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Amazing Nurse Story

Posted on December 5, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Nurses are amazing and they are often the unsung heroes of healthcare. When I think about the times I’ve spent in hospitals I have almost zero memories of the doctors, but I have a lot of great memories of the nurses.

I was reminded of this fact when reading this pretty untraditional nurse story that @rn_critcare shared. I wonder how many times healthcare IT developers think about these kinds of unique situations that nurses face. Ok, they aren’t all this large, but they are just as nuanced.

As told by @rn_critcare:
Today in my role as nurse I wore many hats. Let me tell you a story about how the day went… #NurseLife
#medtwitter

Came in this am to discover my pt from yesterday had imaging overnight that revealed catastrophic injuries, along with her sepsis and multi-system organ failure

Within 1/2 hr her fiance approached me about calling in a chaplain, which I assume is to do final prayers. He informs me that he wants to marry her. Today.

I’m not sure b/c pt is sedated and fully ventilated, with no hope of waking up.

Spend next few hours calling chaplains/priests/ministers. Keep in mind it’s Sunday AM and church is happening soon.

I find out that if we can show “intent to marry” that a ceremony can be performed. Photos of pt trying on dress are used. A minister agrees to come after church.

Preparations are being made. Family is happy that we can do this for their loved ones.

Except Pt starts to deteriorate. Cushing triad. Call family in and discuss options. They have a family member willing to perform ceremony, if only for symbolic reasons now…

Hair is washed and braided. I give the sisters some sheets and scissors for a makeshift wedding dress (new) while I go collect flowers from other rooms around the unit. (borrowed)

Flowers are placed in braids along with headband & veil. A blue blanket is draped at end of bed.
Everyone lines up outside the unit and begin the parade into the room. So. Many. People. Can hardly make my way around but secure a post at the med pumps and monitor.

Music is being played, someone has a guitar and another has a drum.

The chaplains words are brief but loving. Asks him does he take her… I do. Asks does she take him, bridesmaids all reply “she does”

Everyone in tears

They are now all in song with only the drum being played, which I feel is shaking my entire soul
Everyone singing Stand by Me and I’m in tears.

Pt stabilizes somewhat. I realize it’s now afternoon and I haven’t had a break or worse, my coffee! I decide to step away for a few minutes. Go outside for air. Find myself at grocery store across the street…

Purchase cake and have 2 hearts drawn with their initials, some bubbly (sparkling juice), and plastic champagne flutes. There was a wedding after all… New groom takes bottle outside with fam, pops the cork & comes back for mini reception.

So much love

I decide to get some charting done. Post-op comes back across the hall and I’m called to help. CRRT machine beeping next door and tend to that. Realize I still haven’t eaten. Grab a cookie from the desk (weekend tradition from consultants)

Pt begins to fail again.

Family called back in, this time the air has changed. It’s heavier and somehow feels hotter than hours before.

The guitar is being played and everyone is singing Amazing Grace. Am I singing along? Maybe. Not sure with this lump in my throat.

Have to turn away and pretend like I’m tending to something very important, which turns out is the wall, but it’s holding me up now, and the singing and drumming is getting louder and I’m just trying to keep it together, keep her comfortable… Won’t be long now…

Her children are at her side now telling her they love her, how wonderful she is, how much they love their step-dad, don’t worry they will take care of him.

A tear falls down her cheek and now everyone is sobbing. My sobs are internalized and I keep my eye on the monitor…

New groom is by her side and I whisper in his ear that she has passed, as this sacred news is shared with a spouse first.

The new groom is now a widow.

One by one the people exit the room, each one reaching out for a hug. Each hug brings me a little closer to the inevitable spill over of tears. My heart aches for them. There are no words, my eyes pleading with them to accept my sincerest condolences…

They need help with funeral home. Explain of course I can help guide them, this is unchartered territory and I do this all the time. My insides are screaming ALL THE TIME!

Call funeral home, with request to leave braids untouched… Veil and flowers too.

I finish my charting. Realize there’s no supper break happening either. Wash my pt up. Gently remove the countless tubes and IVs. Use hushed tones as I explain to her what I am doing, because even in death we deliver honour and dignity.

Take a new nurse down to morgue with me, because it’s a teaching hospital after all. Carry on chatting as though my spirit isn’t weeping inside.
Get back to unit.

Take a long overdue drink of water.

No time for tears.

There’s an admission on the way.

#nurselife

Dreamforce 2018 – More Healthcare Than Ever

Posted on September 25, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

The annual Dreamforce event starts today in San Francisco. This year, more time on the agenda has been dedicated to healthcare and life sciences highlighting Salesforce’s continued investment in these industries.

I have never been to Dreamforce, but every year I find myself enviously reading the tweets that fly past. There are always great quotes from the high-calibre keynote speakers and a lot of interesting talk about new technologies from attendees.

What I found noticeable about Dreamforce 2018,  #DF18, is the number of HealthIT companies that will be speaking and exhibiting at the event. I have seen more tweets and received more notices about companies participating at #DF18 than in any other year. Some of the Healthcare presenters this year include:

For the full list see this handy Dreamforce TrailMap for Healthcare and Life Sciences:

I remember when Salesforce first appeared at the annual HIMSS event. I spent a lot of time in their booth learning about their healthcare initiative. Back then their solution was focused exclusively on care coordination. Patients were entered as “customers” and health information from different source systems would flow into Salesforce. This data would be associated with the patient record and accessible to different members of the care team to help coordinate care. It was pretty rudimentary.

