Category: Uncategorized

All those of us who work in medical settings are deeply familiar with the increasing requirements for more documentation and administrative work designed to comply with government regulations and healthcare insurance rules.

 

In theory, major frameworks like the Joint Commission (JC) in the US are setting common standards to improve the quality and safety of care, with an understandable focus on reducing returns to the hospital for infections or other complications. The JC has been so successful, as far as measured results, that hundreds of hospitals and medical centers around the world are investing in educational and management programs enabling them to be certified, opening new doors to international patients with reimbursement at a lower cost to public and private payors.

In theory, comprehensive privacy compliance, like HIPAA, and standard system protocols, like HL7, enable software that allows for system integrity and software integration so the process of providing care can be strengthened, errors reduced, and costs controlled.

In practice, however, the pervasive nature of the combination of all these technologies, combined with overlay Electronic Medical Records (EMR), e-prescribing, real time voice, video and messaging applications runs the risk of turning doctors, nurses and others who entered the medical profession to help human beings into “humanoids” who spend more time at keyboards, computers, smartphones and other devices, typing and tapping throughout their shifts.

For many, so much time spent on the “digital paperwork” (along with actual paperwork which may also be required) contributes to burn-out and a sense of being overwhelmed by tasks so much so that there is less and less time for interacting with patients and thinking through problems with colleagues to serve those patients better.

As software improves following decades of this major move to the digitalization of providing and paying for care, we believe it is a perfect time to step back and rethink the critical importance of “human factors” in healthcare.

Human factors bring us back to the fundamentals of quality care – starting with listening, engaging in conversation, showing compassion, and being able to read the non-verbal clue patients share.

As more mundane tasks are automated, and new models for teamwork and management of necessary administrative functions are innovated, we have a moment in time to rediscover the joys and benefits of being able to spend time with patients and their families during traumatic times and over the long haul when managing chronic conditions.

All those of us who work in medical settings are deeply familiar with the increasing requirements for more documentation and administrative work designed to comply with government regulations and healthcare insurance rules.

In theory, major frameworks like the Joint Commission (JC) in the US are setting common standards to improve the quality and safety of care, with an understandable focus on reducing returns to the hospital for infections or other complications. The JC has been so successful, as far as measured results, that hundreds of hospitals and medical centers around the world are investing in educational and management programs enabling them to be certified, opening new doors to international patients with reimbursement at a lower cost to public and private payors.

In theory, comprehensive privacy compliance, like HIPAA, and standard system protocols, like HL7, enable software that allows for system integrity and software integration so the process of providing care can be strengthened, errors reduced, and costs controlled.

In practice, however, the pervasive nature of the combination of all these technologies, combined with overlay Electronic Medical Records (EMR), e-prescribing, real time voice, video and messaging applications runs the risk of turning doctors, nurses and others who entered the medical profession to help human beings into “humanoids” who spend more time at keyboards, computers, smartphones and other devices, typing and tapping throughout their shifts.

For many, so much time spent on the “digital paperwork” (along with actual paperwork which may also be required) contributes to burn-out and a sense of being overwhelmed by tasks so much so that there is less and less time for interacting with patients and thinking through problems with colleagues to serve those patients better.

As software improves following decades of this major move to the digitalization of providing and paying for care, we believe it is a perfect time to step back and rethink the critical importance of “human factors” in healthcare.

Human factors bring us back to the fundamentals of quality care – starting with listening, engaging in conversation, showing compassion, and being able to read the non-verbal clue patients share.

As more mundane tasks are automated, and new models for teamwork and management of necessary administrative functions are innovated, we have a moment in time to rediscover the joys and benefits of being able to spend time with patients and their families during traumatic times and over the long haul when managing chronic conditions.

All those of us who work in medical settings are deeply familiar with the increasing requirements for more documentation and administrative work designed to comply with government regulations and healthcare insurance rules.

