Under a measure drafted by Gov. Deval Patrick's administration, Massachusetts health regulators are expected to make it significantly harder for Boston's teaching hospitals to expand into the suburbs. The move is designed to protect smaller community hospitals that feel under siege from their powerful rivals. The measure is almost certain to win support from the Public Health Council, and will force hospitals to prove that proposed expansions do not duplicate services. Prior to the measure, hospitals hoping to add overnight beds at outpatient facilities faced little scrutiny from the state.
Would we have ever heard of Edith Isabel Rodriguez if her death on a Los Angeles hospital's waiting room floor weren't captured on a video surveillance tape? Probably not. That tape, which has been held for more than a year by county administrators as "confidential, official information," was leaked on the Internet last week, reigniting the discussion on cable news stations about the lack of compassion in America's healthcare system.
But in my mind, the discussion should be more about leadership. After Rodriguez's death in 2007, administrators of the county-run hospital repeatedly tried to cover up the event, reporting the woman's death to the coroner's office as that of a "quasi-transient woman with a history of abusing drugs." There was no mention of how long the woman waited in the emergency department for treatment before she fell to the floor, or how six hospital staff members walked by her as she writhed in pain. In fact, a county administrator told the Los Angeles Times in 2007, "If there wasn't a videotape, we wouldn't be discussing it. Period."
Without the videotape, we wouldn't know anything about Rodriguez, or how the lack of action by hospital staff members contributed to her death. Her family would be given a list of excuses, but few answers. Hospital administrators would have covered up the incident and allowed employees to ease their guilt with a list of excuses.
But a good leader knows that to provide quality patient care, there are no excuses. He or she knows that mistakes happen, and when they do, it is best not to cover up the mistake, but share it with the organization so that others might learn from it. This was the case in Boston last week, when Beth Israel Deaconess Hospital's CEO Paul Levy communicated a wrong-site surgery case to his employees.
"This week at BIDMC, a patient was harmed when something happened that never should happen: A procedure was performed on the wrong body part . . . we are sharing this information with the whole organization because there are lessons here for all of us," Levy wrote in an e-mail to BIDMC employees. He later posted the e-mail and follow-up thoughts on his blog,
Running a Hospital.
Levy writes that the surgeon in this case immediately informed his supervisor when he realized the error, and the organization's Health Care Quality staff was able to immediately interview everyone who was present in the OR when the error occurred, gathering details that will help them figure out how the error happened—and what can be done to prevent future errors. The patient was told of the error and apologized to upon regaining consciousness, Levy says.
Mistakes happen. We're humans, so they always will. But in order to succeed in providing patients the best possible care, hospitals must have effective leaders—leaders who are ready to admit mistakes when they happen, as Levy did, and examine processes to make sure they don't happen again. Good leaders know the value of true transparency and are prepared to face family members of a wronged patient and offer support to clinicians involved in the event.
What kind of bar have you, as a leader, set for your organization? If an error occurs tomorrow, will you put it out there for the world to see, or will you try to sweep it under the rug? Are you prepared to explain the situation to the affected patient and his or her loved ones? Can you offer support to the medical personnel involved? A good leader will turn an unfortunate error into an opportunity to make their organization safer.
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New York hospitals had a higher rate of infection in surgical intensive care units in 2007 than the rest of the nation, according to a report. Compared to the national average of 2.7 infections per 1,000 days of central-line treatment, New York surgical intensive care units had 3.7 per 1,000. The report on hospital acquired infections was conducted by the state in compliance with a 2005 law that required New York to track statewide infection trends. The data for 2007 are not broken down by hospital, but in 2009 that information will be provided for hospitals in 2008.
Perry, IA-based Dallas County Hospital, which was managed for years by executives from Iowa Health-Des Moines, is now being run by Mercy Medical Center. Iowa Health had managed the public hospital since the 1980s, but withdrew from the contract because of undisclosed disagreements with the hospital's board. Iowa Health and Mercy dominate the healthcare market in central Iowa. They own all five of Des Moines' private hospitals, and provide management services for several smaller, rural hospitals.
Anthem Blue Cross and Blue Shield will begin disclosing the estimated cost of 39 common medical procedures and tests in southeastern Wisconsin. The information will be available on the health insurer's Web site, and will include such procedures and tests as mammography, colonoscopy, an MRI of the spine, and knee replacement surgery. Anthem Blue Cross will become the second health insurer in southeastern Wisconsin to disclose estimated prices. Humana Inc. began doing so for people in one of its health plans in early 2006.
Having a communication strategy is not new to the healthcare industry. Many hospitals have trained their clinicians to use techniques like SBAR (Situation, Background, Assessment, and Recommendation) when they are transferring or handing off patients to another clinician to ensure that vital patient information is forwarded to the next caregiver. Hospital executives understand that this type of formal communication is an essential step to providing the highest quality and safest care to their patients. Likewise, senior leaders understand that good communication is an essential component to the success of their organization. But how well do you really communicate your hospital's goals? Do your employees know the hospital's mission, or perhaps most importantly, do they know what their role is in achieving that mission?
Senior executives in community hospitals may mistakenly believe that because their hospital has a smaller staff or because they are located in a small town where everybody seems to know what everyone else is doing that an informal communication strategy is sufficient. But you don't want your employees thinking that they're always the last to hear about the organization's strategy, or worse yet, to hear about organizational announcements from someone else in the community.
Many hospitals have a monthly newsletter or quarterly meetings, but are these methods the best way to reach and engage your staff? Earlier this year, I heard Brian Shockney, the chief executive officer of Logansport (IN) Memorial Hospital, discuss the importance of "lavish communication" to align every hospital employee around the goals of the organization. He also discussed that it was the CEO's responsibility to communicate that message. At Memorial, Shockney holds roundtables with hospital employees once a month that consist of a 10-minute presentation followed by a 50-minute question-and-answer session. He also meets with senior executives once a week, managers once a month, and attends all of the hospital's department meetings at least once a year. In addition, Memorial has a policy against using healthcare jargon during its board meetings and its senior leaders use the employee parking lots.
While you may use different communication techniques in your organization, every hospital should be educating its employees on their role in helping the organization meet its goals. In addition, hospitals should encourage employees to voice their concerns or offer feedback. After all, the top priority on just about every hospital mission statement is providing high quality and safe care to patients. So would your security team or housekeeping staff offer assistance or get help if they saw a patient fall to the floor in the emergency room? Or would they just continue to do "their" job.
Carrie Vaughan is editor of HealthLeaders Media Community and Rural Hospital Weekly. She can be reached at cvaughan@healthleadersmedia.com.
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