Pain mitigation techniques and tools can lead to greater patient satisfaction and higher HCAHPS scores, but the costs vary widely and must be weighed carefully.
Deb Bruene, MA, RN-BC, a nursing practice leader and educator at the University of Iowa Children's Hospital, has an exercise she likes to perform for clinicians about the lasting emotional effects of needle pain experienced in childhood.
"I ask the class for personal experiences," she says. "Everyone there almost always has a story about a child who had a bad experience with a needle, and how this experience impacted that child's care."
Recently, one of Breune's students told a story about a young woman who had been traumatized by receiving painful IV treatments when she was younger. The woman is now afraid to become pregnant, believing herself unable to withstand the pain of delivering a baby.
Deb Bruene, MA, RN-BC
This example may be extreme, but data demonstrates that people are more likely to avoid care when they are afraid of pain, says Peggy Riley, RN, MN, MPH, pediatric pain clinical nurse specialist at the University of Wisconsin Hospitals and Clinics in Madison.
"Needle pain is one of the most common kinds of pain people experience as kids," she says. As a result of forming bad associations between healthcare and pain, people often put off annual physicals and maintenance healthcare. And these anxieties often persist through adulthood.
"On the radio this morning, the talk show hosts were talking about getting their flu shots, and they said they were afraid they would wimp out and not get them," says Bruene. "That's the experience people often have."
Pain Mitigation Linked to Patient Satisfaction
Efforts to lessen or avoid negative patient experiences, including pain, are getting greater attention as the influence of HCAHPS scores on reimbursements grows.
Lisa Dabby, MD
"We seek to minimize pain as much as possible," says Lisa Dabby, MD, an attending physician in UCLA Medical Center'semergency department in Santa Monica. Pain mitigation methods she uses include:
Liquid stitches, a dermal adhesive sold under the brand name Dermabond, that is used in place of traditional stitches
Administering vaccines, pain killers, and other medications through nasal sprays or transdermal patches rather than intravenously
Using a topical anesthetic prior to starting an IV or administering an injection
Using ultrasound-guided IVs and vein finders to reduce the number of failed venipuncture attempts
Both Riley and Bruene have also had success with pain-blocking devices such as Buzzy Bee and Sofstic, which numb an area of skin by using vibrations and cold.
Proper use of painkillers can improve patient experience as well, says Bruene. She recounts the story of a child having a lumbar puncture prior to chemotherapy. The child's mother never used frightening words like "spinal tap." Instead she told him he was going to have a "back check."
The child received topical numbing agents and procedural sedation, and was not aware he was experiencing a procedure that is usually considered painful. Because the child's mother acted as though the procedure was routine, the child never thought to be afraid.
Distraction is an effective option in many cases, says Riley. "It can be something you have with you, it could be a picture on the wall." Riley often asks patients to count how many triangles they see in a drawing or painting, or asks parents to read from a book they brought.
But pain reduction methods have their limits.
Distraction can be fleeting.
Topical pain-relieving creams and sprays mitigate only surface pain, says Riley. "[Topical medications] provide relief as the needle pokes into the skin, but not as it goes into muscle." And then there's the wait. Ultrasound vein finders take "maybe a minute" extra to use. The wait for creams and sprays to take effect can be as long as 20 to 30 minutes, says Dabby. That raises questions about throughput.
And there is the matter of effectiveness. Some of the methods touted as less painful only work on minor or moderately severe injuries. Liquid stitches, for example, should not be used on injuries larger than two inches in diameter, or in high-tension areas. "It should be an area that needs one stitch or two," says Dabby. Liquid stitches should not be used on a large gash or on surgical wound.
Wide Cost Variations In addition to the cost of waiting, the cost of pain-mitigating hospital supplies can vary widely depending upon negotiating power, novelty, and availability of the particular product.
"I would say for the most part… liquid stitches are at least a good 20% less expensive [than traditional stitches]," says Lori Pilla, vice president of strategic alliances, custom contracting and clinical advantage at Amerinet, a group purchaser in St. Louis.
Lori Pilla
Adam Higman, vice president of Soyring Consulting, a healthcare efficiency consultancy, says he's usually found that Dermabond is more expensive than traditional stitches. "[The price is] $20-25.00 per unit on the Dermabond," as opposed to between $2.00 and $5.00 for most sutures, although some specialty sutures can be much more expensive. Higman adds that liquid stitches require less labor and time, which can offset the supply cost.
Adam Higman
When purchased through a group purchaser, vein finders can be as inexpensive as $1000 each, although they are usually "of the realm of $11,000 to $15,000 a piece, if not mistaken," says Pilla.
The same wild variability in cost can be found in clinician training.