In theory, major frameworks like the Joint Commission (JC) in the US are setting common standards to improve the quality and safety of care, with an understandable focus on reducing returns to the hospital for infections or other complications. The JC has been so successful, as far as measured results, that hundreds of hospitals and medical centers around the world are investing in educational and management programs enabling them to be certified, opening new doors to international patients with reimbursement at a lower cost to public and private payors.

In theory, comprehensive privacy compliance, like HIPAA, and standard system protocols, like HL7, enable software that allows for system integrity and software integration so the process of providing care can be strengthened, errors reduced, and costs controlled.

In practice, however, the pervasive nature of the combination of all these technologies, combined with overlay Electronic Medical Records (EMR), e-prescribing, real time voice, video and messaging applications runs the risk of turning doctors, nurses and others who entered the medical profession to help human beings into “humanoids” who spend more time at keyboards, computers, smartphones and other devices, typing and tapping throughout their shifts.

For many, so much time spent on the “digital paperwork” (along with actual paperwork which may also be required) contributes to burn-out and a sense of being overwhelmed by tasks so much so that there is less and less time for interacting with patients and thinking through problems with colleagues to serve those patients better.

As software improves following decades of this major move to the digitalization of providing and paying for care, we believe it is a perfect time to step back and rethink the critical importance of “human factors” in healthcare.

Human factors bring us back to the fundamentals of quality care – starting with listening, engaging in conversation, showing compassion, and being able to read the non-verbal clue patients share.

As more mundane tasks are automated, and new models for teamwork and management of necessary administrative functions are innovated, we have a moment in time to rediscover the joys and benefits of being able to spend time with patients and their families during traumatic times and over the long haul when managing chronic conditions.

All those of us who work in medical settings are deeply familiar with the increasing requirements for more documentation and administrative work designed to comply with government regulations and healthcare insurance rules.

In theory, major frameworks like the Joint Commission (JC) in the US are setting common standards to improve the quality and safety of care, with an understandable focus on reducing returns to the hospital for infections or other complications. The JC has been so successful, as far as measured results, that hundreds of hospitals and medical centers around the world are investing in educational and management programs enabling them to be certified, opening new doors to international patients with reimbursement at a lower cost to public and private payors.

In theory, comprehensive privacy compliance, like HIPAA, and standard system protocols, like HL7, enable software that allows for system integrity and software integration so the process of providing care can be strengthened, errors reduced, and costs controlled.

In practice, however, the pervasive nature of the combination of all these technologies, combined with overlay Electronic Medical Records (EMR), e-prescribing, real time voice, video and messaging applications runs the risk of turning doctors, nurses and others who entered the medical profession to help human beings into “humanoids” who spend more time at keyboards, computers, smartphones and other devices, typing and tapping throughout their shifts.

For many, so much time spent on the “digital paperwork” (along with actual paperwork which may also be required) contributes to burn-out and a sense of being overwhelmed by tasks so much so that there is less and less time for interacting with patients and thinking through problems with colleagues to serve those patients better.

As software improves following decades of this major move to the digitalization of providing and paying for care, we believe it is a perfect time to step back and rethink the critical importance of “human factors” in healthcare.

Human factors bring us back to the fundamentals of quality care – starting with listening, engaging in conversation, showing compassion, and being able to read the non-verbal clue patients share.

As more mundane tasks are automated, and new models for teamwork and management of necessary administrative functions are innovated, we have a moment in time to rediscover the joys and benefits of being able to spend time with patients and their families during traumatic times and over the long haul when managing chronic conditions.

Hospitals and healthcare facilities around the world are investing in earning their Joint Commission International accreditation for many good reasons.

The hundreds now being accredited each year are recognized for quality based on metrics developed over the last few decades and applied primarily in the US, where insurers from the government (through Medicare and Medicaid) to massive commercial payors aligned to create uniform quality standards and metrics designed to decrease returns to hospitals and clinics by reducing complications and related costs.

It is no easy feat to become accredited in the US, or elsewhere, as standards are high and the collection of metrics and methodologies for reporting can be daunting. But the rewards for patients, for medical professionals, for operators and administrators and especially for society are great.

