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  • Hospital Impact - What healthcare leaders can learn from a home health nurse
    there was a real connection between patient me and medical professional The technician asked about me the whole person she addressed my concerns regarding the treadmill and my hip replaced a few years back and I felt cared for and about The physician and registered nurse who administered the stress test were like Penn Teller and had the timing down to a T in terms of when I would feel this or that They care about me We were in this together Ray my nurse even placed his hand lightly on my shoulder for encouragement when he saw I was troubled A compassionate human touch How I needed that They cared about me and it was tangible I felt a safety net My fears were subsiding By definition working in home health this nurse has the opportunity to go into people s homes She sees photos and interesting knick knacks She has her own patient panel and yet the system she works within provides her with the opportunity to assess the patient s environment and the time to connect and to listen to and see much of the patient s whole story She can reference a photo of her patient at Disney World and learn Oh that is me with my grandchild going to see Minnie Mouse How I hope to be able to walk with no pain again so we can go back this spring The home health system positions home health nurses to connect with patients and families far better than many most hospital systems Tools e g pictures are readily available as is time to make important connections and turn a diagnosis with a patient into a patient with a diagnosis To ask about fears to reach out and hold a hand to show your patient you hear them That you care In other words as my friend shared I am fortunate to have the opportunity to view my patients as whole people and not simply as the chest pain in bay 8 I am positioned to know to learn to care and to leverage all of this to co create with my patients a care plan which positions them to achieve their goal e g walking with their grandchild to see Minnie Mouse in Disney World And best of all they know that I care about them as people and that I am there for them As we strive to ensure healthcare becomes healthCARING and as we redesign systems to improve patient experience and instill compassion in healing we health leaders must continue to learn much from those who work in home health For example we must continue to develop tools such as the Patient Passport which includes a photo the patient loves and home descriptors and the This is Me tool which also includes photos along with space for life goals preferred activities communication style and interaction tips All information home health nurses have access to on a daily basis with the patients they serve

    Original URL path: http://www.hospitalimpact.org/index.php/2015/04/30/what_healthcare_leaders_can_learn_from_a (2016-02-10)
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  • Hospital Impact - How leading from behind can transform healthcare
    the brokenness honor these healers and better position them to be successful and rediscover joy in healing With a variety of opinions offered health leaders highlighted the need for innovation in healthcare financing aligned with new care model designs We discussed with great interest and engagement the need for a new vision that would be shared with confidence and implemented effectively And then it happened The subject of leadership approaches and styles came up and I said My preference is to lead from behind And aside from the visceral reaction of You do what the room became silent You know the old saying the silence was deafening I have now truly experienced this phenomenon Note I have tried to live my professional life according to an S3 Leadership Style Servant S1 it s not about me it s about the mission Steward S2 it s not mine and thus the careful and responsible management of all entrusted to my care Shepherd S3 people are precious And especially over the past 9 plus years I have focused on improving my shepherding leadership skills A leader he is like a shepherd He stays behind the flock letting the most nimble go out ahead whereupon the others follow not realizing that all along they are being directed from behind Nelson Mandela as per Linda A Hill HBR I have focused on developing and leading from behind agile strong confident S3 team members leaders who are energized by and dedicated to the mission compassionate and caring about their team and their community about themselves and about all those they we serve And I ensure they are well positioned to truly make a difference And yet And yet these amazing leaders sitting around the table with me and engaged so deeply in improving care for our patients families and communities were not familiar with this form of leadership And in fact the term leading from behind was perceived as a negative as a way to not lead but rather to follow in its weakest connotation So what happened next We had an amazing discussion of leadership philosophy and impact We discussed great leaders and their visions principles and influence We honored one another s perspective we listened to one another and we made note of our observations without judgment We learned from one another we each grew and we each noted how this learning and sharing has better positioned each one of us to achieve our missions So today let s continue to lead to learn and to share together Questions for your consideration What is your leadership philosophy How do you manifest this philosophy What difference are you making How do you measure the impact of your philosophy How are you serving those you are blessed to lead Let s learn and lead together as together we improve the healthcare system for all Thomas H Dahlborg M S M is chief financial officer and vice president of strategy for NICHQ National Institute for Children

