Resources

Ideas to Read and Pass Along

Kevin & Jackie Freiberg

Blow the Doors Off Healthcare-as-Usual

The Situation:

The times they are a changing. Thanks to the Internet and information that is immediately available to anyone, anywhere, at anytime, today’s patient is more educated, more sophisticated, more demanding and less tolerant than ever before. They are more rebellious and risk oriented as evidenced by the fact that they are more willing to question diagnoses and prescriptions and they are more willing to experiment with alternative forms of medicine. Patients want to be informed, they desire a relationship with their physicians where they can become active participants who are fully engaged in their own prevention and healing.

While more cynical patients demand that providers earn their trust, health care professionals—frustrated with declining reimbursements, seeing more patients, making less money and feeling compromised in the quality of care they deliver—are getting burned out. The situation is not pretty. Here are a few ideas that can help you earn the patient’s trust, create a more exciting and hospitable place to work and truly differentiate your organization from the competition.

Stop practicing “Lone Ranger” medicine

Reduce variation, systematically and systemically track procedures and embrace evidence-based medicine. Yes, good facilities, good technology, good training and good intentions are more likely to produce good clinical outcomes, but not automatically. Michael Millenson, author of Demanding Medical Excellence: Doctors and Accountability in the Information Age, states that “A surprising 85% of everyday medical treatments have never been scientifically validated. For example, when family practitioners in Washington State were queried about treating a simple urinary tract infection, 82 physicians came up with an extraordinary 137 strategies.”

While most physicians argue that diagnosis and protocol can’t be generalized, standardized or put into some formula, the following question has to be asked: Is it that we CAN’T reduce variation or we WON’T reduce it because it will require a change in the way we’ve been practicing medicine for years? Is it that we CAN’T reduce variation is it that we don’t want the interference that comes with agreed-upon protocols?

Hospitals get connected

Today we have the capability to do remote and robotic surgery, yet ask a random sample of 200 patients in any hospital: “How many of you can email your doctor?” You’ll probably be shocked by the miniscule number of people who can. Connectivity has made Washington Hospital Center one of the most technologically advanced emergency rooms in the United States. In the ER minutes could mean the difference between life and death. That’s why physicians must be able to access information in real-time. Consider what happens when paramedics bring a patient with a head injury into the ER. The trauma team immediately sends the patient to the CT (computerized axial tomography) suite. At WHC digital CT scans show up on PCs in the trauma unit before the patient is transported back into the ER. The process used to take 20 minutes, now it happens in less than five. This means neurosurgeons don’t have to wait to begin a critical procedure. Having already reviewed the scans, they are ready to go if the patient requires surgery. If the scans show that surgery is not required, the physician can take the next appropriate steps or move on to another trauma patient whose situation may be even more critical.

Electronic Medical Records—now

The future is here, are you equipped to deal with it? David Veillette, CEO, Indiana Heart Hospital says, “Our entire facility is digital. No paper, no film, no medical records. Nothing. And it’s all integrated—from the lab to X-ray to records to physician order entry. Patients don’t have to wait for anything. The information from the physician’s office is in registration and vice versa. The referring physician is immediately sent an email telling him his patient has shown up. It’s wireless in-house. We have 800 notebook computers that are wireless. Physicians can walk around with a computer that’s pre-programmed. If the physician wants, we’ll go out and wire their house so they can sit on the couch and connect to the network. They can review a chart from 100 miles away.”

Imagine the possibilities for speed in a connected hospital. Within minutes of admitting a patient, physicians could access records showing the patient’s history. This could be particularly helpful if the patient is unconscious and unable to describe the medications he or she is taking. When a primary care physician refers a patient to a specialist the patient’s medical records could be transferred electronically. This way the patient isn’t held up in getting an appointment with the specialist and doesn’t have to answer the same set of questions all over again. What were talking about here is added convenience for the patient who now feels better known and added efficiency for the physician who wants to get in and out without compromising the quality of the interview or the quality of care.

