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  • Hospital Impact - Patient experience vs. patient care: Healthcare isn't Disney World
    H and his work at Vanderbilt University Medical Center to learn more And I am so glad I did In the piece Undone in the ICU by Kathy Whitney Dr Ely highlights a specific disconnect between patient experience and care in a very vivid and profound way If a patient comes into the ICU and is dramatically sick he is put on a ventilator The old way of thinking was You are so sick we don t want you to remember any of this We are going to sedate you with drugs tie you down protect you from yourself and when we think you re better we ll wake you up in six or seven days In the meantime the patient has now acquired brain disease and body disease his muscles brain and nerves are all screwed up and it s not just because of the disease he came in with We created more of a disease for him by immobilizing him with both chemical and physical restraints We actually poured kerosene on the fire and made things worse This is an example of a good intention and yet both poor execution and bad outcome The good intention is the goal of we don t want you to remember any of this patient experience The poor execution includes the lack of engaging the patient and family to ensure their preferences were made known and honored And the bad outcome is the ICU delirium experienced by the patients the harm to families watching their family member restrained and the damage to the muscles and nerves all due to the sedation and physical restraints Improved patient experience That was a goal And if the patient was truly sedated and unaware perhaps even achieved but only in the short term And yet the care was not optimal and true harm was done Improved patient experience must not be the end goal Improved health CARE healthCARING must be And to achieve that We must develop authentic relationships and trust with patients and families We must engage with them We must hear their whole stories We must understand their preferences We must develop implement and measure the impact of evidence based protocols such as the delirium protocol referenced below that serve to achieve optimal CARE outcomes And we must not lose focus on care as we seek to improve experience Thank you Doug for sharing as always such engaging and informative information Thank you Dr Blackwelder for sharing such great wisdom Thank you Roberta for educating me on ICU delirium and directing me to the work of Dr Ely And thank you Dr Ely and your team at Vanderbilt for all your efforts to improve the care for ICU patients There are brilliant flames within the broken healthcare system that we need to fan so that they do not go out And this is a wonderful example Now let s all set our aim on healthCARING and ensure we support one another to stay the

    Original URL path: http://www.hospitalimpact.org/index.php/2015/12/10/p5705 (2016-02-10)
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  • Hospital Impact - Time to break down the barriers getting in the way of ACO success
    in Minnesota where the healthcare market tends to be ahead of the curve fee for service payment still dominates in Minnesota with only a small portion of revenues tied to ACO arrangements Two thirds of surveyed providers indicated that 10 percent or less of their organization s revenue was at risk a quarter of respondents expected to see that figure rise to 30 percent by 2020 Thus even in an advanced market we are still four years away from less than a third of healthcare revenues being tied to keeping patients healthy So what does this tell us Does this tell us that the ACO concept is wrong Does this tell us that we should stop trying to coordinate high quality care in order to ensure that patients especially the chronically ill get the right care at the right time while avoiding unnecessary duplication of services and preventing medical errors Absolutely not There remain positive flames we must continue to fan within the ACO model According to Richard Barasch in the same KHN report within ACOs They physicians work hard to get their quality scores where they think they should be and when they re not the doctors are very very chagrined Hospitalizations in 2014 decreased on average by 11 percent for beneficiaries with chronic obstructive pulmonary disease for example and by 8 percent for those with congestive heart failure So let s focus on the positive aspects of the ACO and the mission we must fulfill The aim of the ACO is correct There is much energy passion and momentum in achieving this aim There is much history we can learn from to mitigate our missteps as we proceed on this journey We can measure the impact of the ACO There are parent partners and patient and family advisers throughout the nation ready to help The healthcare industry is beginning to embrace relationship centered and compassionate care and creating systems to ensure all people and organizations throughout the healthcare system are whole and well positioned to be of service and care for one another There is a great need for us to get this right as efficiently and effectively as possible It is not simply a matter of financial impact it is a matter of our families our friends our neighbors and our communities being harmed by the brokenness of the current system we have created The longer we wait to evolve and improve the system the more harm is being done to those we most care about Now we must move beyond politics and ego We must move out of our unproductive entrenchments We must transcend limited beliefs and thinking We must call upon the servant leader within all of us and together and collaboratively break down the barriers to achieving the aim of the ACO evolve the model and get it right and honor all those we love We do not have four years The damage will be is too great Now is the time Thomas H

