The value of confidentiality is of extreme importance to all physicians and, as a result, the entirety of the healthcare industry. In fact, the legal concept of confidentiality is said to have been translated from within the Hippocratic Oath as detailed in the statement “Whatsoever I see or hear within the course of my practice, or outside my practice in social intercourse, that ought never be published abroad, I will not divulge, but consider such things to be holy secrets” (Emson, 1998). From this basic ethical foundation, many different laws and types of legislation have been created for the sake of protecting the privacy of individual patients. This is especially important when considering that divulging such sensitive information could lead to dire consequences for the individual patient or the legally responsible party who thought it would be a good idea to share such information with others.
In general, throwing the proverbial "book" at those who either steal or willingly share sensitive information or documents about an individual patient under their direct or indirect care is justifiable. As a society, we continue to create many legal, electronic, and physical barriers to prevent this. However, what happens to individuals who mistakenly share information either through neglect or sheer stupidity? How are we as individual managers supposed to react? What type of punishment should be considered enough?
Before answering this question, any manager must weigh any of the potential consequences created by addressing this matter. In one hand, the manager must protect the integrity and reputation of the organization at all cost. No matter the individual, it is paramount that the organization's good name be maintained. On the other hand, what possible harm was accomplished? Was any information shared and if anyone can testify with 100% truth that not one bit information was shared or stolen with unwarranted individuals, should there be any repercussion? The answers to these questions are never simple. Like people, ethical situations are very unique and intricate. As a result, a manager must be willing and able to examine the situation and determine what should be the best course of action. However, no matter what type or types of disciplinary actions are taken its clear that mechanisms and protocols must be put into place to avoid a future manifestation of the same problem.
This all seems to be the rational and educated approach to this problem. Unfortunately such ethical problems are not always so easily solved. It should be noted that the vast majority of the time, sensitive patient information is breached not through premeditated decisions, but through sheer lack of professionalism. While many managers may share a sigh of relief, such problems are only small indicators of an even larger more significant situation that at one point will emerge in the future: poor quality. Quality is above all the most important product healthcare managers produce for their community and patients. Without this quality a healthcare organization fails to achieve the overall common goal of any healthcare organization: increasing the quality of human life.
Its possible that this may be an overzealous opinion and that small mistakes should not create create a situation where someone is "over-disciplined". Maybe a manager can even overlook these mistakes or just ignore them. However, when does a manager begin to discipline their staff? When does a problem become large enough to receive their attention? In the end, quality is something that does not happen overnight or by sheer luck, but rather through the combined effort of every individual within an organization. Though it is important to deal with such quality issues in a responsible manner, prevention is always the best medicine. If the problem was not prevented, then is this the fault of the individual or the manager? As stated, quality is everyone's responsibility and sometimes the fault does not lie with the person at fault.
References:
Emson, H. (1988). Confidentiality: A Modified Value. Journal of Medical Ethics, 14(2), 87-90.
Sunday, July 24, 2011
Friday, July 15, 2011
75% of the Time I am Ethically Right all the Time
What is about ethics that tend to cause mass confusion, riots, and nuclear annihilation? When you consider that not one person I have asked today can provide me with a direct answer should begin to give you an understanding why this occurs: people fear what they do not understand. As a result of this misunderstanding, ethics can generally be defined as many different things to many different people. Often, ethics are confused with morality leading many highly educated professionals or "Joe six-packs" to make unethical decisions. Sometimes I find myself questioning what is ethics? I also tend to try and convince myself in true "Law and Order" style as to why something is ethical or unethical. This is never a very effective or efficient manner as talking to yourself is consider a faux pas by many of my co-workers. However, throughout these years I have come up with one simple understanding of ethics: ethics is the weak minded, timid brother of morality.
Morality is a robust and easy to understand "feeling". Often, morality tends to give us a clear direction as to where we are headed and how we are going to get there. Unfortunately, morality also tends to step on others' morality in it pursuit of global domination. In many ways morality means well, but like a bull in a china shop tends to destroy and fracture many items around it. Ethics, on the other hand, is the much more timid, scientific (if you will) brother of morality. Both are the offspring of social and cultural rules established through the hilarious trial and error process of our relatives. Both have been examined and re-examined by scholarly geniuses and the not so scholarly. However, ethics tends to take a much more scientific and worldly view of society and its actions as opposed to morality's local and finite understanding of the world around it. The constant quest of ethics isn't necessarily to be right, but rather to be fair.
So what exactly is ethics? For me, ethics is a way of combining the general aspects of morality, social norms, evidence based practices, the law, and common sense. Ethics is also a long term solution to a social dilemma. For many, ethics can be a painful decision to make, but it is usually the wise decision leading to successful longevity for both the individual or organization. However, as society evolves, ethics evolve. This means that professionals and organizations must be willing to invest both time and resources into continually evaluating, examining and, if needed, re-writing their own ethical backgrounds. This agreement is critical if ethics is to continue to evolve and our understanding to increase.
In summary, ethics is something that no one person or organization can define. On an organizational or individual level, ethics tend to vary greatly. However, ethics can be viewed as a combination of morality, social norms, evidence based practices, the law, and good ole' common sense. While we may never truly understand what it means to be ethical, we can agree that it is ever changing and evolving. At minimum, I know that I am 75% right all the time.
Morality is a robust and easy to understand "feeling". Often, morality tends to give us a clear direction as to where we are headed and how we are going to get there. Unfortunately, morality also tends to step on others' morality in it pursuit of global domination. In many ways morality means well, but like a bull in a china shop tends to destroy and fracture many items around it. Ethics, on the other hand, is the much more timid, scientific (if you will) brother of morality. Both are the offspring of social and cultural rules established through the hilarious trial and error process of our relatives. Both have been examined and re-examined by scholarly geniuses and the not so scholarly. However, ethics tends to take a much more scientific and worldly view of society and its actions as opposed to morality's local and finite understanding of the world around it. The constant quest of ethics isn't necessarily to be right, but rather to be fair.
So what exactly is ethics? For me, ethics is a way of combining the general aspects of morality, social norms, evidence based practices, the law, and common sense. Ethics is also a long term solution to a social dilemma. For many, ethics can be a painful decision to make, but it is usually the wise decision leading to successful longevity for both the individual or organization. However, as society evolves, ethics evolve. This means that professionals and organizations must be willing to invest both time and resources into continually evaluating, examining and, if needed, re-writing their own ethical backgrounds. This agreement is critical if ethics is to continue to evolve and our understanding to increase.
In summary, ethics is something that no one person or organization can define. On an organizational or individual level, ethics tend to vary greatly. However, ethics can be viewed as a combination of morality, social norms, evidence based practices, the law, and good ole' common sense. While we may never truly understand what it means to be ethical, we can agree that it is ever changing and evolving. At minimum, I know that I am 75% right all the time.
Saturday, June 25, 2011
The Ultimate Healthcare Employee
What exactly is the best qualities in a healthcare employee? Is tact, compassion, competence, high work ethic, or diligence the most important? In many ways these qualities tend to boil down to three aspects (not in order of importance): 1. Passion for their profession, 2. The ability to use intelligence in an efficient and effective manner, and 3. The ability to work together.
One of the most important qualities for any potential candidate is not only the ability to work well and cooperate, but also have the desire to do so. Cooperation is the benchmark of any well organized, efficient, and effective healthcare organization as many departments tend to overlap and are heavily dependent on one another. This quality has become so important that many hiring managers have begun to examine beyond the professional and academic qualities of an individual to see if they can become part of the "team" (Bowen et al, 1991). The ability to cooperate and act in a professional manner at all times, while seemingly a simple request, can have a significant effect on the overall efficiency, clinical efficacy, and financial stability of the organization. In summary, the faster the work is processed the more inexpensive the product becomes.
While the ability to cooperate can be look upon as the foundation of any "team", it is also important that each member of the team be well informed, well educated, and continually updated on any pertinent information. Generally, this does not mean that the individual has the potential to be intelligent, but rather that they have the continued ability to gain further knowledge and insight into new techniques, tools, etc. in the ever changing healthcare field (Ganzach, 1998). The ability to have new information and in turn apply it in an effective and efficient manner can not only improve the overall quality of the organization, but also have significant impact on improving employee moral.
Finally, a healthcare employee must have a passion for their work. The healthcare industry is similar in many ways to other industries, but is also incredibly different at the same time. The reason behind this is simple: every action each employee takes directly or indirectly affect the livelihood of an individual. It is critical that each employee or potential employee have the desire to work as many hours as possible, work as hard as possible, or learn as much as possible to help improve the lives of others around them. In the end, while organizations must remain financially solvent it is even more critical that they also remain passionately solvent.
References:
Bowen, D., Ledford, G., Nathan, B. (1991). Hiring for the Organization, Not the Job. The Executive, 5(4), pp. 35-51.
Ganzach, Y. (1998). Intelligence and Job Satisfaction. The Academy of Management Journal, 41(5), pp. 526-539.