Marshall Maglothin, MHA, MBA, a Washington, D.C.-based former executive director of health systems and physician practices and now an independent consultant, designs training clinical programs for recognizing and treating pain. Usually, the programs he designs cost about "$20,000 to $40,000," he says, and can be completed online with interactive tools, at the clinician's convenience.
"Pain control didn't used to be big deal in the ED," he says. "Clinicians didn't used to be sensitive to pain. I think this has improved."
Marshall Maglothin, MHA, MBA
Maglothin says the demand for training is growing among hospitals, and that clinicians benefit from making patients more comfortable. "Pain makes it harder to work with the patients."
Pilla says that avoiding pain is good for the bottom line. "The newer pain-reduction methods tend to be a little more expensive up front, but in the bigger picture, the total cost model, they save money." Improved pain control can lead to better HCAHPS scores, she says.
"You need to look at total picture and cost of delivering care. Reducing pain eventually reduces costs," she says.
Bruene also believes that the benefits of decreasing pain outweigh the costs. "As healthcare providers, we all believe that first we must do no harm. When we know the long-term implications of needle pain, I don't understand why we would not use these [tools]."
A legal expert clarifies some HR scenarios that commonly affect staffing and payroll decisions during the holiday season.
The holidays are an exciting and hopeful time of year, but keeping the hospital fully staffed while allowing workers time off to enjoy the season—without breaking the payroll budget—can be a challenge.
I asked Thomas Shorter, a lawyer with the law firm Godfrey and Kahn in Madison, WI, to comment on a few situations that are likely to arise during the season.The transcript of our conversation last week has been lightly edited.
Thomas Shorter
HealthLeaders Media: What are some FLSA-related errors that employers typically make during the holidays?
Thomas Shorter: One common error is calculating overtime pay for non-exempt employees. Many healthcare systems provide what I will call "holiday pay." The simplest way to explain this is that it's money the employee is paid for the holiday [usually the equivalent of eight hours of labor] despite not actually working.
So, the employee receives pay. But if the employee also happens to work the typical 40 hours that week, it is not it's not uncommon for the employer to get confused and think that they have to pay the extra eight hours at an overtime rate.
Holiday pay does not count toward hours worked. Think of it like this: The employee didn't actually work those hours, they were just given the pay for them. But sometimes, payroll will get confused regarding how to pay that, and will end up counting holiday pay hours as if they were overtime hours worked.
So, they end up paying overtime when they don't have to.
I recommend healthcare systems make a note of this in the in employee handbook to ensure employees are aware of the holiday pay policy and rate, and train payroll staff to understand it as well.
HLM: A common assumption is that employers are required to provide time and a half or double time to employees who work on Christmas. Is that correct?
Shorter: That is not correct.
There is no [legal] requirement to pay a special holiday rate. Now, a lot of organizations try to inspire people to work on Christmas day by offering a higher rate of pay on that day, but that's not related to overtime pay or FLSA requirements. It's a way to get employees to say, "Yeah, sure I'll work Christmas day!"
As long as employees work 40 hours or less, there is no requirement to pay them overtime.
HLM: Comp time, while popular with both employers and employees, is technically illegal. If I wanted to grant employees who work on Christmas or New Year's Day a compensatory day off, would there be a legal way to do that?
Shorter: Under the FLSA, comp time is still not legal; the rule hasn't changed. There really isn't a way to legally grant comp time.
This is a law that many organizations are not in compliance with. Most employees find it beneficial and favorable, so they tend not to complain about being offered comp time—which is why periodically, someone raises it as something that would benefit both employees and employers.
People, frankly, like comp time.
HLM: Let's say I have three time off requests for Christmas day. One is from a worker who says he cannot work on Christmas day for religious reasons, one is from someone who does not celebrate Christmas, and one is from someone who because of the holiday, can't get childcare that day. I need one of them to cover the shift. Legally, what can and should I do?
Shorter: I'm going to assume the religious person requested a religious accommodation.
There is an affirmative obligation by an employer to accommodate religious beliefs. If an employee makes a request for accommodation and indicates that they need time off based on their religious beliefs to observe a religious holiday, the employer has an obligation to accommodate that if they can without an undue hardship.
This means that you then look to others who can cover that particular shift.
Presumably, as a good employer, you will need to figure out which of those two employees can, in fact, work the shift. This is the very reason that many employers offer special holiday pay rates—not because of laws or mandates, but because they're trying to incentivize people to cover days when many people want time off, or at a time when it's difficult for them to work the shift.
In the scenario with the employee who has kids and the nanny is taking the day off, that employee might be forced to dip into their paid time off if the employer doesn't accommodate the scheduling request.
Neither of the remaining two employees in this scenario has a situation that the employer is required to accommodate. You can tell either of them that they have to work.
HLM: Is there a legally preferred way to make sure we have enough staffing coverage over the holidays?