    Original URL path: http://www.hospitalimpact.org/index.php/2015/02/26/how_leading_from_behind_can_transform_he (2016-02-10)
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  • Hospital Impact
    Dahlborg The goal of an ACO is 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 according to the Centers for Medicare Medicaid Services This is clearly a critically important goal to achieve if we are to honor our patients keep them safe and best position them to achieve their optimal health outcomes In a 2010 post for Hospital Impact I shared my concerns regarding the accountable care organization model based on the experience of Harvard Pilgrim Health Care and its PHO risk sharing revenue sharing model in the 1990s Read more Leave a comment When hospital CEOs issue clinical directives healthcare suffers October 1st 2015 by Thomas Dahlborg If there is a surgical intervention option as well as another treatment option available make sure you go the surgical route Are you serious Jim I responded The CEO of your hospital said this to your new podiatric surgeon Yes We had recently brought on this podiatric surgeon and the hospital CEO made it very clear to him early on that the expectation is increased numbers of surgeries and if in fact there are multiple treatment options the surgical option overrides all others So a hospital administrator is now making specific healthcare decisions for the patients families and clinicians at your hospital That s exactly right It is shameful it is harmful and it is wrong And yet it is happening This is an excerpt from a recent discussion I had with a former rural hospital medical director and current quality improvement expert And unfortunately even though I want to say I am surprised I am not as I have heard similar type stories quite frequently Such as the hospital CEO who is also a physician telling me directly that quality of care was not his highest priority because he was focusing on the financial health of his institution Read more Leave a comment A long ago football injury and the case for better evidence based care September 10th 2015 by Thomas Dahlborg If you have played football at any level or perhaps if you have a fantasy football team and all of a sudden care about sports related injuries you are probably familiar with the term Unhappy Triad The unhappy triad is a severe knee injury involving the full or partial tears of the Anterior Cruciate Ligament the Medial Collateral Ligament and a tear of the Medial Meniscus Back in 1984 while playing football in college I decided to do one or two better In addition to tearing the two ligaments and the cartilage listed above I also tore the Posterior Cruciate and Medial Collateral ligaments My orthopedic surgeon at that time said You literally have nothing holding your knee together Well there goes my dream pipe dream that is of joining the Dallas Cowboys as a slot receiver Why do I tell you this In

    Original URL path: http://www.hospitalimpact.org/index.php?blog=1&s=Thomas%20Dahlborg&page=1&disp=posts&paged=1 (2016-02-10)
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  • Hospital Impact
    noted above it is the ritual of the visit I told my son It is us bonding together in something we both enjoy it is the opportunity for us to take a breath and focus on our relationship and the love we share as father and son and doing so as we break bread and it is us doing so while joining in community with others It is this ritual I believe that enhances the experience and creates the specialness of going to Starbucks together And as I was sharing my thoughts I recalled and understood that my response to my son was inspired by the amazing TED Talk by Dr Abraham Verghese A Doctor s Touch in which he brilliantly discusses the importance of ritual in the healing encounter Read more Leave a comment Modeling behavior to improve care November 13th 2014 by Thomas Dahlborg Being the dad of Miss Maine USA 2014 still feels brand new even as my daughter Samantha winds her way through the final few weeks of her reign In this role Sammy had amazing opportunities to support such worthy causes as the Muscular Dystrophy Association Camp Sunshine Maine Women s Fund and so many others as she learned grew and blossomed over this past year During this time she opted to create and follow a course which leads to the modeling industry And this is where I rediscovered the importance of Swanson s Caring Model to achieving optimal outcomes Read more Leave a comment Develop patient engagement tools for optimal care satisfaction October 2nd 2014 by Thomas Dahlborg Patient centered care patient engagement patient activation all terms many of us healthcare leaders use to describe a key output of improving the healthcare system I write a lot about these topics and recently made note of misconceptions and lessons learned specific to these very important focal points A patient s activation and engagement will vary over time and perhaps from visit to visit based on many factors To truly provide patient centered care providers must understand the patient s whole and ever evolving story Patient centered care includes determining what your specific patient needs at that specific time Patient centered care requires truly and authentically connecting with the patient at each and every healthcare encounter Patient centered care recognizes that each patient is different and so is each patient s optimal level of activation and engagement Read more Leave a comment Support patients emotionally to foster full recovery September 4th 2014 by Thomas Dahlborg An incredibly special person recently came into my life She is kind heart centered smart and caring For this blog post I will refer to her as Hope Over the last number of weeks Hope and I shared a lot of time together and developed a relationship and trust In so doing we shared many stories One recent story Hope shared truly caught my attention as it aligns so well with some of my previous Hospital Impact blog posts Unfortunately not

