The push toward patient satisfaction can jumble organizational priorities. It can put new pressures on providers, whose primary focus should be "on staying financially afloat—then quality, and [then] safety," says one observer.
Kathleen Bartholomew, RN, MN, an independent educator, consultant, and nurse leader based in the Seattle area recalls a scene she has seen play out in clinics, hospitals and doctor's offices across the country.
The details involve a senior surgeon and a child who had recently suffered her second ear infection.
The child's mother, hoping to avoid more time away from work due to her child's illness, insisted that the surgeon put tubes in the girl's ears to ward off future infections. But the surgeon refused to do so, citing best practice guidelines. "A child has to have three ear infections before they become a candidate for ear tubes," he stated. This child had had only two, and there was no reason to believe that she was particularly susceptible to them.
The child's mother left in a huff to find another clinic that would do what she wanted.
But the story doesn't end there.
Within days, the surgeon learned that he'd been given an awful review on the patient satisfaction survey by the patient's mother—and would have to explain himself to hospital management. It was a double blow. His actions would affect the hospital's HCAHPS scores and his compensation that year, which was tied to patient satisfaction measures.
"That kind of stuff is happening right now. If the patient doesn't get what they want, they go somewhere else," says Bartholomew.
But Bartholomew casts a cool eye. "You want to focus on the patient experience?" she asks. "It's just the new flavor of the month."
While some health systems are investing in amenities designed to improve the quality of a patient's stay, patient experience initiatives are ultimately about reimbursement, says Bartholomew. Thirty percent of the Centers for Medicare & Medicaid Services Value-based purchasing program, which can affect up to 1.5% of a hospital's Medicare revenue, is currently tied to patient experience scores. By 2017, the VBP program will affect up to 2% of a hospital's Medicare revenue, and patient experience component of that score drops to 25%
At best, Bartholomew sees the push toward patient satisfaction as a confusion of organizational priorities. "The hospital's primary focus is on staying financially afloat—then quality, and [then] safety. Sometimes, [these priorities] conflict."
Marshall Maglothin, MHA, MBA, a Washington, D.C.-based former executive director of health systems and physician practices and now a consultant, sees the move toward patient experience generally as a positive for healthcare professionals, but has some reservations.
"It's not so much [about] having to cater to patients," he says. "It's patients' expectations and [them] learning how to work the system. Some use satisfaction as a lever now."
Maglothin says clinicians are under increased pressures to be available directly to patients around the clock through cell phones, Twitter, email and other means. Another pressure is patients who diagnose themselves based on information they find online.
If a clinician does not agree with the patients' self-diagnoses, they may simply look for another doctor willing to agree with them, and leave low scores for the physician and the organization on their way out.
Hospital Hospitality
Another controversial patient experience issue is the increasingly common practice of employing patient experience officers from hospitality backgrounds, often with little or no healthcare experience on their resumes. Maglothin, believes recruiting from outside healthcare is a good way to get an out-of-the-box perspective.
"I've always found [candidates from outside healthcare] innovative… In this field, we're very conservative—and rightly so—but we have our workflows set." Someone from the hospitality industry can shake things up, says Maglothin.
"Some leaders in the industry have adopted hospitality standards, which they can combine with good quality care itself," resulting in satisfied and healthy patients, he says. He agrees concedes, however, that it is important that such leaders be well acclimated to the healthcare environment.
"It's essential that someone coming from the hospitality industry spend time in the trenches with doctors," suggests Maglothin. "They should have formal rounds. It doesn't have to be a lot of time—maybe two hours in each of the different clinical settings."
Bartholomew, however, is skeptical of the ability of former hospitality workers to become healthcare leaders. "We're hiring people from hospitality to make the facilities nice when 400,000 patients are dying each year due to hospital error? What's wrong with that picture?"
The most important thing, she maintains, is that organizations remain supportive of their employees, and give them what they need to do the most important part of their job; keeping patients alive. "Being alive is the best patient experience of all, and right now, that's not happening," she says.
It's not too late to start strategically prepping for recruiting and retaining physicians, nurses, and other healthcare workers in 2015.
While it can be tempting to spend the final weeks of the year relaxing, and enjoying the holidays, now is the time to begin drawing up plans for next year. It's true no one can see the future, but here are some smart moves that will likely pay off in 2015.
1. Start Recruiting for In-Demand Positions
There will be a rush on billing and coding specialists as the October 1, 2015 deadline for ICD-10 nears. Now is the time to put reqs out, if you haven't already. Also, the need for nurses with special training (APRNs) has never been higher. Nurse anesthetists, nurse practitioners, and nurse midwives are all expected to be in demand for the foreseeable future.
2.Make Your Workplace Appealing to Young Workers
It is predicted that 2015 will be the year when Millennials will begin to outnumber Baby Boomers in the workplace. If you haven't already made your organization the kind of place that appeals to young workers, the time is now.