One of the most important qualities for any potential candidate is not only the ability to work well and cooperate, but also have the desire to do so. Cooperation is the benchmark of any well organized, efficient, and effective healthcare organization as many departments tend to overlap and are heavily dependent on one another. This quality has become so important that many hiring managers have begun to examine beyond the professional and academic qualities of an individual to see if they can become part of the "team" (Bowen et al, 1991). The ability to cooperate and act in a professional manner at all times, while seemingly a simple request, can have a significant effect on the overall efficiency, clinical efficacy, and financial stability of the organization. In summary, the faster the work is processed the more inexpensive the product becomes.
While the ability to cooperate can be look upon as the foundation of any "team", it is also important that each member of the team be well informed, well educated, and continually updated on any pertinent information. Generally, this does not mean that the individual has the potential to be intelligent, but rather that they have the continued ability to gain further knowledge and insight into new techniques, tools, etc. in the ever changing healthcare field (Ganzach, 1998). The ability to have new information and in turn apply it in an effective and efficient manner can not only improve the overall quality of the organization, but also have significant impact on improving employee moral.
Finally, a healthcare employee must have a passion for their work. The healthcare industry is similar in many ways to other industries, but is also incredibly different at the same time. The reason behind this is simple: every action each employee takes directly or indirectly affect the livelihood of an individual. It is critical that each employee or potential employee have the desire to work as many hours as possible, work as hard as possible, or learn as much as possible to help improve the lives of others around them. In the end, while organizations must remain financially solvent it is even more critical that they also remain passionately solvent.
References:
Bowen, D., Ledford, G., Nathan, B. (1991). Hiring for the Organization, Not the Job. The Executive, 5(4), pp. 35-51.
Ganzach, Y. (1998). Intelligence and Job Satisfaction. The Academy of Management Journal, 41(5), pp. 526-539.
Monday, June 20, 2011
"I Perform Surgery Better when I've had a Few!": and Other Phrases You should never Hear from a Surgeon.
I have often find myself wondering what exactly would posses an individual from becoming a physician. The only one that I know by name is my father, there are no physician trading cards, and for the most part each of them are not "rolling in dough". I have often found myself asking friends or peers who are in medical school or planning to attend medical school why they would put themselves through such torture? Not surprisingly many give the same answer: "because it is the ultimate sacrifice I can make to help my fellow man". With such a valiant belief it's not hard to see why so many within our society respect and admire physicians.
While I will be the first in line to congratulate and thank any physician for making this sacrifice the reality is simple: they are still people. This means they are going to make mistakes, act rude, say weird things, or even wear weird clothing. Some physicians are pretty normal, some are eccentric, some are boring, and some are very interesting. However, when they day begins they "put their pants on one leg at a time" like everyone else. This means that while a talented physician may be desired by many different healthcare organizations, they still must be willing or at least able to adhere to the culture of the organization they are joining (Valentine, Godkin, and Lucero, 2002). This means that while they are highly valued, they must be disciplined in the same manner as anyone else.
Recently, I have encountered a case study where a respected doctor fails to keep to his commitment as the on call surgeon and shows up intoxicated to surgery. This, in my opinion, is unacceptable for a variety of reasons. First and foremost, doctors are people and this surgeon could have easily "called in sick" allowing the facility to call another surgeon to replace him. Secondly, the surgeon has gone directly against the Hippocratic Oath by putting himself, others, and the patient due to his drunk driving and possible treatment of the patient while impaired. At the end of the case study the text asks simply: what would you do? The answer is simple: release him immediately. It's one thing to make a mistake, but to act so bold is simply unacceptable. No one individual is greater than the organization and a doctor, by this point, should realize that.
References:
Valentine, S., Godkin, L., and Lucero, M. (2002). Ethical Context, Organizational Commitment, and Person-Organization Fit. Journal of Business Ethics, 41(4), pp. 349-360.
While I will be the first in line to congratulate and thank any physician for making this sacrifice the reality is simple: they are still people. This means they are going to make mistakes, act rude, say weird things, or even wear weird clothing. Some physicians are pretty normal, some are eccentric, some are boring, and some are very interesting. However, when they day begins they "put their pants on one leg at a time" like everyone else. This means that while a talented physician may be desired by many different healthcare organizations, they still must be willing or at least able to adhere to the culture of the organization they are joining (Valentine, Godkin, and Lucero, 2002). This means that while they are highly valued, they must be disciplined in the same manner as anyone else.
Recently, I have encountered a case study where a respected doctor fails to keep to his commitment as the on call surgeon and shows up intoxicated to surgery. This, in my opinion, is unacceptable for a variety of reasons. First and foremost, doctors are people and this surgeon could have easily "called in sick" allowing the facility to call another surgeon to replace him. Secondly, the surgeon has gone directly against the Hippocratic Oath by putting himself, others, and the patient due to his drunk driving and possible treatment of the patient while impaired. At the end of the case study the text asks simply: what would you do? The answer is simple: release him immediately. It's one thing to make a mistake, but to act so bold is simply unacceptable. No one individual is greater than the organization and a doctor, by this point, should realize that.
References:
Valentine, S., Godkin, L., and Lucero, M. (2002). Ethical Context, Organizational Commitment, and Person-Organization Fit. Journal of Business Ethics, 41(4), pp. 349-360.
Wednesday, June 15, 2011
The Unsteady Hand of the Stark Act
From its inception in 1989 Stark (the Act), officially known as the Federal Physician Self-referral Law, has allowed an "ethical background" from which healthcare organization can build and maintain their own ethical regulations and protocols. In many ways, the Act has improved the quality of care available much in the way that antitrust laws have improved quality in the private business sector through the creation of competition. However, the Act is not without its own faults. For example, the Act basically covers Medicare issues in reference to financial relationships between physicians - their immediate family members - and the facilities which they refer Medicare patients (Gosfield, 2009).
This seems simple enough to understand, but many consider the Act to be outdated, very difficult to interpret, and follow (Sutton, 2011). Though the Act is written in very narrow and defined terms, difficulty is created due to its constant evolution and change. For this reason, many organizations have continued to create and apply their own version of the Act within their own organization. This has resulted in a general across the board "bench line" for each of employee of not accepting any freebies or kickbacks whatsoever from any vendor while under the employment of said employer. Sometimes even writing about the Act can be a bit of a mind twister!
This confusion has also led many to believe that the Act is also detrimental in many ways to the business of healthcare. As previously cited, the fear of violating the Act and as a result losing funding through Medicare and other government sources has created a tremendous fear amongst facilities. This, in turn, has created a very regimented business atmosphere that has significantly hurts a healthcare facility's ability to grow (Taylor, 1999).
Though the healthcare industry is not a business in the same sense as companies like Apple or Nike, it is still critical to remain as financially stable as possible. The Act like many other government regulations imposed on the healthcare industry has created a virtual mine field that organizations and administrators must navigate on a constant basis. Ethically, the Act has created a culture that strives to continually evolve ethically, but it should not stand in the way of creation, evolution, and ingenuity. If so, the healthcare industry at best will not perform to its abilities or at worst continually regress.
References:
Gosfield, A. (2009). Stark Law Covers a Narrow Corridor of Actions (Malpractice Consult). Medical Economics, 86(17), 38.
Sutton, P. (2011). The Stark Law in Retrospect. Annals of Health Law/Loyola University Chicago, School of Law, Institute for Health Law, 20(1), 15.
Taylor, M. (1999). Healthcare Struggles with Stark Reality. Modern Healthcare, 29(27), 30.
This seems simple enough to understand, but many consider the Act to be outdated, very difficult to interpret, and follow (Sutton, 2011). Though the Act is written in very narrow and defined terms, difficulty is created due to its constant evolution and change. For this reason, many organizations have continued to create and apply their own version of the Act within their own organization. This has resulted in a general across the board "bench line" for each of employee of not accepting any freebies or kickbacks whatsoever from any vendor while under the employment of said employer. Sometimes even writing about the Act can be a bit of a mind twister!
This confusion has also led many to believe that the Act is also detrimental in many ways to the business of healthcare. As previously cited, the fear of violating the Act and as a result losing funding through Medicare and other government sources has created a tremendous fear amongst facilities. This, in turn, has created a very regimented business atmosphere that has significantly hurts a healthcare facility's ability to grow (Taylor, 1999).
Though the healthcare industry is not a business in the same sense as companies like Apple or Nike, it is still critical to remain as financially stable as possible. The Act like many other government regulations imposed on the healthcare industry has created a virtual mine field that organizations and administrators must navigate on a constant basis. Ethically, the Act has created a culture that strives to continually evolve ethically, but it should not stand in the way of creation, evolution, and ingenuity. If so, the healthcare industry at best will not perform to its abilities or at worst continually regress.
References:
Gosfield, A. (2009). Stark Law Covers a Narrow Corridor of Actions (Malpractice Consult). Medical Economics, 86(17), 38.
Sutton, P. (2011). The Stark Law in Retrospect. Annals of Health Law/Loyola University Chicago, School of Law, Institute for Health Law, 20(1), 15.
Taylor, M. (1999). Healthcare Struggles with Stark Reality. Modern Healthcare, 29(27), 30.
Monday, June 6, 2011
Ethical Tools for All
What exactly is the Healthcare Industry? Who works in the healthcare industry? Does it only constitute doctors, nurses, allied healthcare staff, hospitals, clinics, and the first aid station? For many, the healthcare industry is composed of the staff and facilities that provide direct patient care. However, those who support the healthcare industry have begun to be included, in the author's opinion, in this most important of all social clubs. For example, the individual billing clerk may not provide direct patient care, but their ability to properly (and ethically) code and bill insurance companies can have massive influence when compounded. Multiply their actions by as many billing clerks currently employed today, it is easy to see how billions of dollars and as an effect the quality of healthcare delivery can be seriously augmented by support staff.