    Original URL path: http://www.hospitalimpact.org/index.php/2015/11/05/title_143 (2016-02-10)
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  • Hospital Impact - ACOs: Wolves in sheep's clothing
    cost savings target A percentage of the cost savings below the target will then be shared with the ACOs And according to CMS An ACO will share in savings if program criteria are met but will not incur a payment penalty if savings targets are not achieved Now raise your hand if this rings a bell For those who still have their hand up Correct The Harvard Pilgrim Health Care joint venture arrangements with its contracted PHOs during the time period leading up to Harvard Pilgrim s receivership included a similar methodology Shared savings opportunities with the PHOs with no downside risk to the PHO So what happened The provider organizations quickly realized that the financial incentives were not optimally aligned with working diligently to reduce medical costs with the provider organization s hopes of sharing a percentage of some potential savings Rather the financial incentives were better aligned with the provider organizations continuing to leverage existing and new services centers of excellence expensive procedures technology efficiency improvements focused on boosting productivity and other revenue generating activities aimed at generating productivity based revenues as opposed to working diligently to reduce medical costs while improving efficiency Again you see no downside risk and no requirement or true incentive to significantly change existing PHO business practices This approach was tried did not work in the past and is now being repackaged and tried again as part of the ACO model This is a technical fix based on a flawed model when what we truly need is an adaptive solution It is time for visionary and creative leaders to come together eliminate ego have those challenging conversations break down barriers and focus solely and truly on improving the health of individuals and communities Any fix is not better than no fix The any fix can waste time energy money and other resources and can be dangerous Our communities deserve better Thomas H Dahlborg M S M is executive director of the physician practice True North Health Center where he focuses on improving growth while ensuring access for the uninsured and the elderly He has 21 years of experience creating competitive advantages analyzing customer expectations and developing and implementing focused and aligned strategic deployment plans Formerly he served as the chief business strategy officer at Network Health a comprehensive Medicaid health plan based in Cambridge Mass and was COO of the U S Family Health Plan at Martin s Point Health Care in Portland Maine 2 comments Please enable JavaScript to view the comments powered by Disqus Enter your search terms Submit search form Web www hospitalimpact org Get Hospital Impact in your inbox Healthcare Industry news Final Obama budget takes aim at opioid addiction superbugs Zika outbreak White House seeks 1 8B to respond to virus More hospitals replace nurseries with rooming in with moms Hospitals must train millennial nurse leaders in empathy frontline engagement St Louis hospital creates unit to improve outcomes through innovation 4 ways hospitals can foster family centered care

    Original URL path: http://www.hospitalimpact.org/index.php/2010/12/15/acos_a_wolf_in_sheep_s_clothing (2016-02-10)
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  • Hospital Impact - Time to break down the barriers getting in the way of ACO success
    in Minnesota where the healthcare market tends to be ahead of the curve fee for service payment still dominates in Minnesota with only a small portion of revenues tied to ACO arrangements Two thirds of surveyed providers indicated that 10 percent or less of their organization s revenue was at risk a quarter of respondents expected to see that figure rise to 30 percent by 2020 Thus even in an advanced market we are still four years away from less than a third of healthcare revenues being tied to keeping patients healthy So what does this tell us Does this tell us that the ACO concept is wrong Does this tell us that we should stop trying to coordinate high quality care in order to ensure that patients especially the chronically ill get the right care at the right time while avoiding unnecessary duplication of services and preventing medical errors Absolutely not There remain positive flames we must continue to fan within the ACO model According to Richard Barasch in the same KHN report within ACOs They physicians work hard to get their quality scores where they think they should be and when they re not the doctors are very very chagrined Hospitalizations in 2014 decreased on average by 11 percent for beneficiaries with chronic obstructive pulmonary disease for example and by 8 percent for those with congestive heart failure So let s focus on the positive aspects of the ACO and the mission we must fulfill The aim of the ACO is correct There is much energy passion and momentum in achieving this aim There is much history we can learn from to mitigate our missteps as we proceed on this journey We can measure the impact of the ACO There are parent partners and patient and family advisers throughout the nation ready to help The healthcare industry is beginning to embrace relationship centered and compassionate care and creating systems to ensure all people and organizations throughout the healthcare system are whole and well positioned to be of service and care for one another There is a great need for us to get this right as efficiently and effectively as possible It is not simply a matter of financial impact it is a matter of our families our friends our neighbors and our communities being harmed by the brokenness of the current system we have created The longer we wait to evolve and improve the system the more harm is being done to those we most care about Now we must move beyond politics and ego We must move out of our unproductive entrenchments We must transcend limited beliefs and thinking We must call upon the servant leader within all of us and together and collaboratively break down the barriers to achieving the aim of the ACO evolve the model and get it right and honor all those we love We do not have four years The damage will be is too great Now is the time Thomas H