While some criticize Millennials as self-absorbed, lazy and narcissistic, this is just not so, says Michelle K. Lee, consultant with talent search firm Witt/Kieffer. "I find them to be quite engaged and interested in contributing," she told me. "They just have a different approach."
Millennials can be hard workers—the trick is to engage them on their own terms.
Make flexibility and inclusiveness a part of your corporate culture—9 in 10 Millennials surveyed said they want a job where they can be themselves at work. For example, old-fashioned restrictions on visible tattoos and piercings may be preventing qualified young workers from accepting an offer from your organization. It may be time to consider retiring policies like this.
3. Rethink the Use of Personality Tests in Hiring
Personality assessments promise to uncover everything from how well your candidate will get along with his potential team to his hidden talents. But nothing can take the place of a good behavioral interview when choosing a candidate for your organization.
Many HR departments depend on personality tests to gauge a candidate's ability to sell, his openness to new experiences, leadership potential, or likelihood of fitting into an organization, among other things.
Ultimately, though, what these tests grant is a false sense of security in your hiring decision—that you know what kind of a person the candidate is, that the candidate will fit in with the rest of the team, that he or she will have a pleasant demeanor, that you are not hiring a bully.
Unfortunately, a personality test cannot accurately tell you any of these things. "We do have a measure of social desirability," says Cheryl Oxley, a consultant with the corporate solutions team at Hogan Assessments, which offers a multiple-choice employee personality assessment. But the test does not "get into the world of personality disorders."
4. Consider a Benefits Audit
Most organizations don't know if everyone covered by their benefits programs actually should be covered. Closing the gap could save your organization's millions of dollars.
"On average, 5%–8% of [dependents] are found to be ineligible [during a dependent audit]," says Mike Daugherty, director of corporate benefits at Baptist Health, an 18-facility healthcare system based in KY. It found that about 9% its benefits recipients were ineligible, which translated as an annual savings of nearly $3.5 million.
If you spend a few days this holiday season researching these topics and drawing up plans, your organization will be a few steps ahead of the game this winter.
José Ramón Fernández-Peña, MD, MPA, seeing that the San Francisco Bay Area was in constant need of healthcare workers fluent in Spanish and with a good understanding of Latin culture, helped start the Welcome Back Initiative. It offers individualized guidance and support to anyone who has earned a professional degree in healthcare abroad and who currently resides in the United States.
In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. They are making a difference in healthcare. This is the story of José Ramón Fernández-Peña, MD, MPA.
This profile was published in the December, 2014 issue of HealthLeaders magazine.
"Think of individuals who may have been making $10 an hour when they first came to the United States and are now making $75,000 per year as healthcare professionals."
José Ramón Fernández-Peña, MD, MPA, director of the Welcome Back Initiative and associate professor of health education at San Francisco State University, remembers the frustration he encountered when he began working in the United States after earning his master's degree in public administration from New York University.
"What I began to find was that I had a set of skills and knowledge I could put to work, and those were undervalued. I was surrounded by a group of people who had similar skills to mine, who also had jobs that were also relatively low to our level of training," he remembers. "It seemed a waste of resources, quite frankly. We could have been doing higher-level jobs, but we were not even considered for those jobs."
He also learned that the labyrinthine process of medical relicensure for foreign-trained physicians in the United States was bewildering at best. "You asked one person and got one answer, asked someone else and got another," Fernández-Peña says. At the time, there was no easy reference for how to become relicensed as a physician, nurse, or other medical professional if one's initial training had taken place outside the U.S. He remembers thinking to himself, "Wouldn't it be nice to have a 'one-stop shop' where all the information would be available in one place?"
Fernández-Peña eventually moved to California, where he began working at a community-based clinic as its director of health education. Because his clinic primarily served a Spanish-speaking population, employees needed to be fluent in Spanish and have a good understanding of Latin culture.
Finding suitable candidates was always a struggle, he says. "Whenever people left the organization, we struggled to fill the vacant positions. We had people come in who were a perfect fit, but didn't have the U.S. credentials for that job. As a result, there was a population needing these services who were not getting them due to this gap," Fernández-Peña says. Once again, he witnessed the waste that occurs when foreign-trained professionals are denied jobs due to lack of U.S. certification.
By 2001, Fernández-Peña held a job where his primary responsibility was assessing the training needs of the San Francisco Bay Area health sector. In that process, he found there was a very large demand for a multilingual and multicultural workforce to meet the needs of an ever-growing multicultural population. Fernández-Peña recognized a need for a specialized guidance and support program for foreign-trained healthcare professionals, and he was invited by the California Endowment to submit a proposal to start such an organization. He received his first grant from the Endowment hat year.
Initially, some people were skeptical of the effort, which was dubbed the Welcome Back Initiative. "We had to explain we weren't trying to lower standards or find shortcuts for foreigners," says Fernández-Peña, who notes public opinion improved once the organization demonstrated to licensing boards, potential employers, and schools that it was just trying to help its participants meet the established standards.
