Uncategorized•
on June 3rd, 2010•
By Michelle Gray-Bernhardt
(Part two of a two-part blog)
A wide-ranging sample of nurses from various facilities’ units participated in HMC’s survey. Their responses for the greatest time wasters fell into these broad categories:
1. Charts and documentation
These topics are interrelated. Frustrations around charts include missing or incomplete charts, the necessity of charting excess information, and/or duplicating information. It also includes the difficulty in finding necessary information.
Online documentation is the number one source of inefficiency and hybrid (half paper/half electronic) systems are singled out as particularly frustrating. Nurses also noted problems with incompatible computer systems and the crashing of glitch-prone systems, which required information technology staff intervention.
2. Finding and gathering supplies and equipment
Whether supplies or equipment, time spent searching equals time spent away from patients.
3. Patient flow
Transporting, admitting, and waiting for patients is a frequently-cited inefficiency. This includes lack of exam or treatment rooms or anomalous patients in units.
4. Physician interaction
Waiting for communication with physicians (return phone calls, post-round information, medication orders, discharge orders, etc.) creates frustration among nurses.
5. Communicating with families and patient complaints
Nurses find it challenging when families call frequently and unexpectedly, particularly when there is no clear family spokesperson. The result is that multiple family members call in with the same questions, status requests, etc.
For more information
HMC clients may check out the Nursing Obstacles and Inefficiencies Survey to see a bar chart of the results and see the nurses’ comments. They’ll also learn which nurses are doing well with time management and in maximizing patient time.
Michelle Gray-Bernhardt is an HMC knowledge manager
Uncategorized•
on June 1st, 2010•
By Michelle Gray-Bernhardt
(Part one of a two part blog)
The March 16 edition of the the industry publication HealthLeaders featured an article by Rebecca Hendren titled “Ten ways to increase nurses’ time at the bedside.” This article notes that “the easiest way to know what will save nurses time is to ask them. Stop nurses in the hallway and ask about inefficiencies and they will name umpteen things that drive everyone nuts. Saving five minutes here and there all add up. Removing obstacles that hinder nurses not only saves time, it also saves frustration.”
HMC asks the questions
So, what do nurses at HMC partner facilities think? We asked what tasks take them away from the patient bedside and feel like time wasters. Soon, we’ll be sharing the results.
Stay tuned.
Michelle Gray-Bernhardt is an HMC knowledge manager
Uncategorized•
on May 28th, 2010•
By Karen Jorge
The New York Times just ran an interesting article on hospitals’ increasing use of hospitalists. These specialists, as a sort of “physician-administrator,” handle cases in the hospital from admission to discharge, and can significantly reduce length of stay (from 17 percent to 30 percent) and costs (13 percent to 20 percent) according to The Journal of the American Medical Association. They are also focusing on improving communication with patients, which is crucial not only to patient satisfaction, but also to preventing readmission through confusion about medications or other instructions.
Perhaps the most exciting part of the uptick in hospitalist use is that many of these specialists are intentionally working toward controlling costs and making workflows more efficient. We often see a disconnect between physicians and the finance/performance improvement folks, but all parties need to work together in order to tackle these issues. I was thrilled to see the article discuss hospitalists’ focus on “preventable adverse events,” “cost-effective delivery of care” (yes!), teamwork, and making decisions for cost-cutting. Great!
Too often there is a struggle between how physicians want to practice medicine and how finance teams want to control costs. Both have worthy goals, but they’ve got to work together, and it appears that if hospitalists are used effectively, they might provide a bridge between the two to deliver better care at a lower cost.
Karen Jorge is an HMC analyst.
Uncategorized•
on May 26th, 2010•
According to a recent press release, the American Customer Satisfaction Index (ACSI) noted that while overall customer satisfaction is on the rise, hospital patient satisfaction is declining.
The ACSI, updated quarterly, is a national indicator of customer evaluations of products’ and services’ quality. “Hospitals are taking it on the chin as the quality of inpatient healthcare and emergency room services declines,” states the release. “The hospital industry plunges 5 percent to 73, its lowest level in five years. Outpatient care at hospitals remains steady, but sharp drops for inpatient and ER services has taken a big toll. By contrast, patient satisfaction with office visits to healthcare professionals such as doctors, dentists, and optometrists is steady and scores much higher at 81.”
HMC has initiated a call series about hospital patient satisfaction. The first discussion was held on May 25 and focused on patient satisfaction in the ED. Clients interested in learning more can log on here.