New revenue opportunities for organizations outside the US are also great, particularly as insurers in the US are starting to recognize the cost for many procedures and treatments can be dramatically lower, causing the industry to rethink options including subsidized medical travel.

The cost of care varies greatly, and until more and more internationally-based hospitals can achieve accreditation, the opportunity to reduce overall cost-of-care in the US will remain limited, which is driving a tremendous amount of demand for experienced and skilled Joint Commission experts, especially in China, India and other large countries with increasing numbers of doctors and nurses coming out of medical schools.

Here’s a comparison of costs for procedures as an example of the economics behind more and more interest in establishing formal relationships between international hospitals and payors in the US:

While “medical tourism” has been primarily understood as a reasonable solution for voluntary, patient driven procedures including plastic surgery and medical weight loss, we are starting to see steady increases in referring patients for heart and orthopedic surgeries which are being performed at a fraction of the cost for the identical procedure in the US.

This all sounds good, until complications set in, and patients who traveled a great distance have a bad experience and need additional procedures or expensive corrective healthcare to solve for infections or other “unexpected consequences” – and thus, the movement to identifying hospitals for Joint Commission initiatives and ongoing compliance continues to pick up steam.

Different hospitals employ different strategies to prepare for the JCI process, but all are driven is driven by a desire to serve their primary populations better, to improve outcomes, to improve their operations and economics, but also to attract international acclaim and referrals.

Important organizations including the Joint Commission International (JCI), founded in 1994 by The Joint Commission, are making accreditation on a global scale possible. As of 2018, JCI has helped implement programs in more than 90 countries, working alongside other non-profits like the World Health Organization. Remarkably, JCI is growing at an average of 20 percent annually, which is itself a key metric indicating the health of the accreditation movement.

Ultimately, all agree, one of the main benefits of JCI accreditation is in building a culture of accountability within a hospital. “It makes people uncomfortable to report mistakes, but you need an open and transparent environment,” says Pan. Although achieving accreditation back in 2005 took a lot of effort and resources, she adds, now JCI’s international best practices have become a natural part of hospital operations.

According to the JCI website, health care staffing firms seek certification because it:

• Demonstrates commitment to a higher standard of service
• Provides a framework for organizational structure and management
• Provides a competitive edge in the marketplace
• Enhances staff recruitment and development
• Is recognized by insurers and other third parties
• May reduce liability insurance costs
• Certification process

Best practices and better patient outcomes make the effort to become accredited, and remain accredited, worthwhile.

Fundamentally, the process, which requires a significant commitment of not just time, but cultural change and awareness, can change the entire future of international hospitals, giving those who earn and continue to comply the kind of “five-star” rating that the finest restaurants, hotels and airlines benefit from. Only in this case, that rating opens the doors not only to building consumer confidence, but institutional confidence with a stable source of funding when payors create billing relationships.

Hospitals must work very hard with organizations like JCI, including committing to up-front fees for assessments, consulting, and access to systems and technologies, as well as considerable time from leadership and administrative teams.

Preparing for the inspection process can take up to two years, with the accreditation process covering everything from clinical outcomes and safety to sanitation and environmental policies and practices.

One hospital in China reported growing from $30 million in revenue in 2005 to $150 million in 2018 (Beijing United Family Hospital).

Operating costs due to reduction in errors and readmissions are also having a measured impact on economics.

With upfront consulting fees for professional assessments of up to $100 thousand, including time, travel and accommodation costs, the greater expense can often be the time it takes internal staff, trained in the new quality measures and reporting, to effect cultural change. It is not easy to go from hiding mistakes to openly tracking and training staff on how to avoid mistakes as part of an ingrained commitment to providing the highest, most measurable levels of care.

Ongoing maintenance can be a challenge as well, given that assessments happen every three years. Embedding the collection and analysis of data into the daily workflows can be done more easily with software and training, helping accredited hospitals avoid having to “gear up” to be re-accredited.

Finally, for medical professionals – doctors, nurses, nurse-practitioners and specialists – their ability to work collaboratively and travel themselves on medical missions is enhanced as more and more hospitals and healthcare facilities are speaking a common language.