Company executives that I spoke to did not have answers to my questions about the future direction of their healthcare initiatives. They simply did not know. Fast forward to today and it seems clear that Salesforce is pursuing a healthcare strategy that is like what they have used in other industries – build a few apps on their own to prove it can be done, then be open to others building apps using Salesforce as the backbone and connective tissue.

Judging by the number of HealthIT companies that have chosen to partner with Salesforce, I would say the strategy is working.

“Our patient experience platform is built on the Salesforce platform,” explains Sunny Tara, Co-founder and CEO of CareCognitics. “EHRs are the operational systems for hospitals. They were well suited to replace healthcare’s fee for service billing system. However, as we move to a value-based system focused on improved care, hospitals need the power and personalization that comes from a true CRM system. What we have done is built a platform that bridges existing EHRs with advanced patient loyalty capabilities built on top of Force.com. Doctors and patients love it.”

“Our partnership with Salesforce and integration with Health Cloud is further proof of PointClickCare’s commitment to creating intelligent care coordination between health systems and post-acute providers,” says BJ Boyle, VP Product Management at PointClickCare. “With two-thirds of the skilled nursing market using PointClickCare, we’re uniquely positioned to help LTPAC providers across the country be great partners with health systems. Leveraging Salesforce’s Health Cloud offers us new and exciting ways to do this even more effectively.”

Over the next few days I will be watching for healthcare announcements and tweets from #DF18. I am hoping to see further proof that Salesforce is building an ecosystem of partners to help bring better personalization, interoperability and cloud capabilities to healthcare.

Looking to Improve Patient Experience? Simple Options Can Yield Big Results.

Posted on September 18, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Improving patient experience is a top priority. Instead of grandiose new programs, hospitals and practices would see better results by focusing on simple options that have a big impact – like an eConsent solution. eConsent makes it easier for organizations to treat patients with respect and gets patients involved in their care.

Over the past several years more and more attention has been placed on improving the patient experience. This is partly due to a recognition by healthcare organizations that experiences could euphemistically be called less-than-ideal and partly because of changes to reimbursements that tie $$$ to patient satisfaction (specifically HCAHPS scores). From a patient and patient champion perspective this attention has been a welcome change.

There is a tendency, however, for healthcare organizations to gravitate towards large-scale projects to improve patient experience. Although projects like renovating patient suites and implementing AI chatbots can indeed have a positive impact, these initiatives are resource-intensive and can take a long time to yield results. Instead, hospitals and physician practices should focus on doing small things better and reap the benefits of improved patient experience sooner.

According to a study published by BMJ Open in 2016, positive patient experiences were “closely linked to effective patient-health professional interaction and logistics of the hospital processes”. The authors of the study also found that “positive aspects of the hospital experience were related to feeling well informed and consulted about their care”.

In 2014 a study found that delays in healthcare (wait times) impacted the perceived quality of care received. The longer the delay, the more that confidence in the care provider eroded. Having confidence in the care provider is a key factor in the online ratings patients give to healthcare organizations. Online ratings are the new real-time way to gauge patient satisfaction.

Taken in combination, these studies tie patient satisfaction/experience directly to (1) interactions between patients and their health professionals; and (2) smooth hospital processes.

Interactions with Patients

So what can hospitals do to improve interactions between health professionals and patients? They could implement new communication tools (like real-time chat). They could renovate offices so that patients and clinicians can look at screens together. They could even hire navigators to help patients interact with health professionals. All of these are fantastic initiatives, but all of them will take time and in some cases, a lot of resources.

There are, however, a number of simple things that hospitals could do that do not require significant investments of time or dollars. One would be to train clinicians to ask patients: “Is there anything we have covered today that I can help clarify or that you have questions about” rather than the standard “Do you have any questions?”. Another would be to implement electronic forms during the intake process so that patients only have to enter their information once. There is nothing more annoying than having each department ask for the same information over and over again.

Along these lines, an often overlooked yet quick-hit improvement area, is the informed consent process. The American Medical Association defines it as follows.

“The process of informed consent occurs when communication between a patient and physician results in the patient’s authorization or agreement to undergo a specific medical intervention. In seeking a patient’s informed consent (or the consent of the patient’s surrogate if the patient lacks decision-making capacity or declines to participate in making decisions), physicians should:

(a) Assess the patient’s ability to understand relevant medical information and the implications of treatment alternatives and to make an independent, voluntary decision.

(b) Present relevant information accurately and sensitively, in keeping with the patient’s preferences for receiving medical information. The physician should include information about:

  • The diagnosis (when known)
  • The nature and purpose of recommended interventions
  • The burdens, risks, and expected benefits of all options, including forgoing treatment

(c) Document the informed consent conversation and the patient’s (or surrogate’s) decision in the medical record in some manner. When the patient/surrogate has provided specific written consent, the consent form should be included in the record.”

The informed consent process is a golden opportunity for hospitals to improve the patient experience. It is a chance for health professionals to engage patients in their care. This engagement has numerous benefits including:

  1. Reducing the anxiety patients have about the upcoming procedure, which in turn helps improve patient outcomes. This study published in the British Journal of Surgery, shows patient who are less anxious have fewer post-procedure wound complications.
  2. Demonstrating that the health professional (and by extension the hospital) care about the patient as a person.
  3. Mitigating the risk of malpractice. Lack of communication and feeling like clinicians didn’t care about them are common reasons cited by patients who decide to sue for malpractice. This New York Times article has an excellent summary of various studies into this phenomenon.