While significant cost concerns support staff can create or alleviate is of vital importance to any healthcare facility, what can be said about the human cost? To an extent, support staff can create an environment conducive to increasing the quality of healthcare delivery while maintaining costs. Though nurses are very much considered an integral part of the "staff" of any hospital or related facility, they were considered for many years "support staff" to the all-mighty physician. As a result, more and more studies where conducted to see what affect, if any, nurses had on the health of the patient and finances. The result was not only the elevation of nurses to the level of physicians, but also the need for specialized nurses (Czaplinski, 1998).
With the obvious need for highly trained support staff continues to increase, have we done enough to also give these individuals the tools to act as professionals? Though the level of education is not indicative of one's level of professionalism, it is easy to assume that similar individuals may simply not understand or posses the knowledge to understand the intricacies of what makes a healthcare professional. More specifically, the need to understand and follow the highest ethical standards. Though high ethical standards within traditional healthcare facilities (like hospitals) have become the norm for all staff, many "support staff" operating in non-traditional facilities do not received the same amount (if any) of ethical training required of healthcare professionals. Though we expect support staff to function at the level of any healthcare professional, why do we not provide them with the same tools and expectations?
References:
Czaplinski, C. , et al. (1998). The Effect of Staff Nursing on Length of Stay and Mortality. Medical Care. V36:12. pp. 1626-1638.
While significant cost concerns support staff can create or alleviate is of vital importance to any healthcare facility, what can be said about the human cost? To an extent, support staff can create an environment conducive to increasing the quality of healthcare delivery while maintaining costs. Though nurses are very much considered an integral part of the "staff" of any hospital or related facility, they were considered for many years "support staff" to the all-mighty physician. As a result, more and more studies where conducted to see what affect, if any, nurses had on the health of the patient and finances. The result was not only the elevation of nurses to the level of physicians, but also the need for specialized nurses (Czaplinski, 1998).
With the obvious need for highly trained support staff continues to increase, have we done enough to also give these individuals the tools to act as professionals? Though the level of education is not indicative of one's level of professionalism, it is easy to assume that similar individuals may simply not understand or posses the knowledge to understand the intricacies of what makes a healthcare professional. More specifically, the need to understand and follow the highest ethical standards. Though high ethical standards within traditional healthcare facilities (like hospitals) have become the norm for all staff, many "support staff" operating in non-traditional facilities do not received the same amount (if any) of ethical training required of healthcare professionals. Though we expect support staff to function at the level of any healthcare professional, why do we not provide them with the same tools and expectations?
References:
Czaplinski, C. , et al. (1998). The Effect of Staff Nursing on Length of Stay and Mortality. Medical Care. V36:12. pp. 1626-1638.
Sunday, May 29, 2011
Doing what is right at the RIGHT time
As a future healthcare executive I often think about what is most important when running a healthcare organization. Obviously, it would be to my benefit to provide the highest quality services and access while maintaining a spotless reputation within my respective community. Many believe that maintaining a spotless reputation naturally entails making absolutely no medical errors. This is simply not the case. I have to vehemently disagree with this notion for a variety of reasons. No matter how high the caliber of your staff or how clean or up to date your facilities and equipment are there will always be medical errors. Healthcare executives must acknowledge that they and their staff are imperfect in nature. We should not and cannot expect anyone not to make mistakes. However, we also cannot allow for the trust we have created with our respective communities to be diminished.
Trust between a healthcare organization and the community is paramount. In many ways it is the "Alamo" of all requirements that constitute a quality healthcare organization. In other words, we as healthcare executives must guard this trust with all the power and tools that we have at our disposal. This requires that healthcare executives and healthcare organizations remain as transparent as possible in reference to its shareholders and the community in general. As painful as it may be, this also means that sharing information such as medical errors must be as thorough and as open as possible. For us to maintain our trust we must understand that "human relationships depend on communication of information; without an honest sharing of information there can be no trust. (Perry, 2002)"
Though healthcare executives are willing to share information of medical error with the community (they have to by law), I often wonder if they share this information quickly or thoroughly enough with those in the community. I recently ran across an article that details how a staff member at Emory University Hospital exposed almost 800 individual staff and patients to the potentially life threatening bacterial infection tuberculosis, known as TB (Moisse, 2011). The article briefly details how the community and those affected were made aware and then went on to describe TB. This information is important, but when did these infections occur? Did the executives in charge not only do the right thing, but did they do it at the right time? Generally, TB is very rare and can be completely eradicated if treated early enough. However, how are we to know if the people exposed were treated in an efficient and effective manner so as to avoid any permanent damage?
The healthcare industry continues to make significant strides in preventing medical error. This strides directly affect how organizations ethically treat situations when medical errors to arise. Though we have done a good job of preventing errors and following ethical guidelines we still need to create a culture that accepts the fact that medical errors will continue. We should embrace these situations as an opportunity to display that while we will make mistakes, our communities can always have trust that we will always do the right thing at the right time.
References:
1. F. Perry. (2002). Medical Errors: Paradise Hills Medical Center. The Tracks We Leave: Ethics in Healthcare Management. p. 1-15.
2. K. Moisse. (May 27, 2011). Atlanta Hospital Employee Exposed Hundreds to Tuberculosis. Retrieved May 29, 2011 from: abcnews.go.com/Health/Wellness/atlanta-hospital-notifies-700-patients-tuberculosis-exposure/story?id=13702727
Trust between a healthcare organization and the community is paramount. In many ways it is the "Alamo" of all requirements that constitute a quality healthcare organization. In other words, we as healthcare executives must guard this trust with all the power and tools that we have at our disposal. This requires that healthcare executives and healthcare organizations remain as transparent as possible in reference to its shareholders and the community in general. As painful as it may be, this also means that sharing information such as medical errors must be as thorough and as open as possible. For us to maintain our trust we must understand that "human relationships depend on communication of information; without an honest sharing of information there can be no trust. (Perry, 2002)"
Though healthcare executives are willing to share information of medical error with the community (they have to by law), I often wonder if they share this information quickly or thoroughly enough with those in the community. I recently ran across an article that details how a staff member at Emory University Hospital exposed almost 800 individual staff and patients to the potentially life threatening bacterial infection tuberculosis, known as TB (Moisse, 2011). The article briefly details how the community and those affected were made aware and then went on to describe TB. This information is important, but when did these infections occur? Did the executives in charge not only do the right thing, but did they do it at the right time? Generally, TB is very rare and can be completely eradicated if treated early enough. However, how are we to know if the people exposed were treated in an efficient and effective manner so as to avoid any permanent damage?
The healthcare industry continues to make significant strides in preventing medical error. This strides directly affect how organizations ethically treat situations when medical errors to arise. Though we have done a good job of preventing errors and following ethical guidelines we still need to create a culture that accepts the fact that medical errors will continue. We should embrace these situations as an opportunity to display that while we will make mistakes, our communities can always have trust that we will always do the right thing at the right time.
References:
1. F. Perry. (2002). Medical Errors: Paradise Hills Medical Center. The Tracks We Leave: Ethics in Healthcare Management. p. 1-15.
2. K. Moisse. (May 27, 2011). Atlanta Hospital Employee Exposed Hundreds to Tuberculosis. Retrieved May 29, 2011 from: abcnews.go.com/Health/Wellness/atlanta-hospital-notifies-700-patients-tuberculosis-exposure/story?id=13702727
Monday, May 23, 2011
Healthcare on Your Iphone
The marriage of technology and health care has been one of wedded bliss for some time now. It is hard to imagine a more perfect union that exists at any point throughout the ages. Often, the results are significant and important milestones in the continuous drive to improve the quality of life for all individuals. However, sometimes this marriage can create moral and ethical gray areas, even if the original intentions where noble .
As society continues to its technology march, I often stop to think of the advances we have made throughout my life. I can still remember the day when my 8th grade teacher explained how one day we will have computers small enough to carry in our hands and more powerful than the one we were currently using. This was less then 15 years ago and the arrival of the iPhone (along with other similar smart phones) continues to amaze me to this day. As a result, many technologies continue to be designed among the lines of smaller, cheaper, and more mobile. It isn't much of a surprise that the technology used in health care today follows those same guidelines. One example is the Vscan portable ultrasound device. This small device that resembles a mobile phone both in size and shape has the capability of recording and viewing the same images captured on traditional ultrasound machines with the added mobility of file sharing and email.
It's incredible to imagine the ability such a device has. For example, this breakthrough in technology allows physicians to visit patients in any setting without having to visit the doctors office. Such technology will allow physicians to visit patients in rural areas that do not have access to such technology. It's no wonder that such innovation not only improves the quality of life, but also greatly reduces the cost as the Vscan only costs roughly $8,000. These positives are very significant and important as we continue to struggle with providing quality health care to all individuals no matter their location or income level. However, what happens to all this information once it is gathered?