Since 2001, the Welcome Back Initiative has grown from a single location in San Francisco to 10 offices across the country, in eight states. More than 14,000 people from 167 countries have gone through the program.
The initiative offers individualized guidance and support to anyone who earned a degree in a health profession in another country and is currently residing in the United States. Among its offerings are a homegrown accelerated ESL course that emphasizes terms frequently used in healthcare, an introduction to the U.S. healthcare system, and nurse refresher courses. Also, Welcome Back centers offer step-by-step instructions in relicensure and requirements in each state.
According to Fernández-Peña, it's easy to underestimate the impact that foreign-trained healthcare professionals have on the United States. "Think of individuals who may have been making $10 an hour when they first came to the United States and are now making $75,000 per year as healthcare professionals. They have access to better housing, their children are attending better schools, they are paying higher taxes, and have more incentives to become more engaged in civic activities. The return on investment is not only having a doctor who speaks Spanish—the benefits extend outside the clinic setting."
A legal expert offers thoughts on keeping employees merry and bright while minimizing your healthcare organization's risk of litigation. Spoiler alert: Don't be a Scrooge.
Photo: Shutterstock
For many, the holiday season is infused with joy and hope.
For HR executives, the holidays are a legal minefield, riddled with fears of "anything goes" workplace parties, decorating schemes gone wrong, and complicated holiday pay policies.
Rather than sugarplums, many HR leaders spend the holiday season with visions of lawsuits dancing in their heads. Following a few expert tips, however, can ensure that the season feels more like It's a Wonderful Lifethan The Nightmare Before Christmas.
1. Preventing Party Pitfalls
Oh, the yearly holiday party! An event that comes but once a year and employees can let their hair down and fraternize with coworkers—fraternize being a word that can make any HR professional nervous.
"There will be a festive atmosphere, and very likely alcohol will be involved. With that mix and employees letting loose, there is potential for sexual harassment and other inappropriate behavior," says Michael J. Passarella, an attorney at Jackson Lewis, a White Plains, NY-based firm specializing in employment law.
While drunk driving and sexual harassment are two very separate issues, both have their roots in a common cause—overconsumption of alcohol.
In the case of drunk driving, "there have been a number of cases where employers have been [held liable], says Passarella, "the laws vary state by state." But it's best to take as many precautions as possible—not only to protect your organization, but because it's the right thing to do.
Regulating alcohol is the primary tactic employers can use to mitigate risk.
Consider not serving alcohol, or serving only wine and beer rather than the hard stuff.
Make sure there's always plenty of water, soda, coffee and tea available, and serve plenty of food, too.
Hire a professional bartender, as they are more attuned to monitoring overconsumption. They will refuse to serve drinks to someone who has had too much, which is something a coworker or supervisor may not feel comfortable doing.
Consider arranging for safe transportation home, by arranging for a shuttle, handing out cab vouchers, or having the number of a car service at the ready.
"Employers should make sure all employees are aware workplace policies still in effect for the holiday party," and that they are expected to act responsibly, says Passarella.
In the case of an incident between employees, "employers have a defense that they didn't know what took place at the party and took immediate action to prevent further harassment," he explains. But if it's a situation between a supervisor and an employee, that defense won't be available, Passarella says.
HR team members should take an active role in keeping the environment safe. Don't feel bad about jumping in to conversations between employees at the party—especially conversations that involve only two people of opposite gender. You're not being a buzzkill, you're just making sure everyone is having a good time.
Give the parties a chance to separate if they seem uncomfortable—ask one of them about a project they've been working on, how their spouse is doing, or if they're still pursuing a hobby they have expressed interest in. Also, use this opportunity to gauge who may have had too much to drink and how they are getting home.
Another tip: encourage employees to bring their spouses or a date to the party. Not only does this add to the festive atmosphere, but employees are far likely to misbehave while under the watchful eye of their partner.
2. Decorating Decorum While it's hard for many who grew up celebrating Christmas to understand, Christmas decorations don't bring a smile to everyone's face. Some departments might think it's a great idea ask staff to wear Santa hats the week before Christmas—but some employees might find the idea downright offensive.
It's highly unlikely an employee will sue over Christmas décor. "If a private employer has a Christmas tree or other holiday decorations, there's no requirement that they take them down or put up non-Christian holiday items," says Passarella.
To be safe, Passarella recommends not displaying nativity scenes. While most people are comfortable with secular symbols of the Christmas holiday, such as Santa Claus, reindeer or snowmen, a nativity scene is a religious display, and thus, more divisive.
Speaking of Santa, asking employees to wear anything related to Christmas, such as a Santa hat or reindeer horns is a no-no. Instead, make sure it's clear holiday dress up is voluntary and not within the scope of employment.
