Uncategorized•
on October 20th, 2010•
Is nurse recruitment and retention still a hospital issue? Well, yes.
Overall, in the past three years, it may have become more of an employers’ market rather than an employee’s. However, in nursing, hiring and retention challenges still exist. Preliminary results for HMC’s new survey “Recruiting and Retention – Is It Still an Issue?” have been interesting.
Many hospitals face nursing personnel challenges, but the causes have changed. Examples of these challenges include: budget freezes; loss of good nurses who relocate because their spouses have lost their jobs; and nurses who could retire, but don’t because of personal finances. Sometimes new nursing school grads clearly don’t belong in the field, but don’t want to leave the industry for fear of being unable to obtain another job. There is a younger generation of nurses that feels no qualms about leaving the job abruptly; and there is increasing nurse dissatisfaction because of forced floating.
The survey results will be available in early November. Stay tuned for more info here on the HMC blog. And if you have opinions about this issue or experiences to share, we’d love to hear about them – you can participate in the survey by clicking here. Participants will receive an e-mail summary of the results.
For more information, please contact Pamela Paxton at ppaxton@hmccentral.com
Uncategorized•
on October 11th, 2010•
By Shelley Burns
I listened today to Janie Wilson’s outstanding presentation about reducing elective inductions and the concomitant positive impact on outcomes and cost. (Wilson is operations director for W&N Clinical Programs at Intermountain Healthcare.) She made a point on changing behavior and culture that made me think. She said: “We try to make it easy to do the right thing.”
The implication of that comment – namely, “It’s too hard to do the right thing” – is a pretty good categorization of the current healthcare system in the United States, isn’t it?
It’s too hard …
· for the oncologist to view images or lab work performed by a different hospital, so they perform all the diagnostics again, increasing utilization and cost.
· for some families to get insurance so they use the Emergency Room as their primary care, using expensive resources to treat a sore throat.
· to get all the orthopedic surgeons to agree on a standard supplies and clinical criteria for specialty products, therefore the hospital inventory is bloated with high-priced, non-standard implants.
· for patients to be followed across the continuum of care, so no one does, resulting in unnecessary re-admissions. No one really knows if discharge instructions and suggested follow-up care actually occur, even for chronic diseases such as asthma, congestive heart failure, COPD, and diabetes.
· for the nurses to communicate easily with far-flung and multiple family members, so they answer random phone calls at impromptu times, increasing the likelihood for errors.
· for the primary care physicians to communicate with patients via e-mail because they don’t get paid for their time and are nervous about getting sued. Instead, physicians require an appointment, unnecessarily wasting their time and the patient’s.
· for patients to understand the tsunami of paper they receive from hospitals, physicians, clinics, and insurance companies. Therefore, they can’t uncover the true cost of healthcare and abdicate their decisions about healthcare value.
· for the obstetrician to counsel watchful waiting as opposed to performing a C-section because the financial, malpractice, and social incentives are completely out-of-synch with less-invasive (and often safer) vaginal deliveries.
· for the hospital to drop a clean bill or claim (no payment denials or partial denials). Instead, they hire nearly as many coders, utilization reviewers, case managers, and insurance verification/authorization/denial management coordinators as they hire physicians, increasing costs for everyone.
There’s really no excuse for these things to be “too hard” A great healthcare system requires that we align the incentives to make it easy for everyone to do the right thing.
Shelley Burns is head of knowledge of management at HMC.
Uncategorized•
on October 7th, 2010•
by Ariana Berberich
Hospitals have instituted widespread quality efforts to prevent the non-reimbursed AHRQ off-quality incidents. While these quality improvement initiatives are well-intentioned, ironically, they are misguided. Based on research using our national database of hospitals (ranging in size from 5,000 to 80,000 adjusted admissions), and their admitting physicians (ranging in number from 35 to 1350), additional expenses related to off-quality incidents are not actually widespread among the hospitals’ admitting physicians but are focused among a handful. The implications of this are that broad brush patient safety initiatives will be less effective than those focused on the few physicians with quality problems.
At each hospital, HMC ranked the physicians by their off-quality expenses and determined the percentage of physicians responsible for 80 percent of the extra expense associated with patients who experienced off-quality incidents. Regardless of size, service, and number of physicians, the pattern remained the same with a mean/median of 6 percent of the admitting physicians responsible for 80 percent of the off-quality expense.
Ignore this at your peril.
The physicians at Hospital A show a typical pattern of off-quality expense with a small number responsible for a majority of the off-quality excess. Those physicians in red contribute 80 percent of the total facility off-quality expense.
Ariana Berberich is an HMC analyst.
Uncategorized•
on October 6th, 2010•
By Marc Songini
Working every day around performance improvement initiatives, it’s easy to think of these things only as abstractions. There are so many numbers and targets and goals. There are deadlines and methodologies and meetings in the slow challenging process of attaining excellence. So many acronyms: DRGs, LOS, AHRQ, and so on.
The dynamic changes the day when we actually are admitted to a facility, in great pain or fear. That’s when we hope that the emergency room is state of the art, with top notch networking and computer systems, and there is quick access to our medical records. We think about performance improvement and hope the hospital we are in is taking it seriously, because now it’s our particular health at stake – maybe our life, too. We hope the best doctors are the ones we will see – that they are the ones with performance-based success, and not just the ones who order the most tests.
I have heard it said that if aviation were as dangerous as healthcare, no one would fly. We think about such things when we are being admitted – sometimes too weak or sick to even consciously make a choice. Rather we go with the flow. We hope that the communications in the hospital – from intake to the emergency room to the ward we spend the night – is efficient. We don’t want to be given drugs that might kill us.
We hope that the doctors are all able to collaborate with nurses and other support and technical staff and that they are pointing us in the direction to get better. There are a million details we notice. We hope the nurses handling the IVs don’t have long nails, that there is some sort of rigid checklist someplace, that someone forwarded our specific instructions ahead if we’ve been admitted late at night. We don’t want to sit in pain waiting for medication.
There are so many things that can go wrong. Lab work; the wrong antibiotic; the wrong meal – was it only liquids we were supposed to eat? Or not? We also hope that the cleaning people are diligent. We know of things like MRSA and other infections that are straight from a horror movie
In short, the performance improvement discussion seems quite real when we are vulnerable. And if everything works, the general public just treats that as normal. But for those that understand all the many small cogs that are in the machine that is a hospital, we know it only all succeeds through teamwork, collaboration, and leadership. Working in the field from the administration’s side, we know that success is a choice in a hospital. When inside the hospital as a patient, we don’t see all the invisible forces behind success, but we’re aware that they were there, like the wind that blows a sail. We appreciate someone paid attention to the details.
On the other hand, the general patient, whose loyalty is so desirable, only knows what happened when a cog didn’t fit in right, and they won’t forget it.
Marc Songini is communications manager for HMC.