A simple way to improve the informed consent process is to move away from paper-based consent forms, which can be lost and are often confusing to patients, to electronic consent forms (commonly referred to as eConsent).

According to Robin McKee, Director of Clinical Solutions at FormFast, which offers an eConsent solution, “It’s the right time to be having the conversation about the costly risks associated with a paper-based process. Over 500 organizations recently experienced compliance issues due to missing informed consent forms according to the Joint Commission). Adopting an electronic solution is an easy and quick way to offer a better patient experience during the consent process.”

With an eConsent solution like FormFast’s, hospitals would be able to:

  • Have patients fill out forms on a user-friendly tablet
  • Pre-populate information on the forms with EHR data
  • Link to educational material that explains the procedure and risks in more detail
  • Quickly recall consent forms prior to the procedure by scanning the patient’s wristband
  • Provide a copy of the consent form (and links to the educational material) to patients

Smooth Hospital Processes

Feeling respected as an individual is key to a good patient experience. In fact, a 2015 Consumer Reports Survey found that patients who said they did not feel respected by the medical staff were 2.5 times as likely to experience a medical error versus those who felt they were treated well.  One of the easiest ways to show respect for patients is to value their time and prevent long delays during their hospital stay.

For patients, it is a horrible feeling to show up at the appointed time for a procedure, only to be carted to a waiting area in nothing but a flimsy robe and left to wait with no explanation. Now imagine how it would feel after 20 minutes of waiting to have a member of staff come and ask you to fill out another set of consent forms because your originals had been lost. Of course, while the patient is filling out the form, the staff member must review all the risks and implications of the procedure before you can sign the forms again. I know I would be about as calm as a palm tree in a hurricane.

This situation is referred to as “gurney consent” and is something that many hospitals are trying to eliminate. The National Center for Ethics in Health Care has a special guideline that prohibits gurney consent – VHA Handbook 1004.01 – Informed Consent for Clinical Treatments and Procedures. That handbook states that “Patients must not, as part of the routine practice of obtaining informed consent, be asked to sign consent forms ‘on the gurney’ or after they have been sedated in preparation for a procedure.” This clause was meant to ensure the consent does not occur “so late in the process that the patient feels pressed or forced to consent or is deprived of a meaningful choice because he or she is in a compromised position.”

Sadly, gurney consents are an all too common occurrence in hospitals that use paper-based consent forms. JAMA reports that missing consent forms cause 10% of procedures to be delayed, costing each hospital over $500K each year. This of course does not count the emotional toll it takes on patients.

It would be remiss not to point out that members of staff equally hate the need to have patients re-sign consent forms. It’s not comfortable to be the bearer of bad news and stand there while an upset patient vocalizes their displeasure. After all, the staff member is not the one that lost the form. Medscape’s recent National Physician Burnout & Depression Report found that the top contributor to physician burnout was excessive administrative tasks. Asking for another consent form from a patient certainly qualifies as an excessive administrative task.

“By modernizing document workflows, FormFast gives patients, their family member and clinicians the information they need, when they need it,” says Rob Harding, CEO of FormFast. “Digitizing the informed consent process helps ensure procedures go according to plan – no one is running around trying to find a paper document or asking for forms to be filled out yet again. A frictionless workflow makes for smooth operation which helps both patients and health professionals. eConsent is really a win-win.”

Conclusion

There are a myriad of ways to improve the patient experience. Big, bold initiatives and small, simple changes to existing processes. Although it is not an either-or situation, in the current economic and regulatory environment, hospitals should look for “small wins”, like eConsent, as an affordable and pragmatic way to improve the overall patient experience. As an added bonus, clinicians and administrators will also reap the benefits of lower stress and smoother workflows.

No matter what initiative, a hospital takes, ANY effort made to improve patient experience is a step in the right direction.

FormFast is a proud sponsor of Healthcare Scene.

Patient Safety Market Heating Up with Mergers and New Product Announcements

Posted on July 26, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

For the past few years the patient safety software market has been stable with little in the way of new products and company activity. That has changed with a flurry of recent announcements:

  1. The merger of two market leaders: Datix and RL Solutions
  2. Health Catalyst entering with their new Patient Safety Monitor™ Suite: Surveillance Module
  3. VigiLanz expanding their platform to include Dynamic Safety Surveillance

When something goes wrong in a healthcare facility it is referred to as an adverse event or a medical error. According to a recent study by Johns Hopkins, 250,000 Americans die each year from medical errors making it the third leading cause of death in the United States. The Journal of Patient Safety estimates that non-lethal adverse events happen 10-20 times more frequently than lethal events. This puts the total number of adverse events somewhere between 2.5 – 5 million per year. The financial cost of these events is enormous. Frost & Sullivan estimates that the financial cost of adverse events in the US and Europe will reach $383.7 Billion by 2022.

Traditionally, adverse events have been recorded and logged in incident reporting systems (sometimes called risk management software) – like those offered by Datix and RL Solutions. These systems rely on voluntary reporting of events by staff members and patients. Once entered, these events are reviewed and analyzed by specially trained risk managers to determine root causes. When patterns emerge, changes are made to policies, procedures and physical environments to prevent similar events from happening in the future.

The most recent Research and Markets report estimates the global patient safety and risk management software market is poised to grow at a CAGR of 10.9% over the next decade to reach $2.22 Billion by the year 2025. I believe there are three key drivers for this this growth:

  1. Hospitals transitioning away from traditional after-the-fact adverse event reporting systems to real-time surveillance platforms that take advantage of the data being collected in EHRs and other electronic repositories
  2. The movement towards value-based care where a focus on patient safety has meaningful impact on reimbursements
  3. Realignment of patient safety as part of overall patient experience vs a function of compliance and legal.