Across the continuum of people, a quality JCI process includes leadership, human resources, performance measurement metrics documents, data input, information management, reporting and readiness for audits.

These three standardized performance measures are the backbone of every successful accreditation and re-accreditation platform:

• Do not return rate for clinical reasons
• Do not return rate for professional reasons
• Completeness of personnel file

The oldest and largest standards-setting and accrediting body in health care in the United States, the Joint Commission evaluates more than 20,000 organizations and “inspires them to excel in providing safe and effective care. Joint Commission Resources (JCR) is the official educator and publisher of Joint Commission standards and serves as an expert resource for performance improvement. JCI is a division of JCR.

 

It seems every time I turn around, I meet another person who had a deeply troubling experience with doctors who failed to listen, failed to believe, and consequently failed to heal.

The healthcare system is under a lot of pressure, whether from changes to how care is insured, to pay for performance guidelines, to increasingly regulations associated with patient privacy and safety, to over-crowded and understaffed emergency rooms, clinics and hospitals.

While it may seem to be more efficient to spend less time listening to patients, and easier to “write off” their own feelings about what may be going wrong with their body, it may ultimately reduce time to listen carefully and allow the patient to guide the diagnosis.

My own family members have recently been ignored when we articulate our symptoms, our concerns, our own ideas of what may be going on – given our increasing knowledge through access to more information, our personal knowledge of family genetics and, our sense of how we are living and what we may be exposed to in the environment and awareness of context and change on our health, one would think physicians would be aware of the value of our information and instincts.

Of course, many physicians are great listeners and healers as a result.

Those who ignore patients and fail to trust them can cause short-term and long-term harm.

In my family’s case, we had to research new specialists knowing we were right – and we were in the end, 100% correct. The cost for us? Delays in getting the right treatment, and emotional stress and frustration for months, even years, as certain doctors simply refused to believe what we shared.

A very successful physician we know diagnosed herself with a bacterial infection which started in her sinuses, and eventually moved into her heart. For months, she went to different doctors and specialists, explained her symptoms, shared her diagnosis and was literally ignored, time after time.

“There is nothing wrong with you,” multiple doctors said, “it is all in your head.”

Just last week, when she could no longer breathe, exercise, think or work, she broke down in front of a colleague, who referred her immediately to a nearby hospital and a particularly great doctor who saw her and immediately admitted her for three days of intensive antibiotic treatments through an IV. This doctor may have saved her heart and life – and it all started with listening – and believing.

One couple here in NYC started a foundation designed to save babies lives after their 8-day old daughter was misdiagnosed after several emergency room visits, by doctors and nurses who told the young mother her child only had a common cold.

One ER doctor even said: “Is this your first child?” When the mother answered “yes” the doctor said, “You’re overreacting.”

They sent the mother and her daughter home that evening, and in the morning, their daughter passed away.

The actual diagnosis?

A viral infection.

There is nothing more devastating than losing a child, and nothing more cruel than dismissing a mother.

This family has now raised tens of millions of dollars to bring neo-natal training, equipment, programs and more to dozens of hospitals in the US and abroad, including several of the largest children’s hospitals in the world.

Modern medicine’s true healing potential can only be achieved when medical professionals have the time and capacity to truly listen to patients, hear their stories, and learn not only what’s the matter with them but also what matters to them.

Hurried care incurs hidden costs and while it may save money in the short term, it wastes money over time and renders real damage to individuals and families.

Listening closely to patients communicates respect and builds trust. Collaboration delivers a shared plan that patients will be more likely to commit to. Reduction of errors and the ability to remain agile and respectful in the process of providing care improves outcomes.

Medical decision making done in concert with patients can be incredibly efficient, and meaningfully authentic.

There are many solutions to ensuring physicians have time to spend listening, including improving systems that reduce paperwork, delegating lower-level tasks to non-physician team members, scheduling appointments more efficiently, and using new secure messaging capabilities that work for the “mobile generation.”

Listening – and believing – may seem elusive, but in fact it is very achievable an it is what patients wish for.