Though technology such as this has the ability to provide a quality service at low cost, do the companies that create such technologies invest time and effort into creating some kind of protocol to protect such sensitive information? What happens if the Vscan is lost or stolen? Is it possible that an individual could obtain sensitive information simply by just turning on the device? As an individual I fully embrace and welcome any form of technology that can improve the quality and access of health care, but as a future health care administrator I have to be cautious as to what information and who may use sensitive information against my clients. In the end we all have to acknowledge that even the best marriages have their problems.
References:
Simon, S. (2011, March 28). Medicine on the Move: Mobile Devices Help Improve Treatment. The Wall Street Journal. Retrieved from: online.wsj.com/article/SB10001424052748703559604576174842490398186.html
As society continues to its technology march, I often stop to think of the advances we have made throughout my life. I can still remember the day when my 8th grade teacher explained how one day we will have computers small enough to carry in our hands and more powerful than the one we were currently using. This was less then 15 years ago and the arrival of the iPhone (along with other similar smart phones) continues to amaze me to this day. As a result, many technologies continue to be designed among the lines of smaller, cheaper, and more mobile. It isn't much of a surprise that the technology used in health care today follows those same guidelines. One example is the Vscan portable ultrasound device. This small device that resembles a mobile phone both in size and shape has the capability of recording and viewing the same images captured on traditional ultrasound machines with the added mobility of file sharing and email.
It's incredible to imagine the ability such a device has. For example, this breakthrough in technology allows physicians to visit patients in any setting without having to visit the doctors office. Such technology will allow physicians to visit patients in rural areas that do not have access to such technology. It's no wonder that such innovation not only improves the quality of life, but also greatly reduces the cost as the Vscan only costs roughly $8,000. These positives are very significant and important as we continue to struggle with providing quality health care to all individuals no matter their location or income level. However, what happens to all this information once it is gathered?
Though technology such as this has the ability to provide a quality service at low cost, do the companies that create such technologies invest time and effort into creating some kind of protocol to protect such sensitive information? What happens if the Vscan is lost or stolen? Is it possible that an individual could obtain sensitive information simply by just turning on the device? As an individual I fully embrace and welcome any form of technology that can improve the quality and access of health care, but as a future health care administrator I have to be cautious as to what information and who may use sensitive information against my clients. In the end we all have to acknowledge that even the best marriages have their problems.
References:
Simon, S. (2011, March 28). Medicine on the Move: Mobile Devices Help Improve Treatment. The Wall Street Journal. Retrieved from: online.wsj.com/article/SB10001424052748703559604576174842490398186.html
Monday, November 29, 2010
Work Harder....please.
One of the most important goals for any manager is the ability to run their organization as efficiently and as effectively as possible. This means that all aspects of the organization need to operate in a manner that allows for the best outcomes to occur the first time, every time. For this to occur, it is critical for the manager to have a devoted, effective, and efficient workforce consisting of individuals who are properly trained and (most importantly) are happy with their job.
So, if we assume that efficiency and effectiveness is a byproduct of happiness, how can a manager at minimum ensure the happiness of their workforce? Often, compensation is considered amongst the most important aspects of worker happiness. However, it has been noted that compensation is not the most important determinant of worker happiness (Williams et al, 2007), it is actually one of many different units that determine worker happiness. Instead, to ensure the happiness of their workforce, manager should focus on a total benefits package (Balkin et al, 1993) that focuses on increasing the quality of life of the worker.
This understanding between the difference in compensation and quality of life is very difficult and almost impossible to compare. How do we measure a quantitative value (compensation) vs. a qualitative value (ie: quality of life) in the first place? Many human resources departments have taken it upon themselves to lean in one direction or another, often putting on emphasis on compensation or an emphasis on benefits. In many ways this is a positive for some workers, but is a negative for others. The reality is that benefits should not be viewed as a one size fits all. Rather, they should have the ability to change and be flexible enough to fit the needs and expectations of each individual worker. This is especially true at a time when private industry values flexibility, efficiency, and effectiveness above all aspects; why can't a benefits plan also mirror this belief?
Many benefits plan continue to offer outstanding pay scales, paid vacation, even wellness benefits all aimed at keeping the workforce content, thus leading to less turnover and greater worker efficiency/effectiveness. Though it is commendable that so many companies continue to strive to offer prospective employees a competitive benefits package that is both marketable and equitable, many still do not understand that "throwing money" at the problem will not cause it to go away. Instead, part of the recruitment process should be to gain further understanding of the individual to see what benefits actually are needed to fit their own life. This may help the organization to save money and provide evidence that it is willing and capable of adjusting to fit the needs of the individual. Such savings can even be passed on to the individual worker in the form of increased compensation (if provided they desire this) or even an increase in other benefits.
For an organization to survive and thrive will require further flexibility and adaption on the part of their benefits package. This ability to provide a better benefits package designed for the individual worker provides evidence that the organization is doing everything within its power to support the individual with their won goals and aspirations. This in turn can lead to greater worker happiness and result in a more efficient/effective workforce.
References:
1.)M.L. Williams, et al. 2007. Understanding Multiple Dimensions of Compensation Satisfaction. The Journal of Business and Psychology. V21:3, pp.429-459.
2.)D. B. Balkin, et al. 1993. The Determinants of Employee Benefits Satisfaction. The Journal of Business and Psychology. V7:3, pp. 323-339.
So, if we assume that efficiency and effectiveness is a byproduct of happiness, how can a manager at minimum ensure the happiness of their workforce? Often, compensation is considered amongst the most important aspects of worker happiness. However, it has been noted that compensation is not the most important determinant of worker happiness (Williams et al, 2007), it is actually one of many different units that determine worker happiness. Instead, to ensure the happiness of their workforce, manager should focus on a total benefits package (Balkin et al, 1993) that focuses on increasing the quality of life of the worker.
This understanding between the difference in compensation and quality of life is very difficult and almost impossible to compare. How do we measure a quantitative value (compensation) vs. a qualitative value (ie: quality of life) in the first place? Many human resources departments have taken it upon themselves to lean in one direction or another, often putting on emphasis on compensation or an emphasis on benefits. In many ways this is a positive for some workers, but is a negative for others. The reality is that benefits should not be viewed as a one size fits all. Rather, they should have the ability to change and be flexible enough to fit the needs and expectations of each individual worker. This is especially true at a time when private industry values flexibility, efficiency, and effectiveness above all aspects; why can't a benefits plan also mirror this belief?
Many benefits plan continue to offer outstanding pay scales, paid vacation, even wellness benefits all aimed at keeping the workforce content, thus leading to less turnover and greater worker efficiency/effectiveness. Though it is commendable that so many companies continue to strive to offer prospective employees a competitive benefits package that is both marketable and equitable, many still do not understand that "throwing money" at the problem will not cause it to go away. Instead, part of the recruitment process should be to gain further understanding of the individual to see what benefits actually are needed to fit their own life. This may help the organization to save money and provide evidence that it is willing and capable of adjusting to fit the needs of the individual. Such savings can even be passed on to the individual worker in the form of increased compensation (if provided they desire this) or even an increase in other benefits.
For an organization to survive and thrive will require further flexibility and adaption on the part of their benefits package. This ability to provide a better benefits package designed for the individual worker provides evidence that the organization is doing everything within its power to support the individual with their won goals and aspirations. This in turn can lead to greater worker happiness and result in a more efficient/effective workforce.
References:
1.)M.L. Williams, et al. 2007. Understanding Multiple Dimensions of Compensation Satisfaction. The Journal of Business and Psychology. V21:3, pp.429-459.
2.)D. B. Balkin, et al. 1993. The Determinants of Employee Benefits Satisfaction. The Journal of Business and Psychology. V7:3, pp. 323-339.
Wednesday, October 20, 2010
Can I Work for Free?
Now more then ever and internship has become one of the, if not the most important step any undergraduate or graduate student can take. Though many graduate students naturally work hard and do well in school, an internship can provide you with real world experience, networking opportunities, and exposure to important individuals. However, it also seems that now more then ever it is nearly impossible to work for free. This seems like a difficult issue to understand, but when you examine it more closely it (unfortunately) makes a great deal of sense.
The first hurdle an intern has to overcome is the stereotype of being unreliable and immature. Considering that many internships pay very little (or not at all) it would not be unusual for an intern to simply quit without giving any sort of prior notice. This is especially true if this same intern is lucky enough to be hired at another position within a full time capacity. To put it mildly, they would be fools not to leave this position as quickly as possible. However, how did this intern have the ability to be hired in the first place? Simple, they gained experience from their internship. This logic will eventually lead any Human Resource personnel to believe that in an intern-employer relationship the intern has everything to gain and the employer everything to lose.
The second hurdle an intern has to overcome is the reluctance of many employers to hire interns without pay in the first place. This practice is technically illegal because under federal law an employer cannot compensate an individual who is producing anything for them. In some circles this is considered almost a form of professional slavery. This means that, for example, a railroad intern can drive the engine all over as long as it's not pulling anything. This means that an intern cannot help pitch a new idea to a potential client or look for ways to save money within the budget. In many ways this law simply creates a more competitive atmosphere for interns. Now that they are paid employees (albeit not well paid) of an organization, it is considered that interns will produce for a company rather then learn from it. This in some ways is beneficial to both the intern and the employer, but can also be a very negative experience for the intern and employer. This is particularly troublesome considering that an intern is supposed to "learn" not "do" while they intern. To make this problem even worse, many employers have completely frozen or terminated any internships program to save money and avoid prosecution.