    Original URL path: http://www.hospitalimpact.org/index.php?blog=1&s=Thomas%20Dahlborg&page=1&disp=posts&paged=3 (2016-02-10)
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  • Hospital Impact - Big data plus observation paints complete picture of urgent-care trend
    percent of typical UCC patients are female but the number of men users was unexpectedly large But people s experiences told quite another story To get a true picture of what is going in on any behavioral setting pure data is not enough It was the stories that people told about their UCC experiences that added additional dimensions to the data and gave it meaning Yes they were going to UCCs to get care but their motivations and expectations were not easily captured in the big data points One unexpected finding We saw a lot of men at all times of the day We knew from the data that only 66 percent of men have primary care doctors As we watched and then interviewed men coming to UCCs we heard a common story They wanted easy access to a healthcare provider They sought a place where they could be seen quickly All doctors were the same so it didn t matter where they went or which doctor they saw They often were there because someone had pushed them to take care of themselves spouse partner housemate or employer They had little interest in committing to a primary care physician s care They were not going to take the time to see a specialist for back pain or a sprained ankle A smile would have been nice but fast and easy was what mattered Urgent care centers fit into people s busy lives which is why they re so popular duh The tradeoff They re impersonal One woman told us that when she needed urgent care she would drive by a UCC to see how many cars were outside If there were more than three she went to the next one Little loyalty and a lot of commoditization marked these centers Another person only went to a UCC early in the morning so she could get to work A third used it for her prenatal care because she worked and had no one to leave her children with at night Most tellingly though interviewees told us that the UCC doctors didn t even give their names no cards were exchanged and little effort was made to engage them in a longer term relationship Also there was little care provided after the encounter even though when we spoke with these people they were still not feeling well Where were these stories in the big data Without big data it would be hard to see these individual stories in a bigger context Yet without observational research it would have been hard to capture the role that urgent care centers are now playing in people s healthcare lives It is when you join the two elements together big data and ethnographic research that you can begin to evaluate what the healthcare system is attempting to provide for consumers and if urgent care centers are offering patients the type of experiences the healthcare brand promised Hospital personnel Today s patients are rejecting your patient experience

    Original URL path: http://www.hospitalimpact.org/index.php/2015/11/24/big_data_and_storytelling_the_necessary_2 (2016-02-10)
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  • Hospital Impact - Big data and storytelling: The necessary duo in healthcare
    in your solutions not those of others Also the stories should build on experiences so that your new healthcare models come alive and deliver on the consumer s expectations And finally the stories need to mean something to the consumer not be all about you What can big data tell us about a healthcare user s journey It doesn t matter if it s someone with heart disease or a person seeking bariatric surgery there is clearly a need to move beyond the point in time when a patient meets with a doctor or healthcare provider to get care There is the prequel moment sometimes years before the person gets to that encounter and the sequel that continues long afterward In the process those healthcare providers become part of a person s bigger story For example for people who have had a recent heart attack their buyer s journey story in the data might look like this 1 Their visits to their doctors increased for a period of time before their attack 2 Patients who had heart attacks had been to the doctor on average between 1 3 months before their attack As we thought about this we wondered where in the story those doctors were working to prevent that heart attack with that patient 3 For healthcare providers this was both an interesting data point and a potentially important insight But it was perplexing How could they use this data What does it mean for their treatment of a patient What are they missing as they tell their own stories about why that patient ended up with a heart attack 4 Moreover the data is hidden in an abundance of places If you look at a patients journey map you can imagine how they might move through life until they have encounters with physicians or healthcare systems What is the real story in the data As a result while we search data to understand a population s or a person s healthcare journey there is something else happening here a person s own story that gives that journey meaning People are always searching for the truth There are different stories in the data What we need to better understand is what these stories mean to the people who are living them And then how to use that meaning to help healthcare providers deliver better care to prevent those heart attacks and keep people living active and healthy lives As we learn more about the power of big data we are expanding our understanding of people s experiences before during and after they are engaged with our healthcare system Now it is time for our healthcare systems to begin to realize that they play a valuable role in the lives of these people The stories that emerge from these engagements become part of people s life stories and those of the healthcare systems that they embrace Andrea J Simon Ph D is a former marketing branding and culture change senior

