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  • Hospital Impact - Think 'just like me' to improve patient experience
    emotional pain and suffering just like me This person wishes to be free from pain and suffering just like me This person wishes to be safe healthy and loved just like me This person wishes to be happy just like me Now let s allow some wishes to arise I wish for this person to have the strength resources and social support to navigate the difficulties in life I wish for this person to be free from pain and suffering I wish for this person to be happy because this person is a fellow human being just like me According to Meng clinical and non clinical caregivers alike improving their explicit and implicit 3 capacity to perceive others as just like me will achieve at least three clear benefits When we perceive somebody as being similar to ourselves just like me we become much more likely to feel and act positively towards that person Kind and loving thoughts towards another can be generated volitionally Mental habits can be formed with practice so if we spend time and effort creating thoughts of similarity to others and loving kindness over time these thoughts get generated habitually and effortlessly Healthcare organizations can consider at least the following ways to support caregiver empathy Reduce caregiver stress by designing and providing healing spaces that foster wellness and recovery The space may include soft lighting comfortable chairs floor pillows or cushions warmed blankets a misting machine and the option of meditative music Offer emotional intelligence training for your caregivers to strengthen personal and emotional awareness Partner with local accredited meditation practitioners to offer mindfulness meditation training for caregivers Improving our ability to be in the here and now reduces stress and increases positive emotions like empathy Perceiving patients their families and fellow caregivers as just like me can improve patient perceptions and therefore their overall experience along with caregiver satisfaction and fulfillment Compassion becomes real when we recognize our shared humanity Pema Chödrön 1 Increased gray matter volume in the right angular and posterior parahippocampal gyri in loving kindness meditators Soc Cogn Affect Neurosci DOI 10 1093 scan nss076 2 See among other studies listed here Leung Mei Kei Chan Chetwyn C H Yin Jing Lee Chack Fan So Kwok Fai Lee Tatia M C 2012 Kang Y Gray J R Dovidio J F 2013 August 19 The Nondiscriminating Heart Lovingkindness Meditation Training Decreases Implicit Intergroup Bias Journal of Experimental Psychology General Advance online publication doi 10 1037 a0034150 3 See Hofmann S G Grossman P Hinton D E 2011 Loving kindness and compassion meditation Potential for psychological interventions Clinical Psychology Review 31 2011 1126 1132 Doug Della Pietra is the director of Customer Services and Volunteers for Rochester General Hospital in New York where he directs an intentionally designed patient and family centered volunteer program oversees the front line valet and guest services teams and leads the service excellence element of the Patient Experience Initiative while co chairing the hospital s Patient Experience Team Follow

    Original URL path: http://www.hospitalimpact.org/index.php/2014/01/06/title_117 (2016-02-10)
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  • Hospital Impact
    soon as the red circle of lights started chasing each other around the buzzer s perimeter At the 55 minute mark I worried Is the buzzer broken Did they try and call us but we missed our chance Read more Leave a comment Get to know your patients to improve care September 30th 2013 by Doug Della Pietra Tell me something new or something you didn t already know about your patients the nurse manager asked her team Silence awkward silence the kind of silence most of us would want to fill with just about anything Come on you just worked a 12 hour shift she said No one has learned anything new about their patients Silence prevailed that day and the next and the next Undeterred Clare kept asking the question at daily huddles They were doing the work she said but weren t talking to the patient You don t always have to do something for the patient like give meds You can just go in and talk Read more Leave a comment Sow the seeds of empathy to improve patient experience September 3rd 2013 by Doug Della Pietra Last week I posted the following to Twitter and LinkedIn The Wisdom of Giving http ow ly naFzP puts givers in charge of patient experience initiatives to influence the patient experience In his SlideShare Bruce Kasanoff suggests many customer and I suppose patient experience initiatives fail because they are designed and led by takers who he describes as driven more by ego than empathy and who put their own needs above the needs of others In addition takers focus more energy on selling than serving and don t understand customer needs because they don t really listen Read more Leave a comment Prioritize operational standards for patient experience success July 31st 2013 by Doug Della Pietra Does your organization have a prioritized operational framework for the patient experience that would effectively guide the beliefs behavior and ultimate decision of the emergency department doctor in the following example and true story An elderly woman presents with stroke like symptoms After negative test results and failing to satisfy the criteria for admission an ED doctor in Columbia S C planned to send her home but admits her when the woman s family insists Why As the Forbes article Why Rating Your Doctor Is Bad For Your Health from earlier this year explains Her family refused and they told me so Do I call security and escort them out I was more concerned with them giving me a bad patient satisfaction survey score than her going home and having a stroke which he considered highly unlikely Read more Leave a comment Previous Page Next Page 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