    Original URL path: http://www.hospitalimpact.org/index.php/2015/11/05/p5689 (2016-02-10)
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  • Hospital Impact - When hospital CEOs issue clinical directives, healthcare suffers
    the exact opposite This is hospital centric care And it is so with the specific intent of generating additional revenue for the institution We talk about patient education It doesn t seem to me that this CEO directive would allow room for optimal patient education in which the patient would be fully aware of all the options available and their risks prior to a treatment decision being made We all or many of us say we want to ensure we develop partnerships with patients yet in a true partnership there would be an authentic relationship transparency trust and optimal communication and sharing There is much discussion about shared decision making and yet in this scenario clearly the decision has already been made and the focus has turned to the implementation of the decision the surgery Reducing per capita costs is reportedly a priority in the healthcare system and yet this directive in many cases will increase costs if in fact a lower cost with less risk option is available and appropriate Patient engagement Maybe surface engagement as the decision is implemented But an authentic relationship transparency with trust and optimal communication for informed decision making Not quite Patient experience is another purported high priority within the healthcare system and while it is possible that patients will have a positive experience in this scenario but if they were fully aware that other options may have been available to them and also aware of the risk they faced without fully understanding the other options I would surmise their experience score would decrease significantly A podiatric surgeon is trained to assess the patient as a whole and provide a range of non surgical medical and surgical interventions according to the College of Podiatry The clinical performance of the podiatric surgeon should be guided by professional standards against which the podiatric surgeon may be judged And absolutely a surgical intervention may in fact be the best option for a patient But a healthcare administrator must NEVER take this decision making into his or her own hands As non clinical healthcare leaders our jobs are to ensure patients families and clinicians are best positioned for shared decision making that they have access to the best information available in which to make decisions and optimal understanding of this information and have the space and tools to co create care pathways that are appropriate and aligned with the patients preferences When we do this together we will measurably improve patient safety patient experience and patient outcomes We will also reduce the cost of care and in doing so will be better positioned to re invest these savings in additional areas to positively impact our patients families and communities Anything less is unacceptable Thomas H Dahlborg M S M is an industry voice for relationship centered and compassionate care keynote speaker author consultant and adviser Leave a comment Please enable JavaScript to view the comments powered by Disqus Enter your search terms Submit search form Web www hospitalimpact

    Original URL path: http://www.hospitalimpact.org/index.php/2015/10/01/title_140 (2016-02-10)
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  • Hospital Impact - When hospital CEOs issue clinical directives, healthcare suffers
    the exact opposite This is hospital centric care And it is so with the specific intent of generating additional revenue for the institution We talk about patient education It doesn t seem to me that this CEO directive would allow room for optimal patient education in which the patient would be fully aware of all the options available and their risks prior to a treatment decision being made We all or many of us say we want to ensure we develop partnerships with patients yet in a true partnership there would be an authentic relationship transparency trust and optimal communication and sharing There is much discussion about shared decision making and yet in this scenario clearly the decision has already been made and the focus has turned to the implementation of the decision the surgery Reducing per capita costs is reportedly a priority in the healthcare system and yet this directive in many cases will increase costs if in fact a lower cost with less risk option is available and appropriate Patient engagement Maybe surface engagement as the decision is implemented But an authentic relationship transparency with trust and optimal communication for informed decision making Not quite Patient experience is another purported high priority within the healthcare system and while it is possible that patients will have a positive experience in this scenario but if they were fully aware that other options may have been available to them and also aware of the risk they faced without fully understanding the other options I would surmise their experience score would decrease significantly A podiatric surgeon is trained to assess the patient as a whole and provide a range of non surgical medical and surgical interventions according to the College of Podiatry The clinical performance of the podiatric surgeon should be guided by professional standards against which the podiatric surgeon may be judged And absolutely a surgical intervention may in fact be the best option for a patient But a healthcare administrator must NEVER take this decision making into his or her own hands As non clinical healthcare leaders our jobs are to ensure patients families and clinicians are best positioned for shared decision making that they have access to the best information available in which to make decisions and optimal understanding of this information and have the space and tools to co create care pathways that are appropriate and aligned with the patients preferences When we do this together we will measurably improve patient safety patient experience and patient outcomes We will also reduce the cost of care and in doing so will be better positioned to re invest these savings in additional areas to positively impact our patients families and communities Anything less is unacceptable Thomas H Dahlborg M S M is an industry voice for relationship centered and compassionate care keynote speaker author consultant and adviser Leave a comment Please enable JavaScript to view the comments powered by Disqus Enter your search terms Submit search form Web www hospitalimpact

