Having positive physician/nurse relationships.

The best hospitals have their docs and nurses working hand in hand. It’s a relationship among peers: Both professions share in getting patients well, and delivering the best healthcare experience possible.

Here are two best practices Dr. Jonathan Burroughs, a certified physician executive, and president and CEO of The Burroughs Healthcare Consulting Network, has uncovered through his experience working in the hospital setting:

1. Nurse-Physician Councils — It’s a group of nurse and physician leaders, who meet with a specific purpose — to improve and optimize nurse/physician relationships and communication. They address nurse/physician issues such as:

• trust and respect
• communication, which entails consistent use of Situation, Background, Assessment, Recommendation (SBAR)  and other patient safety tools to optimize clinical effectiveness
• protocols that help to coordinate schedules so physician and nurses work together
• clinical and functional pathways to identify when they’re obligated to respond to each others needs and concerns, and
• bad behaviors.

The council addressed issue of mutual concern that affected patient safety, staff morale, turnover and frustrations.

2. Nurse-Physician Dyads — Nurses and physicians need to lead together if they are going to work effectively. In this best practice, a nurse and physician manager lead their clinical units together through all phases of operations, including:

• oversight of physician and nursing performance
• establishment of clinical and functional protocols and evidence-based practices
• oversight of the operation plan and budget
• supply chain management and inventory
• peer review and performance improvement activities, and
• modeling an effective collaborative culture.

This requires both professions to re-examine their roles and co-manage. For some it means taking on greater responsibilities, for others it entails listening and being more open to different opinions. It’s not easy, but it’s well worth it in the end.

What best practices has your facility implemented to advance nurse/physician relationships? Share your practices in the comments section below.

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A new study, which was done in two pediatric ERs, suggests that having professional translators – not a patient’s family member – in the ER may lower medical errors by limiting miscommunications.

When the translator was an amateur (family  member or a hospital employee) the amount of translation slips – omitting or adding certain words or phrases –that had potential health risks was 20% to 22%.

When a professional translator was available to Spanish-speaking families, 12% of translation slips could have had medical consequences, such as giving a wrong medication dose.

And when translators had 100 hours of training or more the translation slips dropped to only 2% having the potential for doing harm.

Approximately 25 million Americans have limited English proficiency, and the law requires U.S. hospitals that receive federal funds to offer some type of translation help for these patients. That can be a heavy financial burden for hospitals with already limited budgets.

However, other studies have already shown that having a translator may improve care and actually cut costs. Getting the proper treatment, medication and guidance for home care lowers the risk of unnecessary tests or patients having to return to the ER.

This study shows the added benefits of having a “professional” translator – avoiding potentially dangerous doctor/patient miscommunications.

Unfortunately, while federal law requires hospitals to provide an interpreter, it doesn’t require government or private insurance to pay for them, leaving hospitals and the taxpayers to cover the costs.

However, some hospitals in California are proving that the cost doesn’t have to be significant. The facilities have joined together to offer translators by phone and audioconference, which only costs $25 per patient.

Does your facility offer translators for your non-English-speaking patients? If so, what kind (in-person, audioconference or phone)? Share your experiences in the box below.

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a business strategy.

A new report by PwC’s Health Research Institute (HRI) titledSocial media likes healthcare: From marketing to social business found social media is changing the nature of healthcare interactions, and facilities that can’t see beyond marketing are missing out on a great opportunity to engage consumers.

And it would seem that many facilities are indeed missing out, according to this statistic from the report: During a sample one-week period, while eight out of 10 healthcare companies had a presence on various social media sites, community sites had 24 times more social media activity than corporate sites.

So what does this mean to your facility?

Basically, if you aren’t using social media as a way to listen and engage with consumers on their terms, you’re missing out on a great business opportunity. It offers instant feedback on services and products, as well as new ideas that could lead to better services — which would then lead to a higher quality of care, more loyal customers and possible revenue growth.

“Health organizations have an opportunity to use social media as a way to better listen, participate in discussion and engage with consumers in ways that extend their interaction beyond a clinical encounter,” said Kelly Barnes, US health industries leader at PwC, on PR Newswire. “Savvy adopters are viewing social media as a business strategy, not just a marketing tool.”

