Hospitals and health systems can mitigate the effects of their copious energy consumption and waste generation by engaging with staff. Here's how one Michigan health system's sustainability efforts are boosted by its HR department.
The Hippocratic Oath is "first do no harm," but hospitals are among the greatest generators of waste and consumers of energy. Ironically, it's no secret that inefficient use of resources have a negative impact on everyone's health.
According to the Environmental Protection Agency, the average hospital contributes approximately 7,000 tons of waste daily—an amount which includes hazardous, infectious, and solid waste. Hospitals consume large amounts of electricity and water for domestic use, heating, cooling, and landscaping purposes.
But as healthcare systems look for ways to reduce consumption and shrink waste, the HR department is often front and center of these efforts.
"We have quite a few staff who are engaged in our sustainability program, and a lot of them are human resources staff," says Sarah Chartier, sustainability program manager at Spectrum Health, a not-for-profit health systembasedin Grand Rapids, MI. "They are ambassadors for our sustainability program, and have worked to include our environment-friendly activities in the employee orientation that occurs with all of our new employees."
In honor of the 45th annual Earth Day on Wednesday, April 22, let's review some strategies HR executives can take to make their organizations more environmentally sustainable.
1. Move Beyond Standard OR Procedures In 2007, Spectrum Health, which has 11 hospitals and 170 ambulatory and service sites, learned that 30% of hospital waste was generated in its operating rooms. Reducing OR waste became the first priority.
Spectrum OR recycling program focuses on recycling plastic, paper and cardboard, and recycles 75,000 pounds of blue wrap from its operating rooms yearly.
"Our program has evolved through collaboration with our recycling vendor," says Chartier. The two organizations have worked together to brainstorm new solutions for the hospital's waste—which can be tricky when the materials can carry biohazards. One safe use they found for blue wrap is to melt it down into plastic pallets, which are shipped for use around the country.
Another way Spectrum has reduced its OR carbon footprint is by simply turning off the lights. Keeping operating rooms ready at a moment's notice without exception was found to be unnecessary. Now when it is known that a specific OR will not be used over a period of time, the HVAC and lighting are turned off to conserve energy.
Sarah Chartier
Sustainability Program Manager,
Spectrum Health
2. Reduce Food Waste The cafeteria is another major waste center for hospitals, so Chartier worked with food service staff to find a solution.
All cafeterias within Spectrum's system now offer reusable cups for its more than 21,800 employees. Those who bring their own get a 10-cent discount. And one hospital within the system now composts vegetable waste from its kitchens, while another has gone Styrofoam-free within the last year.
To further reduce carbon emissions, Spectrum purchases locally sourced produce when possible. "We support several local businesses through purchasing bread, coffee, and other items we feature in our cafeterias from them, but here in Michigan our growing season isn't year round. It can be a challenge when attempting to locally source our produce," says Chartier. Spectrum attempts to feature locally sourced produce during the summer months, and uses Michigan apples year-round.
It also offers an agricultural pick-up service for their employees, allowing them to pick up farm-fresh, locally farmed and produced food at work during the summer months. "It helps with the need to support local farmers while encouraging our staff to eat healthy," she adds.
3. Offer Transportation Alternatives Not only is it energy inefficient for each employee to drive to work alone every day, but parking lots take up a lot of space, explains Rick Redetzke, vice president of facilities and real estate at Spectrum Health. Public transportation and carpooling are much more efficient, but making them convenient or affordable for employees can be a challenge.
With that in mind, Spectrum's leadership team collaborated with the local transportation authority and was able to work out a program where its employees get bus passes monthly at no cost.
"It's key to have a strong partnership with your city and the transportation authority in town," explains Redetzke. "They want what we want—safe streets and a green solution that not any one organization can do on its own."
Rick Redetzke
VP of Facilities
and Real Estate,
Spectrum Health
Currently, six percent of Spectrum's staff ride the bus to work at least once a month. About three percent of the staff ride it to work daily. While that might not sound like many, for a large system like Spectrum, it comes out to just over 1,300 employees who otherwise would be fighting for parking spaces.
Since public transportation isn't an option for everyone, employees are also offered an online tool that allows them to enter their working hours and address for a list of suggested coworkers with whom to carpool.
Employees who carpool are rewarded with prime parking spots right next to the hospital's back door, says Redetzke. There are currently seven daily scheduled carpooling groups and 250 employees using the tool.
4. Engage Your Employees Both Chartier and Redetzke agree that the most important sustainable resource is a hospital's employees, and that sustainability is a topic it's easy to get employees passionate about.
"This is an opportunity to engage employees at work," says Chartier, who has helped coordinate environment-themed events such as an interdepartmental recycled art competition where teams created artwork from hospital garbage and then voted on which team had the best piece. "Employees got an opportunity to get to know each other a bit better and do some team-building exercises."
Bringing up the organization's sustainability related benefits, such as free bus passes and the agricultural pickup is also an opportunity to start a conversation with employees about other benefits offered, she says.
But what Chartier finds most compelling is the opportunity to help employees see the affect the hospital has on the world around it, both locally and globally. "The employees care a bit more about how we affect the community, and they feel empowered to make changes at work as well."
