To lessen the terror that kids may feel before a scary procedure, some hospitals are incorporating "medical play" for them. Kids make puppets out of tongue depressors, they play a version of bingo in which O stands for nurses and N is for X-ray, and they put bandages on dolls. There are more than 400 such efforts in the United States and Canada, according to the American Academy of Pediatrics.
Tens of thousands of people insured under the Massachusetts universal healthcare system have had their coverage terminated since the start of the year, figures show. In some cases, patients were terminated because of mistakes they made themselves and in other cases because of errors by the state. The state figures, however, do not show how many of the people later re-enrolled and do not track how many were wrongfully terminated. But lawyers and community advocates said they have seen several enrollees whose insurance was unilaterally canceled by the state through no fault of their own.
Fingering the next serial killer might sound like a job best suited for CSI, but in the organized chaos that is the typical healthcare organization, the best gumshoe might just be you.
At least the Hospital Association of Southern California thinks so. The association recently held a daylong workshop titled "Detecting and Preventing Serial Murders in Hospitals." It is not a topic that immediately springs to mind when one considers healthcare human resources.
The agenda included classes on the demographics of serial murder by healthcare professionals, case studies of nurses charged with serial murder, tips for evidence collection, early identification of potential serial murderers, prevention, risk management, working with law enforcement, and media relations.
In the pamphlet promoting the workshop, the association says it felt compelled to sponsor the event because of the widespread media attention focused on Charles Cullen, a nurse now serving 11 consecutive life sentences after he confessed to killing more than 40 patients in 10 hospitals in New Jersey and Pennsylvania.
"As hard as it is to believe, this is not an isolated incident. Over 90 nurses and other healthcare professionals have been prosecuted for serial murder of patients in their care in 20 different countries," HASC says.
The serial killer workshop got me thinking about some other, albeit less striking, healthcare human relations trouble spots I'd read about in recent weeks. There was the case of the "rising star" hospital executive in South Florida who omitted from his resume his conviction and dishonorable discharge from the U.S. Navy for credit card theft. Rodney E. Miller also failed to tell his superiors at Memorial Healthcare System about an ongoing criminal investigation in the U.S. Virgin Islands that includes allegations of fraud and theft at a hospital Miller ran on St. Thomas.
On another topic, we have come to learn that peeking at celebrities' confidential health records has become a popular pastime at UCLA Medical Center, where so far 127 hospital employees have been named in a growing scandal. The list of celebrities whose files were compromised and whose privacy was violated includes California First Lady Maria Shriver, pop singer Britney Spears, and actress Farah Fawcett.
And then we have the heartwarming story of the hospital CEO in Los Angeles who allegedly orchestrated a scam that billed the government for bogus medical treatments performed on homeless people recruited from nearby Skid Row.
Of course, these tawdry stories do not provide an accurate snapshot of the state of the healthcare industry today. The reason they attract so much media attention, in fact, is because they happen so rarely.
But they do provide cautionary tales. Lessons can be learned from each of the examples. In the case of Cullen, for example, nurses at many of the hospitals where he committed his crimes frequently complained about his aberrant behavior; but no one listened. Does your healthcare facility have an outlet for staff to raise concerns about colleagues' behavior? Is anyone listening? Better yet, is anyone responding?
Memorial Healthcare System found out too late that its routine criminal background check on Rodney Miller did not cover his military career. Do your HR background checks provide for such contingencies? Have you look lately to see exactly what your background checks encompass and what they leave out?
What security measures do you have to ensure that patients' records remain confidential? And who is watching your CEO? What checks and balances are in place in your hospital to ensure C-Suite compliance?
Generally speaking, the healthcare industry attracts a particularly professional, disciplined, and noble breed. Whether they are involved directly in patient care or serve in administrative and leadership roles like human resources, these are people committed to the mission of healing. They understand and take quite seriously their vital role in their communities. With that burden of responsibility, people inside the healthcare industry share a common bond. They may be inclined to think that charlatans or criminals could not breach that bond. But the stories just noted show that it can happen, albeit rarely. There are wolves out there and all of us need to remember that.
John Commins is the human resources and community and rural hospitals editor withHealthLeadersMedia. He can be reached at jcommins@healthleadersmedia.com.
Wellness programs boost employee health, and participants in such programs also are more engaged employees, according to a recent study.Employees at companies that offer such programs are "significantly" more satisfied with their jobs, more likely to remain with the company long term, and more likely to recommend it to a friend or family member as a place to work, according to the findings. It's up to employers, though, to use communications, education, and leadership to encourage employees to participate in wellness programs, experts say.