Shorter: Well, the main objective is to ensure that your organization is not exposed to any FLSA or religious discrimination claims. What that really means is that you try to seek out which employees are willing to work voluntarily that day, and, if you don't have enough staff based on volunteers, you then make a decision about offering incentives, financially or otherwise, for people to work on the holiday, or mandate that certain employees will work that day whether they want to or not.
All of this has to be done in advance so you're not left short-staffed.
Some employers have concerns about mandating coverage on a holiday date with a religious observation component to it. The best way to handle this is, when seeking volunteers or making staffing decisions for the holiday, [is to] make a statement that if someone is in need of a religious accommodation on that day, that person must reach out to HR.
This creates a documentation trail of the employer's fulfillment of their obligation to attempt to accommodate the religious observance.
Senior healthcare leaders discuss how they are maintaining high quality care delivery while implementing cost containment efforts.
Hospitals and health systems need to keep costs down while simultaneously striving to provide optimal care for their patients. Leaders are examining their cost containment efforts to ensure that the quality of care does not dip as they try to achieve these two goals.
"We try to focus very carefully on our cost-containment initiatives, always being careful to balance them with any downstream effects they might have," says Reza Kaleel, COO of St. Mary's Medical Center in Grand Junction, CO. "But in many cases, reducing costs can actually improve quality. By removing added steps in a complex process, you may remove some of the reasons why errors were made in the first place."
Some organizations have been able to identify key components of their cost and quality efforts. "Benchmarking is a big part of our quality control and cost containment," says Chris McLean, CFO of Methodist Le Bonheur Healthcare in Memphis, TN. "We don't just benchmark against ourselves, but against other not-for-profit and even some for-profit healthcare entities. We're open to learning as many best practices as we can so we can implement them."
Gift swaps, secret Santa programs, and other holiday gift-giving traditions can be festive, but they also invite unforeseen and unwelcome consequences into the workplace—unless HR lays down some basic ground rules.
As the young clinician opened her gift at the hospital's Secret Santa gift exchange, a look of disgust crossed her face. Removing the wrapping paper revealed the package's contents were candy cane-flavored edible underwear that proclaimed "MERRY CHRISTMAS!" across the backside, bringing what had been a lovely, light-hearted party among coworkers to a screeching halt.
Who would give such a gauche gift?
They figured it out "through process of elimination," says Laura Palmer, now senior industry affairs fellow with the Medical Group Management Association, remembering the incident from her days as a healthcare administrator in the southwest. "The guy thought it was a gag, and that it would be funny… he just used poor judgement."
Because the employee had never had any run-ins with HR, the organization's leadership simply decided it was a social gaffe made by someone who didn't know what to give a colleague he was not well-acquainted with.
But holiday-related missteps are common. "Invariably, someone does this. As they group gets larger, the potential for more than one gift in poor taste increases," says Palmer.
Gift giving is a holiday activity associated with great potential for hurt feelings, confusion, or awkwardness if guidelines and ground rules are not properly communicated. HR can help prevent sticky situations around the holidays by setting policies around holiday gifts, communicating them, and enforcing them.
Opting Out
It's important to acknowledge that the holiday season has different meanings for everyone, and for some, no meaning at all.
People who follow religions or come from cultures that do not celebrate Christmas, may not feel comfortable participating in Christmas-related activities or gift exchanges. The safest course of action is to skip an organized holiday gift exchange—although that doesn't necessarily mean avoiding gift giving completely.
"Rather than do [a workplace gift exchange], departments might decide to do something good,like adopt a needy family," says David Twitchell, a member of the Society for Human Resource Management'sspecial expertise panel and vice president of HR at Catholic Charities of New Hampshire. Twitchell has worked in hospital HR departments throughout the northeast.
"A hospital I worked for decided that rather than a gift exchange, we would adopt a family. We went through the local Salvation Army," he says. Other options might include throwing holiday parties for children in foster homes, creating gift bags for military personnel on deployment, or having a canned food drive.
These activities alone may not be enough for some hospitals. For them, the holiday season just isn't the same without a workplace gift exchange. HR must set clear guidelines: "It's important to ask employees to opt into the gift exchange, rather than asking them to opt out," says Palmer. Make sure everyone understands that gift exchanges are voluntary, and not an expectation.
Secret Santa SNAFUs Make clear what gifts are not acceptable from the start.
"No alcohol, nothing too personal, and no gag gifts," Palmer says you should convey to employees. "And don't even think about gifts that refer to flatulence, weight issues, or anything that says 'you so ugly.'"
Laura Palmer
Find a price point for gifts that employees will be comfortable with and make sure they stick with it. Palmer's suggestion is to put up a chalkboard or poster in the employee lounge asking employees to anonymously indicate how much they're willing to spend on a Secret Santa gift. Take the lowest number and go with that. The $10 to $15 range is common.