Use this season to be inclusive to everyone. If your hospital is located in an area where many people celebrate Chanukah or Kwanzaa, consider displaying a menorah or a kinara near the tree.
3. Avoid Being a Scrooge Finally, the best part of the season is a paid day off or time and a half plus a comp day for everyone working on Christmas. That's a requirement, right?
Wrong.
While the vast majority of US employers provide Christmas as a paid holiday or give their employees time and a half or even double time and/or a comp day for working on Christmas, this is a custom, not a law, says Passarella.
"There's no legal requirement. Christmas and New Year's Day are federal holidays, and I've never seen an employer not offer those as paid holidays," he says. "You're not legally obligated… but it's a good idea to reward employees working on Christmas," he adds.
As hospitals don't close for Christmas or New Years, employees will be working throughout the holiday. It is within good taste to offer extra compensation to those who work Christmas Eve, New Years' Eve, and sometimes the day after Christmas.
Why not make it festive? Put out donuts, bagels and hot coffee in the break room Order in lunch and dinner on those days. Passarella suggests giving a small token of thanks, such as gift cards for Starbucks, to make sure employees feel appreciated.
"I think it's important to remind employees that the last two weeks of the year are a busy time for everybody," he adds, "but let's get our work done so we can go home to our families and continue to give great care to our patients. These sentiments go a long way towards employee morale."
Surprisingly, poor physician ratings posted online are not the result of angry patients or professional rivals, a researcher says. Instead, the numbers are often skewed because of low numbers of reviews.
Hospital marketing departments and physicians practices like to see their doctors get positive reviews on consumer websites, and online ratings are popular with consumers. One-third of consumers in the United States who consulted physician website ratings reported selecting or avoiding physicians based on those ratings.
But there is no correlation between online patient ratings and clinical quality, according to a study published in JAMA Internal Medicine.
"Our study is important because it is one of only a handful of studies to examine the ability of physician website ratings to reflect the quality of care patients are likely to receive," says lead author Bradley Gray, PhD.
"We found that 60% of physicians are rated online—and that number is growing," Gray said by phone last week. He makes it clear that while he feels websites provide consumers with some valuable information, such as whether or not physicians are board certified, the rating systems can be a distraction and scores tend to be "completely random."
The study looked at 1,299 physicians who completed an ABIM Patient Experience Practice Improvement Module in diabetes or hypertension between July 2001 and November 2012. Researchers compared patient survey responses and chart abstractions against physician ratings on eight popular health-based websites which were selected based on Google searches of each participating physician's name, city, and specialty.
Gray and his team found no evidence that physician website ratings were associated with clinical quality measures.
Results indicated that physicians with poor website ratings of one-out-of-five stars received ratings of very good or excellent in hospital-provided surveys from 79% of patients—a number similar to physicians with a five-star website rating, who received ratings of very good or excellent from 82% of patients.
Linked-Out Poor physician ratings are not the result of malicious trolling by angry patients or vengeful rivals, a finding Gray calls "surprising."
"We found no evidence that the web ratings were somehow reflecting antagonistic consumers. They seemed very random… We initially thought we might find that, but we didn't really."
He and his team had hypothesized that lackluster scores might be a result of more angry consumers leaving negative reviews than satisfied consumers leaving positive reviews, but that did not bear out to be true, either.
Instead, Gray says, the numbers are often skewed because of low numbers of reviews, which makes them unreliable and statistically insignificant. "We found a median of [a total of] four ratings per physician, which is not a high enough number for there to be any scientific rigor."
The researchers' findings suggest that hospital leaders should not be overly concerned about physicians receiving poor scores on consumer website, especially if their HCAHPS and patient satisfaction surveys are positive.
But the findings should also not diminish the importance of patient feedback, explains Gray. "There is very good evidence that patients provide important information on quality of care, and patient feedback is an important piece of provider care quality—but the web reviews are not a good source of information about that."
More Data to Come To remedy this problem in the future, Gray recommends using board certification as a quality standard consumers can trust, as it is a rigorous process directly related to quality of care.
Unfortunately, there is little recourse for physicians with damaged online reputations. In such cases Gray advises sharing board certification data with patients and strong patient survey scores with wary employers.
More accurate quality information may be available soon-- beginning January 1, the Centers for Medicaid & Medicare Services will be update its Physician Compare website with more objective data on physician quality. Additional data is planned for release in 2016.
In the meantime, "the results of our study should make consumers think twice about relying only on these website ratings as a source of quality information. This study also highlights the need for more valid and reliable physician quality information to be made publicly available," says Gray.
Troubled by frequent false alarms from medical devices, a pediatric unit at an Ohio hospital assembled a multidisciplinary task force and set out to fix the problem.
Christopher Dandoy, MD
A common and not-so-silent killer is lurking in hospitals.
The Joint Commission reports that there were 98 alarm-related sentinel events and 80 alarm-related deaths in the U.S. between January 2009 and June 2012.