By listening and interacting with consumers, hospitals can find out: what consumers like, what they need, how they behave and when their experiences demand an immediate response, notes Daniel Garrett, US health information technology leader at PwC. “Health organizations can engage IT to integrate social data intelligence with existing systems and processes, yet most are still struggling with how to manage the data from their own clinical systems.”

Another recent HRI social media survey of more than 1,000 U.S. consumers and 124 members of the eHealth Initiative (eHI) revealed some statistics that would interest health executives:

• One-third of consumers now use social media sites, such as Facebook, Twitter, YouTube and online forums for health-related matters, including seeking medical info, tracking and sharing symptoms, and broadcasting how they feel about doctors, drugs, treatments, medical devices and health plans
• Four in 10 consumers say they have used social media to find health-related consumer reviews (e.g., of treatments or physicians)
• one in three consumers have sought information related to other patients’ experiences with their disease, and
• one in four have “posted” about their health experience.

When the survey respondents were asked how info found through social media would affect their healthcare decisions:

• 45% said it would affect their decision to get a second opinion
• 41% said it would affect their choice of a specific doctor, hospital or medical facility, and
• 34% said it would affect their decision about taking a certain medication.

A final point of interest: Who’s sharing information on social media?

Of course, the majority (80%) of individuals between 18 and 24, said they were likely to share health info through social media and of those 90 % said they would trust the info they found there. On the other hand, less than half (45%) of people between the ages of 45 and 64 years old said they were likely to share health info on social media.

Is your facility using social media as a business strategy? If so, share how you are doing it in the comments box below.

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Pop quiz time: If an employee spots a medical error, what is he/she most likely to do?

1. Report it right away.
2. Keep it to him/herself.
3. It depends on the kind of policy your facility has on reporting safety/medical error incidents.

Of course, you’d hope the answer is A – that staff would drop everything and report it immediately. But for many facilities, the answer is C – it depends on your policy.

A recent study by the Agency for Healthcare Research and Quality (AHRQ), revealed many hospitals still are lagging behind in their open communication of medical errors. The study, which surveyed nearly 600,000 staffers at more than 1,110 hospitals nationwide, found:

• 54% said when an adverse event is reported, “it feels like the person is being written up, not the problem”
• nearly 50% of participants said they felt their mistakes were held against them, and
• almost 66% said they worried mistakes were being held in their personnel file.

The AHRQ did its first patient-safety culture report in 2007, and unfortunately, only about one-fifth of hospitals have improved their performance in the category of “non-punitive response to error,” — and 16% have gotten worse! The rest are struggling to make progress.

What hospital executives have to realize is the “carry a big stick” approach when it comes to staff making medical errors only places patients in more danger.

The American Medical Association supports non-punitive policies for reporting safety incidents. Your employees need to feel OK with admitting mistakes. They need to know that they won’t be punished – unless it’s an act intended to cause harm or noncompliance with safety protocols. But regular “oops” mistakes need to be looked into and learned from.

Yes, this is much easier to write than to do, but studies are showing that higher safety culture scores are correlated with better clinical outcomes and lower rates of hospital-acquired conditions.

Here are some articles from the AHRQ that can help you improve your safety practices:

• Safe practices for better health care
• Impact of working conditions on patient safety
• Patient safety tools: Improving safety at the point of care

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That’s the disturbing takeaway of a recent survey of health care workers by the Agency for Healthcare Research and Quality (AHRQ). The survey looked at data from almost 60,000 staffers at more than 1,100 hospitals to measure how well the organizations had instilled a “culture of safety.” The results aren’t promising.

Most employees reported at least some reluctance to report safety incidents for various reasons. Among the findings :

• 50% of employees said they thought their mistakes are held against them by management
• 54% said that when an adverse event is reported, it appears the person involved is “written up” instead of the actual incident or problem
• More than half of respondents said they don’t feel safe questioning the safety actions of those with more authority, and
• 37% said they are afraid to ask questions about potential safety mistakes.

The findings are troubling: An environment where workers feel safe reporting potential safety issues is vital to any hospital that wants to improve. Even worse: The results of this survey haven’t changed in any significant way since it was first asked in 2007 — which means all the time and energy spent creating a “culture of safety” hasn’t done much to actually make employees feel safe speaking up.

What would it take for hospitals to make staffers feel truly safe in reporting safety issues? Share your thoughts in the comments.

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Routine testing discovered she had diverticulitis, and a follow-up CT scan showed she had a foreign body in her stomach. It turned out to be a pen.

