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
Monday, July 19, 2010
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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