But staff at one Ohio hospital discovered a way to quell the noise—and in the process created a better environment for patients and their families.
"When there are hundreds or thousands of alarms, it becomes hard to differentiate between what's real and what's not. Humans have a natural tendency to disregard alarms if they're overused," says Christopher Dandoy, MD, a physician in the Cancer and Blood Diseases Institute at Cincinnati Children's Hospital and lead author of a study on his hospital's experiences on alarm fatigue.
While these alarms were designed to alert hospital staff that something needs to be attended to immediately. But in practice, the number of alarms can be overwhelming for hospital staff, patients and their families.
Dandoy and his team learned that up to 95% of these alarms are false—usually traceable to non-customized parameters and inadequate staff-training—and that nurses spend up to 30 minutes per shift simply dealing with false alarms.
In addition to desensitizing medical staff to alarms, the incessant beeping and ringing caused problems for patients, too. "Sometimes patients would try to decrease the sounds [from the alarms] on their own," recalls Dandoy.
Both patients and hospital staff reported the alarms made them nervous, said Dandoy. "There's a lot of anxiety surrounding these things." The sound of an alarm can make it hard for a recovering patient to sleep, and can needlessly cause panic and worry for their families.
"The reason this came up was that we looked at the number of alarms we had on our floor, and it was just a monster number," says Dandoy. "It was just a small, small percent of those alarms that were acute decompensations or patients that needed specific attention."
The Search for a Solution
In January 2012, Dandoy established a multidisciplinary task force consisting of various stakeholders, including physicians, nurses, patient care assistants, and the families of pediatric patients. The study focused on a 24-bed pediatric bone marrow transplant unit.
One of the team's strengths was its diversity. "We had a huge team... each person was able to give input," Dandoy remembers, adding that patient family involvement was a top priority. The team reviewed current practices, published recommendations, identified areas that needed improvement, and began to test new practices and ideas using Plan-Do-Study-Act measures.
80% of Cardiac Monitors Set Incorrectly The team learned that only a small amount—20%—of cardiac monitors were set to the correct parameters for an infant or child, accounting for many of the false alarms heard on the floor daily. An intervention to properly train staff on setting the monitors to the correct parameters for each patient was quickly staged.
"We kind of invented this cardiac monitor care process based upon our findings," Dandoy says. The team additionally worked to ensure correct calibration of other monitoring equipment prone to setting off alarms.
The team also learned that if monitor electrodes are not replaced daily, the number of false alarms increases due to reduced connectivity. Testing found that the number of false alarms increased 25% to 30% each day the electrodes were not changed.
An obstacle to daily replacement, however, is that many patients—especially children—find the removal and replacement of electrodes to be painful.
But the nurses on Dandoy's team had a solution. They knew that immersion in water—as in a bath—makes electrode removal much less painful. The practice has since been adopted throughout the hospital. And a policy of discontinuing the use of electrodes as soon as it is safe to do so has also been adopted.
Results The number of false alarms has reduced from 95% of all alarms to 50%, and the amount of time nurses spend on resolving them to 10 to 15 minutes per shift. It's also made the hospital environment far more conducive to healing, says Dandoy. "People saw there was a substantial difference... they didn't hear the alarms going off anymore in the halls—[the change] sustained itself just with the sheer positive reaction people had from it."
In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. They are making a difference in healthcare. This is the story of Bryan Coffey.
This profile was published in the December, 2014 issue of HealthLeaders magazine.
"It doesn't matter how close a hospital is to closing its doors; there's a model that can be followed to keep it alive."
Faced with budget cuts, dwindling patient populations, and difficulty in recruiting clinicians, many rural hospitals are cutting services or closing their doors completely. But Hamilton County Hospital in Syracuse, Kansas, is expanding its services and increasing its patient load by bringing itself into the 21st century.
Some people might not want to live in an area so rural that the nearest Wal-Mart is 50 miles away, but Bryan Coffey, CEO and chief financial officer of Hamilton County Hospital, thinks it's the perfect location to live, work, and raise a family. It's also an ideal place to pursue his two greatest passions—rural healthcare and telemedicine.
Coffey spent the beginning of his healthcare career as a systems strategist. In 2007, he made the transition into leadership and became the CFO of Fredonia Regional Hospital in Kansas. His first experience as a CEO was at Sac-Osage Hospital in Osceola, Missouri. In that role, Coffey realized that hospital CEOs are in a unique position to transform healthcare in the United States.
"Through CEO leadership, I could effect change in healthcare more effectively and efficiently than as a CFO," he realized. His appointment at Sac-Osage was a yearlong contract role he took on for the small rural hospital. It was then he realized he enjoyed the challenge of turning around failing healthcare facilities.
Located on the plains of eastern Kansas, Hamilton County is sparsely populated. For specialty medical services, such as pediatric care, residents are asked to drive for hours to get treatment. Additionally, there are situations such as a stroke, when every minute without the right medical attention can mean the difference between life and death.