One way Palmer has kept the gift exchange fun and festive while avoiding potential awkwardness is by creating themed exchanges. She's seen healthcare organizations exchange funny socks, homemade cookies, bobbleheads, and old Christmas CDs from bargain bins.
"I thought people would just think it was funny, but some people really did want that old Perry Como or Jackson 5 Christmas CD!" she says. Other "safe" gifts for gift exchange include, gift cards to coffee shops, coffee mugs, lottery tickets, and hospital-branded items.
Proper Giving Some people enjoy giving gifts so much that they want to give them to everyone in their lives, from the nurse who treated them at the hospital to their boss. It's helpful to staff and patients to have a hospital policy outlining how these situations should be handled.
Employees giving managers gifts is tricky business with little consensus, says Palmer. "The advice columns seem to recommend that if you're a new employee, check to see what the going tradition is in the organization. In many organizations, they frown upon it and would prefer not."
Palmer says she has seen organizations with a policy against gift giving—but it's a tough policy to enforce. Twitchell agrees. "How can you tell someone they can't give something to someone? The most important thing is to make sure there are no strings attached, and that it's done in spirit of giving."
Gifts to managers should be small—Christmas ornaments, baked goods, or a coffee card are typical gifts for the boss, says Palmer.
David Twitchell
She cautions that some health systems have a policy against giving gifts to physicians or administrators who work at the hospital. "The exception on that is probably food items. Bringing in cookies or something that everyone can share is probably more common."
Another sticky situation is when a patient wants to give a gift to a doctor, nurse, or department. "Employees should not be accepting gifts from patients, residents, or family members. If [the patient] insist[s], the gift should be shared by everybody," says Twitchell.
Palmer agrees. "Explain to the patient why you cannot accept gift, and that it will be donated to the hospital." If a patient tries to give a book, for example, it should be donated to the waiting room; if they send flowers, the arrangement should be placed in a high-traffic area where everyone can see and enjoy it.
When appropriate, a patient or family may be asked to consider making a charitable contribution to the hospital's foundation. [This practice itself is a topic of debate and merits its own policy.] Most foundations do allow for donations to be made to a specific resource, such as the hospital chapel, the patient waiting area or the pediatric ward, says Palmer.
"It's very straightforward with patients—you don't accept gifts of any kind," says Twitchell. "The purpose of working in healthcare is to give service."
With a little wisdom and guidance from leadership, the giving season can be less confusing—and we can get back to enjoying the spirit of the season.
Uncertainty over coming revisions to federal overtime pay regulations is no excuse for delaying to prepare for changes that could profoundly affect how workers view their jobs.
Even when there's warning, shifts in employment regulations can be unnerving. Coming adjustments to federal rules that govern overtime pay are no exception.
The proposed changes seek to increase the cap for overtime pay for full time, salaried workers and to do away with OT exemptions for managers and supervisors.
As if these major pay structure changes weren't daunting enough, uncertainties surrounding the rule are putting pressure on hospitals and health systems as they put the finishing touches on their 2016 plans and budgets over the next few weeks. But with the Department of Labor (DOL) still mum on the final version of the new regs, healthcare execs will be flying blind.
Public comments are now closed, but the DOL has received "thousands" of comments about the new regulations, says Alicia Koepke, an attorney at Trenam Law in Tampa, Florida.
Alicia Koepke
"There were objections on both sides," Koepke says. Some were about the amount of the increased cap. Some commenters requested a delay in the implementation of the regulations. [DOL has indicated that it will release the final version of the new regulations in 2016, but has not said when.] The agency is still reviewing all comments, says Koepke.
She expects that the new regulations will become law by the middle of 2016, and says now is the time for employers to prepare. Koepke offers five recommendations:
1. Involve a Lawyer
The revisions to the regulation will be complicated and specific, and the financial stakes are high, so legal counsel should be involved. No one should try to guess at how changes in the regulations will affect salaries, impact labor relations, or whether employers' policy changes put place as a result are legal.
"[HR leaders] should certainly speak with a lawyer… They have the benefit of open, frank, and privileged communications to make sure [clients are] following all the legal obligations," says Koepke.
2. Think Before You Act What changes to personnel will your organization have to make in order to offset costs associated with the new regulations? Some may hire more part-time employees to minimize having to pay overtime. Others may decide to make some hourly employees salaried, while others might do the opposite.
Before changing titles and duties, cutting hours, or drafting layoff plans, review employees and their individual situations. It's possible that not everyone under the 40% threshold is actually non-exempt, even under the new regulations.
"For a hospital, I don't think you are going to have many [employees]… that fall into that category, but they might have a couple," Koepke says. She suggests waiting until all the facts have been gathered before deciding which steps to take next.