According to a report by the Agency for Healthcare Research and Quality (AHRQ), it is estimated that less than 6% of adverse events are reported voluntarily. This means that healthcare organizations are potentially missing out on 94% of events that are happening within their four walls. In addition, very few organizations have effective ways to capture near misses – adverse events that did not occur because they were stopped BEFORE someone was harmed. There is a better way.

With the exponential growth in the quantity of healthcare data and the rapid increase in computing power, it is now possible to mine medical data to detect adverse events and near misses in real-time. For example, it is possible to look at EHR data to determine if the wrong medication was given to a patient based on their diagnosis. It is also possible to track the number of times the drug-drug interaction warning message is displayed to clinicians (each being a near miss). Justin Campbell of Galen Healthcare Solutions recently wrote an article about mining EHR audit log data to uncover workflow bottlenecks that touches on this same approach – commonly referred to as “real-time surveillance”.

Stanley Pestotnik, MS, RPh, Vice President of Patient Safety Products at Health Catalyst had this to say about this detection methodology: “The current approach to patient safety is like doing archaeology – digging through ancient safety events to identify the causes of harm, which does nothing to help with the patient in the bed right now. Our patient safety suite, along with our quality-improvement services and the Health Catalyst PSO, turns the current paradigm on its head. Unlike other approaches to using analytics within a PSO to identify and address episodes of patient harm, we monitor triggers in near real-time to reveal whether a patient is currently at risk for a safety event, so clinicians can intervene to prevent it. And we provide constant vigilance; no patient encounter goes unnoticed.”

Real-time surveillance of adverse events is the approach that Health Catalyst and VigiLanz have incorporated in their product offerings.

“The RL+Datix merger comes at a time when patient safety events are surging,” states Erik Johnson, Vice President of Marketing at VigiLanz. “It is not surprising that consolidation is happening as companies try to address the needs of the market.”

Johnson points to a recent Frost & Sullivan report that predicts further market consolidation. The report states that by 2022, adverse patient events will lead to 92 million hospital admissions and 1.95 million deaths in the US and western Europe. These avoidable hospital admissions will be a drag on financial performance – especially as we move to a value-based system.

Under the value-based models, healthcare organizations are reimbursed based on patient outcomes and satisfaction scores, not on treatment volume. This means organizations are no longer compensated for patients that are re-admitted or stay longer due to an adverse event experienced at the facility. This has put a spotlight on patient safety initiatives and is a key reason why healthcare organizations are once again investing in this aspect of their operations.

“We are seeing organizations take the opportunity, as they transition from volume to value, to renew their patient safety protocols and technologies to ensure they are capitalizing on the lessons learned from incident data,” continues Johnson. “It’s not just patient incident data either. Adverse events can happen to guests and employees as well. Hospitals are looking to get a better handle on all their events – not only to capture them, but to derive deeper insights on root cause and even further to automate the detection of events through surveillance technology.”

A request for comment from Datix and RL Solutions on their recent merger was politely declined. A company spokesperson pointed back to the press release announcing the merger which states: “the combined company will contain the largest repository of patient safety data in the world, enabling the creation of data-driven insights for healthcare stakeholders across the continuum of care.”

The final driver for growth is the recognition that patient safety is closely linked to patient experience. In the past, adverse event tracking fell to the Risk Management team inside a hospital which typically reported up through the CFO or legal counsel. It was seen as a compliance and back-office function. In recent years, however, there has been a realization that the patient safety function is a better fit under the umbrella of patient experience since the two are closely linked.

“From our perspective at The Beryl Institute, if we approach healthcare from the lenses of those that use the system not only safety, but also quality, service, cost and more are all part of the experience someone has within healthcare,” says Jason A. Wolf PhD CPXP, President of The Beryl Institute – the world’s leading community of practice for patient experience. “To differentiate safety from experience diminishes both, relegating safety to processes and checklists and experience to satisfaction or amenities. Rather, experience is the integration of all the above.”

Wolf cites the recent State of Patient Experience from The Beryl Institute where healthcare leaders acknowledged quality and safety as essential to overall experience. A parallel study, the Consumer Perspectives on Patient Experience mirrored the provider result with 68% of global healthcare consumers agreeing that safety is part of the healthcare experience.

“I see the movement towards aligning patient safety and patient experience as acknowledgement of all that impacts the overall experience,” adds Wolf. “That first and foremost to consumers, their health matters to them and how they are treated both clinically and as a person is essential to their healthcare experience. This too reinforces the expectations patients and families have always had, that their care will be delivered in a safe and reliable manner.”

lt will be exciting to watch the patient safety space as the three drivers of (1) changing technology, (2) value-based care and (3) realignment under patient experience, continue to push investments in this market. I’m curious to see if the Datix + RL merger is a one-off or if other players like QuantrosRiskonnect, Origami Risk, Ventiv, Policy Medical and The Patient Safety Company will merge or be acquired. This market is definitely heating up!

Approaches For Improving Your HCAHPS Score

Posted on June 27, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Improving your HCAHPS scores gets easier if you make smart use of your existing technology infrastructure. To make that work, however, you have to know which areas have the greatest impact on the score.

