For more than 20 years, trial lawyer Rick Boothman defended doctors and hospitals in malpractice lawsuits. The job taught him plenty about the disconnect between the defensive behavior practiced by the medical establishment and the humane treatment patients want. So when the University of Michigan Health System needed a new in-house attorney in 2001, Boothman made an offer: hire me and revolutionize your approach. We’ll be up front with patients when medical errors happen, and we’ll pay quickly when a case warrants it, rather than dragging everybody into court. “It’s the decent thing to do,” says Boothman. A new study published in August found that since Michigan adopted Boothman’s program of disclosure and compensation, lawsuits have declined and legal-defense costs have dropped by 61 percent. There’s no proof that acknowledging mistakes led directly to savings, but it didn’t cause a malpractice frenzy either. “The sky doesn’t fall in when you are open and honest,” he says.
With fewer beds available due to budget cuts, the wing of the state hospital that houses mentally ill children and teenagers has suspended admissions for the second week in a row. The Anna Philbrook Unit stopped admitting children Thursday and was still at capacity late Friday afternoon. A week earlier, the unit had to suspend admissions for 48 hours.
That hasn't happened in "a very long time," said New Hampshire Hospital's acting CEO, Paula Mattis. But she said she expects the hospital will be forced to continue suspending admissions now that children and adolescents are being housed in the same wing.
Before this year, children age 14 and under who needed to be involuntarily admitted to the state hospital went to a separate building, the Anna Philbrook Center.
The economic recession, whether it is over or not, has pushed record numbers of Minnesotans into state-subsidized welfare and health insurance programs, according to figures published this week by the Department of Human Services.
The number of Minnesotans eligible for Medical Assistance, the state's version of Medicaid, climbed to 610,000 in an average month in fiscal 2010, compared with 557,000 on average in 2009. That is the largest one-year increase in at least the past decade and represents more than one in 10 Minnesotans.
Earlier this year, Sallie Latty, RN, BSN, MA, one of a pair of ANCC Magnet Recognition Program® (MRP) coordinators at St. Vincent Hospital Indianapolis, set out on a very specific research project. As part of crafting the organization's application documentation for MRP recognition, her focus turned to the Source of Evidence Transformational Leadership, Advocacy and Influence (SOE TL-4).
This requirement asks organizations to describe and demonstrate how the chief nursing officer is enabled to influence organization-wide changes. Latty devised an initial list of evidence and then reached out to her colleagues in the field for additional brainstorming ideas.
"When I started writing, I talked about our CNO and how she was able to influence the organization through her participation in the board of the directors," says Latty, who provided meeting minutes, discussed presentations the CNO gave, and highlighted her attendance.
She also focused on the CNO's job description.
"Even though we include the overall job description in our organization overview, we took this opportunity in the SOE to highlight specific competencies," says Latty.
There are some administrators who have a reporting relationship to the president of the organization but also have a dotted-line reporting relationship to the CNO.
"In the SOE, I talked specifically about the level of expertise required of a CNO in our organization," says Latty. She focused on competencies that affect the ability to influence, such as:
Coaching
Proficiency of teamwork
Decision-making ability
"I also focused on pieces of the organizational chart to give detail about her reporting relationships and factors that tie her in across the organization," says Latty.
Don't be afraid to ask for additional support from leadership, either.
"I also had our president write a letter summarizing his level of influence and how, in his absence, our CNO is the acting president," says Latty.
The biggest part of the document includes examples of the CNO's ability to influence the organization through her involvement with groups on multiple levels, key committees and councils where her voice would have an effect on the entire organization.
Key groups Latty discussed in the MRP document were:
Executive committees, such as the administrative council. All of the organization's executives at the highest level meet weekly, including the CNO.
Quality councils/committees, such as the quality committee of the board. This is a sub-council of the board of directors.
For each of these roles a roster is included, as well as minutes where appropriate, highlighting the CNO's expertise and identifying her contributions in blue ink.