Uncategorized•
on May 24th, 2010•
By Shelley Burns
(This is part two of a two-part blog)
This eye-catching article reports that Google is highly regarded as a source of health information. Doctors are still number one, by quite a bit, but my bet is that their influence is going to erode further because of the difficulty inherent in accessing a physician. I experienced this myself.
Unknown to us, my mother-in-law quit taking a prescription drug. We, and her physician, were baffled by her deteriorating mental state. She was becoming unsafe in her apartment and we were frantic. It took us about 10 days to figure it out. After we did, we were relieved, but had concerns about how to restart her medication – bolus? ramp-up? I called the physician – he was on vacation, but I explained it to the nurse. She refused to help, even though I had a healthcare power of attorney, and had been conversing with the physician about Mom’s status almost daily.
“You’ll have to discuss this with Dr. Z.”
I pleaded: “Can’t one of the other physicians just tell me if it’s safe to start this med up at her previous level?”
No, there was no one in the office who was going to talk to me over the phone, and the next appointment that was available for my mother-in-law was weeks out. She would have to be hospitalized before she’d make that appointment. So I went online, and Googled “restarting drug X.”
I found several sites and felt confident enough to restart Mom’s medication. It was successful, although I realize we were lucky, and we would have preferred communicating to a doctor about it. It was only because I was desperate that I turned to Google.
Now, if the results of these two polls, corroborated by my own ubiquitous experiences, don’t demonstrate the importance and necessity of electronic communication and interaction, I don’t know what would. Doctors cannot be available 24/7, but they can sure expand their reach with e-mail, online scheduling, accessible electronic records, and some basic care information.
Hospitals can provide services such as online registration, basic discharge instructions, family communications, and even “traffic” reports in the ED in a more timely fashion and for lower cost (who doesn’t want lower cost in healthcare?). Fair warning, doctors and hospitals, if you want to keep the top spot for health information influence, you’d better be on the ‘Net in ways that benefit your patients.
Shelley Burns is head of knowledge management at HMC.
Uncategorized•
on May 21st, 2010•
By Shelley Burns
Part one of a two-part blog
As I scanned my e-mail messages this morning, my eye caught two articles, posted side by side, from HealthLeaders Media Marketing Weekly. The first was titled “Parents want e-communication with doctors but few have it.” It reported that the C.S. Mott Children’s Hospital National Poll on Children’s Health found that less than 15 percent of people have electronic communication with their children’s pediatricians, but more than 50 percent want it. I feel their pain!
Our family physician’s office allows me to have an electronic chart, but not my children. My workaround? I send my doctor queries about the kids via MY electronic chart (“JoEllen has had a slight cough for 10 days. No fever and she seems fine. Something going around or do you want to see her?“). My doctor chastises me every time, but…I don’t care. She answers my query first and then chastises, so it works for me. I often need my kids’ immunization records for school, sports, the band, the chess club, for juggling, you name it. The physician’s office is very prompt – they’ll fax it right away – as long as I need it between 8:30 a.m. and 4:30 p.m., Monday through Friday.
My children – like all children – hand me the permission slip on Sunday evening at 9 p.m., with the wailing declaration that they must return it tomorrow at 7:30 a.m. So, I have an immunization record problem. I’ll leave a message on the doctor’s tortuously long office voice mail that evening, but they must call me back to ensure I’m not requesting immunization records for nefarious purposes. Then I’m in a meeting when they call.
I return the call, but the nurse is with a patient…you KNOW how this goes. My workaround is to keep a record of their immunizations in the notes section of their Outlook contact record. Voila – it’s accessible and can be updated by me, the payer, 24/7 at work, at home, or on my iPhone. (And, so, doctor, when I am frantically typing away on my phone during my kids’ physicals, I’m not answering e-mails. I’m updating their PHRs).
Shelley Burns is director of knowledge management at HMC.
Uncategorized•
on May 19th, 2010•
By Thomas Day
I recently read an entry in Paul Levy’s blog, titled “Is your organization too flat?” A pretty good question, and so I read it with interest. The various entries were a disappointment, actually, starting with one post suggesting that BP’s recent reorganization – which reduced their 11 layers to 7 – was suicidal, and then intimated that the recent deep-water explosion was the result. (IMO: 11 layers is ridiculous, and I sure wouldn’t leap to that conclusion).
Another post noted Toyota’s supervisory structures were notoriously heavy, and that’s good given their history of quality – except their recent troubles, which he suggests are not related. And the consensus, which makes perfect sense, was that form must follow function, so different types of decisions made in different departments call for different structures, and so on. The part that was troubling was that all of this was made to sound very complicated – almost mystical, and certainly unknowable without deep insight (and perhaps a mantra or two). Commentators turned phrases such as flat may be more “efficient, but is it more effective?” Here’s the link so you can read it for yourself.