3. Review HR Materials "Companies already have in place job descriptions, hiring letters, employment manuals, and benefit plans that may refer to a salary for these employees. If they're going to reclassify these employees as non-exempt… they're going to have to take a look at these [documents] and decide what needs to be changed," says Koepke. Many organizations' HR-related forms and materials will probably refer to a soon-to-be outdated compensation structure or policies that no longer fit. Review the materials and be ready to edit them to comply with the final regulations once they're released.
4.Train Employees on Time Tracking Employees who are switched from salaried to non-salaried status may need a refresher on how to properly track their time. If your organization is using time-tracking software, ensure that everyone is properly trained before the new regulations go into effect.
The same goes for the payroll department. Just as workers might not know how to track time, payroll processors might need a refresher as well. Be sure they are using the right rates, that all exemptions are accounted for, and that they demonstrate proficiency on any new timekeeping or payroll programs or tools.
5.Communicate Carefully
Get ready for some difficult conversations. Depending on the changes to be made, expect a wide range of employee reactions. Some employees will be delighted to learn they will be able to earn more money for overtime work; others may be infuriated to have to "punch in" when they arrive at work.
An even bigger challenge is communicating the change in status from full-time to part-time, or from salaried to hourly. "There is a psychological aspect to telling someone who was previously salaried that they are now hourly," says Koepke.
But, she says, "The employer can explain that this change was done to comply with new legal requirements, and it is not a reflection of the employee's importance to the organization."
It's important to develop a clear message for employees and to apply it consistently among all employees. When explaining employee status changes to employees, come prepared for questions, concerns, and possibly some angry reactions from workers.
These legal changes are confusing to everyone, so it's important to begin planning for them now. Don't wait until the last minute to hastily make policy changes that could profoundly affect how workers view their jobs and their pay.
In our June 2015 Intelligence Report, 80% of healthcare leaders indicated that cost containment efforts were not negatively impacting quality of care, although 10% said quality had declined. HealthLeaders Media Council members discuss efforts to maintain quality.
This article first appeared in the December 2015 issue of HealthLeaders magazine.
Chris McLean
Chief Financial Officer
Methodist Le Bonheur Healthcare
Memphis, TN
We're big believers in the balanced scorecard. We have financial measures, quality measures, and service measures that measure consistently in reporting. We don't just report the financials each month—we track over 100 quality measures, as well as service measures like patient satisfaction and employee engagement.
We keep an eye on measures as they roll out. If we see a decline in our quality measures, we do a deep dive into what's causing it, and if any cost reductions are part of the problem, we'll make adjustments. And one of our mantras is that the easiest way to reduce costs is to not add unnecessary costs.
Benchmarking is a big part of our quality control and cost containment. We don't just benchmark against ourselves, but against other not-for-profit and even some for-profit healthcare entities. We're open to learning as many best practices as we can so we can implement them.
Change management is always the hardest part of cost containment—we have to convince ourselves that the goals are achievable, and convince our leaders and the frontline staff that the changes make sense. Even when transforming just one area of a given hospital, you must stay diligent to ensure the change is properly implemented.
Mark Herzog
President and CEO
Holy Family Memorial
Manitowoc, WI
Holy Family Memorial is deeply committed to process improvement methodologies. When we decide that we need to change processes to accommodate new operating realities, our extensive use of process improvement takes into consideration that the change will add value for customers, including safety and quality, as opposed to detracting from them.
Continuing changes in payment methodologies do, however, impact on patient access and quality, and providers' efforts to ensure continuity and safety are challenged.
What frequently happens is that patients think that Medicare or their insurer is going to cover something expensive—for example, a month of their stay in the nursing home—and later learn that they are not covered.
In the nursing home example, Medicare frequently points out that they were not an official inpatient at the hospital for three nights—possibly, they left the hospital before midnight or were marked as being under observation. This affects the willingness of the patient to be admitted to the skilled nursing facility—for many of these patients, if their stay is not covered, they're going home. Some patients forgo necessary tests or treatments for similar reasons, too—and high-deductible plans are a cause of this as well.
Reza Kaleel
Chief Operating Officer
St. Mary's Medical Center
Grand Junction, CO
We try to focus very carefully on our cost-containment initiatives, always being careful to balance them with any downstream effects they might have. But in many cases, reducing costs can actually improve quality; by removing added steps in a complex process, you may remove some of the reasons why errors were made in the first place. I think that, in most cases, reducing costs will not automatically impact quality.
We have multiple cost-saving initiatives in our hospital. Perhaps most important is our comprehensive throughput initiative. We've been closely examining all the steps in the value stream from the point that the patient accesses us and removing non-value-added steps. We also are utilizing a dashboard of key process indicators we monitor to identify where we have the most opportunity to save money or improve our process.