Hamilton County Hospital, a 25-staffed-bed critical access facility, was in a "death spiral" when Coffey chose to take on the challenge of both saving the hospital and bringing it into the modern era. "It doesn't matter how close a hospital is to closing its doors; there's a model that can be followed to keep it alive," he says.
When Coffey first arrived in June 2013, it had not employed a physician in years. Turnover was around 70%, and the majority of the work was divided between a nurse practitioner and a physician assistant.
Coffey first chose to focus on outpatient care, then began equipping the hospital with state-of-the-art tools. "Once inside, visitors quickly come to understand we're a high-tech facility," he says. Among the equipment is a specialty MR scanner and a 16-slice CT scanner.
The facility's pride and joy, however, is a robot with a screen mounted at eye level that allows doctors in locations as far away as California, New York, and Massachusetts to see patients remotely. "That robot really makes its rounds," says Coffey. "It's used for neurology, stroke treatment, heart attacks, and the rural health clinic attached to our hospital." This tool makes Hamilton County feel much more connected.
Coffey and his staff have been able to widen the offerings at the hospital, including dermatology, rheumatology, endocrinology, immunology, pulmonology, psychology, and neurology. There are plans to offer first-trimester pregnancy care and an ear, nose, and throat specialist.
Employee turnover rates have gone from 70% annually to 25%. The volume of patient visits has grown by 40%, which has prompted the hiring of new clinicians who have joined the team. Coffey also implemented a 360-degree review process and yearly employee appreciation events. The last appreciation event had 90% employee attendance and featured morale-building prizes like paid time off and gift certificates.
"Here in Syracuse, we're excited about what the future holds. Not only is the hospital not closing, but … we've got a successful model for rural healthcare. We've experienced phenomenal growth and turnaround," Coffey says.
In addition to spreading the word about telemedicine to other organizations by speaking at conferences and publishing a white paper about how rural organizations can afford their own robots, Coffey has been fighting for growing acceptance of telemedicine.
"I've worked with local politicians in both Missouri and Kansas to improve access to telemedicine, but I want to get more involved at the federal level. Telemedicine can be rolled out to the entire country. It will increase access to providers," he says.
Coffey's belief that telemedicine is the future of rural healthcare is unequivocal. "Telemedicine can really be leveraged in rural America. And not just specialists, but primary care, too. We have such a shortage in rural America of primary care. The leading innovation has to be through telemedicine."
In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. They are making a difference in healthcare. This is the story of José Ramón Fernández-Peña, MD, MPA.
This profile was published in the December, 2014 issue of HealthLeaders magazine.
"Think of individuals who may have been making $10 an hour when they first came to the United States and are now making $75,000 per year as healthcare professionals."
José Ramón Fernández-Peña, MD, MPA, director of the Welcome Back Initiative and associate professor of health education at San Francisco State University, remembers the frustration he encountered when he began working in the United States after earning his master's degree in public administration from New York University.
"What I began to find was that I had a set of skills and knowledge I could put to work, and those were undervalued. I was surrounded by a group of people who had similar skills to mine, who also had jobs that were also relatively low to our level of training," he remembers. "It seemed a waste of resources, quite frankly. We could have been doing higher-level jobs, but we were not even considered for those jobs."
He also learned that the labyrinthine process of medical relicensure for foreign-trained physicians in the United States was bewildering at best. "You asked one person and got one answer, asked someone else and got another," Fernández-Peña says. At the time, there was no easy reference for how to become relicensed as a physician, nurse, or other medical professional if one's initial training had taken place outside the U.S. He remembers thinking to himself, "Wouldn't it be nice to have a 'one-stop shop' where all the information would be available in one place?"
Fernández-Peña eventually moved to California, where he began working at a community-based clinic as its director of health education. Because his clinic primarily served a Spanish-speaking population, employees needed to be fluent in Spanish and have a good understanding of Latin culture.
Finding suitable candidates was always a struggle, he says. "Whenever people left the organization, we struggled to fill the vacant positions. We had people come in who were a perfect fit, but didn't have the U.S. credentials for that job. As a result, there was a population needing these services who were not getting them due to this gap," Fernández-Peña says. Once again, he witnessed the waste that occurs when foreign-trained professionals are denied jobs due to lack of U.S. certification.
By 2001, Fernández-Peña held a job where his primary responsibility was assessing the training needs of the San Francisco Bay Area health sector. In that process, he found there was a very large demand for a multilingual and multicultural workforce to meet the needs of an ever-growing multicultural population. Fernández-Peña recognized a need for a specialized guidance and support program for foreign-trained healthcare professionals, and he was invited by the California Endowment to submit a proposal to start such an organization. He received his first grant from the Endowment hat year.