It seem ridiculous that a company would not want to hire (even at minimum wage) an individual who is obviously well qualified and willing to work hard for some exposure. Particularly in this current economic environment its hard to imagine why so many employers are not looking for new ideas to propel their organizations into the future. However, even with all these hurdles internships are still available and some can have very beneficial outcomes for both the intern and the employer. For example, many schools offer internships through their own relationships with business and community partnerships. More and more employers have begun to provide interns with "intern contracts" that morally and ethically "bind" the intern from any behavior that may be disruptive to the organization. Though such documents are not legal, it is highly frowned upon by professionals to go against your own word. There are also small businesses and start ups that are willing to gamble on the inexperience of a student for the possibility of finding the newest, freshest ideas within their respective industry. Though it may not be impossible to find an internship, it is incredibly hard to work for free.
The first hurdle an intern has to overcome is the stereotype of being unreliable and immature. Considering that many internships pay very little (or not at all) it would not be unusual for an intern to simply quit without giving any sort of prior notice. This is especially true if this same intern is lucky enough to be hired at another position within a full time capacity. To put it mildly, they would be fools not to leave this position as quickly as possible. However, how did this intern have the ability to be hired in the first place? Simple, they gained experience from their internship. This logic will eventually lead any Human Resource personnel to believe that in an intern-employer relationship the intern has everything to gain and the employer everything to lose.
The second hurdle an intern has to overcome is the reluctance of many employers to hire interns without pay in the first place. This practice is technically illegal because under federal law an employer cannot compensate an individual who is producing anything for them. In some circles this is considered almost a form of professional slavery. This means that, for example, a railroad intern can drive the engine all over as long as it's not pulling anything. This means that an intern cannot help pitch a new idea to a potential client or look for ways to save money within the budget. In many ways this law simply creates a more competitive atmosphere for interns. Now that they are paid employees (albeit not well paid) of an organization, it is considered that interns will produce for a company rather then learn from it. This in some ways is beneficial to both the intern and the employer, but can also be a very negative experience for the intern and employer. This is particularly troublesome considering that an intern is supposed to "learn" not "do" while they intern. To make this problem even worse, many employers have completely frozen or terminated any internships program to save money and avoid prosecution.
It seem ridiculous that a company would not want to hire (even at minimum wage) an individual who is obviously well qualified and willing to work hard for some exposure. Particularly in this current economic environment its hard to imagine why so many employers are not looking for new ideas to propel their organizations into the future. However, even with all these hurdles internships are still available and some can have very beneficial outcomes for both the intern and the employer. For example, many schools offer internships through their own relationships with business and community partnerships. More and more employers have begun to provide interns with "intern contracts" that morally and ethically "bind" the intern from any behavior that may be disruptive to the organization. Though such documents are not legal, it is highly frowned upon by professionals to go against your own word. There are also small businesses and start ups that are willing to gamble on the inexperience of a student for the possibility of finding the newest, freshest ideas within their respective industry. Though it may not be impossible to find an internship, it is incredibly hard to work for free.
Sunday, September 26, 2010
Outsourcing Patient Care
As the recession continues to drive businesses to adapt and innovate, many organizations have found it much more cost effective to outsource what were once considered "in-house only" services. These sentiments are also being felt throughout the healthcare industry as new healthcare reform laws begin to take affect. However, while the current recession plays a significant role in the outsourcing of individual positions within the healthcare industry the main reason for this rise in outsourcing is not financial, rather it has to do with the availability of qualified professionals to fill these roles. Even more interesting is that the majority of these outsourced jobs pay as much (even more) then a typical U.S. based position. These factors combined with the ability of foreign professionals to be trained, educated, and licensed in the U.S., it isn't a mystery why so many positions are being filled by others outside of the U.S.
Take for example an Altoona, PA hospital. Only a few years ago, the number of nigh time cases in need of interpretation by a radiologist got so bad, the seven on staff members had to consistently work 60+ hours per week just to cover all the work. All this changed when the hospital began to outsource their work to a small Bangalore, India firm called Teleradiology Solutions. This firm is operated and owned by Dr. Arjun Kalyanpur, who happens to be educated at Yale University and licensed in the U.S.
It's extremely perplexing to find an industry that is not outsourcing due mainly for financial reasons, but rather mainly due to a severe shortage of professionals within its own borders. How did this "telemedicine" trend begin? Many researchers point to the sharply rising demand for IT professionals to tackle the Y2K "bug" of the late 1990's. This demand led to many foreign students (particularly from India) to migrate to the U.S. for education and training. This trend became such the norm, that US officials often joked that "President Bush had sacked the elected members of Congress and was replacing them with staff hired in Bangalore" (Chithelen, 2004).
So what is an HR department to do? On one hand you have very qualified, American trained/educated/licensed and English speaking professionals ready and capable of working when everyone else is sleeping. On the other hand, you still need to pay them just as much (considering the need, possibly even more), you need to educate yourself with foreign laws, and deal with the possibility of high turnover (over 50% in service sector jobs outsourced to India). These problems coupled with recession, and the incredible need from Americans to find skilled, well paying positions it can only give you a glimpse of the massive problem this recession has created.
While the rest of the world was willing to work hard, sacrifice, and become better trained, American workers simply lacked the understanding to make more savvy career moves and HR administrators could not for see the future needs of the industry. However, even with this problem the reality is that the need is still needed. This need creates the oppurtunity for the American worker to receive the same kind of training and (considering their relative vicinity)more then likely receive preferential treatment when filling these positions. Even in the midst of the "Great Recession" there is still oppurtunity and hope left; all that HR administrators can do is hope that others see this as well.
References:
1.) Outsourcing to India: Causes, Reactions, and Prospects. Chithelen, Ignatius. Economic and Political Weekly. 39:10 (2004), pp. 1022-1024.
Source:
Some U.S. Hospitals Outsourcing Work: Shortage of Radiologists spur Growing Telemedicine Trend. msnbc.msn.com/id/6621014
Take for example an Altoona, PA hospital. Only a few years ago, the number of nigh time cases in need of interpretation by a radiologist got so bad, the seven on staff members had to consistently work 60+ hours per week just to cover all the work. All this changed when the hospital began to outsource their work to a small Bangalore, India firm called Teleradiology Solutions. This firm is operated and owned by Dr. Arjun Kalyanpur, who happens to be educated at Yale University and licensed in the U.S.
It's extremely perplexing to find an industry that is not outsourcing due mainly for financial reasons, but rather mainly due to a severe shortage of professionals within its own borders. How did this "telemedicine" trend begin? Many researchers point to the sharply rising demand for IT professionals to tackle the Y2K "bug" of the late 1990's. This demand led to many foreign students (particularly from India) to migrate to the U.S. for education and training. This trend became such the norm, that US officials often joked that "President Bush had sacked the elected members of Congress and was replacing them with staff hired in Bangalore" (Chithelen, 2004).
So what is an HR department to do? On one hand you have very qualified, American trained/educated/licensed and English speaking professionals ready and capable of working when everyone else is sleeping. On the other hand, you still need to pay them just as much (considering the need, possibly even more), you need to educate yourself with foreign laws, and deal with the possibility of high turnover (over 50% in service sector jobs outsourced to India). These problems coupled with recession, and the incredible need from Americans to find skilled, well paying positions it can only give you a glimpse of the massive problem this recession has created.
While the rest of the world was willing to work hard, sacrifice, and become better trained, American workers simply lacked the understanding to make more savvy career moves and HR administrators could not for see the future needs of the industry. However, even with this problem the reality is that the need is still needed. This need creates the oppurtunity for the American worker to receive the same kind of training and (considering their relative vicinity)more then likely receive preferential treatment when filling these positions. Even in the midst of the "Great Recession" there is still oppurtunity and hope left; all that HR administrators can do is hope that others see this as well.
References:
1.) Outsourcing to India: Causes, Reactions, and Prospects. Chithelen, Ignatius. Economic and Political Weekly. 39:10 (2004), pp. 1022-1024.
Source:
Some U.S. Hospitals Outsourcing Work: Shortage of Radiologists spur Growing Telemedicine Trend. msnbc.msn.com/id/6621014
Monday, August 30, 2010
What does Human Resources mean to you and what is their role in healthcare organizations?
For many individuals, the word "Human Resources" (HR) can bring up a caveat of emotions. Often a call from HR means bad news for the individual, often leading to a demotion or an outright "letting go" of the individual. However, HR should not be viewed as some kind of grim reaper in khaki pants. Instead, the role of HR in healthcare should be viewed as a department that helps to mold and build the most successful, efficient, and stable/comfortable work environment for the most qualified individuals available. If HR does their job well there should be no reason to "fire" or let go of any individual, set aside economic conditions.