The woman told her doctor that about 25 years earlier, she had been poking at a spot on her tonsil with the pen when she slipped, fell and accidentally swallowed the pen. At the time, both her husband and her doctor dismissed the possibility and said she must have been mistaken. (X-rays taken at the time showed no pen in her gut.)

On this most recent visit to the doctor, the pen was removed — and found to still work. Her symptoms have gone away, and the hospital is using the case as a teaching example of two rules: 1) Abdominal X-rays don’t show every single foreign object, and 2) Even if a patient’s story sounds unbelievable, it may just be true.

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Social media has real business benefits within health care — and serious negatives that can be hard to protect against — whether or not you even use the sites.

The open nature of social media sites like Facebook and LinkedIn means that no matter how carefully you manage your own profile — or even if you choose not to use them — there are some things you simply can’t protect yourself from.

Take the case of Jerry Penner, the CEO of Murray-Calloway County Hospital in Murray, Kentucky.

Shortly after coming to the hospital, a hospital VP made a joke about Penner having sent a friend request to all of the VP’s staffers, but not the VP himself. The only problem? Penner hadn’t sent any of the requests.

A little sleuthing turned up a fake profile of Penner that used a photo of him from a hospital web page, and his basic biographical info such as his educational and work history, which were correct aside from a few mistaken dates. There were few posts made on the page, and aside from some poor grammar and spelling, none of the information posted was damaging or harassing to Penner — but he was understandably disturbed.

Penner said his privacy settings on the site are relatively high and he uses the page mostly to communicate with business connections and promote the hospital.

Activity on the fake profile died down until recently, when a flurry of Penner’s real-life friends and colleagues received friend requests from the fake profile. Most upsetting to Penner: One hospital employee received a friend request with an “I love you” note attached.

In that instance, the person was already connected to Penner on Facebook and knew there was an impostor afoot. But Penner has no ideas who else may have received such inappropriate messages, and if those people realize they aren’t coming from him.

Penner said he had received little assistance from Facebook about the fake account — while he can no longer see the page when he logs on, he said other friends of his can.

For medical professionals who are already leery of social media’s privacy pitfalls, this may seem like one more reason not to use it. But not having the ability to monitor what other people say about you (or say as you) on social networking sites can be even more damaging in the long run.

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• When patients are admitted, hospitalists enter patient data into a system that uses automatic reminders to ensure certain procedures are followed, for example that certain prescriptions are issued. As the patient is prepped for discharge, the physician will also get a pop-up reminder that the patient needs to be discharged with that prescription.

• Hospitalists have regular meetings with nurse practitioners, nursing team leaders, case managers, and social workers to discuss every patient in the unit and any issues they need to focus on before discharge.

• Members of the care team may also go to a patient’s room to jointly exchange information with patients and their families to discuss discharge plans and follow-up care.

• Within 48 to 72 hours of discharge, patients are contacted by the system to ensure they aren’t experiencing any unexpected symptoms, that they have the medications and home health equipment they need, and that any required follow-up appointments are made.

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So far, more than 30,000 doctors have signed up for the Doximity network since its launch seven months ago — that’s twice the number of physicians on LinkedIn, according to Doximity.

The services is a HIPAA-secure communication platform for doctors that lets them connect and collaborate with their professional peers.
Unlike other popular social media sites, Doximity membership is reserved for medical professionals, such as  physicians, nurse practitioners and physician assistants. Members sign up with their real names and verified credentials. The general public can’t access any information on the site, so health care pros can have true — and private — peer-to-peer communication.

Click here for more information on HIPAA.

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Primarily, systems that protect anonymous reporting and don’t emphasize assigning blame for the error get more reports than more traditional reporting systems. That’s the takeaway from a recent report in the journal Pediatrics.

After instituting a new system at a pediatric clinic in North Carolina, the number of mistakes reported increased from an average of five per year to 86.

Under the clinic’s old system, reports weren’t anonymous and frequently led to punishment of some sort for those involved in the error. With the new system, employees were able to report anonymously, and punishments weren’t attached to the error reports. Employees from all areas of the practice were put on a safety team to review reports once a month and find solutions to the reduce the likelihood of a similar mistake happening again.

The most common mistake by far was incorrect data being entered into a patient record, followed by delayed or forgotten lab work and medication errors. About 75% of the mistake reports were addressed by the team with simple procedural changes and staff training.

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