In 2007, Florida Hospital rolled out a bold marketing campaign for two of its campuses: Emergency-room patients would be seen by a doctor within one hour of arrival. A year later, neither ER has come close to achieving that one-hour maximum wait for all patients. A major goal of the new Cover Florida health-plan initiative is to reduce ER crowding by providing affordable insurance to the state's 3.8 million uninsured. But ER crowding and wait times are unlikely to improve soon, experts say. That's especially true in Central Florida, where the economy and the population continue to expand at faster-than-average rates.
Six months after the mother of Kanye West died following liposuction and breast implant surgery, California lawmakers and physicians are urging greater protections for patients undergoing cosmetic surgery. Such surgeries are increasingly done outside hospital settings in outpatient clinics, where a doctor can avoid the rigorous reviews. More than a decade ago, California pushed to regulate outpatient surgical centers amid high-profile reports that patients were critically injured or dying during procedures.
Legislators passed a law that said such centers must be accredited by an agency recognized by the state. But critics say the law has not been effective.
The National Health Service has recently barred British physicians from wearing neckties, jewelry, and long sleeves, all in the name of disease prevention. Officials there are particularly concerned about antibiotic-resistant diseases such as MRSA. Some U.S. doctors find the move strange, and say there are better ways to prevent the spread of germs to patients.
A partnership between Austin, TX, hospitals, government groups, nonprofits and the Travis County Healthcare District is working to alleviate a severe shortage of psychiatric beds and a shortage of psychiatrists willing to see inpatients.
The shortage has resulted in psychiatric patients landing in emergency rooms where there are no contracted psychiatric consultants and where physicians have little experience with anti-psychotic drugs, hospital officials say.
Jim Van Norman, MD, medical director of Austin/Travis County Mental Health and Mental Retardation Center, says the county has recently been able to contract for 11 beds per day at two private non-profit psychiatric hospitals, funded by $3 million from the healthcare district. That is in addition to its allocation of 63 beds per day at the Texas State Hospital. Van Norman says that is still about 65 beds short of what is needed for Travis County's population of nearly a million.
During 2006 and 2007, the county used significantly more than its allocated inpatient days at the state hospital, garnering itself a $2.5 million bill for the excess coverage. Recently, the state has waived those fees because the coalition added 11 beds at Seton Shoal Creek Hospital and The Lakes, located adjacent to St. David's Hospital. Travis County MHMR has also launched an Integrated Behavioral Health Program, funded by St. David's Foundation, at People's Free Clinic, a non-profit primary care center in Austin. They also created a mobile crisis team to help head off the need for inpatient care.
Van Norman says mental health services in the county have suffered from chronic under-funding exacerbated by explosive population growth, a situation made worse by the fact that none of the city's general hospitals have inpatient psychiatric beds. "That's in striking contrast to most counties," says Van Norman. Also, Travis County has a shortage of psychiatrists, and many of those practicing in the county do not see hospitalized patients.
Trish Young Brown, president and CEO of the healthcare district, says the coalition is focused on finding the money to pay for 27 new beds, which could be available at The Lakes and Shoal Creek. The Department of State Health Services has awarded the county a $1.9 million grant for 2008, and those funds are expected to be ongoing, says Young Brown. That leaves another $5.1 million needed to fund the 27 beds. "That's a big gap. And that's if we can find psychiatrists and psychiatric nurses to staff the beds," says Young Brown.
Currently, inpatient psychiatric coverage at Shoal Creek is provided by the faculty and residents in the Austin Graduate Medical Education program. "We hope to increase the number of residents in the near future, to add more psychiatrists to the Austin area," says Young Brown.
Federal health officials will begin monitoring prescription drug usage by Medicare participants in an effort to identify potential safety problems. New regulations will enable the FDA, states and academic researchers to screen the Medicare claims data. The FDA primarily relies on physicians and patients to report suspected adverse events, and it often takes a number of cases before someone at the agency detects a pattern that's worth investigating. But now at the first hint of trouble, the FDA now will be able to query databases involving tens of millions of patients.
There was a lot of talk at last week's National Patient Safety Foundation Congress in Nashville about strong leadership and how important leadership is to an organization's mission to deliver quality healthcare. As we all know, it's easy to talk about leadership, but one session in particular offered the results of a study that looked at top performing hospitals and what they all have in common.
Barbara Youngberg, vice president for insurance, risk, quality, and legal for the University Health System Consortium, said an in-depth study of UHC's member organizations shows that top hospitals have strong leaders who share the following characteristics:
They have a shared sense of purpose. Top leaders are the first to tell you that patient care is the most important mission of their organization. They're constantly working to improve quality and safety scores, regardless of how high the scores already are. These leaders consider top-notch customer service, quality care, and patient safety a competitive advantage for their organization.
They lead by example. Youngberg said top leaders have an "authentic, hands-on style." They're not above greeting patients at the door or guiding a visitor who has lost his or her way. Leaders of top hospitals are often seen in hospital departments, talking to nurses and physicians about the challenges of their jobs. They don't just appear to be interested. They are interested.
They focus on results. Top performers are relentlessly working to improve the care offered at their facilities. They're not waiting for a new building or a new technology infrastructure to improve—their organizations are in a state of constant improvement.
They collaborate to get results. Top leaders recognize that everyone in the hospital—whether a physician, nurse, or front desk clerk—contributes to the quality healthcare experience. They appreciate the contributions of employees at all levels and often recognize those who do their job well. The result is that employees value each others' critical knowledge when problem solving.
They have an accountability system for service, quality, and safety. As I mentioned above, top leaders are "hands on," but that doesn't mean that they don't expect their department chairs to accept responsibility for their individual unit's improvement. Prioritizing, developing measures, and settings goals and targets are centralized functions, while tactics to improve are decentralized. The result? Hospital units that are accountable and innovative.
These qualities are the building blocks of top performing organizations that are consistently defining new levels of excellence in quality and patient safety, Youngberg said. How many of them do you recognize in yourself?
Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.
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