Assuming the the job of HR within a healthcare organization is to accomplish the statements above, what is needed for HR to be successful in this endeavor? First and foremost, HR must understand what motivates and drives individuals to work their best. Are they influenced by compensation, work environment, incentive packages, or some sort of combination? Though it is critical for HR to maintain their traditional activities (payroll, benefits, etc.) they must also focus on the "environmental and organizational aspects that impinge on human resource activities" (Fottler, 2008). This means that HR must also focus on strategic human resources management (SHRM) to fill in the "doughnut hole" left by classic human resource management (HRM) activities. More specifically, they should focus on:
1. recruitment/selection
2. training/development
3. employee relations
It is important to note that while compensation is important, it is generally not the most important factor when an individual chooses to become part of an organization. Many researchers even consider the environment as a supplement to compensaiton in general. This understanding is based on research that determines "employees who feel and display positive emotion on the job, will experience positive outcomes in their work role" (Morgeson et al, 2001). This means if HR focuses on:
1. recruiting and hiring the "right" people,
2. continually training and developing these individuals, and
3. continually keeping communication clear and concise between employees and management..
compensation should be a very minimal aspect of their roles. In fact, a focus on compensation can actually be used in a negative way. For example, it can become a tool used by management to demand or assume employee loyality to an organization. Instead, this tool can often lead inviduals to feel "like a number" rather then an individual and create a high turnover rate., decreasing overall quality in many ways. Though high compensation can initially draw the best talent to an organization, this focus often results in high employee turnover before their impact (and the investment made by the organization) can come to fruitition. This often leads to a host of problems that decrease overall quality such as lost revenue and a decrease of employee morale.
However, by maintaining a focus on environment, it is my opinion that HR can continually maintain an organization that fosters stability, personal development, a feeling of control of destiny, and (most importantly) delivers quality healthcare within all operations. Though the classic day-to-day operations of HR should also be maintained, HR should be willing and able to give employees the tools to succeed and the ability to truly control their own destiny within the organization. For these reasons, HR's overall role within a healthcare organization is the "front-line" of the organization's Continuous Quality Management (CQM) model.
Sources:
1. Strategic Human Resource Management. Fotter PhD, Myron D. Human Resources in Healthcare: Managing for Success. Chapter 1, (2008) pp. 1-27
2. Understanding Pay Satisfaction: The Limits of a Compensation System Implementation. Morgeson, Frederick P., Campion, Michael A., Maertz, Carl P. Journal of Business and Psychology. Vol. 16, No. 1 (Sep., 2001), pp. 133-149
Assuming the the job of HR within a healthcare organization is to accomplish the statements above, what is needed for HR to be successful in this endeavor? First and foremost, HR must understand what motivates and drives individuals to work their best. Are they influenced by compensation, work environment, incentive packages, or some sort of combination? Though it is critical for HR to maintain their traditional activities (payroll, benefits, etc.) they must also focus on the "environmental and organizational aspects that impinge on human resource activities" (Fottler, 2008). This means that HR must also focus on strategic human resources management (SHRM) to fill in the "doughnut hole" left by classic human resource management (HRM) activities. More specifically, they should focus on:
1. recruitment/selection
2. training/development
3. employee relations
It is important to note that while compensation is important, it is generally not the most important factor when an individual chooses to become part of an organization. Many researchers even consider the environment as a supplement to compensaiton in general. This understanding is based on research that determines "employees who feel and display positive emotion on the job, will experience positive outcomes in their work role" (Morgeson et al, 2001). This means if HR focuses on:
1. recruiting and hiring the "right" people,
2. continually training and developing these individuals, and
3. continually keeping communication clear and concise between employees and management..
compensation should be a very minimal aspect of their roles. In fact, a focus on compensation can actually be used in a negative way. For example, it can become a tool used by management to demand or assume employee loyality to an organization. Instead, this tool can often lead inviduals to feel "like a number" rather then an individual and create a high turnover rate., decreasing overall quality in many ways. Though high compensation can initially draw the best talent to an organization, this focus often results in high employee turnover before their impact (and the investment made by the organization) can come to fruitition. This often leads to a host of problems that decrease overall quality such as lost revenue and a decrease of employee morale.
However, by maintaining a focus on environment, it is my opinion that HR can continually maintain an organization that fosters stability, personal development, a feeling of control of destiny, and (most importantly) delivers quality healthcare within all operations. Though the classic day-to-day operations of HR should also be maintained, HR should be willing and able to give employees the tools to succeed and the ability to truly control their own destiny within the organization. For these reasons, HR's overall role within a healthcare organization is the "front-line" of the organization's Continuous Quality Management (CQM) model.
Sources:
1. Strategic Human Resource Management. Fotter PhD, Myron D. Human Resources in Healthcare: Managing for Success. Chapter 1, (2008) pp. 1-27
2. Understanding Pay Satisfaction: The Limits of a Compensation System Implementation. Morgeson, Frederick P., Campion, Michael A., Maertz, Carl P. Journal of Business and Psychology. Vol. 16, No. 1 (Sep., 2001), pp. 133-149
Monday, July 19, 2010
Doctor....what are you REALLY thinking?
Throughout the process of becoming a better healthcare manager and a supporter of better quality, I have come across again and again the need for implementation of Evidence Based Practices or EBP. Basically, EBP is "the integration of best evidence with clinical expertise, path physiologic knowledge, and patient references in decision making about individual patients" (Schumacher et al, 2003). To put it simple, EBP uses the latest technology integrated with the best available professional expertise while maintaining the patient's wishes. In a way it sounds like healthcare quality juggling. EBP is only a small part of what is called a Continuous Quality Improvement (CQI) which is the mainstay of any quality improvement of maintenance program within a healthcare organization or facility. This is essentially the understanding the quality is continually improving and adapting and as healthcare managers we must improve and adapt with it or doomed to see our organization fail miserably.
As more and more healthcare organizations begin to implement their own CQI projects and integrate EBP (as its use is rather new in the field) we must focus on what we are doing well and what we are doing not so well. First the good news. Our healthcare professionals are amongst the best and arguably the best qualified and trained individuals in the world. Their training and education is the best possible when compared to other industrialized nations. Secondly, there is absolutely, 100% no doubt that the U.S. healthcare system in general does a fantastic job of maintaining a high quality of healthcare treatments, research, equipment, and pharmaceuticals. So good of a job, in fact, that we have begun to overspend and over focus on our scientific strengths leading into inefficient use of this incredible technology. This leads us to what we do not do so well, the doctor/patient relationship. In our efforts to treat every human being the same way we treat cars, we have somehow forgotten that these patients are individuals who have the right to know what is going on and to request different avenues of treatment. This is a direct product of overworked physicians who view their opinion and desires almost as the "law". Instead of the physician viewing their job as simply keeping a person alive, physicians must begin to understand that even though their expertise may lead to the most favorable outcome, in the end the patient has to deal with both the good or bad consequences.
This "fragmenting" of the doctor/patient relationship has not always been the weak link in our continued use of EBP. At one point in our not so far of history we were forever linked to a doctor from birth to death. This individuals became a trusted and respected part of our family, sometimes even showing up to our backyard BBQ's and family events (I have the pictures to prove it). However, due to the constant migration of families, the disappearing of the traditional nuclear family, and the ever increasing strains of healthcare costs, we have begun to see a trend of individuals going through a variety of primary care physicians. This leads to little if any communication between the physician and the patient allowing for an environment of mistrust and at times hostility. So what is a healthcare manager to do?
There are a variety of ways we can begun to "reconnect" physicians with patients. Maybe teleconferencing can replace house visits, or maybe the physician can begin making patients "follow" their own blog. These all are good ideas, however they are not very practical and can even be somewhat expensive. Why not think simply, quick, efficient, and (most of all) cheap? Rather then create another hurdle for communication why not simply open up and share all the information available? Recently a study called the OpenNotes Project is looking at what happens when a doctor's notes becomes available for a patient to read. This simple yet very effective technique has proven to "improve patient understanding of their health and get them to stick to their treatment regimens more closely" (Landro, 2010). This incredible show of trust by physicians has also led to improving the doctor/patient and decreasing any hostility or mistrust a patient may have. This has often lead to better treatments, happier physicians and patients, and improved healthcare quality. However, the news isn't always sunshine and lollipops. Researchers have also found that patients may panic if the see words such as cancer or heart disease and doctors fear that patients simply may not understand what their notes are saying.
Though we still have many hurdles ahead to improve the doctor/patient relationship, such simply strategies have improved overall healthcare quality by stressing one very important factor: trust. This project has begun to take notice by many healthcare providers, chief amongst them Kaiser Permanente who may begin to publish doctors' notes on the Internet for their patients' viewing. It's incredible how such a small step can improve quality. Though I do not question the importance of such a program I do have one simple question: What to do about the terrible handwriting so many physicians have?
1. JHQ - 130 A Model Structure for an EBM Program. Schumacher, Dale N., Stock, Joseph R., Richards, K., and Joan, K. (July/August 2003). Retrieved June 18, 2010 from: webcourses.ucf.edu/webct/urw/lc4130001.tp0/cobaltMainFrame/dowebct
2. What Doctors Really Think. Landro, Laura (July 2010). The Wall Street Journal. Retrieved July 19, 2010 from: online.wsj.com
As more and more healthcare organizations begin to implement their own CQI projects and integrate EBP (as its use is rather new in the field) we must focus on what we are doing well and what we are doing not so well. First the good news. Our healthcare professionals are amongst the best and arguably the best qualified and trained individuals in the world. Their training and education is the best possible when compared to other industrialized nations. Secondly, there is absolutely, 100% no doubt that the U.S. healthcare system in general does a fantastic job of maintaining a high quality of healthcare treatments, research, equipment, and pharmaceuticals. So good of a job, in fact, that we have begun to overspend and over focus on our scientific strengths leading into inefficient use of this incredible technology. This leads us to what we do not do so well, the doctor/patient relationship. In our efforts to treat every human being the same way we treat cars, we have somehow forgotten that these patients are individuals who have the right to know what is going on and to request different avenues of treatment. This is a direct product of overworked physicians who view their opinion and desires almost as the "law". Instead of the physician viewing their job as simply keeping a person alive, physicians must begin to understand that even though their expertise may lead to the most favorable outcome, in the end the patient has to deal with both the good or bad consequences.