Healthcare in Nevada seems to suffer from a "normalization of deviance," according to this article in the Las Vegas Sun. In two recent high-profile cases, trained professionals apparently ignored strong evidence of wrongdoing. Fifty thousand people had to be tested for infectious diseases because of a hepatitis C outbreak caused by unsafe injection practices at Endoscopy Center of Southern Nevada. And for years, doctors in Las Vegas were profiting by overworking foreign doctors, underpaying them, and ordering them away from the medically needy patients they were supposed to serve so they could bring in more revenue in hospitals, say the authors.
David Boucher talks about how Companion Global Healthcare is expanding its network of JCI-accredited hospitals and overcoming barriers to medical travel. +
The scenario is a common one these days. A hospital CEO hears about a group of surgeons planning to build an ambulatory surgery center, gastroenterologists developing a GI center, or radiologists opening a freestanding imaging center. Or hospital leadership hears a rumor about a group of physicians on the medical staff planning to build a surgical hospital with an outside developer. The typical reaction is, "I had no idea!"
Well, shame on the CEO. These events don’t occur in a vacuum. Physicians pursue entrepreneurial relationships with other physicians or with partners outside of the hospital for a reason. And the reason is that their relationship with the hospital is broken—trust has been lost, requests have gone unanswered, they feel undervalued and ready to toss in their lot with someone who appreciates them. The evidence is there—medical staff is apathetic, meeting attendance is spotty, interest in hospital programs and services is lacking. CEOs just find it easier to stay in a passive, reactive mode. Sure they might be responsive when physicians approach them with entrepreneurial ideas, but it is rare for CEOs to approach physicians in a proactive, collaborative manner.
So how can hospitals engage physicians as business and clinical partners in the delivery of healthcare services? Here are six suggestions.
1. Get out of the office. The CEO of a Mid-Atlantic health system spent the first four months on the job using his car as his office. He met with physicians in their offices and on their turf to rebuild relationships. He commented that it was easier to understand and empathize with their issues and concerns when he was out of his office and in theirs. An open door policy wasn’t enough. Another hospital CEO spends the first hour of the day in the physician lounge, near the computer terminals with patient records. Her goal is to visit with physicians on their turf to identify issues that are impeding the day-to-day practice of medicine.
2. Implement a comprehensive and systematic outreach program. Few approaches, if properly developed, result in stronger physician-hospital relationships than physician outreach. One of the best examples of an effective implementation of this approach is the Bon Secours Hampton Roads Health System in Virginia. Senior leadership, supplemented with outreach liaisons, meets regularly with physicians and identifies critical operational issues that are disrupting their practices. Examples include the availability of specialists, efficiency and quality of imaging services, care provided by the emergency department, and availability of operating room time. By listening to the physicians’ concerns and addressing these issues, the health system believes it can earn the referral relationships of physicians who have other choices for alignment—other hospitals, surgery centers, imaging centers, and diagnostic and treatment facilities. This outreach program is so vital to Bon Secours Hampton Roads Health System that the system CEO monitors the issue lists daily—tracks the resolution of issues and timely feedback to physicians—and shares information from the hospital or outpatient facility with other entities within the system.
3. Don’t rely only on economic models for physician alignment. Many hospital leaders are quick to conclude that physician relationships must involve formal economic relationships, such as employment, equity model joint ventures, or medical director stipends. However, the outreach program example illustrates that successful physician-hospital alignment and strong referral relationships don’t have to be driven by economics.
4. Include physician leaders in developing the strategic direction of the hospital and its programs and services. Many hospital leaders are fixated on return on investment, market share, and other concepts that are foreign to clinicians who focus on the delivery of patient care. Physician leaders are likely to be far more engaged if the strategic direction of the hospital includes the pursuit of high quality, efficient services, and the purposeful recruitment of clinicians who are complementary to the skills and expertise of the current medical staff.
5. Don’t rely on traditional committees, such as the medical executive committee, for physician input. Hoag Memorial Hospital Presbyterian in California formed a physician advisory council to deal with substantive medical staff issues in a forum that provides the appropriate amount of time and attention. The traditional medical executive committee was burdened with an agenda of standing committee reports, such as pharmacy and therapeutics committee, credentials committee, safety committee, and others. By the time physician leaders addressed critical issues facing the medical staff, meetings were often hours long. The physician advisory council meetings focus on service line development, measurement and demonstration of quality of care, achievement of pay-for-performance rewards from contractual payers, and other issues pertinent to medical practice. A committee like this can also include informal leaders, typically younger, future leaders of the medical staff, who are often overlooked by the elected membership of the medical executive committee.