Good strategic planning by HR executives can minimize trickledown turnover and keep the business on track during periods of leadership transition.
Strong leaders and long tenures don't always go hand-in hand. Sure, Bill Belichick has coached the New England Patriots to four Super Bowl victories over a 15-year career with the team. But he holds the record for shortest stint of any NFL coach—one day as head coach of the New York Jets in 2000.
Since hospital CEOs often have shorter tenures than NFL coaches, the key to keeping your organization thriving is to have a survival plan in place, and to be actively implementing it year round—not just right after the CEO gives notice.
When a hospital CEO, CFO, CMIO, or other high-ranking leader departs, he or she may give many months' notice, but sometimes, departure comes swiftly, and HR and administration must make decisive choices quickly. John McCabe, MD, CEO and senior vice president of hospital affairs for SUNY Upstate Medical University in Syracuse remembers the sudden turn of events in early 2004 that led to him assuming his current role.
He had been chair of the department of emergency medicine at his hospital for "most of his career," he says, and when the previous CEO announced his departure, his colleagues knew they would have to find a leader from the inside who would be trusted by both the medical staff and administration.
McCabe's tenure with the university began in 1987, so he was a known quantity, and hospital's administration thought his being physician would help make the staff more comfortable with him.
"When [our prior CEO] left, our campus president asked if I would step in on an interim basis to do the CEO's job… So, I stepped in to that role for a bit, and that seemed to work well for everybody." He was eventually moved to the CEO role permanently.
Not only did this work well for McCabe, but, the organization faced no real interruption in the wake of its last CEO's departure.
Finding good leaders—especially just after losing one—is not always so easy, but human resources leaders can make the transition more seamless by following two strategic best practices.
1. Re-Recruit the C-Suite Has it ever seemed like executives decide to leave their organizations at the same time? It's not all in your head—they do, says Lydia Ostermeier, vice president of executive search at B. E. Smith, a healthcare management consultancy. "When a CEO departs, there is always lots of uncertainty. Everyone asks themselves, 'what does this mean for me?' This can lead to high C-suite turnover," she says.
"The CFO, COO, or CNO are not unlikely to go with them, if they were very beloved and had good relationship, or if they are just uncertain or uncomfortable after their colleague's departure. This can lead to unintended turnover," says Ostermeier. She says she's recently noticed a trend of former hospital CEOs recruiting C-suite members from their last hospitals to their new organizations.
The turnover trend can trickle down all the way to caregivers, which can lead to a loss of momentum and strategic direction—and even negatively impact quality of care.
"Re-recruiting your top performers is going be key," says Ostermeier. "HR immediately needs to talk to them.". Her suggestion is to make sure they know their voices are heard:
Schedule a one-on-one meeting with each member of your current C-Suite.
Explain to them how valuable they are to your organization and to you.
Tell them that they will be part of selection process for the new leader. Make them feel included, and keep them incorporated in the executive search process.
2. Be Prepared and Don't Panic But don't just keep your C-suite is in the loop—make sure the entire organization is aware that the hospital will continue to operate as usual.
"Some organizations just go in to stand-still mode," warns Ostermeier. "They were in full-tilt boogie before the CEO departed, but then everything gets put on hold, from construction projects to research, until each department is sure that the new leadership will stand behind each project."
As a result, financial and clinical performance can both take a dip—a result that McCabe finds completely unacceptable. "Leadership changes should have no impact whatsoever on patient care. If our systems are built right, they should never be dependent on one person to run smoothly."
Both McCabe and Ostermeier suggest that HR leaders use this time to seek out interim leadership, launch a full-scale executive search and use any succession plan already in place. It's key to be proactive and get an interim or acting executive in to the role as quickly as possible to keep the wheels turning.
"Don't panic. None of us should be irreplaceable. The institution should be able to run just as it always has," says McCabe. He's in the habit of asking his employees to always keep an eye open for potential replacements. "All of my reports should be looking around and asking themselves who my replacement is—who can do my job?" He says their reports should be doing the same thing.
McCabe believes in training promising employees to jump in to an open job at a moment's notice, if need be—just like he did. McCabe acknowledges that this may be an easier process to set up in a for-profit healthcare setting, and says that he definitely thinks it's a tougher subject to broach in an academic medical center. "In the finely tuned private business world, it's just an easier conversation to have," he says.
Remember that there will always be departures. "Always be prepared," advises McCabe. "Push the leadership team to talk succession planning. Make sure everyone has a clear understanding of what their team will have to do in the weeks and months after an announcement is made."
It's rare to see clinicians, unions, hospital administrators and community leadership cooperate, but there is one event that will bring them all together: Fighting to keep a hospital from closing.
Adversity can breed unexpected alliances, but few events can galvanize a diverse group of people with vastly different priorities like the threat of a hospital closure says Ramon Rodriguez, CEO of Wyckoff Heights Medical Center in Brooklyn, NY. But the closure of a hospital affects so many people, that finding allies might be easier than expected.