    Original URL path: http://www.hospitalimpact.org/index.php?blog=1&s=Doug%20Della%20Pietra&page=1&disp=posts&paged=2 (2016-02-10)
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  • Hospital Impact - ACOs are based on flawed assumptions
    to pay for themselves but not enough for the physician to retire on Ah ha cries the critic You Dr Primary Care don t really have enough in office resources to provide high quality coordinated care I see no educators pharmacists social workers physical therapists specialists subspecialists billing coordinators or dieticians That s costing the health care system money Or according to the experts a primary care practice is too small to provide high quality cost efficient coordinated care because it lacks all of these elements Therein lies the problem The ACO model depends upon the assumption that all health care delivered by primary care physicians in their office is cost inefficient and of lower quality than what an ACO will provide without the necessary evidence Could the care provided by private physician practices be improved Certainly But where is the evidence that the fee for service private physician model of health care is not efficient and does not provide good care The ACO model is still fee for service It s just that the fee will go to a larger organization composed of many more people all fighting for a piece of that dollar and creating costly overhead Do people with the vast majority of medical problems such as acute upper respiratory infections urinary tract infections hypertension and diabetes Do they really need a multidisciplinary task force to take care of them Such is the nature of an ACO Hospitals have certainly jumped on the bandwagon for ACOs with good reason from their point of view Hospitals are an anachronism when it comes to providing cost effective care That s not a bug That s a feature Hospitals are supposed to be for people who cannot be managed as outpatients In fact the irony is that outpatient medical care largely delivered by outpatient physicians in private practice has advanced to the point where hospitals have seen their occupancy rates plummet Few remember the days in the 1950s and 1960s when those who survived heart attacks might spend several weeks recuperating in the hospital Hospitals now employ more than 50 percent of physicians and that number is expected to grow Among reasons cited the new generation of doctor is more interested in lifestyle and security rather than the stress of private practice But in accepting employment offers from hospitals are doctors trading one set of stresses for another I believe so especially if the ACO model is widely adopted Dr Jesse Cole is a radiologist in private practice in Butte Montana He is also subspecialty certified in neuroradiology and vascular and interventional radiology and practices at Big Sky Diagnostic Imaging in Butte with a limited practice at Community Hospital in Anaconda 16 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

    Original URL path: http://www.hospitalimpact.org/index.php/2010/12/01/aco_s_are_based_on_flawed_assumptions (2016-02-10)
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  • Hospital Impact - Reliable clinical research is missing piece of healthcare reform puzzle
    treatment be when up to half of the most acclaimed clinical research can t be trusted according to Dr John Ioannidis who has challenged his peers misleading and simply wrong clinical research In fact he claims that 80 percent of non randomized studies and 25 percent of randomized studies are wrong Add this to the Institute of Medicine s claim that only about half of medicine is based on valid science And it s clear we have a great opportunity to significantly improve the healthcare paradigm and the care we provide to our communities Many amazing caring physicians and other individuals are stuck in the broken healthcare system and it will take these and other selfless caring brilliant people who understand the keys and barriers to real healing to truly fix the care model To achieve that they must understand valid science optimal research methods and the critical need for accessible valid understood and trusted clinical research outcomes It will take true leaders who can leverage adaptive and collaborative leadership skills to rise above the quagmire the misaligned financial drivers the egos and the inherent biases of the current broken healthcare system to make a real and positive difference At a minimum and as a start we need to ensure the following elements of a new healthcare paradigm are in place 1 Physicians must have easy access to unbiased clinical research experts 2 Physicians must be educated on how best to critically review assess and analyze the clinical research for themselves 3 Physicians must have the time to invest in assessing the latest research 4 Physicians must have the time and space to discuss the research data and resulting varied treatment options with trusted colleagues 5 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 6 Physicians and patients must have the time and space to develop real relationships and trust where information flows freely 7 Physicians and patients 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 understood unbiased and trusted clinical research outcomes and which is best suited for the specific patient 8 Outcome goals and metrics for each specific patient must be developed together by the physician and patient assessed regularly and the treatment approach modified as appropriate using a PDCA or plan do check act type approach and again leveraging the now understood and trusted clinical research 9 Physicians must be compensated appropriately for all the above Without valid understood trusted evidence based clinical research what are we truly providing access to Improved access to insurance is not enough and as seen in Massachusetts doesn t lead to better access to care or expense reductions Now is the time to implement these changes We can do better Thomas H Dahlborg M S M is executive director of