My own posted response follows:
I doubt that anyone is honestly advocating that BP’s 11 layers of management seems like it might have been the right thing, and moving away from such a structure required a great deal of study to sort out. And I also suspect that no one really thinks that removing front-line supervisors is flattening an organization, or, finally, that hospital work is so varied and complex that these things don’t have “boundaries” of reasonableness.
These questions can be made to seem so complex so as to paralyze common-sense approaches. My apologies in advance if I’ve read the above comments too harshly. But to imagine that layers of assistant department heads reporting to department heads reporting to assistant vice presidents reporting to vice presidents reporting to etc. may provide organizational flexibility, and that it requires study to sort out, doesn’t make sense to me. It seems obviously wrong, just as red is not green.
In a hospital setting, structures get calcified over time – especially when (non-acquired) FTE growth won’t accommodate career/responsibility growth. Thus promotions to really good people serve as rewards for a job well done – guaranteeing structures get complex and layered over time.
It’s pretty easy to measure where structures are not commonsensical and it’s also pretty easy to measure where front-line supervision is starved. And of course different types of work require different structures. Call me Shallow Hal if you’d like, but a great first step is to find these areas and clear them out.
Uncategorized•
on May 17th, 2010•
Sentara Williamsburg Regional Medical Center , an HMC client, has just announced its sixth straight year without a single case of Ventilator Associated Pneumonia (VAP). This hospital-acquired infection (HAI) causes death and raises the cost of care. HMC has done extensive research on both HAIs and other hospital acquired conditions (HACs). HMC found hospitals lose $2 million annually because of HACs – and these HACs are also avoidable. For more, read here.
Uncategorized•
on May 12th, 2010•
HMC has found that current conditions demand hospitals consider the Medicare break-even point (BEP) as a key strategy for profitability. Medicare is typically the single largest hospital payer by far, covering 45 percent to 65 percent of all inpatient costs. HMC research of 40 facilities revealed only 10 percent of them were profitable with Medicare, and 10 percent were on the cusp of Medicare profitability. The large majority of hospitals lost significant money on Medicare work.
With the healthcare reform bill now law, hospitals face an even greater payment reduction risk. In light of this, HMC found its more successful clients proactively reevaluating their Medicare management and reimbursement strategies. For more on this, please see the HMC press release today.
Uncategorized•
on May 10th, 2010•
By Shelley Burns
One aspect of my job is to help hospital managers decode a set of performance benchmarks and develop action plans to address gaps the benchmarks uncover. As a result, managers ask me all the time: “What is the best practice for (insert any hospital department or process here)?”
Many ask as if the best practice is an object, something to be acquired from an external source, or a shiny round solution to all problems – in essence, a noun. Grammar was not my forte, but I learned from “Schoolhouse Rock” that a noun is a person, place, or thing, and a verb is an action or state of being. It troubled me – why is a change or improvement to the status quo (the best practice) characterized as a noun?
I looked up the word practice in the Visual Thesaurus (love it!) and sure enough, it’s a noun. However, some of the definitions describe verbs: “a customary way of operation or behavior”; “systematic training by multiple repetitions”; and “translating an idea into action.” I really like that last definition!
Scrolling down in the Visual Thesaurus, I see that practice is also a verb: “carry out, as in job or profession”; “learn by repetition”; “engage in rehearsal”; and “perform.” Now that makes more sense!
Treating the best practice as a noun – something you can import without consideration of organizational goals, environment, or talent – will lead to disaster or, if you’re lucky, no forward motion. I liken it to my childhood piano experience, which was similar to that of many other people, I’m sure. I was required to “practice” for 30 minutes every day and I certainly did my time on the piano bench. However, I was a lazy practicer, much more prone to daydreaming about how much better I’d sound on a grand piano, instead of putting the hard work into my pieces so that I could actually improve. How many of us treat the best practice for our departments and processes the same way?
Make the best practice a verb in your organization. Challenge managers to reset their activities between searching for the best practice and actually doing something, no matter how small, to improve the current practice. Research is necessary, of course, but it should follow the 80/20 rule. That is, 80 percent of your time, resources and energy should be spent in doing, repeating, measuring, tweaking, changing, improving – these verbs are the true characteristics of the best practice. Your own practice will improve each time you streamline a procedure or remove an inefficient step. And the more often you practice improvement, the better you’ll become. And pretty soon, the best practice will be the one you’ve built yourself.
Shelley Burns is director of knowledge management at HMC.