"This could include any discussions she has led or where she has contributed her voice," says Latty.
Other key meetings detailed in the document include:
Quality and safety committee
Medical executive council
Departmental meetings
Business development
Patient safety committee
Risk and safety committee
Nursing peer review committees
Credentialing committee
The business development component is important because the organization is able to demonstrate the CNO's ownership over key projects and detail the progress of those projects.
"We also discuss how she's involved in our shared governance model," says Latty.
View from the field
Latty received a number of ideas from her colleagues in the field for inclusion in the report. The first, and most striking, was budget information.
"The whole focus we have here is to describe and demonstrate the ability of the CNO to influence organizationwide change—the budget can show she's put funding towards those changes," says Latty. "I hadn't thought of that!"
Others suggested information about board retreats. "We often do our strategic plan on these retreats," she says.
Still others suggested delving into further details about the CNO's role in quality improvement. Being a member of a committee is one thing, but is there anything beyond that to demonstrate the process behind her influence?
St. Vincent Hospital uses the Lean structure many hospitals are adopting, which its CNO is heavily involved in. Latty chose to include an explanation of how she influences this process and how Lean is used to influence the organization as a whole.
Challenges
There were some hiccups along the way in building the documentation needed to prove these facets of the CNO's role and influence.
"One thing I encountered was, when asking for meeting minutes for executive meetings, people don't want to let you take them," says Latty. "They're confidential documents. You have to be willing to have people tell you they can't send them to you."
Be prepared to go to the appropriate office, read through the document, and highlight the parts you need.
During this process, you may find that councils or committees don't update their charters or membership as often as they should.
"You don't want to include old information in your documentation," says Latty. "Motivate them to update their charter or membership list."
These smaller tasks can be very time-consuming, she notes. Anticipate spending more time than you would otherwise expect tracking down these items or requests.
Your CNO
Your greatest asset in creating this portion of your MRP document is your CNO.
"You need your CNO to be your advocate," says Latty. "They can be your intercessor in obtaining important documents or getting access to the right meeting minutes."
It is possible the CNO may not be comfortable standing in the spotlight—and this is a fear you need to help him or her get over.
"Once they see that what you're doing is to make them look as good as possible, they'll become your advocate," says Latty. "They're a great CNO and do all these wonderful things, and you want to capture that. Our own CNO, as we finish each SOE or component, thanks us for painting her in such a good light."
Because MRP designation is one of the organization's strategic initiatives, the board of directors has been behind the project from the start. The CNO takes on the role of keeping the board up to speed—which is key because, as Latty points out, it's important to have an open line of communication between you, the CNO, and the board through the whole process.
________________________________________________________________________ This article was adapted from one that originally appeared in the August 2010 issue of HCPro's Advisor to the ANCC Magnet Recognition Program®, an HCPro publication.
Scientists are reporting in a new study that mammography is not an effective screening tool for women in their 40s because a tumor and the patient's tissue appear to be the same color.
Stanford University researchers reporting in the Journal of the National Cancer Institute said while the screening technique works best for women older than 50, the denser tissue of younger women tends to obscure tumors.
For years, doctors have known that tumors and dense tissue tend to appear white on a mammogram. In women who have undergone menopause, breast tissue often appears gray on a mammogram, so the sharp color contrast of the tumor is not as difficult to miss.
The State Board of Health rejected a petition Wednesday to add Tourette's syndrome to the list of conditions for which patients can obtain medical marijuana.
It was the first time in the 10-year history of Colorado's medical-marijuana law that a petition to add a new condition had made it through the state health department's review process and come before the board. The decision suggested that the board will require a high standard of proof before allowing new conditions to go on the list.
Board members expressed concerns over the health impacts of smoking marijuana, noted that there are other medications that could be used to treat Tourette's and concluded that the research wasn't evolved enough to show that marijuana would be useful in treating Tourette's.
"I don't see what we add to the mix by actually adding Tourette's under these circumstances," said Glenn Schlabs, the board's president.