America has two healthcare systems: One that is largely white; another that is largely black, brown and poorly administered. That's the troubling finding of two studies funded by the Robert Wood Johnson Foundation and conducted by the Harvard School of Public Health. Fewer than 5% of hospitals provide care to more than half of all elderly African-American and Hispanic patients, and that care is often substandard, the studies found.
Press Ganey Associates, Inc. has released its annual Hospital Pulse report, providing trends in patient perspectives. The report says patients in the 65 to 79 age group are the most satisfied, while those in the 35 to 49 age group report the least satisfaction. The report also says Wichita, KS, is the metropolitan area with the highest satisfaction rate.
Experts are calling new guidelines released by the Canadian Patient Safety Institute a major step forward in quality healthcare. The guidelines encourage doctors to tell patients when there has been a close call or adverse event that has affected their healthcare.
In what officials are calling a "tragic medical error," a surgical team removed the wrong kidney from a patient with kidney cancer at Methodist Hospital in St. Louis Park, MN. Officials said the error occurred weeks before the surgery, when the kidney on the wrong side was identified on the patient's medical charts as cancerous. The patient, who was not identified, was left with the cancerous kidney when the healthy one was removed.
More than a decade ago, one of my patients told me that the result of her knee replacement surgery was terrific but that her experience in our hospital was so negative that she would not return for her second knee replacement.
It was at that moment that I realized the patient experience is absolutely critical to the success of my practice and that my patients' time in the hospital had been neither effective, efficient, or patient/family friendly. A new model of care was needed.
It didn't take much investigating to see that the patient care process at the hospital was disjointed. Each department lived in a self-contained silo with little, if any, interaction with other silos, other than some casual hall conversation amongst the various caregivers. No one was focusing on service from the patient's point of view.
Patients don't perceive the episode of care as a hand-off from one caregiver to another. They actually think that everyone is working together and that providers communicate regularly with each other. As a surgeon, I had to stop complaining and collaborate with the administration and clinical staff to develop a solution. With the hospital as a partner, I led a team that set out to develop a vastly improved model of patient care. The hospital could not develop a service line for us surgeons; it could only do it with us. A service line is, after all, a team effort.
The continuum of care As part of our evaluation, I learned that the education I provided for my patients often conflicted with the information provided at the hospital. For example, I might tell the patient that the length of stay would be three days, but the hospital pre-admission testing might indicate a four day stay, leaving the patient confused.
When developing the service line, each patient interaction must convey the same messages, in and out of the hospital, to create a seamless continuum of care. Here is how the cycle should work on a step-by-step basis:
Step 1: Community education. The patient knows he or she has a problem and wants to learn more about the causes and the solutions. This is the information-seeking phase. Quality information can be provided through educational seminars, the hospital Web site, health screenings, articles in newsletters, and interactive electronic Q&A sessions. This is when the patient becomes aware of your branded service line.
Step 2: Primary care physicians. PCPs are looking for help and should be involved in the service line. They welcome help with their patients through educational information, seminar and screening dates, in-service education on the developing service line, and direct links to specialist's offices. They are not equipped to answer all questions about specialty areas so the program becomes a great asset to them.
Step 3: Specialists' offices. All parts of the office should be learning centers for the patient and their family members. Verbal education is often inconsistent and ineffective; it takes a great deal of time but very little of the information is retained by the patient. Therefore, I provided education through videos, written materials, and physician/patient interaction. This saved hours of my time and provided much better education/retention for the patient.
Step 4: Pre-operative teaching and testing. One thing that we learned early in our service line development: It is essential to set expectations for both the patient and the family. Therefore, we established a pre-op class for about two weeks before the surgery. This prepares everyone for pre-operative readiness, the hospital stay, and discharge preparation. As a result, the patient does better and the family members feel comfortable bringing the patient home.
Step 5: Designated team and designated unit within the hospital. In order to become a branded service line, there has to be a designated interdisciplinary team for the program and a designated space for it--with a sign. The designated team of nurses and therapists become experts in this area of care. In addition the team becomes a valuable resource for the surgeon. A dedicated team is able to assess clinical protocol changes and their effectiveness.
Step 6: Post-operative follow up. We realized that it was critical to involve extended care facilities, home health organizations, and outpatient physical therapy in the continuum of care. Transitional treatment plans were developed so that these caregivers would follow our pathways. We also developed vehicles for the transfer of information.
Step 7: Measurement/outcomes/results. To complete the continuum of care, we realized that patients want to know the effectiveness of the service line. More than 10 years ago we began tracking outcomes, aggregating the data, and posting the results for everyone to see. This served several purposes. First, measurement kept our pulse on the areas of the program that were strong as well as those that needed further attention. Second, it let us know if new clinical elements (anesthesia protocols, physical therapy exercises, pain or nausea prevention treatments, etc.) were effective. And third, monthly patient luncheons (focus groups) provided relevant information on the patient experience.
This new model of care has led to some very positive results, including: Increased patient satisfaction, lower per case costs, increased volumes, rapid recovery, improved surgeon efficiency, and community/regional recognition. With the increase in competition, developing a service line from the patient's perspective connects all stakeholders into a unified and educated voice. As a result of this model, the hospital has become well-known for its care of joint patients.
Marshall K. Steele, MD, is the President of Marshall Steele & Associates. He has consulted with over 250 hospitals and now leads a team that provides service line development services for hospitals nationwide. He can be reached at msteele@marshallsteele.com or jjones@marshallsteele.com.
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The main ingredient in recalled Heparin was modified to yield the contaminant linked to as many as 21 deaths among users of the popular blood thinner, the Food and Drug Administration said in a recent report. FDA officials still don't know whether the modified ingredient caused the deaths and more than 700 other reports of side effects, and whether it was introduced deliberately as a substitute.
Seventy-eight million Baby Boomers will soon hit retirement age, according to the National Association for Home Care and Hospice, and a large percentage of them will need help to remain independent in their own homes. There enters home healthcare, a $53 billion industry that delivers home-based medical services to 76,000 Americans. Efforts to contain costs and a growing consumer preference for care in the home are key factors in this growing healthcare sector.
Being uninsured can be a death sentence, with a national health organization estimating that 750 Ohioans died unnecessarily in 2006. The estimated total translates into two deaths a day in Ohio, according to Families USA, a national health advocacy organization that promotes affordable healthcare for all Americans.
Someday soon Haelen Hyperbarics will reach across the nation and its hyperbaric oxygen therapy will be an everyday part of the nation's healthcare, if the management team's vision comes true. The Hilton Head Island, SC-based company plans to open centers in Raleigh; West Palm Beach, FL; Austin; Savannah, GA; and Memphis, TN, by the end of the year. The company is considering Charlotte as well.
The Masonic Home of Louisville expects to start work next month on a new skilled-care nursing facility at its 81-acre campus off Frankfort Avenue. The $25 million, 136-bed Louisville Care Center would have about 180,000 square feet, making it more than three times larger than the skilled-care center it would replace, the St. John's Day League HealthCare Center. The new center will include areas for residents with late-stage Alzheimer's disease, rehabilitation and a dialysis clinic that will be open to the public.