The greatest barrier around sustainable cost reduction is the assumption many people tend to make: that if costs are driven down, quality will automatically be reduced. So, a challenge for us is trying to educate and bring along people in control of a lot of those costs that, no, we're not trying to make changes that are going to impact quality or safety in the negative—here's why we don't think it will, and then make our case for why these changes will actually improve quality and safety.
Ken Lewis, MD, JD
President and CEO
Union Hospital
Elkton, MD
On the value of improving care: Frankly, the best way to reduce cost in the long run is to improve quality. We do this using the Lean process model; when waste is eliminated or clinical outcomes are improved, that reduces the cost of care in the long run.
I realize costs can be reduced by cuts in labor and services, and certainly we look at contract negotiations and our supply chain for savings, but we believe that broader initiatives to improve quality are actually the heart and soul of true cost-reduction efforts.
On improving process improvement: We're moving away from a top-down senior executive–driven leadership and process model to a middle management and frontline model. Many hospitals have a committee structure that sometimes overemphasizes analysis or is not anxious to move forward with changes.
At our hospital, we do rapid-cycle testing to quickly assess whether or not a proposed quality initiative will have an impact. It's also key to make good on the ideas by providing resources needed to analyze data from those workers and come up with the best methodology to achieve change. Don't just sit on the data—use it.
Four senior healthcare leaders discuss their organizations' concerns and expectations for their EDs over the next three years.
The ED, often the first point of contact between a patient and hospital, is often where expectations are set. Organizations aiming to increase efficiency face a variety of challenges.
An engaged staff is one area where healthcare leaders are focusing their attention. "We're trying to determine strategies to retain staff, including retention bonuses and other efforts to try to keep staff on board once they get here, but it often feels like they leave as soon as we hire them," says Pamela J. Stoyanoff, executive VP and COO of Methodist Health System in Dallas, TX. "Often, it feels like a "churn-and-burn" scenario."
Other organizations are focusing on technology. "Developments in telemedicine have been immense for us," says David User, CFO of Coteau des Prairies Health System in Sisseton, SD. "Telemedicine links us with major trauma centers and allows us to move forward with telepsychology, telepsychiatry, remote substance abuse counseling, and other important issues we run into here that we're just not equipped to cope with."
With the increasing challenges associated with monitoring and maintaining reputation, more organizations are considering hiring a reputation management professional. Here's what you need to know about this role.
What is reputation management and why is it important for healthcare organizations today?
Having a reputation management pro on staff is vital, says Tim Langhorst, vice president of executive communications and reputation management at ProMedica, a nonprofit 13-hospital health system based in Toledo, Ohio. "It's a hybrid position of legal, HR, and risk management—and it's a position that's becoming more needed," he says.
A reputation management specialist should be able to anticipate the broad spectrum of consequences that are possible for any action their hospital takes, from failing to properly address a patient's angry comment on Yelp to helping to craft a response to a lawsuit to weighing in on a proposed new logo.
Tim Langhorst
As healthcare moves to a more consumer-oriented market, the importance of reputation will only grow—and hospital leaders cannot rest on their laurels, even if they have a solid century-old reputation. It's now vital to address issues that could negatively affect the organization's reputation.
In a brief discussion we had, Langhorst lays out a reputation management specialist's role, and describes a qualified professional candidate. This interview has been edited for brevity and clarity.
HealthLeaders Media: Tim, can you tell me what a reputation management professional's job entails?
Tim Langhorst: It depends on the day, but mostly we're trying to help the organization be a little more sensitive. Branding and reputation are so closely intertwined. As reputation management professionals, we're trying to help build reputations and relationships, while trying to do the right thing for the community at the same time.
Reputation management specialists look at different ways to build a reputation for the organization. I don't think a lot of people really think about that. When most people hear the reputation management professional title, I think they usually think of issues and crisis management, but people are taking someone who focuses on reputation more seriously these days, and asking more how to build a reputation. I spend as much of my time thinking about that as how we manage issues.
ProMedica believes in a philosophy of healthy communities and individuals. As an organization, we take a broader view related to that. This includes the social determinates of health, such as hunger as a health issue, infant mortality, mental health, and behavioral health, and how social determinants like poverty, shelter, and education really impact the health of a community. One of my duties is keeping our organization focused on how we can improve on making connections related to those issues. It's not only the right thing to do for the community, but it also helps to build the reputation of the organization.
There are also the more traditional issues management and crisis management aspects to the job as well.
HLM: What are some personal characteristics of a good reputation management professional?
Langhorst: I think a reputation management professional needs to have good critical thinking skills. They need to understand the industry, and in a broader sense than just public relations or issues management; they need to understand perspectives like finance, operations, legal, and HR. They need to understand the nuances of different support areas so that they can provide the best counsel and advice possible.
