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Nutrition

Hospital Leadership, Strategy, And Culture In The Age of Health Care Reform

With just eleven months to go before the Value-Based Purchasing component of the Affordable Care Act is scheduled to go into effect, it is an auspicious time to consider how health care providers, and hospitals specifically, plan to successfully navigate the adaptive change to come. The delivery of health care is unique, complex, and currently fragmented. Over the past thirty years, no other industry has experienced such a massive infusion of technological advances while at the same time functioning within a culture that has slowly and methodically evolved over the past century. The evolutionary pace of health care culture is about to be shocked into a mandated reality. One that will inevitably require health care leadership to adopt a new, innovative perspective into the delivery of their services in order to meet the emerging requirements.
First, a bit on the details of the coming changes. The concept of Value-Based Purchasing is that the buyers of health care services (i.e. Medicare, Medicaid, and inevitably following the government’s lead, private insurers) hold the providers of health care services accountable for both cost and quality of care. While this may sound practical, pragmatic, and sensible, it effectively shifts the entire reimbursement landscape from diagnosis/procedure driven compensation to one that includes quality measures in five key areas of patient care. To support and drive this unprecedented change, the Department of Health and Human Services (HHS), is also incentivizing the voluntary formation of Accountable Care Organizations to reward providers that, through coordination, collaboration, and communication, cost-effectively deliver optimum patient outcomes throughout the continuum of the health care delivery system.
The proposed reimbursement system would hold providers accountable for both cost and quality of care from three days prior to hospital admittance to ninety days post hospital discharge. To get an idea of the complexity of variables, in terms of patient handoffs to the next responsible party in the continuum of care, I process mapped a patient entering a hospital for a surgical procedure. It is not atypical for a patient to be tested, diagnosed, nursed, supported, and cared for by as many as thirty individual, functional units both within and outside of the hospital. Units that function and communicate both internally and externally with teams of professionals focused on optimizing care. With each handoff and with each individual in each team or unit, variables of care and communication are introduced to the system.
Historically, quality systems from other industries (i.e. Six Sigma, Total Quality Management) have focused on wringing out the potential for variability within their value creation process. The fewer variables that can affect consistency, the greater the quality of outcomes. While this approach has proven effective in manufacturing industries, health care presents a collection of challenges that go well beyond such controlled environments. Health care also introduces the single most unpredictable variable of them all; each individual patient.
Another critical factor that cannot be ignored is the highly charged emotional landscape in which health care is delivered. The implications of failure go well beyond missing a quarterly sales quota or a monthly shipping target, and clinicians carry this heavy, emotional burden of responsibility with them, day-in and day-out. Add to this the chronic nursing shortage (which has been exacerbated by layoffs during the recession), the anxiety that comes with the ambiguity of unprecedented change, the layering of one new technology over another (which creates more information and the need for more monitoring), and an industry culture that has deep roots in a bygone era and the challenge before us comes into greater focus.
Which brings us to the question; what approach should leadership adopt in order to successfully migrate the delivery system through the inflection point where quality of care and cost containment intersect? How will this collection of independent contractors and institutions coordinate care and meet the new quality metrics proposed by HHS? The fact of the matter is, health care is the most human of our national industries and reforming it to meet the shifting demographic needs and economic constraints of our society may prompt leadership to revisit how they choose to engage and integrate the human element within the system.
In contemplating this approach, a canvasing of the peer-reviewed research into both quality of care and cost containment issues points to a possible solution; the cultivation of emotional intelligence in health care workers. After reviewing more than three dozen published studies, all of which confirmed the positive impact cultivating emotional intelligence has in clinical settings, I believe contemplating this approach warrants further exploration.
Emotional intelligence is a skill as much as an attribute. It is comprised by a set of competencies in Self-Awareness, Self Management, Social Awareness, and Relationship Management, all leading to Self Mastery. Fortunately, these are skills that can be developed and enhanced over the course of one’s …

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Good Health

Hospitalized Again? Keeping Your Older Parent From Returning to the Hospital

According to studies by Medicare 18-20% of patients find themselves back in the hospital within 30 days of being released. Lack of follow up by patients is the main reason for a return trip. Discharge instructions almost always recommend that patients see their primary care physician within one to two weeks of being released from the hospital.
This is important because medical care today is very different from medical care years ago when your primary care physician actually came to the hospital to see you. Today, physicians called hospitalists care for you while in the hospital. Your primary care physician cares for you when you are in the community. Many times your primary care physician has no idea you were even hospitalized, thus the importance of making an appointment to discuss further treatment for the condition that placed you in the hospital in the first place. Otherwise it’s likely you’ll win a return trip to the hospital.
Make sure any prescriptions that you leave the hospital with are filled and that you take the medication as prescribed. These prescriptions were written for a reason, yet many of go unfilled. Were you prescribed physical or other therapy? Participate. Again more recommendations that go unheeded by patients. Did you think you ended up in the hospital because you were caring for yourself properly? Is it your intention to go back home and do the same thing? You’re playing monopoly with your life, lose a turn and go back to the hospital.
Many older adults fail to see the progression and seriousness of their diagnosis. This occurs for several reasons. Physicians talk in medical speak. Older adults seeing the physicians as god-like are hesitant to ask questions; they do not ask questions about anything they do not understand. Physicians also diagnose versus offer information that affects the day to day life of their patients. For example many physicians do not tell patients to lose weight, improve their diets or stop smoking when this direction would benefit many individuals.
Due to insurance issues, hospitals are also rushed to push patients out the door, usually in three days or less. This rush many times does not allow for conditions to be fully diagnosed thus the problem resulting in the hospitalization is not resolved. What happens then? The patient is released, does not take medications, does not make a follow up appointment with the primary care physician and ends up back in the hospital.
This is expensive not only to the patient but the healthcare community. In 2009 a trip to the hospital costs the average Medicare patient a co-pay of $1,068. The ambulance trip to the hospital another $600-800. If individuals, not insurance, had to pay these costs I have to believe that we would take better care of ourselves.
Other issues with older adults that complicate this situation is memory loss. Many individuals do not take care of themselves because they simply can’t remember if medications were taken, meals were eaten, and bathing was completed. About fifty percent of individuals over the age of 85 have dementia, many times undiagnosed unless a family member notices because the individual cannot report a condition to their physician of which they are not aware. To further complicate the situation; most general physicians do not have experience with the subtlety of memory loss.
It is important if you are an older adult to have someone who can advocate for your health care needs. If you are a child, offer to attend medical appointments or coordinate information for your parents. Make sure they follow up with post hospitalization recommendations. You’ll save unnecessary trips to hospital emergency rooms and help your parent have a better quality of life. A little help goes a long way.…