This "fragmenting" of the doctor/patient relationship has not always been the weak link in our continued use of EBP. At one point in our not so far of history we were forever linked to a doctor from birth to death. This individuals became a trusted and respected part of our family, sometimes even showing up to our backyard BBQ's and family events (I have the pictures to prove it). However, due to the constant migration of families, the disappearing of the traditional nuclear family, and the ever increasing strains of healthcare costs, we have begun to see a trend of individuals going through a variety of primary care physicians. This leads to little if any communication between the physician and the patient allowing for an environment of mistrust and at times hostility. So what is a healthcare manager to do?
There are a variety of ways we can begun to "reconnect" physicians with patients. Maybe teleconferencing can replace house visits, or maybe the physician can begin making patients "follow" their own blog. These all are good ideas, however they are not very practical and can even be somewhat expensive. Why not think simply, quick, efficient, and (most of all) cheap? Rather then create another hurdle for communication why not simply open up and share all the information available? Recently a study called the OpenNotes Project is looking at what happens when a doctor's notes becomes available for a patient to read. This simple yet very effective technique has proven to "improve patient understanding of their health and get them to stick to their treatment regimens more closely" (Landro, 2010). This incredible show of trust by physicians has also led to improving the doctor/patient and decreasing any hostility or mistrust a patient may have. This has often lead to better treatments, happier physicians and patients, and improved healthcare quality. However, the news isn't always sunshine and lollipops. Researchers have also found that patients may panic if the see words such as cancer or heart disease and doctors fear that patients simply may not understand what their notes are saying.
Though we still have many hurdles ahead to improve the doctor/patient relationship, such simply strategies have improved overall healthcare quality by stressing one very important factor: trust. This project has begun to take notice by many healthcare providers, chief amongst them Kaiser Permanente who may begin to publish doctors' notes on the Internet for their patients' viewing. It's incredible how such a small step can improve quality. Though I do not question the importance of such a program I do have one simple question: What to do about the terrible handwriting so many physicians have?
1. JHQ - 130 A Model Structure for an EBM Program. Schumacher, Dale N., Stock, Joseph R., Richards, K., and Joan, K. (July/August 2003). Retrieved June 18, 2010 from: webcourses.ucf.edu/webct/urw/lc4130001.tp0/cobaltMainFrame/dowebct
2. What Doctors Really Think. Landro, Laura (July 2010). The Wall Street Journal. Retrieved July 19, 2010 from: online.wsj.com
Monday, June 21, 2010
The customer is ALWAYS right!
The health care industry is a very peculiar thing. It is part corporation and humanitarian organization. After all, the major goal of any health care organization is to maintain and improve the quality of health care available to its patients/customers and the community in general. This means that the health care industry must be mindful of providing the best "product" available while maintaining strict financial guidelines. Such challenges are unique and only seen by the health care industry as their actions directly affect the quality of human life. This is made even more difficult because humans tend to have varying opinions regarding the same situation. Cultural, financial, ethical, and moral beliefs always come into play when an individual gives their own personal opinion about an organization or process they have been affected by. To put it lightly the same exact event may happen to 10 similar individuals, but these same individuals may have 10 very different opinions.
As health care professionals we must understand that quality improvement is directly linked to an individual's perception of our "product". While others may believe we have delivered a "quality product" the stark reality is that there will always be someone who translates this product to an adverse event in their life. This means that as health care professionals we have to strive to treat the entire community while paying attention to the individual for one reason:
-The community is made up of individuals.
For health care quality to continue to grow, we must begin to diversify our understanding of health care delivery and realize that one type of plan, process, or technique simply will not suffice for every individual. Instead, our health care system needs to concentrate on treating the whole individual and having them take part in their own health care. For this to occur the patient must pay attention to the physical and psychological aspects of their health, physicians must listen more intently to the all the needs of the patient, administrators must find ways to allow physicians to accomplish their work to the best of their ability, and policy makers must understand that health care is a personal choice, not a community decision.
Quality is a perception of the individual and as a result we must treat the entire individual. If we do not, we most certainly can expect the community to flounder.
As health care professionals we must understand that quality improvement is directly linked to an individual's perception of our "product". While others may believe we have delivered a "quality product" the stark reality is that there will always be someone who translates this product to an adverse event in their life. This means that as health care professionals we have to strive to treat the entire community while paying attention to the individual for one reason:
-The community is made up of individuals.
For health care quality to continue to grow, we must begin to diversify our understanding of health care delivery and realize that one type of plan, process, or technique simply will not suffice for every individual. Instead, our health care system needs to concentrate on treating the whole individual and having them take part in their own health care. For this to occur the patient must pay attention to the physical and psychological aspects of their health, physicians must listen more intently to the all the needs of the patient, administrators must find ways to allow physicians to accomplish their work to the best of their ability, and policy makers must understand that health care is a personal choice, not a community decision.
Quality is a perception of the individual and as a result we must treat the entire individual. If we do not, we most certainly can expect the community to flounder.
Sunday, June 6, 2010
The Direct Link between Team Building and Health Care Quality
If you have ever experienced at minimum one work day you have probably heard over and over again the concept of you and your co-workers being a "team". This may be an admirable (or not so admirable) attempt by your Human Resources (HR) department to build some kind of comradery within the ranks. Unfortunatley, no matter how admirable their attempt, the concept of being a "team" is no more then a slogan on the wall or some printed words on recruitment materials to make their organization look progressive or employee friendly. The unfortunate reality is that HR simply does not want to deal with your bickering and would rather you and your fellow "team" members deal with as many issues as you can amongst yourselves so that they can go back to their real functions, ie: keeping a close eye on all of you!
As you already may know, the "team" concept is not new. This concept is used in all sorts of professional settings with varying degrees of success and failure. However, the concept of a "team" is one that is crucial to the consistent improvement and maintainence of quality within the health care industry. Make no mistake, health care staff and professionals must operate as a team at all times, not doing so allows for costly errors that lead to many negative occurrences which ultimately lead to the detriment to the quality of life for people and communities and on occasion sometimes even lead to the loss of life. It is no wonder that team building is such an important concept within the health care industry and one that all health care administrators, professional staff, nurses, physicians, and allied health staff are extremely serious about. Being a "team" is much more than a simple slogan on a wall or some creative print in a recruitment pamphlet, it is must be considered crucial to the delivery of health care services.
Time and time again, research has proven that "team building can increase efficiency and productivity" (Antai-Otong, 1997). So what exactly is a team? The concept of "team" is often mistaken with the concept of a "work group". Though they share many similarities one stark and very significant difference between the two is that a team shares the blame for their mistakes while the work group is prone to blaming an individual or individuals. This means that the team must work together, often helping each other out, to accomplish a single goal. For this to occur, we must move away from building work groups to building teams, but how can we accomplish this?
One crucial step in team building must be the realization by the administration, staff, and support staff that it can take quite some time to build a team. This period of time can be months or years. However, no matter how long it takes, a commitment must be made by all members of the "team" to see the process through. Abandoning or quitting during the process will lead to even greater obstacles then before the process even began! For a successful team to evolve we must have four essential qualities:
1. Open and effective communication
2. Member involvement and member ownership
3. Clearly defined goals
4. Trust
It must be noted that trust cannot be created, in fact, trust is essentially a byproduct of the first three qualities successfully being implemented. In many ways, the first three qualities are only a part of the process that eventually leads to the ultimate goal of team building: trust. Once trust has been accomplished, team efficiency, productivity, and quality seem to have unlimited boundaries. In many ways team building is an exercise in achieving trust, which ultimately allows teams to operate their most efficient levels while maintaining high levels of quality work.
Considering how much of a significant affect team building can have on quality and productivity, it's hard to imagine why every single organization does not find a way to incorporate team building into the development of their staff. Unfortunately, many organizations simply do not have the resources or the need to build teams and simply resort to "pretending" to believe in team building. Other obstacles such as workload and/or staff turnover are simply too great to establish any sort of a team environment within an organization.
Though the challanges are great, many organizations have overcome them through perserverance, leadership, and consistency. One of the best examples of organizations overcoming such adversities exists within professinal sports. In an era where team rosters can literally change from year to year, many professional sports teams have been able to maintain a level of excellence unparalled by other clubs. This is not accomplished by attracting the greatest talent, best educated, or even the best skilled individuals. It is accomplished by two simple goals:
1. Consistent leadership within key positions
2. Attracting individuals who "buy into" the system
A team building program cannot exist without certain key leaders throughout the entire process. This consitent leadership is not necesserily composed of those who lead the process of team building, but instead are "keepers of the flame" whom have gained the respect and loyalty of the organization. These individuals must be retained to safeguard the "culture" of the agency, which in turn determines how the team building process will take place. This "culture" must be nurtured and maintained at all costs.