Physicians get connected

Wireless connectivity is making life easier for physicians as well. Whether it’s standing next to the patient in the exam room or fishing at a nearby lake, physicians can now enter patient prescriptions on their wireless devises. Choosing items from a pull-down menu on a Palm Pilot eliminates the illegible writing for which doctors are so well known. Pharmacists who don’t have to decipher the physician’s handwriting create fewer prescription and dosing errors. Physicians can be warned about prescribing medicine that might have dangerous drug-drug or drug–food interaction effects. Electronic prescription-writing also means that the requested drugs can be waiting for patients in the pharmacy before they ever leave the doctor’s office. This is NOT insignificant when you consider the fact that the Wall Street Journal and the Institute of Medicine report that there are one million serious medication errors per year due to “illegible handwriting, misplaced decimal points and missed drug interactions and allergies.” This begs the question: “Is it possible that we could save thousands of lives if we simply mandated electronic prescriptions?”

Doctors who carry hand-held organizers can now receive laboratory results anywhere in real-time. This allows for more accurate and efficient diagnosis and the potential for quicker treatments. If doctors didn’t spend 40% of their time looking for information they don’t have, they could see more patients. Between 1995 when it got connected through a state-of-the-are computer system and 2000, patient load factors rose 36% at Washington Hospital Center.

Empower the patient

Get rid of the paternalistic mindset evident in most hospitals where the patient feels helpless and victimized. Put the patient in control by keeping them informed, involving them in the process, giving them choices and partnering with them regarding the decisions affecting their clinical outcomes. Planetree (www.planetree.org), a 90 hospital membership organization, is blowing the doors of business-as-usual with an open chart policy. Patients are encouraged to read their own medical charts, and write notes to the physicians and nurses. This facilitates a healing partnership between the patient and caregiver. Also, Planetree has a self-medication program patients who are able can keep their medications at the bedside and assume responsibility for their administration. “Patients are not just bodies that a doctor should be doing something to,” said Susan Frampton, PhD, executive director of Planetree, based in Derby, CT. “A patient is the whole person who needs to be a partner in any decision that’s being made about his care.”

Turn up the volume on kindness and empahy

There is widespread agreement that bedside manners count. Being impatient, indifferent, non-responsive, totally clinical and objective or speaking in medical acronyms only a doctor can understand, leaves patients feeling frightened, alienated, frustrated, out of control and angry. The result? Patients become withdrawn or combative, cooperation, compliance and persistency decrease, and malpractice litigation increases. Sure, time is money for the physician and labor costs in a hospital are significant, but I think it’s safe to argue that lack of empathy and kindness chews up more time and money than if the patient would’ve had a positive interaction in the first place. The research suggests that while patients want a successful clinical outcome, they also want health care providers who listen and empathize. A doctor who walks me out to my car after informing me that I have cancer demonstrates a unique level of empathy that sets him or her apart from all others. There is also a strong correlation between employee satisfaction and patient satisfaction. This begs the questions: “What does your culture look like? How do your physicians treat your nursing staff? Are your people ALIVE and engaged or do you have DEAD PEOPLE WORKING?

Compliment traditional with alternative forms of medicine

An aging boomer population is willing to embrace alternative forms of medicine that will help them turn back the clock. From exercise and nutrition to elective surgery and Viagra to therapy and homeopathy, many boomers are aggressively seeking the fountain of youth. This represents a HUGE opportunity for providers who have the guts to step out of the comfort zone and try something new. The world is not changed by those who are unwilling to take risks. Read Oprah, Men’s Health, Prevention, Women’s Health, Shape, Fitness or any of the other hundreds of magazines that address mind, body, beauty, food and fitness. What do you find? The articles and advertisements appeal to a readership that wants to slim down, improve their smile, cure baldness, enhance their breasts, reduce stress and have better sex. The advertisements tout everything from wrinkle reducing cream, herbs, protein powders, acupuncture, massage therapy, and the latest miracle exercise equipment.

Unrestricted visits for family, friends—and pets

Engage friends and family in the healing partnership. Susan Frampton, Laura Gilpin and Patrick Charmel, co-authors of Putting Patients First, found that “When hospital staff members are asked to list the attributes of the ‘perfect patient and family,’ their response is usually a passive patient with no family.” Not at Planetree. Family and friends are not considered intrusions, but rather a welcomed and integral part of the healing process. Most Planetree hospitals have completely eliminated visitor restrictions—even in the ICU—for family and friends. Why? Because Planetree knows that family, close friends and significant others have a huge positive impact on the long-term health and happiness of the patient. Medical and social researchers are finding that things that promote a sense of love, connection and community are healing. How about volunteer care partner—someone to hold my hand as I go into surgery—for those patients who are alone?