"Everyone understands how important these hospitals in these communities are… These institutions are some of the most important institutions in the area," Rodriguez says, and that the ability for hospital administration to work with unions and members of the community might be the difference between life and death for troubled hospitals.
Along with 27 other New York state hospitals, Wyckoff is in danger of imminent closure if the state senate and assembly do not elect to include $290 million in vital access hospital funding in the final state budget, which is to be decided before April 1.
While the funding was included in Governor Andrew Cuomo's (D) original budget, the money was unexpectedly omitted in the senate and assembly version of the budget. "This issue was proposed in January, but it wasn't until two weeks ago that the preliminary house budget was released," explains Helen Schaub, vice president and New York state director of policy and legislation with the 1199SEIU labor union.
The Governor's office announced over the weekend that a budget agreement has been reached. Details are to be released today (Monday, March 30).
This is not an isolated incident. Across the country, community and independent hospitals skirt closure yearly, weekly, or monthly as they face the rocky transition toward value-based-healthcare, and as it becomes increasingly difficult for a community hospital to operate without a parent healthcare system.
While the C-suite and administrators take on much of the visible advocacy of keeping hospitals open, human resources can work behind the scenes to mobilize employees, work with unions, and reach out to their communities for support to help fight for their hospitals.
Mobilizing Clinicians
"I think it will be devastating," says Tammy Wilson, a licensed practical nurse at Auburn Community Hospital in Auburn, NY, when asked what would happen if her hospital, which is among the 28 currently at risk, closes.
"There are people who [have worked] there for years… I especially worry about the people who are close to retirement. Good jobs with good benefits are hard to come by," she says. Wilson also expresses concern for the patients she sees daily, most of whom are elderly and would have a hard time adjusting to new providers, in her view.
She is not alone in her reaction—many clinicians feel the same way, and are eager to help save their hospitals. Schaub suggests releasing clinicians to lobby state legislators, as several hospitals in New York have done. The presence of a nurse or physician visiting in person can have a strong influence on an elected official. Other clinicians have organized letter writing, telephone, or email campaigns among fellow staff, community members, and patients.
If your hospital's employees are represented by a union, you should definitely involve them in this process. Not only do unions have the respect of employees, but they also have experience in advocacy and lobbying—and know how to get heard.
"We have working relationship with the unions who represent our employees, and we are consistent with them in our goal to save our hospital," says Rodriguez. "Without unions, I'm not sure our voice would have been heard."
Schaub agrees. "The leadership of each group can sit down together and come up with a joint plan where everyone can work together to keep their hospital doors open."
Act Locally Community leaders are growing increasingly aware of the importance of keeping local hospitals alive.
"We have about 1,600 employees," says Rodriguez, "those employees contribute in our community about one billion dollars [annually] in spending power. For that reason, people who live in our neighborhood are very interested in making sure that the community has our hospital."
Another growing concern in both urban and rural communities are healthcare deserts—areas with limited access to healthcare. It's no secret that every minute counts in a medical emergency, and every mile a stroke or heart attack victim has to travel to get care hurts their chances for recovery. Forward-thinking community leaders will fight hard to prevent becoming one.
One hospital in New York state hosted a community event with a press conference and asked a local firefighter to talk to both the media and neighborhood leaders about the importance of access to a hospital in the area, says Schaub. It was well attended, and allowed a member of the community who was not affiliated with the hospital to explain to both the media and the locals why the hospital needs to stay open.
Rodriguez sends representatives from Wyckoff to different community boards, business associations, and health committees to share data and information on an ongoing basis, so the community is aware of the importance of the hospital long before the crisis hits—and is ready to work on his hospital's behalf when it does.
While healthcare leadership, clinicians, unions and members of the community might not always see eye to eye, it's important to utilize these opportunities where everyone wants the same thing and work together. "While we may have a different point of view at the bargaining table, at end of day, we must work together and build respect," says Rodriguez.
You might think the trick to avoiding tone-deaf press releases and communication blunders is to hire a PR specialist. Think again.
With staffing budgets tight, HR leaders naturally zero in on roles that might be redundant. To the untrained eye, a crisis communications specialist and a public relations specialist might look pretty similar—both roles are in the marketing or corporate communications departments, may require similar educational backgrounds, and appear to share similar skill sets.
But merging those roles would be terrible idea, says Barb Bortner, vice president of marketing and public relations at Mercy Health System in Janesville, WI. "By definition, public relations and crisis communications are different roles," she says.
"Public relations builds publicity for the organization and coordinates media interaction and events," Bortner explains. The crisis communicator's job is to protect the image the PR specialist has worked so hard to cultivate during a crisis.
Barb Bortner
VP of Marketing and Public Relations
Mercy Health System
Without proper crisis communication, the results can be disastrous. "You would be struggling to figure out what to do. You may not find right people to answer questions, and would run the risk of looking like your organization is trying to cover something up. Ultimately, you could lose credibility with your audience—which would be the worst," cautions Bortner.
Don't Get Complacent It can be easy to assume you'll never need a crisis communications specialist. Facilities located in small towns or a rural areas might feel like they're immune to crises. These are quiet places far from the media spotlight.
