City supervisors have given their approval to a $5.1 million settlement stemming from a 2005 incident of medical malpractice at San Francisco General Hospital. A spokesman for City Attorney Dennis Herrera said the settlement is "the largest in recent memory involving medical malpractice." The city admitted to mishandling the case of John Weatherspoon III, who visited the hospital in June 2005 complaining of fever and cough symptoms that had persisted for nearly a week.
When the president of the AMA issues a call to action to physicians, it usually is related to reimbursement cuts, malpractice litigation, or another familiar advocacy issue tied to the business of medicine. But when AMA President Ronald M. Davis, MD, addressed physicians in an AMA eVoice column last week, he asked for physician commitment to a different cause—making healthcare “green.”
“I urge you to make your practice greener in ways that are ecologically sustainable, are safe for public health and the environment, and promote good patient care,” he wrote, going on to suggest that environmental awareness should be a part of medical school courses and continuing physician education.
Will physicians heed his call? Some have already gone green. New Orleans ophthalmologist Eric Griener, MD, decided to emphasize environmentally-friendly building principles when designing and constructing a new eye clinic. Alan Greene, MD, (yes, that’s his real name) has found a nice marketing niche for himself as a prominent “green pediatrician.”
The benefits of going green in healthcare construction and marketing have already been demonstrated for hospitals—technology editor Gary Baldwin has covered eco-friendly technological innovations for HealthLeaders Magazine and marketing editor Gienna Shaw has written about the benefits of waving the green flag. The same basic principles hold true for physician practices, though there are limitations.
The reimbursement and cost woes that seem to permeate every aspect of physician practice management also limit the amount of time and resources physicians can dedicate to environmentally friendly medical practices, at least for now. Given the challenges physicians are facing in implementing EMR systems—which provide significant ancillary environmental benefits by reducing paper usage—asking for more extensive facility redesign or green marketing efforts may be too ambitious, particularly for small and medium-sized practices that are struggling financially. When given the choice between purchasing carbon offsets and investing in medical equipment, I think we know what most doctors will have to choose.
But, as Davis points out, health and the environment are inextricably linked, and many physicians are naturally inclined toward environmentalism. For now, most of these physicians will take incremental steps, focusing on simple practice improvements that don’t require heavy investment (energy efficient light bulbs, to use a basic example, can actually save practices money).
For an idea of where healthcare environmentalism might be headed, however, look to the North. Last fall, the Canadian Medical Association (CMA) voted overwhelmingly to encourage physicians to discuss environmental issues with patients, reduce and recycle practice waste, and include environmental programs in medical education. The AMA has a less-ambitious environmental policy, and Davis considers the CMA’s environmentally-friendly meetings an inspiration.
Healthcare is headed toward greener pastures, though the road may be slow-going. Have you made an environmentally friendly practice improvement? I’d love to hear about it.
St. Joseph's Hospital will help the Lawrenceville, GA-based Gwinnett Medical Center operate its cardiac services program, pending approval from the Georgia Department of Community Health. GMC and St. Joseph's will jointly own and manage the newly created Gwinnett Cardiovascular Services. St. Joseph's doctors will offer consultation, training and support to Gwinnett Medical Center.
Medicare is lurching toward disaster and the next administration will have to act to stop rising costs and get control of the $400 billion federal health insurance plan for the elderly, U.S. Health and Human Services Secretary Michael Leavitt said during a speech. Leavitt said paying for each medical action separately is wasteful and "it often results in bad referral decisions, sloppy hand-offs, duplications, fraud, and poor quality of care. The result is inappropriate care and unnecessary cost."
With two-thirds of the medical specialists having fled Iraq, and with the country's healthcare system shredded by war and sapped bare by corruption, the assembly of Iraqi heart specialists at Ibn al-Bitar Hospital for Cardiac Surgery in Baghdad was a triumph. The meeting marked the first time the conference, sponsored by the hospital and the Iraqi Cardiothoracic Society, was being held since 2003. More than 100 cardiac surgeons and cardiologists from around the country attended the meeting, where they heard talks on mitral valve surgery, angiography, coronary bypass surgery and other procedures to diagnose and treat heart disease.
Staff members and clinicians have a firsthand view of what goes on in your practice every day and may be able to recognize poor performance patterns and recurring patient complaints. As a result, a staff satisfaction survey used in conjunction with a patient satisfaction survey can help provide your management team with a complete picture illustrating how to better serve your patients.
The following are three steps to ensure that your staff survey will provide the results needed to improve service:
1. Compose, format, and tailor questions. Surveys should be handed out or mailed to all staff members, including practice managers, billers, physicians, nurse practitioners, medical assistants, and front desk staff members. Ask them to fill it out, without including their names, and send it back to the office to be reviewed.
Surveys must go to all employees or a representative sample from all departments. “Don’t skew the results,” Pat Kearney, RN, MPA, ARM, risk management advisor at Stevens & Lee in Lancaster, PA says. “You can’t pick and choose who you want to query because you’re not going to get the feedback you want. You have to be absolutely consistent about it.”
Keep the format clear and simple. Tailor the questions in the survey to the issues in your practice that you want solved, such as staff members using better phone etiquette when talking to patients, Kearney says. Include five to 10 questions with both open-ended and multiple-choice options. Provide a scale system for the survey questions ranging from one to five, correlating to “not good,” “fair,” “good,” “very good,” and “excellent.”
Lois Summers, an office administrator at General Internal Medicine in Lancaster, says the staff survey in her office offers a comment section where employees can write any problems that bother them or list suggestions to improve the quality of service in the office, such as to hire new staff members or providers to better handle the patient flow and office operations.
2. Organize results and provide feedback. Once the surveys begin to come back, start reviewing the results and compile a list of the most significant areas to address to your practice. Highlight the topics a majority of the people show a concern about, Kearney says.
Next, form an internal quality improvement committee composed of staff members. Meet on a regular basis and talk about any ongoing issues. The goal of this committee is to determine a sound plan of action that will help the office implement better service.
Although the survey may underscore many negative responses, Kearney says managers and physicians should always tell their staff members to celebrate their successes too. “The staff needs to know that not every patient is complaining about them,” she says. “If you get positive feedback, tell your staff that they are doing something right.”
3. Analyze and implement. The next step is to review the survey responses and find solutions to some of the obvious problems or most popular issues brought up by your staff members. Kearney says to make sure that you have calculated the numbers and discuss the results with your lead physician, considering the root causes of these problems.
Shannon Sousa is the editor of The Doctor's Office. She may be reached at Ssousa@hcpro.com. This story was adapted from one that first appeared in the March edition of The Doctor's Office, a publication by HealthLeaders Media.