Swedish Covenant Hospital in Chicago is one of 300 across the nation that have pledged to improve the quality and sustainability of the food they serve, not just for the health of their patients but, they say, the health of the environment and the U.S. population.For many of these institutions, the initiative includes buying antibiotic-free meats. Administrators say they hope increased demand for those products will reduce the use of antibiotics to treat cattle and other animals, which scientists believe helps pathogens become more resistant to drugs. The Centers for Disease Control and Prevention estimate that antibiotic-resistant infections kill 60,000 Americans a year. Although the U.S. doesn't keep national records on antibiotic use in animals, the Pew Charitable Trusts estimate that up to 70% of all antibiotics used in the U.S. are administered to healthy animals to speed growth and compensate for crowded living conditions.
As the academic year draws to a close, many residency programs are conducting their final exit interviews. To be most effective, program directors and other exit interviewers must remember that these meetings are a two-way street. Not only do you provide trainees with valuable feedback, you also gain insights for program improvement.
Take advantage of uncensored feedback
Hold exit interviews in the last month of training after residents have completed all of their formal requirements, says Liana Puscas, MD, MHS, otolaryngology residency program director at Duke University School of Medicine in Durham, NC.
"You'll get unfiltered feedback about the program, didactics, faculty, and even other residents," Puscas says.
If you perform exit interviews before residents meet all of their requirements, they may withhold information, fearing retribution that could affect their graduation status.
When you meet with residents, some will be more than willing to share their opinions, whereas others may not see the value of the feedback or feel uncomfortable giving negative responses, says Eric Katz, MD, FACEP, FAAEM, emergency medicine program director at Maricopa Medical Center in Phoenix, adding that he has a strategy for drawing constructive criticism out of residents.
"I'll say, 'You spent three years of your life here. What is the one thing that you've always wanted to say but you've bitten your tongue about?'" Katz says.
That approach often succeeds, but if it doesn't work, don't push. Instead, tell residents that if they change their minds, they can call or e-mail you, Katz suggests.
Another option for getting feedback is to ask residents to complete a survey before the exit interviews, says Christine Cook, MD, OB/GYN department chair and program director at the University of Louisville in Kentucky. Cook asks common questions, such as:
How has the program improved since you started?
Which aspects have you become increasingly disappointed with since you started training?
Identify specific parts of the program you want comments on and add related questions to your questionnaire. For example, Cook emphasizes to faculty members that each trainee has strong and weak points, and it's up to them to help residents play to their strengths and work with their weaknesses. She asks residents to evaluate whether she and the faculty were successful on the survey.
Additionally, during Cook's meetings with graduating residents, she asks whether there are any junior residents who are struggling or doing exceptionally well. Residents also tend to give feedback about which attending physicians are excellent teachers, Cook says.
Impart words of wisdom
Whether you combine the exit interview with the resident's final summative evaluation or choose to hold those conversations at different times, allow residents to review any data you will discuss prior to the meeting, says Katz.
"I don't want them to sit there and read their evaluations with me," he explains. "We should talk about where they feel they are and where they're going."
During his exit conversations with residents, Katz reiterates feedback that he's given during previous conversations, but he puts a real-world spin on it.
For example, when meeting with a resident who hasn't responded well to feedback, rather than discussing an example related to the residency training, Katz will ask the resident to consider a hypothetical situation in which the peer review committee sends him or her letter regarding a patient complaint. Katz then works through the problem and possible responses with the resident.
Don't be hesitant to broach personal topics with graduating residents. Help them set personal and professional goals, Cook says.
Julie McCoy is an associate editor for the residency department at HCPro, Inc. Click here to read more residency news.
