is.

As Jack Silversin, president of Amicus Inc., told a packed assembly during December's Institute for Healthcare Improvement (IHI) forum in Orlando, "The word 'engagement' means different things to different people."

"To some doctors, if you tell them we want to engage you, their expectation is that if they receive advice, it means 'You'll do what I say,' " Silversin says. That's not the way it has to be, however, he says.

In essence, engagement means getting everyone on the team to understand the reasons for a policy or practice and incorporate those goals into everyday procedures.

For patients, being engaged means that providers have tried to cultivate their trust, making sure on repeated occasions that they understand their diagnosis and the importance of adhering to the prescribed care regimen, and of course, doing adequate follow-up.

11. Getting to zero. Look for increased controversy in the use of this phrase to describe the goal to reduce adverse events, surgical errors, hospital-acquired infections, ventilator-associated pneumonia, and anything else bad that happens to patients in healthcare settings.

There's a sense among providers that the use of this phrase only provokes frustration, because realistically, zero can never be fully achieved forever. And some events are just not preventable. Simple as that.

Another take in this controversy is that if an organization does achieve the elusive zero one day, it may provoke a subtle complacency.

12. Service recovery mode. When bad things happen to a restaurant meal or store purchase that wasn't the customer's fault—or it's not clear who was at fault—smart companies go into service recovery mode. A round of free drinks for the wrong order or a hair in the soup. A full refund plus 5% when the wrong gift was sent. The pizza is free when the delivery takes more than 30 minutes.

It could be likewise in healthcare. Increasingly, providers are using this phrase to indicate policies that include apologies and financial compensation, even visits from the CEO, when mishaps occur, even before fault is clearly assigned and long before litigation begins.

A white paper by IHI senior fellow Jim Conway provides case studies of reduced attorneys' fees, improved morale, and happier patients when healthcare providers are transparent and apologetic whenever bad things happen to patients, regardless of who's at fault.

Have any buzzwords—oxymoronic, just plain moronic, or otherwise—to add? Please contribute a comment below.

See Also:
11 Hot Healthcare Buzzwords for 2011
10 Phrases That Became Part of the Healthcare Lexicon in 2009

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