Initially, some people were skeptical of the effort, which was dubbed the Welcome Back Initiative. "We had to explain we weren't trying to lower standards or find shortcuts for foreigners," says Fernández-Peña, who notes public opinion improved once the organization demonstrated to licensing boards, potential employers, and schools that it was just trying to help its participants meet the established standards.
Since 2001, the Welcome Back Initiative has grown from a single location in San Francisco to 10 offices across the country, in eight states. More than 14,000 people from 167 countries have gone through the program.
The initiative offers individualized guidance and support to anyone who earned a degree in a health profession in another country and is currently residing in the United States. Among its offerings are a homegrown accelerated ESL course that emphasizes terms frequently used in healthcare, an introduction to the U.S. healthcare system, and nurse refresher courses. Also, Welcome Back centers offer step-by-step instructions in relicensure and requirements in each state.
According to Fernández-Peña, it's easy to underestimate the impact that foreign-trained healthcare professionals have on the United States. "Think of individuals who may have been making $10 an hour when they first came to the United States and are now making $75,000 per year as healthcare professionals. They have access to better housing, their children are attending better schools, they are paying higher taxes, and have more incentives to become more engaged in civic activities. The return on investment is not only having a doctor who speaks Spanish—the benefits extend outside the clinic setting."
In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. They are making a difference in healthcare. This is the story of Cole Galloway, PT, PhD.
This profile was published in the December, 2014 issue of HealthLeaders magazine.
"If you give a baby even a couple minutes a week of joystick driving, they have better cognition and language development, and they learn to walk and crawl earlier."
Cole Galloway, PT, PhD , a professor of physical therapy at the University of Delaware in Newark, was initially skeptical of rehabilitation robotics, but that all changed when a colleague from mechanical engineering department told him about baby-driven robots. Once Galloway saw that a baby could use a joystick to drive a small, mobile robot, he was hooked, and ultimately developed GoBabyGo, a nonprofit project that helps clinicians, families, and others to create low-cost, customized toy race cars to serve as mobility devices for young children.
"If you give a baby even a couple minutes a week of joystick driving, they have better cognition and language development, and they learn to walk and crawl earlier," Galloway says.
The mobility of an infant or young child affects everything in that child's life, from language development to social skills to balance. "The exploratory drive has to develop," says Galloway. "As soon as a child starts to crawl, things will start to change dramatically. After a kid spends a couple weeks crawling, they never look back."
The earlier in life a child gets a taste of mobility, the more normal his or her development is, says Galloway—but when a child is born with a mobility impairment, he or she faces tough odds from day one.
Insurance won't typically cover the cost of a power wheelchair until the child is 5 years old. The cost of a power chair can be thousands of dollars. Additionally, the chair can weigh about 150 pounds, and families may need to install ramps at home or modify a van to accommodate the child.
While Galloway's professional life took off after he was able to demonstrate that a child's mobility could be greatly improved with the use of baby-driven robots, the accolades brought him little satisfaction.
"I went out and talked about this … at conferences, to families and clinicians. The response was a very predictable yet hard to handle reaction. Audiences were very enthusiastic and lots of people asked, 'Where do I get a robot for my child?'
"I always had to tell them, 'I'm not in that business. I'm just a researcher,' " Galloway recalls, and says the experience was depressing.
"Mobility is a human right, and I was dangling it in front of parents, yet not even attempting to follow though. No one except these families was telling me that there was a broken pipeline. It was too traumatic."
Galloway then realized that he wanted to find a way to help these children and their families in a tangible way. Bringing a research assistant with him, Galloway went to a toy store and bought multiple ride-on toy cars. He began altering them so they could be used as mobility devices for children as young as 18 months.
Realizing that he was on to something big, Galloway patented the alterations—and then began giving the devices away for free. GoBabyGo remains a nonprofit organization that operates in conjunction with the university, where Galloway still works as a researcher and professor.
More than 100 families received their devices directly from Galloway's lab, but there are about 20 different programs around the United States. "We'll do 15 or 20 workshops this year. Usually, those workshops turn into program sites," says Galloway. Approximately 500 families have received ride-on cars through these labs, but because instructions for altering the cars are available on the Internet, it's impossible to know how many families have benefitted from Galloway's work.
These devices are affordable and available on demand, if a family can get to a toy shop and a hardware store. "They're all built by the child's family or a clinician who loves these kids. There's no waiting around for a distributer or a manufacturer," says Galloway. Each of these ride-on cars costs around $200, even with customizations, and they can be transported in the back of a small car.
The most rewarding part of this work, says Galloway, is seeing the expectations families have for the disabled child change after they are able to move around and explore. "When they see their kid trying to stand, trying to walk … their perceptions of what their child can do changes."
Some Millennials have overly high expectations early in their careers: Ideal schedules, fawning from colleagues, frequent promotions. Keeping their expectations in check is essential for all concerned.
A nurse manager caught the potentially fatal error in just the nick of time. A young nurse had almost administered the wrong medication to a patient via IV. The manager pulled the young worker aside and emphatically told her that this is how patients die unnecessarily.