Eighty-one hospitals in Florida are teaming up with one important goal: to reduce the number of infections and complications that occur after surgery. For patients throughout the state, the coalition's work could cut their chances of being readmitted to the hospital after an operation. And for hospitals, fewer complications could reduce the sorts of costs that will come under increasing scrutiny with the new federal health-overhaul law. Currently about one in five patients discharged from the hospital is readmitted for complications. These subsequent hospital stays add $11,000 or more to the average cost of a patient's care. Starting this fall, hospitals ranging from 759-bedWinter Haven Hospital to the entire Florida Hospital network will study four types of hospital patients: those who developed urinary-tract infections, those with surgical-site infections, those who had colorectal surgery and those 65 or older 65 who had any type of surgery.
A wiry man, clad in a top hat and coat, approached a table of volunteers at Providence Hospital in Northeast Washington, signing on to one of the largest community weight-loss initiatives in the District's history. "Abraham Lincoln," he called out when asked to identify himself, "We appreciate you participating, Abe," said Sister Elaine Jordan. "But I'm not sure how much weight you can afford to lose." The man shrugged, not admitting to a glimmer of irony, and the 16th U.S. president's name was added to a growing list of participants in the hospital's 150,000-pound weight-loss challenge. If the anachronism could pass anywhere, it would be here, at the hospital chartered by Lincoln in 1861. The facility is so proud of its connection to Honest Abe that a Lincoln impersonator is invited to address the crowd at public events. The hospital that once treated soldiers injured in the Battle of Bull Run now is battling a modern epidemic: rampant obesity.
Two Milwaukee County hospitals performed many more abdominal imaging tests than other hospitals around the country, potentially exposing patients to unnecessary radiation, according to new federal data. Nearly 58% of the outpatient CT scans of the abdomen performed at Wheaton Franciscan-St. Francis in Milwaukee were double scans - meaning that technicians performed one CT scan with a contrast dye followed by a second without dye, according to the federal government's Hospital Compare website. More than 64% of scans at Wheaton Franciscan-Franklin in Franklin were double scans. By contrast, hospitals around the state performed double scans on only 11% of the outpatients who received the scans, according to the data from 2008.
Healthcare reform is a topic that has blanketed the pages of newspapers across the country with its implications disputed and defended by pundits since the idea was born. Of course, everyone has an opinion. And everyone can identify with the idea of overhauling the healthcare system or perhaps just identify with potential problems that may arise due to the Healthcare Reform Bill.
As a leader, you are used to dealing with varying opinions and helping your people properly channel ideas that you may not necessarily like if it means improving your team, department, or company. Healthcare reform may be something you've been waiting for earnestly, or you may find yourself in a position where you're responsible for driving a change you don't believe in. Whatever your personal point of view, you must inspire your people to commit to the change and everything that goes with it.
But to do so, you need to be aware of critical factors in order to ensure that you manage the change effectively and efficiently while maintaining high quality patient care during the transition period.
How Change Affects You
The response to big changes can be similar to the grief response. Understanding how people respond to grief can help someone cope with change. As a leader, you need to focus on yourself and look at how you are coping with the change. Then figure out how it is affecting those around you, and lead them effectively through the change.
Let's explore what is likely to happen as people transition through the changes associated with healthcare reform. Although everyone experiences change in slightly different ways, there is a typical response pattern. The model outlined below highlights three clear phases people experience when faced with change; the 'struggling phase,' the 'engaging phase,' and the 'thriving phase,' As you read each phase, think about yourself and identify the responses that reflect what you are experiencing.
The 'Struggling' Phase
Denial: Your first reaction to the change is to go into denial, you deny that reform is going to happen, you convince yourself that it will not really happen, or that it will not affect you. You do not engage in conversations about the changes because as far as you are concerned, the changes won't happen. To other people, it appears that you do not care, because you are very passive.
Resistance: Once it is drummed into you that reform is actually happening, you resist it, and look for all the problems and reasons that it should not happen. It is now that you begin to show hostility and anger. When colleagues try to talk to you about your behavior you disagree with what they are saying and the conversation goes nowhere.