Severe weather. As winter storms battered the east coast this winter, many hospitals felt it necessary to reassure the media and the public that they were prepared to receive and treat patients. Facilities in regions that do not experience snow, should consider how to handle similar questions about hurricane, tornadoes, flooding, or even severe drought.
Consolidation. After a national healthcare system acquires a smaller one in your area, the local media starts eyeing your hospital as the next potential "victim" of consolidation
Patient experience. A local paper publishes a letter to the editor about an unsatisfactory experience at your hospital
Staff issues. A previously well-respected clinician turns out to behiding an unpleasant secret—and now there are media inquiries and requests for comment
No matter how well an organization tries to avoid the spotlight, these are all situations that any hospital could experience—and must be ready for. While it is tempting to ask your media relations team to hand these scenarios off to your PR staff, Bortner explains why that should be avoided.
"There are certain aspects of throwing someone into a crisis—they need to be ready for it. Their background and their training needs to be specifically for those kinds of situations. It's not that someone with a marketing or PR background could never handle crisis communications, but they need special training so be ready know what to do in case of crisis."
The Right Fit The training never stops in crisis communications. In addition to general on-the-job training, many localities organize regional table-top simulations—sometimes with no warning—to keep essential staff well-trained and on their toes for unexpected emergencies.
And while many organizations insist a crisis communications specialist have a degree in marketing or public relations, Bortner says that she looks more at a candidate's experience than what subject they studied in college. She does, however, suggest that a candidate holding a certificate in crisis communications would be a huge plus.
"The candidate must be a good communicator and able to proactively plan for a future event that may never happen. I need someone who can think on their feet and think strategically about the messages that would put the organization in the best light possible," she says. Additionally, she looks for candidates who are decisive, outgoing, and able to juggle many tasks at once.
Crisis communications doesn't always require a senior level position. Many organizations have multiple crisis communications specialists with different experience levels—usually a senior-level public information officer and a crisis communications specialist.
While hiring staff to specialize in crisis communications may feel like a luxury, these employees are an indispensable part of your media relations team—and not the right place to cut corners.
The convenient care industry is quietly beefing up benefits and looking for ways to entice clinicians into joining its ranks—potentially stealing away top talent from hospitals, health systems, and physicians practices.
If you thought retaining your nurse practitioners and physician assistants was already a challenge, hold on to your hats—it may be about to get even harder. Retail clinics are proliferating, attempting to hire from the same pool of clinicians as hospitals and healthcare systems, and offering enticing workers' benefits to boot.
From an employee's perspective, there is definite appeal to the retail clinic setting, also known as convenient care clinics. Healthcare workers have traditionally worked long hours, often under stressful conditions. A retail clinic setting might offer a way out of the pressure cooker, says Tine Hansen-Turton, Executive Director at the Convenient Care Association in Philadelphia.
"This is very gratifying work. In most healthcare environments, we have a lot of disgruntled customers, but customers seem to really like convenient care clinics. When you're a provider and you have happy customers, it's a good thing."
Between 85% and 90% of clinicians employed by retail clinics are nurse practitioners, says Hansen-Turton, and the next most commonly employed clinician is a physician assistant. The clinics are usually overseen by one or two physicians.
"We're currently experiencing an increase in appetite for convenient care, and as this ramps up, will see more clinicians investigating this kind of work environment," says Bonnie Britton, Senior Vice President, Locum Tenens Division at San Diego-based staffing service AMN Healthcare who is responsible for overseeing recruitment of clinicians to be placed in retail clinics.
Clinician compensation is usually similar to what one would experience working in a hospital, says Britton. "It appears to be comparable—I don't see any wide discrepancy yet," she says, adding that, as a relatively new employment setting, compensation levels are still evolving.
Hanson-Turton agrees, stating that clinician salaries in convenient care settings are "very competitive."
Working Conditions That Work Unlike working in an emergency department or even a physician's office, retail clinics rarely see complicated or extreme cases. Retail clinic staff usually deal with common maladies such as pinkeye, urinary tract infections, strep throat, and minor injuries. Anything more serious, whether it be a broken bone or suspected cancer, gets referred to a physician's office or nearby emergency department.
"The employee benefits packages are similar to hospitals," says Britton, "but there's more flexibility and more autonomy working in a retail clinic. It's usually pretty easy to get a day off." Unlike a hospital, a retail clinic's hours are usually 8:00 am to 8:00 pm, meaning that there is no overnight shift—which many clinicians with families find appealing. Additionally, it's often easier to negotiate the ability to work part time in a retail clinic setting, says Britton. Many clinicians who find retail clinics appealing are young, says Hansen-Turton. "We're seeing younger graduates than we saw before." They like the ongoing education opportunities offered by retail clinics, says Hansen-Turton. "This is really a practice where you also learn a lot of business skills and how to manage a business, which is attractive to a lot of practitioners as well… it's an opportunity you don't see in other care settings."
From The Same Pool "We are working from the same pool of candidates as an acute care facility. They have the same certifications and qualifications," says Britton. Most of the retail clinic-bound clinicians recruited through AMN are experienced healthcare workers with outpatient settings and acute care on their resumes, she added.