According to healthcare communications vendor Spok, hospitals can boost their scores by focusing on five particularly important areas which loom large in patient satisfaction. Of course, I’m sure these approaches solve problems addressed by Spok solutions, but I thought they were worth reviewing anyway. These five areas include:

  • Speed up response to the call button
    Relying on the call button itself doesn’t get the job done. If calls go to a central nursing station, it takes several steps to eventually get back to the patient, it’s possible to drop the ball. Instead, hospitals can send requests directly from the call button to the correct caregiver’s mobile device. This works whether providers use s a Wi-Fi phone, smartphone, pager, voice badge or tablet.
  • Lower the noise volume
    Hospitals are aware that noise is an issue, and try everything from taking the squeak out of meal cart wheels to posting signs reminding all to keep the conversations quiet. However, this will only go so far. Spok recommends hospitals take the additional step of integrating the monitoring of equipment alarms with staff assignments systems, and as above, routing nurse call notifications to the appropriate patient care providers mobile device. Fewer overhead notifications means less noise.
  • Address patient pain faster
    To help patients with the pain as quickly as possible, give staff access to your full directory, which allows nurses to quickly locate provider contact information and reach them with requests for pain medication orders. In addition, roll out a secure texting solution which allows nurses to share detailed patient health information safely.
  • Make information sharing simpler
    Look at gaps in getting information to patients and providers, and streamline your communications process. For example, Spok notes, if communication between team members is efficient, the time between a test order and the arrival of the phlebotomist can get shorter, or the time it takes the patient transport team to bring them to the imaging department for a scan can be reduced. One way to do this is to have your technology trigger automatic message to the appropriate party when an order is placed. Also, use the same to approach to automatically notify providers when test results are available.
  • Speed up discharge
    There are many understandable reasons why the patient discharge process can drag out, but patients don’t care what issues hospitals are addressing in the background. One way to speed things up is to set up your EMR to send a message the entire care team’s mobile devices. This makes it easier for providers to coordinate discharge approval and patient instructions. The faster the discharge process, the happier patients usually are.

Of course, addressing the patient care workflow goes well beyond the type of technology hospitals use for coordination and messaging. Getting this part of the process right is a good thing, though.

PESummit Day 2 – Being Vulnerable Opens Us to Deeper Connections

Posted on June 19, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Whether it was planned or by cosmic happenstance, Day 2 of the 2018 Patient Experience: Empathy and Innovation Summit (#PESummit) reinforced a theme from the prior day:

  • Making yourself vulnerable opens us up to deeper connections with others

On Day 1, Cleveland Clinic President and CEO, Tomislav Mihaljevic MD @TomMihaljevicMD shared a story of a patient that died in the OR (see my Day 1 summary for details). It was a very personal story. By sharing it Mihaljevic made himself vulnerable and instantly forged a connection with the thousands of attendees in the hall.

Most people find it difficult to share stories that make them uncomfortable – especially ones where we are at the center of the story. We don’t like to talk about our fears, our failures or our losses because we are afraid of what other people may think (which is another way of saying that we fear that we will be rejected). Yet paradoxically by making ourselves vulnerable in this way, we actually make it easier for others to connect with us. Adrienne Boissy @boissyad, Chief Experience Officer at Cleveland Clinic stated exactly that after Mihalijevic shared his story.

Day 2’s opening keynote speaker, Kelsey Crowe PhD, founder of Help Each Other Out, articulated how the fear of being a burden or being seen as needy, holds patients back from asking for help. In other words, its hard for patients to admit to being vulnerable:

Crowe went on to share how small gestures of kindness and empathy, made at the times of vulnerability made a tremendous difference in their care. A unique “gesture wall” that she deployed at a healthcare facility allowed patients to capture these wonderful moments for staff to read.

This theme of being open, honest and vulnerable as a way to connect with people was reinforced by the next keynote speaker, Michael Hebb, founder of Deathoverdinner.org, and Drugsoverdinner.org.

In fact, Hebb’s entire keynote featured story after story about how sharing the fears about the end-of-life opened up the conversation, providing families and loved ones with the chance to better connect.

Vulnerability was also featured by Day 2’s closing keynotes: Brennan Spiegel MD @BrennanSpiegel, Director of Health Services Research, Cedars-Sinai Health System and Zubin Damania MD @ZDoggMD

At the end of Brennan’s fascinating presentation on the clinical application for an efficacy of Virtual Reality, he shared a failure that counterbalanced the exceedingly positive stories that he had showed the audience. Like Mihaljevic, talking about a failure helped the audience connect with Brennan and the patient that had suffered a panic attack as a result of the VR simulation.

Vulnerability was also featured by Day 2’s closing keynotes: Brennan Spiegel MD @BrennanSpiegel, Director of Health Services Research, Cedars-Sinai Health System and Zubin Damania MD @ZDoggMD

At the end of Brennan’s fascinating presentation on the clinical application for an efficacy of Virtual Reality, he shared a failure that counterbalanced the exceedingly positive stories that he had showed the audience. Like Mihaljevic, talking about a failure helped the audience connect with Brennan and the patient that had suffered a panic attack as a result of the VR simulation.

As is normal for Damania (aka ZDoggMD), his session was energizing and entertaining. However, in the midst of live renditions of his favorite medical rap parodies and fun stories of his parents, Damania shared the story of Turntable Health – the novel practice he was forced to close in early 2017. “No one was more pissed off about it than me.” said Damania.

By sharing this painful part of his journey, Damania made himself vulnerable and judging by the body language, many in the audience could relate to his do-everything-right-yet-still-not-work-out feelings. That story gave context to Damania’s impassioned plee to join him in ushering in Health 3.0 – a vision for care partly based on the best parts of his Turntable Health experience.