But the young nurse interrupted her.
"Actually, you are doing this conversation wrong," she corrected her boss. "You are supposed to give me some positive feedback before you criticize my work."
This is just one of many stories from exasperated managers and HR departments that Bruce Tulgan, founder and chairman of human resources consultancy RainmakerThinking and author of Not Everyone Gets a Trophy: How to Manage Generation Yhas heard regarding what to some is baffling behavior from the youngest generation of workers.
By 2020, post-Baby Boom [born 1946 – 1964] workers will make up 80% of the workforce. Already managers have complaints about overly confident young employees with poor social skills and a hard time taking criticism who expect praise and rewards in abundance.
Some of these issues have their roots in the cultural attitudes of the 1980s and 90s marked by helicopter parenting, everyone-plays/everyone wins sports teams, summer camps designed to bring out hidden talents, and school schedules constructed to maximize the chances of snagging a coveted spot at a dream college.
The resulting overly structured and sheltered existence is theorized to stifle the development of social skills, independent thinking, and time management skills.
But regardless of where Millennials [born between 1981 and 2000] have been, employers need to start taking steps to get them where they need to go—whether that be in the operating room, a patient's bedside, or eventually the C-suite.
Tulgan offers three recommendations for laying down the workplace law and managing expectations for incoming Millennials.
1. Make Expectations Clear From the Start
Sometimes, managers get so excited when they meet a candidate who seems like a good match that they forget to tell them the drawbacks of the job. That's a huge mistake, says Tulgan.
"Give them a realistic preview. Try to sell them, then try to scare them away and see who sticks. Let them know in advance what this job look like, not just at best, but on a bad day as well. Give a preview of harder aspects of job."
Tell them about high turnover rates, that they will likely have to work nights for their first couple years, or that the manager of their prospective department went three years without a raise and seven years before being promoted. Make sure they can never say you didn't warn them.
But it doesn't stop there. Use orientation and the onboarding process to establish ground rules. Along with basic performance standards, explain how people are expected to interact in your organization, who the managers are, where they will work, how shifts are decided, their assignments and responsibilities. "You cannot assume your Millennial employees [intuitively] know these things," says Tulgan.
If you find something your Millennial does unacceptable, whether it's showing up late, spending too much time staring at their phone, or being overly informal, it's vital to make it clear early on what your expectations are—and the consequences for continuing such behavior.
2. Think Short-Term Employment
Once upon a time, employees went to work for a company a few months after leaving school and stayed there until it was time to retire.
Those days are long over—but, unlike Boomers or even Generation Xers [born 1965-1980], Millennials don't remember a time when this was the norm.
While most Boomers or Traditionalists [born 1945 or earlier] would instinctively think they should 'keep their heads down and pay their dues' early in their career, a Millennial doesn't think that way. "That view is so old fashioned. It depends on having confidence in the system to take care of you," says Tulgan.
Millennials think of employment as a short-term transaction. They aren't planning to work for you for 30 years; they plan to work for you until the job gets stale and they're ready to move on.
This generation doesn't have delayed gratification down yet—if they ever will (ever watch a Millennial patiently wait for a YouTube video to load? Yeah, me neither). "Young people don't think of long term rewards—they're taking life one day at a time," says Tulgan.
The solution: Have managers check in with young reports every week, possibly every day, about what their expectations are. What do you want from them today? This week? This month? Try to be tolerant of any youthful mistakes young employees make early on, but explain to them why their idea or proposed plan isn't going to work. And, if they want to be promoted, tell them why they aren't getting it now, and what they need to do to get the job they want.
3. Take a Reality Check
Kids today! They're slackers who are only out for themselves. Wait. That's a stereotype about Generation X.
Let's try again: Overly idealistic flower children who spent their youth rebelling against the status quo and never understood what their parents' generation sacrificed for them to have the lifestyle they have come to enjoy. Wait. Those are stereotypical Baby Boomers (or at least it was, before that generation matured and became the career-centric team players and mentors we know them as today).
Older generations have been weeping for the future since Socrates' time, and every generation has had to contend with negative stereotypes as it's come of age. When asked how much of the perceived issues with Millennials are just issues young people always have, Tulgan says he believes it's "about fifty-fifty. Half of the problem is just being young."
If most of us think back to the early part of our careers, we can probably remember a few faux pas we've made along the way, like thinking we had mastered a skill we really didn't, dress code flops or getting caught red-handed playing hooky from work.
It takes time to learn professional etiquette, develop a work ethic, and learn effective time management skills. Be realistic when passing judgment on the young'uns—are all newly minted college grads really that lazy and entitled, or are you forgetting what it's like to be 22?
A firm touch can go a long way. As for the nurse manager I mentioned at the beginning of this column, she gave her young employee the only positive feedback she could muster given the circumstances.