When asked if retail clinics are competing with hospitals for qualified employees, Britton responded, "I would agree. There is a shortage of physicians and clinicians in this country, and we're all competing for those very valuable resources and talents."
However, Hansen-Turton suggests that the new trend toward partnerships between retail clinics and healthcare systems will make it easy for clinicians to transition from retail clinic roles to hospital roles and back again.
"As many retail clinics now have partnerships with hospitals, some employees may work for both," she suggests, saying that some clinicians divide their time between the hospital and retail clinic setting. "[This arrangement is] very attractive to nurse practitioners," she says, and the relationships formed through these partnerships gives clinicians a foothold back in the hospital setting.
The key for retention is to stay competitive with other potential employers and keep the options interesting. "If you make the choices exciting for the clinicians, they will come," says Britton.
Obstetricians and gynecologists are notoriously difficult to recruit to rural areas, but offering the right candidates loan forgiveness, shortened work weeks, extra vacation time, and housing allowances can be effective.
Patients living in rural areas may be accustomed to having to travel for healthcare services, but few specialties have become as inaccessible as obstetrics and gynecology, says Katy Kozhimannil, PhD, MPA, assistant professor of health policy and management at theUniversity of Minnesota School of Public Health.
"I'm speaking specifically to obstetrics and childbirth services, but in general, there are access issues and challenges to delivering services in rural areas," she says. Between 1985 and 2000, hospitals in rural areas providing obstetric services dropped by 23%—and that number is on the rise.
Traveling for OB/GYN care is not ideal. "Studies have shown that the farther expectant women have to travel for their prenatal care and delivery, the higher the rate of infant and maternal morbidity," Kozhimannil says.
Rural Life
Obstetricians and gynecologists are notoriously difficult to recruit to rural areas, says Kenneth Platou, president and CEO of Dignity HealthMercy Medical Center in Mount Shasta, CA, a rural city in the far northern part of the state with a population of approximately 3,500.
He says it's important to filter candidates carefully and make sure their lifestyles are compatible with remote regions. "It takes a special kind of physician to want to practice in rural settings," he says. "The biggest barrier is the lifestyle. You have to like small-town life. If you like opera and Nordstrom's, rural opportunities aren't going to appeal to you," he says.
As the town's current gynecologist is nearing retirement, Platou recently found himself in need of finding a replacement. After a rigorous search, a candidate was found, in neighboring Oregon. That means the specialist will have to be licensed to practice in California—a process which, he says, "can take months."
Mercy Medical Center sweetened the deal by offering a guaranteed income loan for the first year with the hospital—a loan which will be forgiven after and additional three years of service. It was worth the wait and inconvenience, Platou insists, to find a candidate he is convinced will be happy in a small town.
Realistic Recruiting
It's important to play up quality of life perks to candidates and incentivize them, says Tommy Bohannon, a senior recruiter with Merritt Hawkins. He has seen gynecologists and obstetricians offered student loan forgiveness, shortened work weeks, extra vacation time and housing allowances by rural hospitals.
"Whatever it takes to get them there," Bohannon says. "Women's Services is a hard service line to recruit and maintain," he adds, saying that competition for a good gynecologist can be fierce, even in urban centers.
Add in the element of a small town where people might feel distrustful to an unfamiliar clinician and the isolation an outsider might feel, and positions gain the potential to remain vacant for months, if not years.
Bohannon says he's seen many rural hospitals resort to contract labor to maintain gynecology as a service line, which he says should never be considered as a long-term solution. "It's not economically viable and, while passable for routine gynecological procedures, local women will not be comfortable starting their pregnancy with one obstetrician, then giving birth with another," Bohannon says.
He considers himself a realist regarding the situation many rural health systems find themselves in, and believes that maintaining women's services is not financially viable for all systems. "When making these decisions, [leadership] has to ask themselves: is the revenue we're getting worth doing this? Because often, it's not."
Appropriate Level of Care
Kozhimannil conducted a study of rural hospitals in nine states and found that a common strategy to cope with staffing shortages was to team up clinicians with different specialties in an attempt to cobble together the right combination of skills.
"Larger rural hospitals more likely to have an obstetrician or gynecologist and nurse Midwives together," she says, "while smaller facilities often have family physicians working with general surgeons."
She suggests that rural clinics evaluate each pregnancy and determine the proper care setting for that particular mother and her child. "Pregnancy is not an ailment. Most women need a lot of information, support, and some screening, but medical requirements are minimal for 70% of pregnancies." These are the pregnancies that are candidates to be handled in a rural hospital by a nurse midwife or family physician.
But the additional 30% might need a more advanced care setting, says Kozhimannil. "Watch those twins, anxiety disorders requiring meds during pregnancy, women who develop diabetes while pregnant… Those are the higher risks."
For all the obstacles of rural life, rural birth, and rural healthcare, Platou is optimistic about the future of his hospital and others like it. "I can't think where I'd rather [like] be to manage population and community health," he says, including bringing new lives in to this world. "I'd rather be here than in downtown Manhattan."
Continuous improvement techniques used in manufacturing have helped at least six nationally recognized hospitals reduce wait times and drive up HCAHPS scores.