Can you imagine a hospital where even the patients’ pets can visit the patient? At Griffin Hospital, a Planetree affiliate, the program is called P.A.W.S. (People and Animals Working in Spirit). The Dog Visitation Therapy is a means of providing comfort and companionship to patients, their friends and families, and to hospital staff. Researchers have found that pets can have beneficial effects on health, including a lowered blood pressure, mood elevation and enhanced social interaction.

Heal the patient’s sou

Focus on the whole person, the person behind the case, not just the “gallbladder” in room number 212. Why shouldn’t priests, pastors, rabbis and the like be an integral part of the prevention and healing process? Many people believe in the power of prayer and meditation to heal. Why not provide chapels, gardens and meditation rooms for reflection and prayer, places where patients can meet with spiritual mentors to find meaning in their suffering and hope for recovery? Doesn’t it make sense to employ every potential means available for healing, health and wholeness?

Use architecture and design to promote health and wellness

Visit the general offices of Southwest Airlines and you will find three floors of a massive building decorated with 30,000 pictures and memorabilia of employees having fun, opening new facilities, inaugurating new airplanes and attending social events such as chili cook-offs, awards ceremonies and charity events. Drop in on GSD&M, one of the world’s foremost advertising agencies and you will see a room decorated for each of the firm’s major clients. If you are working on the Chili’s account you will sit down in a room designed to look just like a restaurant. Jump over to QuadGraphics, the largest printer of magazines in the northern hemisphere and you will find a manufacturing plant with air ducts painted in bright colors versus dingy gray and beautiful art work all over the place. At Planet Honda in Union New Jersey, one of the most successful Honda dealerships in the world, the place is infused with aromatherapy to create a more relaxing environment. These companies understand that the corporate environments in which we reside make a difference in our attitudes and in how we approach our work. Wouldn’t the same be true for promoting health and wellness? Physicians, nurses and ancillary staff that get to work is a warm, hospitable environment will bring a spirit of hospitality to their co-workers as well as their patients.

What if patients could be given aromatherapy before going in for an MRI—might they be more relaxed? What if the layout of your facility eliminated the barriers that hinder patient privacy or family participation? What if your facility was designed to reduce clutter and stimulate patient mobility?

At Planetree Hospitals the focus is on creating a nurturing environment in which the patient feels warm and secure. Passive aromatherapy such as the smell of baked bread or cookies contribute to a home-like decor. How does this happen? The kitchen is open to anyone who wants to use it. Families who want to make grandma’s favorite soup have complete access. How about a patient/family lounge featuring water treatments such as fountains and a salt water aquarium or a music lounge, where patients and their visitors may enjoy the talents of the various musicians?

Lighten up

Clowns, funny movies, and comedians can create an atmosphere of fun and playfulness. The impact of humor on health is pouring out of the medical universities. Consider these facts: Laughter gives the lungs a workout. A hearty laugh enables us to take in six times more oxygen than when we talk. Twenty seconds of good laughter causes the heart to pump more and increases blood circulation. It gives the heart the same exercise as three minutes of hard rowing. Muscle tension, heart rate, and blood pressure rise when we laugh—but they all drop to levels lower than before we started laughing. This relaxation lasts up to 45 minutes. Laughter stimulates the body’s immune system and helps us fight off infections and germs that can multiply inside us. Laughter helps us reduce stress—a major contributor to six of the leading causes of death including heart disease and cancer.

Leverage the power of art and entertainment

At Monarch High School in San Diego, a first-of-its-kind high school for homeless kids, painting murals is a powerful form of therapy. On one wall of the school you can see artwork created by the kids that depicts the life they want to get away from. Another set of murals show the kids’ vision for a new life they want to create. The murals enable the kids to express themselves and get at the emotional pain many of them have internalized for years. Using art, teachers expand the boundaries of the healing process by getting these young people to open up and talk about their feelings. Create a program where artists, actors, musicians, dancers, poets, storytellers and potters volunteer their time to work with patients.

Make nutrition fun

Say the word nutrition and many people immediately think of bland, boring and tasteless tofu sandwiches. Bring experts in to teach cooking classes and talk about how to develop healthy eating habits. Lead by example by making sure that dining rooms and vending machines offer food choices that are consistent with the type of lifestyle you are trying to promote.

Become a junction box for knowledge

Patients are hungry for information. Whether it is through on-site education centers that contain books, tapes, and journals or high-tech kiosks that connect them with satellite libraries and experts in their field from around the globe, make it quick, convenient and user friendly for patients to get their hands on the information and insight they want.