    Original URL path: http://www.hospitalimpact.org/index.php/2015/10/22/big_data_and_storytelling_the_necessary (2016-02-10)
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  • Hospital Impact - How are urgent care centers changing the doctor-patient relationship?
    card to hand out The model was that the doctors rotated among the sites Within that structure neither party medical professional or patient seemed all that interested in starting an ongoing relationship Sorry doc I m just not that into you While some of this can be attributed to the fast moving nature of the UCC many of my preliminary observations are supported by other studies that have been conducted this year among a much broader group of patients not just those who use UCCs but others who still go to primary care physicians PCPs and even emergency departments In general there are serious changes in the doctor patient relationship Vitals com released a fascinating survey of 850 adults in January 2015 The key takeaway was A whopping 70 percent of people are not fully satisfied with their doctor patient relationship Given the intensely competitive post Affordable Care Act reform landscape that finding doesn t bode well for many PCPs Vitals went on to note more statistics that wouldn t make doctors or hospitals feel much better Nearly 54 percent describe their relationship as good enough for the moment Another 15 percent said they weren t into him her or have a cold and emotionless relationship with their doctor In stark contrast to the Vitals com findings just five years ago Consumer Reports polled more than 49 007 of its subscribers and found that 75 percent of them were highly satisfied with their doctors That said several consumers still complained about long wait times and ineffective treatments The physicians had their own complaints Consumer Reports also surveyed 660 physicians back in 2010 and found that they thought patients could do more to get the most of their relationship with doctors Suggestions included Putting a high value on courtesy and professionalism Taking notes about what the doctor advised Trying to figure out ahead of time more about the doctor s personality and treatment style to help find the right match Those suggestions from doctors in 2010 pointed to some issues that have become even more pronounced today Docs don t have enough time to spend with patients Deane Barker states it quite simply Doctors have no time to spend with patients anymore To stay in business and make money they have to churn em and burn em Meanwhile in a Forbes article Todd Hixon also notes that the doctor patient relationship is at a crossroads adding that it often depends on the type of healthcare system pursued by the patient This decade is bringing large new demands on the healthcare system from expansion of health coverage to aging of the large baby boom cohort he adds These changes are forcing change of the structure of the healthcare system and particularly the doctor patient relationship At UCCs is there a customer relationship anyway So this discussion brings us right back the UCCs Some 9 300 UCCs exist now They ve increased 14 percent from 2008 and the share of patients using them

    Original URL path: http://www.hospitalimpact.org/index.php/2015/08/20/how_are_urgent_care_centers_changing_the (2016-02-10)
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  • Hospital Impact
    ve found so far shows several potential patterns emerging Each one is worth more observation Read more Leave a comment Are urgent care centers brands or commodities May 7th 2015 by Andrea J Simon As I observe the extraordinary growth of urgent care centers UCCs I am seeing some important changes taking place both in the customer experience and in the range of services offered These changes are raising important questions for leaders of UCCs namely Are we just another outlet offering fast convenient care like the ones down the street or at the CVS Or are we establishing a proprietary brand in the way we deliver care and the range of services we offer Whether you are involved with the launch and growth of a UCC or lead another type of healthcare organization you should be asking yourself the branding question Why you Because you better believe your customers are asking it And with the growing abundance of healthcare options they re going to be asking it a lot So what might you do to answer the question Why you Read more Leave a comment What hospital leaders should know about urgent care centers March 25th 2015 by Andrea J Simon I have been working with a hospital s urgent care centers to address the emerging issue of how to create experiences that are differentiating and of value to their customers Not patients customers Already there are 26 urgent care centers in the urban suburban area this hospital serves with lots more coming soon Talk about competition With urgent care centers popping up everywhere safeguarding the brand is more important than ever but all too often overlooked As an anthropologist I always love to watch change coming first as a dribble and then as a roaring tidal wave As we were researching the state of the urgent care center from a customer experience perspective interestingly there was nothing much to find However we found some other things that were well worth sharing with our Hospital Impact audience Read more Leave a comment 6 must know inbound marketing facts for healthcare leaders February 26th 2015 by Andrea J Simon A friend of mine had a really awful knee story She had injured it skiing and her primary care doctor had sent her to a surgeon The surgery failed to address the problem and she was still in terrible pain So my friend went online She researched which doctors were considered specialists in the type of knee surgery she knew she needed Then she researched his training infection rates patient satisfaction and testimonials and then she made an appointment When the surgeon asked how she had found him she was quite blunt on the Internet He was stunned When I shared this story with a senior hospital executive he was perplexed Completely missing the significance his attitude was So what Here was the future of consumers approach to healthcare right in front of him and he was ignoring it Read more

    Original URL path: http://www.hospitalimpact.org/index.php?blog=1&s=Andrea%20Simon&page=1&disp=posts&paged=2 (2016-02-10)
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