The management principals behind a car maker's success can drive down long wait times in hospitals, revving patient satisfaction rates and HCAHPS scores in the process.
Lisa Brandenburg
A discussion paper published by the Institute of Medicine suggests that patient wait times can be decreased and patient satisfaction improved by using well-known continuous-improvement approaches frequently found in industrial engineering and manufacturing trades.
Long wait times are a systemic problem that contribute not only to poor patient experience and create a barrier to accessing care, but also contribute to burnout among healthcare professionals, says Lisa Brandenburg, president of Seattle Children's Hospital, and an author of the paper. Other authors represented Denver Health, Mayo Clinic, Geisinger Health System, and Kaiser Permanente.
"Everyone comes to work wanting to take great care of the patients, not searching for supplies, spending lots of time looking for information, or duplicating steps that don't need to be duplicated... All of us in healthcare want to spend more time serving the patients," said Brandenburg who was reached by phone.
Additionally, the paper found that long wait times drive down HCAHPS scores.
Continuous Improvement A key component of Seattle Children's care redesign is the management practice of continuous improvement, which is also known as the Lean process, Kaizen, or the Toyota Model. It has been widely adopted in manufacturing. Brandenburg says her hospital adopted it about ten years ago.
Seattle Children's Hospital's leadership, along with the leadership teams from other hospitals associated with the paper made it a mission to observe their surroundings and look for ways to improve them, focusing on eliminating wasted time from their systems.
"Healthcare has many steps that would be considered waste—things that do not add value to the customer," says Brandenburg. One example: A nurse searching for the right tool to do a procedure correctly. A remedy is having each nurse bring to the OR the supplies he or she needs rather than wasting time looking for them.
Brandenburg and her colleagues argue that long wait times in healthcare will require a remedy that is focused on improving the efficiency of scheduling systems and take into account the laws of supply and demand.
Recognizing that demand is flexible, the organization has attempted to make its supply of clinicians more flexible, taking in to consideration trending data on demand that is recalculated daily in real time.
Using this data, Seattle Children's has been experimenting with different methods for making its clinicians more available to patients. A few approaches:
Improving communication regarding scheduling backups before they become severe, to prevent problems from growing unchecked
Scheduling nighttime appointments for physicians who also teach classes during the day
Improving transparency around wait times. Seattle Children's now posts wait times for every clinic in hospital lobbies so patients know to expect.
These efforts have brought the wait times for the hospital's specialty clinics down to 12 days from 18. Since the improvement is intended to be continuous, it won't end with these changes, says Brandenburg. "We want to be at seven days…. But we can continually make improvements and continue to take waste out of the system, including search time, travel time, transport time, and excessive complexity," she says.
A Proactive Approach One commonly raised concern is that while most departments in a hospital can strictly adhere to a schedule, the emergency department can't—after all, no one schedules a heart attack or accident.
Through use of computerized monitoring and improved planning, however, Seattle Children's has been able to beat long wait times in the ED.
The hospital once had a reactive approach to incoming ED patients, it now uses metrics and a dashboard to track patient influx and throughput, then it uses that information to predict wait times. Once the predicted wait times reach a level that could escalate to intolerable, the hospital staff calls in more clinicians. "Once the level gets to orange, we begin asking ourselves, 'what else do we need to do right now?' says Brandenburg.
The goal is to stop bottlenecks before they start. The result has been a 25% improvement in patient flow for admitted patients, as well as decreased wait times for patients who do not require admission.
Other areas marked for improvement through the Continuous Improvement process have included improving parking availability, the patient registration process, the discharge process, and time-to –obtain-a-procedure.
Now, says Brandenburg, with some waste out of the way, hospital staff can focus on what they do best—help the patients. "Everyone involved has a shared belief that it's possible to create high quality, high value experiences for the patient with less waiting and more patient-focused care," she says.
Misunderstandings around FLSA law are common and the penalties are real and potentially damaging to a hospital's finances, reputation, and retention efforts, a legal expert advises.
Everybody makes mistakes—but when those mistakes involve the Fair Labor Standards Act (FLSA), a mistake can be ruinous, destroying both finances and employee trust.
Thomas Shorter
Unfortunately, FLSA errors are easy mistakes to make.
FLSA errors are especially expensive for hospitals, says Thomas Shorter, a healthcare and employment attorney and shareholder at Godfrey and Kahn, S.C.
Just askSt. Mary's Hospital in Madison, WI. A nurse who had been terminated filed a suit citing the hospital's practice of asking nurses to stay within an area where they could hear a PA system during their meal breaks.
St. Mary's was found guilty of violating FLSA law by not allowing nurses a period where they were relieved of all duties. It agreed to pay $3.5 million dollars to settle a class action lawsuit for failing to pay 1,400 nurses for meal breaks when they had to stay on call.
"Large organizations have a large potential pool of employees, who in turn have a lot of hours for which they are entitled to overtime payments," says Shorter.
"Healthcare employers tend to be big, with many people working for them. If you, for example, misclassify whole set of employees [as exempt] in a healthcare setting, then you're going to have big problem on your hands," he says.