I think they need to understand that this role is more than PR, and understand how all different aspects of the organization act and how they cause impact.
I think a reputation management professional needs to be a good listener, and they need to understand nuance—and what the real issue is. Often, someone might say that they have an issue with one thing, while what's really upsetting them is something completely different, and a reputation management professional should be good at getting to the heart of the matter.
And this person should be able to get the right people in the room. Reputation management is such a group effort—it's not just something I do, everyone in the system responsible.
But, first and foremost, you have to be an honest person who can focus on always doing the right thing. You have to be willing to say to your CEO, "This is the right thing to do. This will be hard, but we made a mistake, and here's how we're going to fix it."
HLM: What professional background and training should a reputation management professional have?
Langhorst: Honestly, there's not a lot of schools that do a great job in training someone to do reputation management. The ideal candidate is going to be someone who knows something about legal, PR, HR, ops—all of those different areas. And that's kind of a unique individual.
As for my background—and this was 30 or 40 years ago—my undergraduate degree was in education, and I did work toward a master's degree in English, although I did not complete that degree.
HLM: When looking at resumes when selecting a new reputation management professional, what are you looking for?
Langhorst: That's a tough one, because it's a very senior position to begin with. I don't know that there would be anybody who would be right out of school and ready to take that kind of role on.
I might consider someone who could demonstrate that they could create kind of a proactive reputation building and reputation management program, and, through the interview, ensure that they have an understanding of what crisis management means, and what reputation management and issues management mean. I'd also be interested in hearing their thoughts about how they would monitor and utilize social media relative to getting a sense of reputation trends, and how social media can be used to help build communities and increase reputation capital.
This candidate would have to really be able to analyze issues from multiple perspectives and have an anticipatory ability to think about possible issues that might arise in the future, and work with senior leaders in helping to anticipate and create action plans against those issues.
An ideal candidate would need an understanding of connectiveness between reputation and branding, because they are so interconnected in so many ways, and how they would measure the success of the reputation and things of that nature.
Hospitals are often microcosms of their communities, which can be violent. But there are things healthcare providers can do to keep workers, patients, and facilities safe.
Everyone in a hospital needs to be prepared for the worst, says Jason Berenstein, director of hospital security at Oakland Regional Hospitalin Southfield, MI. "Unfortunately, it's a sign of the times. We have to train hospital staff to be ready for anything," he says.
Jason Berenstein
"Hospitals are the only place that is open twenty-four hours a day, seven days a week for anyone who needs care," says Gail Blanchard-Saiger, vice president of labor and employment with the California Hospital Association. They are often microcosms of their communities, creating unique challenges for hospital security and law enforcement, she says.
"It's a challenge. One size does not fit all."
But there are things hospitals can do to keep workers, patients, and facilities safe.
1. Maintain Balance
"It's a balancing act," between the need to keep patients and staff safe and maintaining an environment that is conducive to healing and where workers feel comfortable says Blanchard-Saiger.
Look at your hospital objectively and decide which areas truly need safety enhancements. Are the walkways well lit? Does the parking area need new security cameras? Ask your hospital security team to walk through the hospital and, with a critical eye, pinpoint potential security risks and draw up a plan to remedy them. Consider the impact of safety enhancements on how staff, patients, and visitors will move through the facility.
2. Take a Proactive Approach The adage is that "many hospitals are more reactive than proactive, but being more proactive will help prevent further liability, loss of life, or injuries," says Berenstein. "It's much better if you have policies and procedures in place before an incident happens than if you have to decide what to do as it's happening, or afterward."
Blanchard-Saiger has a similar suggestion. "Assess your entire organization. Take a look at what's working and what’s not."
Gail Blanchard-Saiger
Don't wait for incidents to happen—start training for them today.
Berenstein makes it a point to train hospital staff in how to handle workplace violence. He ensures that there's an action plan in place for active shooters and stages real-time drills that allow hospital workers to role-play in scenarios that would be dangerous and frightening in real life.
Some workers say this prepares them for violence outside the workplace as well, says Berenstein.
"This training allows workers to be prepared anywhere. They become well versed through many different situations. The staff feels safer knowing what to do after having been trained."
Employees should be trained to monitor the hospital for anything that seems out of place or odd. When in doubt, they should use the "see something, say something" approach, says Berenstein. "When employees are proactive and say something immediately, 99% of the time, the problems are resolved and the situation corrected."
3. Reach Out to Law Enforcement
It is always desirable to attempt to cultivate a good relationship with local law enforcement. While this is not always possible, "reaching out to local law enforcement can create a variety of benefits," says Blanchard-Saiger.
While some communities find the relationship with local law enforcement to be challenging, they are also stakeholders hospitals should try to engage. A positive relationship with law enforcement will encourage a stronger police presence near the hospital, faster response times, increased sharing of information, and increased trust between the two organizations.