Day 2 of PESummit even better than Day 1. I can’t wait for the final day tomorrow. Follow the conference hashtag – #PESummit for real-time updates!

PESummit Day 1 – Empathy is Hot in Cleveland

Posted on I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

With the mercury hitting an incredible 90+ in downtown Cleveland, it was only fitting that the speakers and attendees at the 2018 Patient Experience: Empathy and Innovation Summit (#PESummit) turned up the heat on the passion for more empathy in healthcare WITHOUT a corresponding increase in burnout.

Day 1 at PESummit kicked off with Cleveland Clinic’s dynamic duo of Adrienne Boissy @boissyad, Chief Experience Officer and K. Kelly Hancock @kkellyhancock, Executive Chief Nursing Officer. Boissy issued a challenge to the audience in her opening:

They were followed by Cleveland Clinic President and CEO, Tomislav Mihaljevic MD @TomMihaljevicMD who shared a number of things that we could each do to increase empathy in our daily work. The clear favorite was eating lunch with someone you don’t know, and get to know them:


But the most poignant part of Mihaljevic’s time on stage came when he shared a failure from his past – the time he lost a patient in the OR. He spoke about how he and his team was unable to repair the damage to a patient’s heart and how devastated the team was when despite their best effort, the patient died. As the leader Mihaljevic held himself accountable and not only did he have to support the patient’s family in dealing with their loss, he had to help his own team deal with the death as well.

It was a pleasant surprise to hear Mihaljevic talk about the feelings he had in the moment and how he learned lessons that he carries with him today.

The highlight of the breakout sessions was the panel discussion on “When Patient and Healthcare Innovation Meet” that featured Grace Cordovano @GraceCordovano, Julie Rish @julie_rish, Christine Traul MD @traulc and Michael Seres @mjseres.


My favorite was Cordovano’s tip for patients to go into the doctor appointments PREPARED – with questions they are seeking answers to.

Day 1 ended with Thomas H Lee MD @ThomasHLeeMD, CMO of Press Ganey talking about “grit” (aka resilience) at the individual and team levels.


Lee’s most provocative statement was when he cited his research that found that it is ineffective to use financial incentives to motivate behavior that is inherently non-financial in nature. This punched a hole through the concept of paying people to sleep more than 7 hours that was mentioned by one of the morning keynotes and other gamification techniques that have become popular over the past few years.

Day 1 at PESummit was fantastic and I’m looking forward to a equally great Day 2. Follow along on Twitter #PESummit

 

 

 

 

Origin Story: Mark McCloskey, President of Oneview Healthcare. Living Up to Commitments.

Posted on May 29, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Right from the start I knew Mark McCloskey’s origin story was going to be special.

McCloskey, President and Founder of Oneview Healthcare, agreed to meet while we were both traveling through Chicago. We booked the meeting well in advance, but it turned out that we accidentally picked a date when Oneview was hosting several key customers at its US headquarters in Chicago. It would have been completely understandable if McCloskey postponed our meeting, but he and his team insisted keep it on the books. They had made a commitment and they wanted to make good on it.

Making commitments and living up to them is something that permeates McCloskey’s origin story and makes it special. In fact, this commitment is something that McCloskey has infused into the company he founded. Oneview has a strong reputation as a company that listens to its customers and delivers on promises made. This is partly why their customers are such strong advocates.

McCloskey’s story begins as many Irish tales do, as a young man leaving his beloved home to seek his fortune abroad. In McCloskey’s case, his journey began with a commitment made to a dress-maker friend of his. He took five dresses designed by his friend with a promise to sell them in London. Armed with nothing more than determination to succeed, he sold those dresses to a local London fashion retailer, Next PLC and convinced them to let him have space in one of their stores in return for a percentage of his dress sales.

With no experience in either fashion or retail, McCloskey focused on listening to what customers wanted and then tried it. Eventually he found a winning formula and in short order, he grew the business from one location to several dozen. He hired staff, took care of marketing and worked with his dressmaker friend to ensure a steady supply of dresses for the sprawling retail operation. By the tender age of 22, he had 84 people working for him and he was selling dresses all over England.

Unfortunately, it all came to abrupt end in 1988 when his dressmaker friend decided to retire from the business in order to start a family. McCloskey wound down the operation and returned to Ireland.

Back at home, McCloskey became a successful sales executive at a telecommunications company that was later acquired by British Telecom. He then went on to co-found a company that ran Ireland’s first independent ATM networks because he thought people should be able to conveniently access their own money from any ATM. That company was acquired by Ulster Bank in 2004. Two years after that acquisition, McCloskey found himself in hospital for knee surgery and it was his experience that ignited the flame that would become Oneview Healthcare.

“They put me in a ward room after my surgery,” recalled McCloskey. “The room held 4 people in total and had just 1 TV. The biggest guy in the room had the remote so no one was going to argue with him about what to watch. So for three days I watched what he wanted to watch.”

During those three days, McCloskey began to take note of the odd and inefficient processes at the hospital. “I noticed that everything was paper based,” recounted McCloskey. “Whenever a nurse or doctor came in the room, they asked the same questions over and over. It became very repetitive. On top of that, I got woken up every morning at 6am when a lady from food services came in the room to hand us slips of paper with that day’s menu on it. We had to check what we wanted for breakfast, lunch and dinner and then the lady would collect all the papers. I would come back after physio and the lunch that I ordered would be on the tray and it would be cold because it had been sitting there for an hour. They hospital delivered the meals according to the kitchen’s schedule and not the patient’s schedule. Then after almost 4 days in the hospital, they gave me an A4 sheet of paper with some instructions on it and said ‘there’s your physio’ now off you go.”