Here are a few common FLSA mix-ups and tips on how to prevent them.
1. Exempt Vs. Non-Exempt
The most common mistakes involve misclassification of employees as exempt, says Shorter. Many people mistakenly believe that anyone paid a salary or in a supervisory role is exempt and does not need to be paid overtime for hours worked in excess of forty per week. This, however, is false.
"This happens more frequently than anyone in HR probably realizes, and certainly more often than gets litigated," Shorter says. But ignorance is not an excuse and neither the DOL, nor the courts will be sympathetic.
"When the DOL comes in on cases, they will interview employees and ask them to describe what they do. If you can't fit their job descriptions within an actual exempt role, you've got an unpaid overtime problem on your hands—a big one," he says.
Sometimes, this confusion is exacerbated by changes to employees' responsibilities without any official documentation or HR involvement.
The best defense against roles morphing or the scope of an employee's job description changing unnoticed is to require periodical audits of all departments regarding each employee. Keep a copy of every employee's job description, and ensure that the job description actually matches the job.
2. Accidentally Off the Clock It's not uncommon for hospital employees to log out for lunch or a break and to be suddenly summoned back to attend to an emergency, or to voluntarily rush back to help. It's understandable that in their haste, they might neglect to log back in to the timekeeping system.
This scenario happens frequently. And, almost as frequently, no one catches the error, says Shorter.
Another common time-tracking mistake is that some time clock systems automatically factor a 30-minute meal break in to an eight hour shift—but not all employees know this. If an employee logs out for a 30-minute meal break, he or she is accidentally taking an additional half-hour out of their time worked.
"It ends up creating a significant issue where [employees] have a bunch of time they don't get compensated for," says Shorter.
Regardless of whether this is the employee's error or not, the employer is responsible for paying for the hours worked. It's important to keep an eye out for anything that looks odd—like someone logging out, then logging back in 30 minutes later if the system automatically deducts a break, or any other odd patterns that don't match up with typical schedules.
Additionally, make sure that payroll coordinators and managers in each department understand how the time clock system works and can explain to employees how to use it correctly.
3. The Myth of Comp Time An employee in accounting stayed an extra four hours last night to crunch numbers for a special project. Since he's a non-exempt employee, he has to be compensated for the extra time he spent working. Why not offer him comp time and tell him he can leave at noon on Friday?
Because it's illegal, that's why.
"There's a very limited exemption for certain government entities that allow comp time, but if your organization is not a government entity—like, if you're a hospital system—attempting to do this will create significant problems," says Shorter.
While many organizations erroneously allow employees to take comp time to even out the hours they've worked, it is technically illegal. "If an employee had a workweek where they worked over 40 hours, they are entitled to overtime compensation for that time under the FLSA. Comp time is a myth—it's never been applied to the private sector," says Shorter.
FSLA law can be confusing, even for the most experienced HR pros. But making sure that the HR team is up-to-date and well-versed on the topic is one of the best ways to keep your hospital out of the papers and the court room, while keeping your workforce engaged and loyal.
"Disrespect" shown by some healthcare providers "may discourage future visits or delay essential care that could lead to weight loss or the detection of diseases associated with obesity," a researcher says.
With more than one-third of Americans suffering from obesity, clinicians are struggling to find the key to help these patients get and stay healthy. But a new report suggests that cultural changes in healthcare and properly educating clinicians about obesity might be the secret weapon to engaging these patients.
Attitudes that obese patients are a lost cause, are lazy or non-compliant and are personally responsible for their condition were found to be widespread among medical professionals.
"The disrespect shown by some providers may discourage future visits or delay essential care that could lead to weight loss or the detection of diseases associated with obesity," says Dietz, who adds that judgmental clinicians, chairs in waiting rooms that cannot properly accommodate an obese person, and scales situated in high-traffic areas all inhibit obese patients from seeking timely medical care or asking for information about losing weight.
Published in The Lancetthis week, the report draws conclusions based on obesity management literature and studies published between 2000 and the end of 2013.
Among the researchers' other findings:
Changes in policy and environment can prevent people from becoming obese, but they do not help the currently obese to lose weight.
Prejudice against overweight patients is partly rooted in a lack of education about underlying causes of obesity during medical school and other clinical training.
"Clinicians need to become more comfortable addressing obesity," Dietz says. "Their biases and assumptions get in the way of providing these patients with good clinical care." His prescription is to provide better information on obesity at every level of clinician training, from undergraduate education through residency.
Watch Your Language Dietz's first prescription for healthcare workers is to change the way obesity is talked about. "We need to encourage the use of people-first language…. Obesity has become an identity, not a disease," he says.
Dietz also found that clinicians need to brush up on their approach when attempting to engage patients who are obese. "We need undergraduate education that teaches [future clinicians] how to talk about this problem. They need to understand what the common consequences are, how to assess the severity of the problem, and how to proceed in treatment."
Frequently, a clinician will bluntly tell a patient that he or she has a weight problem, then begin to discuss steps they believe the patient should take to lose weight. But Dietz and his coauthors found that this approach is not likely to be helpful.