Berenstein says the local chief of police visits his hospital once a month. "If I don't get local law enforcement involved, I'm setting the hospital up for failure."
The most important thing to remember, he says, is to make sure hospital workers know that they have the ability to keep their environment safe. "Empower your employees. Once the hospital staff is trained, knows their training and practices it, it just makes for a safer organization.
In our May 2015 Intelligence Report, healthcare leaders cited a variety of concerns related to the emergency department in the coming three years. HealthLeaders Media Council members discuss their expectations.
This article first appeared in the November 2015 issue of HealthLeaders magazine.
Timothy Greco, MD
Medical Director of Emergency Services
St. Jude Medical Center
Fullerton, CA
We have a good triage team, but we're trying to make it even more efficient. The hope is to combine a simpler protocol for triage and simplify the exhaustive and long intake questionnaire that currently serves as initial welcome.
We've recently hired on a team of consultants to help us with metrics and building new efficiencies into our intake and triage process.
I'd say that the best "technology" in the ER right now is actually people who can do nonphysician things for the physician.
Scribes have been a big plus. The electronic medical record is still something that is alien to many of us. I think that while most doctors are fairly computer savvy, many are still not comfortable with EMRs.
We're also developing workers who will manage patient placement. Placing alcoholics, drug addicts, or psych patients after a hospital stay, or placing older people in nursing homes takes a ridiculous amount of time. We're also trying to bring in individuals who help manage patients for the physician. This person will be tracking when the patient is ready to be seen, if the patient got in to a bed, and so on. These are all things physicians don't do very well, and that takes them away from their clinical goals.
Lou Hochheiser, MD
CEO
St. John's Medical Center
Jackson, WY
Our hospital is situated in a rural area, but we have as many as 3 million travelers come through the area every summer on the way to visit the national parks, including Grand Teton and Yellowstone. The greatest challenge associated with being in an area with a large transient or seasonal population is the lack of predictability.
We never know what kind of volume we're going to experience in our emergency department. If a new, dangerous bike path is opened or if we have thunderstorms on the mountain while people are climbing, we can have a sudden, unexpected increase in volume.
Accidents are our emergency department's greatest cause of bottlenecks. A couple years ago there was a lightning strike on top of the mountain that brought 17 people in with injuries resulting from it. But one of the benefits of being a hospital in a small, rural community is that, frequently, our staff finds out about emergencies and comes in to help out, even if they're not on call.
One of the other challenges we have is that more and more tourists are visiting from foreign countries. Last year, we had a bus overturn in a nearby national park. We ended up with 27 Mandarin Chinese speakers. We dealt with the incident with the help of local members of our community who spoke Mandarin—and a lot of gesturing.
David Usher
Chief Financial Officer
Coteau des Prairies Health System
Sisseton, SD
As a critical access hospital, our challenges are generally the same as everybody else's, except that we don't have economies of scale. I can go two days and not see a single patient in the ED, then I'm here on a Friday night and we get 20 patients, one right after the other. It makes staffing an absolutely unknown level of requirement, and it's really quite difficult.
We're currently considering going to a model that focuses on employing paramedics rather than nurses, as they're easier to staff and equally talented. I believe that moving to paramedic providers will help increase efficiency. I can train paramedics quickly, there are more of them available than other health professionals, and their scope of practice is quite wide, especially in emergency situations.
Developments in telemedicine have been immense for us. Telemedicine links us with major trauma centers and allows us to move forward with telepsychology, telepsychiatry, remote substance abuse counseling, and other important issues we run into here that we're just not equipped to cope with. Telemedicine technology is proving to be very necessary to us.
Pamela J. Stoyanoff
Executive Vice President and Chief Operating Officer
Methodist Health System
Dallas, TX
On ED bottlenecks: We are definitely experiencing significant increases in ED traffic. If I look at our emergency visit volume from the current fiscal year and compare it against last year, it has grown by almost 11%, and we have no reason to believe that will decline.
To handle this rise, we have increased our ED footprint to serve more patients at three of our four campuses. The fourth campus is landlocked, and there's nowhere we can expand to. Instead, we are building more ICU rooms within our patient tower so we can move patients to critical care sooner, which should free up space in the ED.
On ED staff retention: High nurse and technician turnover in our EDs has been a significant obstacle for us. I wouldn't say that we need to expand these positions or change our ED staff composition; we just need to fill and retain the positions we already have. If we can fill our current vacancies, we'd be staffed effectively.
It's very difficult to keep the ED staff engaged—it's a rough place to work. We're trying to determine strategies to retain staff, including retention bonuses and other efforts to try to keep staff on board once they get here, but it often feels like they leave as soon as we hire them. Often, it feels like a "churn and burn" scenario.