As you can see, team building is not an easy 1-2-3 process, instead it is an ongoing process that is being constantly repeated and improved throughout the team building process and the lifetime of the organization. Graphically, team building can be categorized by the following:
Consistent Leadership --> Recruiting people to "buy into" the system ---> Commitment by all team members to "see the process through"--> Incorporating the 4 essential qualities of Team Buildng--> TEAM
Though team building is a difficult and laborious task, it has been proven to improve both quality and efficiency. The concept of team building will be a crucial step in the evolution and improvement of health care delivery services in the United States now and in the future.
Works Cited:
Antai-Otong, Deborah (1997). Team Building in a Health Care Setting. The American Journal of Nursing. 1997, 7, pp. 48-51.
Retrieved June 6, 2010 from: http://www.jstor.org/stable/3465461
As you already may know, the "team" concept is not new. This concept is used in all sorts of professional settings with varying degrees of success and failure. However, the concept of a "team" is one that is crucial to the consistent improvement and maintainence of quality within the health care industry. Make no mistake, health care staff and professionals must operate as a team at all times, not doing so allows for costly errors that lead to many negative occurrences which ultimately lead to the detriment to the quality of life for people and communities and on occasion sometimes even lead to the loss of life. It is no wonder that team building is such an important concept within the health care industry and one that all health care administrators, professional staff, nurses, physicians, and allied health staff are extremely serious about. Being a "team" is much more than a simple slogan on a wall or some creative print in a recruitment pamphlet, it is must be considered crucial to the delivery of health care services.
Time and time again, research has proven that "team building can increase efficiency and productivity" (Antai-Otong, 1997). So what exactly is a team? The concept of "team" is often mistaken with the concept of a "work group". Though they share many similarities one stark and very significant difference between the two is that a team shares the blame for their mistakes while the work group is prone to blaming an individual or individuals. This means that the team must work together, often helping each other out, to accomplish a single goal. For this to occur, we must move away from building work groups to building teams, but how can we accomplish this?
One crucial step in team building must be the realization by the administration, staff, and support staff that it can take quite some time to build a team. This period of time can be months or years. However, no matter how long it takes, a commitment must be made by all members of the "team" to see the process through. Abandoning or quitting during the process will lead to even greater obstacles then before the process even began! For a successful team to evolve we must have four essential qualities:
1. Open and effective communication
2. Member involvement and member ownership
3. Clearly defined goals
4. Trust
It must be noted that trust cannot be created, in fact, trust is essentially a byproduct of the first three qualities successfully being implemented. In many ways, the first three qualities are only a part of the process that eventually leads to the ultimate goal of team building: trust. Once trust has been accomplished, team efficiency, productivity, and quality seem to have unlimited boundaries. In many ways team building is an exercise in achieving trust, which ultimately allows teams to operate their most efficient levels while maintaining high levels of quality work.
Considering how much of a significant affect team building can have on quality and productivity, it's hard to imagine why every single organization does not find a way to incorporate team building into the development of their staff. Unfortunately, many organizations simply do not have the resources or the need to build teams and simply resort to "pretending" to believe in team building. Other obstacles such as workload and/or staff turnover are simply too great to establish any sort of a team environment within an organization.
Though the challanges are great, many organizations have overcome them through perserverance, leadership, and consistency. One of the best examples of organizations overcoming such adversities exists within professinal sports. In an era where team rosters can literally change from year to year, many professional sports teams have been able to maintain a level of excellence unparalled by other clubs. This is not accomplished by attracting the greatest talent, best educated, or even the best skilled individuals. It is accomplished by two simple goals:
1. Consistent leadership within key positions
2. Attracting individuals who "buy into" the system
A team building program cannot exist without certain key leaders throughout the entire process. This consitent leadership is not necesserily composed of those who lead the process of team building, but instead are "keepers of the flame" whom have gained the respect and loyalty of the organization. These individuals must be retained to safeguard the "culture" of the agency, which in turn determines how the team building process will take place. This "culture" must be nurtured and maintained at all costs.
As you can see, team building is not an easy 1-2-3 process, instead it is an ongoing process that is being constantly repeated and improved throughout the team building process and the lifetime of the organization. Graphically, team building can be categorized by the following:
Consistent Leadership --> Recruiting people to "buy into" the system ---> Commitment by all team members to "see the process through"--> Incorporating the 4 essential qualities of Team Buildng--> TEAM
Though team building is a difficult and laborious task, it has been proven to improve both quality and efficiency. The concept of team building will be a crucial step in the evolution and improvement of health care delivery services in the United States now and in the future.
Works Cited:
Antai-Otong, Deborah (1997). Team Building in a Health Care Setting. The American Journal of Nursing. 1997, 7, pp. 48-51.
Retrieved June 6, 2010 from: http://www.jstor.org/stable/3465461
Friday, May 21, 2010
What, exactly, is Quality Health Care?
How do we measure quality within a health care system? Is it measured by greater access, lower cost, a combination of both, or none of the above? Is it even possible or responsible for us to use quantitative measures to make a qualitative assessment? It's not rare for researchers, companies, and/or individuals to convert qualitative assessments into quantitative measurements for the purpose of comparison. This technique has been the general "measuring stick" when comparing two different systems, groups, etc. to find what, how, or if changes need to be made or even if there is a need to start from the beginning all together. Though quantitative measures have been used in the past to compare general qualitative aspects of our lives, it is possible that the measure of "health care quality" cannot be measured with such general quantitative measures?
By its very nature health care quality is a (surprise!) qualitative value. This means that health care quality is a perception or opinion of the individual making the measurement. However, we simple cannot rely on qualitative values when we asses a health care system, so what are we to do? The biggest stumbling block is creating a clear definition and measurement tool for "quality" within a health care system.
The World Health Organization (WHO) measures quality as a "by product of access and cost". This means that a cheap and highly accessible health care system would be considered "quality" by the WHO standard. This, unfortunately, is the WORST definition of quality I have ever heard. There is no mention of outcomes or improvements to the individual or community and the WHO relies heavily on the individual to strictly follow doctors orders and receive scheduled check ups no matter what. This measurement seems to not take into account the massive amounts of variables life seems to continually throw at us on a daily basis. What about environmental, social, and education aspects of each community and individual?
Instead of measuring health care quality as a by product of cost and access, why not measure the outcomes of such health care systems? Measures such as overall health, quality of life (ie: absence of disease and illness), psychological stability (Maslow's Hierarchy of Needs), and other such measurements should be incorporated into what makes a health care system "quality". Though many would argue that such systems would only help to balloon the cost of health care or force companies to cut costs to increase revenue, there are many current examples that have proven that a more holistic/total approach to health care that addresses all aspects of a healthy life (education, security, physical/mental health) not only create happier individuals it can also significantly cut costs. Generally, these programs have accomplished such miracles by de-centralizing the health care apparatus, creating incentives for individuals who choose to have healthier lifestyles (yearly check-ups, eating properly, getting better exercise) both through financial and motivational incentives. Rather then focusing on the group, such programs focus on the entire health of the individual or community and tailor the system to meet the specific needs of the community. These programs have the increased flexibility to grow and adapt as the community or individual changes through time. To summarize, health care quality should focus on the individual's total health, not on the health of their bank account.
By its very nature health care quality is a (surprise!) qualitative value. This means that health care quality is a perception or opinion of the individual making the measurement. However, we simple cannot rely on qualitative values when we asses a health care system, so what are we to do? The biggest stumbling block is creating a clear definition and measurement tool for "quality" within a health care system.
The World Health Organization (WHO) measures quality as a "by product of access and cost". This means that a cheap and highly accessible health care system would be considered "quality" by the WHO standard. This, unfortunately, is the WORST definition of quality I have ever heard. There is no mention of outcomes or improvements to the individual or community and the WHO relies heavily on the individual to strictly follow doctors orders and receive scheduled check ups no matter what. This measurement seems to not take into account the massive amounts of variables life seems to continually throw at us on a daily basis. What about environmental, social, and education aspects of each community and individual?
Instead of measuring health care quality as a by product of cost and access, why not measure the outcomes of such health care systems? Measures such as overall health, quality of life (ie: absence of disease and illness), psychological stability (Maslow's Hierarchy of Needs), and other such measurements should be incorporated into what makes a health care system "quality". Though many would argue that such systems would only help to balloon the cost of health care or force companies to cut costs to increase revenue, there are many current examples that have proven that a more holistic/total approach to health care that addresses all aspects of a healthy life (education, security, physical/mental health) not only create happier individuals it can also significantly cut costs. Generally, these programs have accomplished such miracles by de-centralizing the health care apparatus, creating incentives for individuals who choose to have healthier lifestyles (yearly check-ups, eating properly, getting better exercise) both through financial and motivational incentives. Rather then focusing on the group, such programs focus on the entire health of the individual or community and tailor the system to meet the specific needs of the community. These programs have the increased flexibility to grow and adapt as the community or individual changes through time. To summarize, health care quality should focus on the individual's total health, not on the health of their bank account.
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