"The problem with this approach is that patients have usually already tried some of those things, and that they have a weight problem is no surprise to them," says Dietz. Instead, he suggests a technique called motivational interviewingwhich attempts to engage the patient in a conversation about health, including possible changes that can be made.
Many clinicians believe that a major lifestyle overhaul would be most beneficial. But Dietz and his coauthors found that small changes that can easily be work into a patient's routine are best for taking weight off and keeping it off. These may include eliminating a daily snack, having vegetables on a pizza rather than pepperoni, or taking the stairs rather than the elevator once a day.
Role Models Other changes need to take place at the hospital, says Dietz, who sees a parallel between changing attitudes toward tobacco and obesity. "When hospitals eliminated vending cigarette machines and took tobacco products out of the gift shop, when doctors stopped smoking, it sent a message that this is an unhealthy behavior. Hospitals can be role models," he says.
Dietz suggests that hospitals stop selling fast food in their lobbies and ensure that their cafeterias offer nutritious, healthful options at all times. He points to a recent experiment at Massachusetts General Hospital where cafeteria options were color-coded by level of healthfulness. He also says that physicians who themselves have healthy eating habits are more likely to be comfortable engaging patients around obesity.
Dietz is hopeful that these cultural changes can lead to a near future where obese patients are treated in a more enlightened way by healthcare professionals.
"Our findings suggest that we must take steps now to transform the way obesity is treated, with more emphasis on partnerships, better training for health professionals, and initiatives aimed at erasing the stigma surrounding this serious health condition," Dietz says.
Employee wellness programs are hyped as a perk for employees and a cost-saver for employers. But a privacy advocate urges HR executives to proceed with caution.
Once a rarity, workplace wellness programs have become commonplace over the last decade. They are especially popular within the healthcare industry, with 99% of healthcare employersoffering some kind of program.
Typically, these programs include physical and/or mental health screenings, smoking cessation programs, and yearly flu shots. Employees who are willing to participate are usually offered incentives, such as free gym memberships or discounted on health insurance premiums.
Employers like wellness programs because they promise lower costs on health insurance and a potentially happier, healthier workforce who will take fewer sick days.
But there's a dark side. "One of the big problems is that workplace wellness programs believe themselves to be outside of any kind of laws," says privacy advocate Deborah Peel, MD, founder and chair of PatientPrivacyRights.org. The group advises companies on how to keep sensitive information private.
Given the downright personal nature of the information these programs gather on their participants, the lack of protections is astonishing.
1. Wellness Programs Not Covered by HIPAA
"The programs ask all kinds of things about how you live your life," says Peel. This may include smoking and drinking habits, whether or not participants are sexually active (and if so, how many partners they have had in recent years), medical history, and what medications have been prescribed.
While most of us are used to having such personal information protected by confidentiality laws, that's not the case when it comes to wellness programs. "It's very important to understand that most health information is not covered by the HIPAA. The HIPAA laws cover information you share with your doctor, but not workplace wellness programs."
Should an employer expect employees to bare their souls and answer very personal questions about their relationships and activities outside of work in exchange for no promise of privacy?
Relinquishing such information could create the opportunity for employees to claim that the data was later used against them in a discriminatory fashion. And employees who refuse to participate potentially create an additional concern for HR.
2. Data at Risk / Data Sharing
Here's a disappointing story from the front lines of the data security wars: The names, birth dates, and contact information of more than 14,000 wellness program participants administered by the StayWell Company was hacked earlier this year. While no medical or financial information was leaked, it's still unsettling news.
Don't let the lack of big headlines around security breaches at these companies fool you: While there have been few stories of wellness programs being hacked, that is partly because they are not required to report security breaches, as they are not governed by HIPAA, explains Peel.
Additionally, many wellness companies have repackaged the employee data they have been entrusted with and resell it, unbeknownst to the employees or their employers. "They believe they can do what they want with the information," she adds. Employers should read the contracts carefully.
3. No Trust, No Disclosure
There's no way to sugar coat this: If employees don't trust the workplace wellness program, they won't be honest about their habits, medical conditions, or lifestyle choices.
"A lack of privacy has big effects," says Peel. "When people know things are not private, they actually lie, or delay, or avoid treatment, and the public is growing more and more aware that they can't trust these systems."
What is the point of promoting a smoking cessation program if employees are lying about quitting? What is the point of offering counseling for stress management if employees are afraid to take advantage of it?
Why survey employees on how many medications they take or what chronic conditions they have if their reward for candor will be, at best, getting inundated with ads targeted to people who suffer from the same conditions, or potentially having their personal information leaked on the Internet?
Organizations determined to use a wellness program should ask the provider to prove that its data security practices is sound. "At very least," says Peel, "the company should provide proof of an external audit showing level of security they have, that intrusion testing has been done. Make any companies you use divulge the exact details of the intrusion testing."
They should also be able to meet HIPAA standards, even if they don't technically apply to them," she suggests.
Ultimately, Peel advises that human resources leaders ask themselves whether a break on insurance costs or other benefits truly outweigh the potential for damage to employees' privacy. "The violation of trust—that's the big thing," she says.