    Original URL path: http://www.hospitalimpact.org/index.php/2011/01/02/p1661 (2016-02-10)
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  • Hospital Impact - What a M*A*S*H episode can teach us about patient-centered care
    of his leg meant very little to him while at the same time the negligible side effect to his right hand meant the world Now as a surgeon in a M A S H unit with wounded soldiers being brought in consistently how could Charles possibly know his patient s preferences and yet and yet once Charles realized once he had the time to connect with his patient to sit with him and listen and truly hear his patient s preference we see Charles humanity as his heart is touched and he strives to both learn how he can now help David and actually do so Yes Charles struggles and relies on his own support system Father Mulcahy in this case He also taps into his own experiences and wisdom and with his new understanding and this relationship with David he develops an approach that honors his patient s preferences Don t you see Your hand may be stilled but your gift cannot be silenced if you refuse to let it be The gift does not lie in your hands I have hands David Hands that can make a scalpel sing More than anything in my life I wanted to play but I do not have the gift I can play the notes but I cannot make the music You have performed Liszt Rachmaninoff Chopin Even if you never do so again you ve already known a joy that I will never know as long as I live Because the true gift is in your head and in your heart and in your soul Now you can shut it off forever or you can find new ways to share your gift with the world through the baton the classroom or the pen As to these works they re for you because you and the piano will always be as one As a healthcare leader so many messages from this episode both resonate and reinforce the need for us to ensure we develop systems that Allow our patients to share their whole stories so that we have a better understanding of our patients see them beyond a diagnosis and are clear as to their expectations Allow for these stories to truly be heard understood and honored Allow for an authentic connection between clinician and patient to develop Do not create barriers to this connection Rely on the very best evidence based care as the standard of care AND allow for individualized approaches aligned with the patient s preferences and goals Place an emphasis on relationship trust and compassion for all stakeholders within the healthcare system including patients doctors nurses staff and families and develop supports for each so that each of them each of us remain best positioned to heal and to care for and about one another So yes MaineTV sorry MeTV brought back many memories while also reinforcing how much we must do if we are to truly innovate healthcare and create the healthCARING system we owe to our

    Original URL path: http://www.hospitalimpact.org/index.php/2015/08/13/what_a_m_a_s_h_episode_can_teach_us_abou (2016-02-10)
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  • Hospital Impact - A reminder for health leaders to emphasize relationship-centered care
    relationship centered care I try to honor this philosophy and approach in all of my encounters with patients One day I saw on my schedule that I would be meeting with Mrs Smith name changed She is a 54 year old Caucasian woman who had seen members of my care team for 10 or so years but this was my first appointment with her I reviewed her file her previous test results her most recent test results her MRIs over time and I was so very excited to meet with her I walked in and introduced myself I sat across from Mrs Smith We made and held eye contact and we began to talk I learned more about Mrs Smith and she learned more about me And after a good amount of sharing I excitedly said Mrs Smith I have reviewed all of your tests and I have great news You do not have MS multiple sclerosis Well Tom here I am thinking I am delivering wonderful news But no Mrs Smith was furious and was adamant that she had MS Dr Michaels said I have a touch of MS He has been treating me for years You must be wrong I want to see MY doctor again I couldn t believe it I thought I had done the right thing I researched her file I ensured I introduced myself I began to connect with Mrs Smith I was transparent I assumed this would be good news And that was one of my mistakes I assumed As I said this was my first time meeting Mrs Smith I had not established a relationship with her to date I tried to connect during our albeit limited time together but it was not enough We did not have years of continuous learning and sharing together I did not understand the emotional and mental aspects of her illness and how they were being impacted I did not realize her very identity was now so thoroughly connected to her illness MS that my news was actually devastating to her I did not know Tom this incident serves as a reminder to me that relationships cannot be hurried Relationships take time This situation also serves to remind me that the emotional mental and spiritual dimensions of health and healing must be embraced by the care team Only focusing on the physical aspect of health will inadvertently cause harm like I did Looking back if I could do over my visit with Mrs Smith I would have discussed her history with her in a far different way We would have discussed the various dimensions of her health and healing I would have sought deeper understanding I would have leveraged my training skills intuition and wisdom and developed with Mrs Smith a pathway that would have helped rather than harmed This is how I practice now This is how I teach and this is how I lead And as a healthcare leader it is my responsibility to