6. Listen to the medical staff, don’t sell. Far too many hospital leaders try to sell programs and services rather than listen to physicians talk about the issues of the greatest interest to them. When hospital leaders use the jargon of financial return or poaching market share from competitors, this language represents a disconnect from patient care issues and the clinical practice of physicians. One hospital CEO uses an 80:20 rule, devoting the majority of time to listening to physicians (80%) and the minority of time (20%) to speaking.
CEOs who employ proactive communication and interactive approaches with their medical staff will discover that they are less likely to be blindsided by entrepreneurial, competitive physician initiatives. Instead, these initiatives won’t occur at all, or when they do, hospital leadership will be engaged enough to see the warning signs early on and take the appropriate, proactive measures needed to potentially salvage the relationships.
Craig E. Holm, FACHE, senior vice president of Health Strategies & Solutions, Inc. in Philadelphia. He can be reached at cholm@hss-inc.com.
The Centers for Medicare & Medicaid Services is now disclosing hospital mortality rates to consumers for heart attacks, heart failure, and pneumonia on its Web site, Hospital Compare, which provides information on how well hospitals meet patients' needs on more than two dozen measures ranging from surgical procedures to communication.
The extent to which consumers will actually use online tools to compare hospitals before deciding where to receive treatment is still in question. Consumers haven't exactly swarmed the government's site, which may be why the agency also released its mortality data to USA Today, which created its own hospital comparison tool that will not only reach a broad audience, but is also easy to use. Still, experts contend that as patients become more familiar with the information, they will start using it to make healthcare decisions—and that has some hospital executives worried.
Their concern is that patients will not fully understand how to interpret the data or how the rates are calculated, and may come away with the wrong impression about the quality of care their hospital offers. For example, will the average consumer understand that hospitals treating a lower volume of patients, more acutely ill patients, or patients who delayed seeking care or had to travel long distances to the hospital can skew the results? I'm not convinced that they need to.
I'm not arguing that all of these points aren't statistically valid. They will impact your hospital's rating. (By the way, the formula used by CMS does account for some of these concerns—it factors in patient mix and captures all deaths among Medicare beneficiaries that occurred within 30 days of the patients' hospital admission, so hospitals can't send risky patients elsewhere.) But many hospitals—including some with a poor patient base or smaller size—have still found a way to improve their scores and provide great quality. How? Rather than complaining about all the statistical problems with the data, these hospital leaders focus on how to improve their quality scores and reduce mortality rates despite the obstacles.
For better or worse, quality is becoming more transparent—I, for one, think it's a step in the right direction. Hospitals are diligently working to improve their quality across the nation, and you don't want to be left behind. More importantly, you don't want to be judged on a different set of criteria. The argument that you are smaller or located in a poorer region, and therefore should be judged by a different set of standards is not in your best interest. Consumers will then perceive your facility as second rate, and, if possible, seek treatment elsewhere. Hospitals regardless of size, location, and demographics need to be judged on the same set of standards.
Granted some of you may have difficult challenges to deal with. But how your hospital's senior leaders overcome adversity, inspire employees, and hold everyone accountable to improve quality is what will ultimately separate the best-performing hospitals from the low performers.
Carrie Vaughan is leadership editor with HealthLeaders magazine. She can be reached at cvaughan@healthleadersmedia.com.
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The University of Pittsburgh Medical Center posted a slim $5 million profit for fiscal 2008, down from a record $612 million profit the previous year. UPMC's investments returned a negative $128 million for the 12 months that ended June 30, dropping from a $403 million gain in fiscal 2007. The medical center's other core revenue generator—its hospitals, doctors and health insurance plans—also didn't do as well profit-wise compared with the previous year.
The board chairman and nine other directors have resigned from the University of Maryland Medical System, and the remaining members installed new leadership at the system that oversees hospitals in Baltimore and around the state. The moves follow disagreements between some board members and Gov. Martin O'Malley over what they perceive as the governor's attempt to politicize the board and also between physicians and former Chief Executive Officer Edmond F. Notebaert over concerns that he ignored their interests. The turmoil has clouded the future of the University of Maryland Medical System, which is an important economic driver in the state.