The 'Engaging' Phase
Acceptance: At some point, and often with the help of others, you realize that reform is happening whether you agree with it or not. You understand that you must accept it and get on with things. At this stage there is likely to be a lot of anxiety and confusion about the impact the change will have on you and the hospital, and whether you and your team are going to be able to deal effectively with the change.
Exploration: Once you have accepted that this is going to happen, you are ready to start exploring the different options, and you have energy and interest in the possibilities. You become very open and ask lot of questions to understand the implications and the pros and cons of all of the options.
The 'Thriving' PhaseCommitment: Having explored all of the possibilities, you decide on the most effective and appropriate course of action and you take ownership of it. You become much clearer on what needs to be done and this gives you confidence as you feel more and more in control of what is happening. This gives you more energy and you are now confident in taking calculated risks.
Growth: : Finally, you take even more ownership and responsibility by starting to look for other, better ways of leveraging the change. Having achieved success, you gain more confidence and become more creative, testing more ideas and options. You also really focus on your own performance and seek feedback from others to ensure you are continuing to develop and be the best that you can be.
We've recently witnessed the above phases in action with work done for a healthcare client. Let's call him 'Don.' He holds a leadership role at his organization. He had recognized that while he is usually an easygoing, patient, and confident leader, he had become quite short-tempered and intolerant with his team and even, at times, with his patients.
Some of his team members were concerned about him, finding their once effective and positive leader less approachable. They described him as being 'awkward' and were starting to doubt his leadership because of the impact his behavior was having not only on his own performance, but also on the performance of the whole team.
At the start of the coaching process, it became clear that Don was struggling with the impending changes associated with healthcare reform. He had very strong views opposing the bill, and it soon became clear that he was so resistant on the change based on his own point of view, that he was not prepared to focus on what this meant for his hospital.
He was also feeling increasing pressure to identify how the hospital was going to start implementing changes. Don was letting his feelings of being under pressure and his negative views about the reforms turn into stress. He was viewing the changes as a threat to the efficiency of the hospital, and worse still, he was communicating these messages to his staff.
Having heard the feedback, Don realized that the changes were unavoidable and that as a leader it was his responsibility to accept it and begin to work on identifying the changes his hospital needed to make. He committed to stop resisting the changes and to stop feeling like a victim of a situation which was being imposed on him.
Don started to view the changes as an opportunity to make his hospital even more efficient, while continuing to provide the best patient care. With renewed confidence and energy, Don was in a much better position to navigate his team through the changes with conviction, so they would be motivated to overcome the obstacles and work toward finding the best solutions.
Don began to communicate his big-picture plans in a compelling way, and not only in more formal forums including meetings, but also in one-to-one conversations. Don was giving people the chance to make sense of the change, what it would mean for the hospital and, more importantly what it would mean for them as an individual.
Don's proactive and positive behavior was clearly reinforcing what he was saying, he was role modelling the behaviors of someone who was embracing change himself. Don demonstrated vulnerability and honesty, by sharing his initial reaction to the bill and how he had struggled with it. At this point, Don started to ask people what else he could be doing, how he could be more effective at leading them through the change. His team was relieved to see his confidence renewed, and the changes began to excite them.
Six Tips To Move Yourself Quickly Through The Change
When Congress passed the bill, what was your first reaction? Did you go into denial, or were you already in acceptance, believing that it was inevitable that the bill would be passed and you would just have to get on with it? What stage of change are you at now? Here are 6 steps to help you move quickly through the stages of change:
To move out of denial: Wake up to the change. It's happening. Don't get left behind.
To move out of resistance: Let go of the past. Make a choice; get on board with the change or get out.
To move out of acceptance: Embrace the change: look for the opportunities.
To move out of exploration: Find ways to make the change work effectively.
To move out of commitment: Now you've defined the strategy for change stick with it and bring people along with you.
To continue in growth : Look for more ways of using the change to work even more effectively.
Tara Jones is a principal consultant at Lane4 Management. She may be reached at Tara.Jones@lane4performance.com.