Following his hospital stay, McCloskey found himself on a plane to New York City with his wife. With the less-than-stellar healthcare experience still fresh in his mind, McCloskey was pleasantly surprised by much better experience he had as an airline passenger – especially with the in-flight entertainment system. [Editor’s Note: It is never a good sign when the customer experience in the AIRLINE industry is superior to your own].

During that trip, McCloskey committed himself to bringing that same airline experience to healthcare and Oneview Healthcare was born.

It was here that his early experience selling dresses helped him. Once again, McCloskey found himself in an unfamiliar industry (healthcare) attempting to sell a product he knew very little about (patient entertainment systems). Taking a cue from his past, he started by finding out what customers actually wanted and then incorporating that into his offering.

One of the first organizations he showed the product to was Epworth HealthCare, the largest private hospital group operator in Australia’s state of Victoria. They were impressed, but had numerous suggestions to improve the product which the small Oneview team added to the product. This virtuous cycle repeated itself over and over as McCloskey continued to show the product to healthcare organizations around the world including: UCSF Mission Bay, Chris O’Brian Lifehouse and  Maimonides Medical Center.

Fast forward to the end of 2012. At this point Oneview was a company of eight and without any customers, McCloskey had to make a tough decision. The company needed an infusion of cash in order to ensure it could make the Christmas payroll. McCloskey went to his wife and explained the situation. Together they decided to sell both their cars and put the money in the company. His wife had just one condition – that when the company “made it” that she would get the car of her dreams. McCloskey agreed and the cars were sold quickly.

And then the call came.

Alan Kincade, CEO of Epworth HealthCare called McCloskey to ask him to come to Australia to make a last presentation to the selection committee who was looking at new patient entertainment systems. McCloskey flew down to Australia and met with the Epworth team. The product’s vastly improved feature set, which went well beyond a simple entertainment system, impressed the committee. After the presentation, Kincade asked to meet privately with McCloskey.

“At that meeting Alan told me that we had the best product he’d ever seen,” said McCloskey. “But before we could move forward, he wanted me to answer a few questions from their financial controller. At that point he invited Liz into the room and she asked me three questions which I answered as honestly as I could.”

“How many employees do you have?”

“Eight”

“What’s your revenue?”

“Our revenue is zero right now.”

“What’s your balance sheet look like?”

“Not that good actually. Right now we’re $5 Million in debt.”

According to McCloskey it was at that point that the controller turned to Kincade and said: “Honestly Alan you can’t sign a contract with a company from Ireland with eight people who are 5 million in debt.”

OOF.

But just when all hope seemed lost, Kincade said the magic words that would set Oneview on a path to success: “Mark, can you sort out your debt problem? If you can get back to me in 6 months and prove to me that you have the money and the balance sheet sorted out so that I can sign a contract for 5 years, I’ll do business with you.”

McCloskey committed to Kincade that he would.

The meeting happened on a Wednesday and by Friday McCloskey was home in Ireland getting ready with his wife for a dinner party with some friends. By cosmic coincidence, one of the other guests at the dinner party just happened to be a financier from Australia who helped companies raise capital. Over dinner, the two of them agreed to meet at the Oneview office on Monday.

During that meeting, McCloskey and his team impressed the financier who agreed to help Oneview raise money and restructure its debt. That financier was James Fitter, who is now Oneview’s Chief Executive Officer.

Together McCloskey and Fitter raised $8 Million from family, friends and angel investors. They bought back the company’s debt from the bank and in a few short months they got the balance sheet in order. A week after they completed the financing, the company inked its first deal – from Chris O’Brian Lifehouse in Australia. A week later, UCSF called to negotiate a deal.

“Joe Bengfort, CIO of UCSF Medical Center called me up and told me ‘You have a great product and you are one of two finalists’,” said McCloskey. “He then told us that the other company was installed in 40,000 beds compared to the zero that we had. Despite that, he let us know that we had won the contract because ‘UCSF has not gotten to where it is without making brave and bold decisions’”

To secure the deal, McCloskey had to make several commitments including: handing over Board of Director notes to Bengfort so that he could read about the technical direction and financial health of the company (something that Fitter had implemented as standard company practice earlier in the year) and to allowing a member of the UCSF team serve on the new customer advisory board for the Oneview product (which they did).

With these two new customers in the fold and having met the conditions outlined by Kincade at their last meeting, McCloskey returned to Epworth and signed the deal. In just a few months Oneview went from zero revenue to having three large hospital clients. It was just the boost the company needed.

Today, Oneview is a successful company with offices in Dublin (Global HQ), Chicago, Dubai, Melbourne and Sydney. The company recently announced a further global expansion with customers in Thailand and the rest of UAE.

As McCloskey told his story, I was struck by the number of times he was asked to make a commitment and was impressed by his effort to make good on those commitments. Whether it was a promise to sell a certain number of dresses, to address the company finances or to buy a car of his wife’s dreams, McCloskey never waivered in his commitment.

In this day and age, it is easy to make a verbal promise and even easier to break it. Verbal agreements simply do not have the heft they once did. To me it is rare and special to you hear a story like McCloskey’s – of promises made and kept.

Over this past year I have gotten to know a few members of the Oneview team and I can tell you firsthand that the company has a culture of living up to commitments. When they say they will do something, they do it. It’s not hard to trace this culture back to McCloskey. It is one of the reasons why the company is succeeding.