    Original URL path: http://www.hospitalimpact.org/index.php/2015/10/01/p5674 (2016-02-10)
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  • Hospital Impact - A long-ago football injury and the case for better evidence-based care
    percent of cognitive psychology studies were able to be replicated meaning that for all the others the originally reported findings vanished when other scientists repeated the experiments Why is this important as we seek to improve the health of our patients families and communities Because similar to the intervention for the unhappy triad which was eventually proven dangerous mental health interventions are based on the evidence stemming from psychology research outcomes And based on this study there is a 64 percent failure rate even among papers published in the best journals in the field John Ioannidis professor of health research and policy at Stanford University between the social and cognitive psychology studies told The Guardian And yet interventions that affect patients families and communities remain reliant on these outcomes But this is not new As I shared back in the 2011 piece Reliable clinical research is missing piece of healthcare reform puzzle the Institute of Medicine has claimed that only about half of medicine is based on valid science Ioannidis also noted at that time that 80 percent of non randomized studies and 25 percent of randomized studies are wrong And again healthcare treatments continue to become the standard of care based on these studies We can do better As research improves we healthcare leaders in the meantime must develop new systems to better position clinicians patients families and communities to optimize the challenging research outcomes within this broken system And in fact in the 2011 piece referenced above I highlight a process to do so that also leverages relationship centered care principles which I update here At a minimum we need to ensure the following elements of a new healthcare paradigm are in place Physicians must have easy access to clinical research experts with all biases clear and understood noting there is always bias Physicians must be educated on how best to critically review assess and analyze the clinical research for themselves Physicians must have the time to invest in assessing the latest research Physicians must have the time and space to discuss the research data and resulting varied treatment options with trusted colleagues and experts Physicians must have the opportunity to leverage the now understood clinical research and discuss a challenging patient situation and or a best practice in a safe setting with trusted colleagues Physicians and patients and families when appropriate must have the time and space to develop real relationships and trust where information flows freely and where whole stories are told heard and understood Physicians and patients and families when appropriate must have the time and space to get to the root cause of a symptom and co create a treatment plan that is based on accessible valid clear bias understood and trusted clinical research outcomes and that is best suited for the specific patient Outcome goals and metrics for each specific patient must be developed together by the physician and patient and families when appropriate assessed regularly and the treatment approach modified as appropriate

    Original URL path: http://www.hospitalimpact.org/index.php/2015/09/10/title_137 (2016-02-10)
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  • Hospital Impact - A long-ago football injury and the case for better evidence-based care
    percent of cognitive psychology studies were able to be replicated meaning that for all the others the originally reported findings vanished when other scientists repeated the experiments Why is this important as we seek to improve the health of our patients families and communities Because similar to the intervention for the unhappy triad which was eventually proven dangerous mental health interventions are based on the evidence stemming from psychology research outcomes And based on this study there is a 64 percent failure rate even among papers published in the best journals in the field John Ioannidis professor of health research and policy at Stanford University between the social and cognitive psychology studies told The Guardian And yet interventions that affect patients families and communities remain reliant on these outcomes But this is not new As I shared back in the 2011 piece Reliable clinical research is missing piece of healthcare reform puzzle the Institute of Medicine has claimed that only about half of medicine is based on valid science Ioannidis also noted at that time that 80 percent of non randomized studies and 25 percent of randomized studies are wrong And again healthcare treatments continue to become the standard of care based on these studies We can do better As research improves we healthcare leaders in the meantime must develop new systems to better position clinicians patients families and communities to optimize the challenging research outcomes within this broken system And in fact in the 2011 piece referenced above I highlight a process to do so that also leverages relationship centered care principles which I update here At a minimum we need to ensure the following elements of a new healthcare paradigm are in place Physicians must have easy access to clinical research experts with all biases clear and understood noting there is always bias Physicians must be educated on how best to critically review assess and analyze the clinical research for themselves Physicians must have the time to invest in assessing the latest research Physicians must have the time and space to discuss the research data and resulting varied treatment options with trusted colleagues and experts Physicians must have the opportunity to leverage the now understood clinical research and discuss a challenging patient situation and or a best practice in a safe setting with trusted colleagues Physicians and patients and families when appropriate must have the time and space to develop real relationships and trust where information flows freely and where whole stories are told heard and understood Physicians and patients and families when appropriate must have the time and space to get to the root cause of a symptom and co create a treatment plan that is based on accessible valid clear bias understood and trusted clinical research outcomes and that is best suited for the specific patient Outcome goals and metrics for each specific patient must be developed together by the physician and patient and families when appropriate assessed regularly and the treatment approach modified as appropriate

    Original URL path: http://www.hospitalimpact.org/index.php/2015/09/10/p5664 (2016-02-10)
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