    Original URL path: http://www.hospitalimpact.org/index.php/2015/07/09/a_reminder_for_health_leaders_to_emphasi (2016-02-10)
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  • Hospital Impact - Chief nursing officer's tale highlights need for empathy in healthcare
    head and leaning in as I spoke And when I stopped to take a breath he shared Yes This is so true I have seen this same occurrence throughout my own journey as a healthcare leader and am appalled that to date we have not made the necessary improvements to allow for such critical information to be shared We have failed our patients and our clinicians in many ways and must do better The confirmation of what I have seen and the need to improve was one thing but then he continued with a story that actually caught me off guard Some years ago I was working in a rural community as an Interim CNO I was getting to know my team and developing my plan to improve the nursing systems currently in place and yet something was gnawing at me At first I could not put my finger on it but something was wrong Something was truly wrong with my nursing team I looked in the mirror I looked at our aim the plans we were creating our pathway to improvement and all were in line with successful endeavors in my past But here something was very wrong After much processing I made my way to Human Resources and there without consciously thinking about it I shared my nursing team they act as if they have all been victims of abuse Tom I was blown away when the response I received was Don t you know This county has the highest rate of childhood abuse in the state Many of the people on your team were victims of childhood abuse Not only was I shocked to hear this I was also so very disappointed in myself that I did not know the stats and more importantly did not recognize more quickly the challenges many members of my nursing team were facing The next day I brought my team together and I apologized I apologized for my behavior and for my lack of awareness And together slowly at first we began to develop a relationship We began to share and to develop trust as you referenced We began to share stories and connect at a much deeper and a much more important level And together we began to ensure they our team were healing while they also ensured our patients were healing Childhood abuse impacts our patients and their families It may also be affecting members of our organizations and of our teams and perhaps some of us As healthcare leaders it is incumbent upon us to be aware to develop healthCARING models for both our patients and families and our team members and ourselves that allow for time relationship trust and for whole stories to be told heard and together acted upon as appropriate Only when we have invested the time and energy to do so will we truly be honoring those we are blessed to serve improving patient and clinician experience improving patient safety and providing optimal care

    Original URL path: http://www.hospitalimpact.org/index.php/2015/06/18/title_134 (2016-02-10)
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  • Hospital Impact - The bane of many physicians: The "non-compliant" patient
    the physicians would take the easy road Heifetz and Linsky write playing it safe by pandering to the desire for a technical fix avoiding the difficult conversations rather than disturbing people in an attempt to change the ways they lived Patient non compliance that s the medical industry s term is actually not a patient failure but rather another data point to be assessed and another opportunity to re engage creatively with the patient perhaps with the help of others To re engage creatively it s important to create a healing environment where trust can grow This allows the patient the space to tell his or her story the opportunity to share in a safe place fears goals and dreams And with time nurturing and trust the patient and physician can co create a strategy to address the patient s fears and achieve the patient s goals and dreams Sometimes a patient is not ready to hear to believe or to follow a physician defined and dictated care plan Sometimes a patient needs to first overcome a mental health barrier a financial barrier an environmental barrier or a spiritual barrier before being ready to address a physical challenge and follow a prescribed care plan These patients are not non compliant they simply have more steps to complete at the beginning of the process before engaging and arriving at a place where they are ready to either accept the advice and input of the physician or ideally co create a patient specific healing journey If we truly want to create a healthy health care system than we must create an environment where the practitioner has the time relationship and patient s trust to assess and identify the real barriers to healing those early steps in the process that must be addressed Then together they must take the opportunity to co create a healing journey that will best position the patient to achieve specific health goals To meet the patient where he is at and begin the co created plan at that point a truly patient centered and patient specific approach to healing is key We must lose the ego that exists in the system lose the hierarchical approach to healing and truly engage with and help patients get well 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 7 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

    Original URL path: http://www.hospitalimpact.org/index.php/2010/11/03/the_bane_of_many_physicians_the_a_non_co (2016-02-10)
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