EPILOGUE: McCloskey did buy his wife the car of her dreams. He never did get around to replacing his vehicle and now uses Uber instead.

PX2018: The Line Between Patient Experience and Patient Engagement Continues to Blur

Posted on May 4, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

The 2018 Patient Experience Conference, #PX2018, hosted by The Beryl Institute, was a wholly different than previous incarnations. In prior years the central focus was squarely on patient experience. This year, there was significant emphasis placed on patient engagement and activating patients. It was a welcome change.

The Beryl Institute’s annual conference is one of the events I look forward to each year. It is a positive, upbeat, and reaffirming event that brings together healthcare professionals involved with improving patient experience. Attendees come from around the world including: Canada, UK, Sweden and Asia. This gives the event an international flavor and brings together many different perspectives on patient experience.

In 2004, I attended my first patient experience conference. Back then the event was organized and hosted by the Society of Healthcare Consumer Advocacy (SHCA) – a society within the American Hospital Association. In those days, the annual gathering was designed specifically for Patient Feedback professionals and Patient Advocates that worked inside hospitals. The event, was dominated by sessions about patient surveys (later becoming HCAHPS) and timely responses to patient complaints. For many years the annual SHCA event remained operationally focused.

In 2013, SHCA was integrated into The Beryl Institute and things began to shift markedly. Instead of an annual SHCA conference that was narrowly aimed at patient complaints, the new conference from The Beryl Institute was much broader and covered the whole of patient experience. The sessions became less operational and more strategic in nature. Words like “empathy” and phrases like “meeting patients where they are” became part of the hallway chatter.

Fast forward to 2018. “Patient Experience” has become an even broader term and perhaps slightly overused. All sorts of HealthIT companies and consulting firms now boldly state they are in the patient experience business. The term is now used to refer to everything from patient advocacy to patient rights to online reviews (and reputation management) to patient engagement/activation. As the definition has changed, so too has The Beryl Institute conference.

The first hint that something was different came when I scanned the program agenda a few weeks before the conference. There were several sessions that I did not expect to see:

  • Engaging Families and Teams in I-PASS to Improve Patient Safety and Experience
  • OpenNotes: Breaking Barriers, Changing Culture, Engaging Patients
  • Building Operational Capacity for Patient Engagement

I was also pleasantly surprised by the depth and breadth of vendors in the exhibit hall. Companies like OneView, TVR Communications, Relatient and eVariant each had demonstrations of products that educated patients, reminded patients about their care plans and directed patients to the most appropriate service line or physician based on an analysis of their needs. All of these capabilities are focused in the world of patient engagement yet judging by the busy traffic at these booths, it is clear that patient experience professionals are stakeholders and influencers for the purchase of those solutions.

Even consulting companies like Cast & Hue (who did a fun design-thinking exercise in their booth) talked about how they can help healthcare organizations build better processes and workflows to encourage more patient involvement.

I welcome the blurring between patient experience and patient engagement. Although it is possible to be good at one without the other, the goal should be to improve one alongside the other. To me, patient engagement is tangible and measurable – something which was becoming increasingly difficult to do in the world of patient experience pre-2010. I believe a good patient experience is a prerequisite to engaging patients in their care which leads to better outcomes – which is ultimately the goal we are all striving for.

Is EMR Use Unfair To Patients?

Posted on April 24, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As we all know, clinicians have good reasons to be aggravated with their EMRs. While the list of grievances is long — and legitimate — perhaps the biggest complaint is loss of control. I have to say that I sympathize; if someone forced me to adopt awkward digital tools to do my work I would go nuts.

We seldom discuss, however, the possibility that these systems impose an unfair burden on patients as well. But that’s the argument one physician makes in a recent op-ed for the American Council on Science and Health.

The author, Jamie Wells, MD, calls the use of EMRs “an ethical disaster,” and suggests that forced implementation of EMRs may violate the basic tenets of bioethics.

Some of the arguments Dr. Wells makes apply exclusively to physicians. For one thing, she contends that penalizing doctors who don’t adapt successfully to EMR use is unfair. She also suggests that EMRs create needless challenges that can erode physicians’ ability to deliver quality care, add significant time to a physician’s workday and force doctors to participate in related continuing education whether or not they want to do so.

Unlike many essays critiquing this topic, Wells also contends that patients are harmed by EMR use.

For example, Wells argues that since patients are never asked whether they want physicians to use EMRs, they never get the chance to consider the risks and benefits associated with EHR data use in developing care plans. Also, they are never given a chance to weigh in on whether they are comfortable having less face time with their physicians, she notes.

In addition, she says that since EMRs prompt physicians to ask questions not relevant to that patient’s care, adding extra steps to the process, they create unfair delays in a patient’s getting relief from pain and suffering.

What’s more, she argues that since EMR systems typically aren’t interoperable, they create inconveniences which can ultimately interfere with the patient’s ability to choose a provider.

Folks, you don’t have to convince me that EMR implementations can unfairly rattle patients and caregivers. As I noted in a previous essay, my mother recently went to a terrifying experience when the hospital where my brother was being cared for went through an EMR implementation during the crucial point in his care. She was rightfully concerned that staff might be more concerned with adapting to the EMR and somewhat less focused on her extremely fragile son’s care.

As I noted in the linked article above. I believe that health executives should spend more time considering potentially negative effects of their health IT initiatives on patients. Maybe these execs will have to have a sick relative at the hospital during a rollout before they’ll make the effort.