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  • Hospital Impact - The importance of ritual in transforming healthcare
    A Doctor s Touch in which he brilliantly discusses the importance of ritual in the healing encounter More And I began my ritual I always begin with the pulse then I examine the hands then I look at the nail beds then I slide my hand up to the epitrochlear node and I was into my ritual And when my ritual began this very voluble patient began to quiet down And I remember having a very eerie sense that the patient and I had slipped back into a primitive ritual in which I had a role and the patient had a role And when I was done the patient said to me with some awe I have never been examined like this before Now if that were true it s a true condemnation of our health care system because they had been seen in other places And this memory of Verghese s ritual discussion prompts me to write today There are amazing caring clinicians throughout the healthcare system i e physicians nurses therapists and so many others And yet as healthcare leaders we do not position them or their patients for optimal healing Rather we continue to create caring models that are essentially antithetical to true caring Our physicians are burning out and worse Our nurses are burning out Fewer and fewer physicians are choosing to become primary care physicians And we wonder why We healthcare leaders must do better We must create and improve systems to position these amazing clinicians to re engage with the reasons they became healers in the first place We need to create healthCARING models that allow for ample time and continuity for clinicians and their patients to develop relationships for authentic human connection to be achieved for trust to grow for whole stories to be told and truly heard and for co created individualized care pathways to be made And we need to bring ritual back into healing Listen to Verghese s TED Talk And note that rituals are all about transformation And further if you shortchange that ritual â you have bypassed on the opportunity to seal the patient physician relationship So let s transform healthcare Let s create healthCARING Let s go back to the Hippocratic Oath I will remember that there is art to medicine as well as science and that warmth sympathy and understanding may outweigh the surgeon s knife or the chemist s drug Let s bring ritual back into healing and let s seal the physician patient relationship It is not too late and yet long overdue Thomas H Dahlborg M S M is chief financial officer and vice president of strategy for NICHQ National Institute for Children s Health Quality where he focuses on improving child health and well being Leave a comment 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

    Original URL path: http://www.hospitalimpact.org/index.php/2015/01/14/the_importance_of_ritual_in_transforming (2016-02-10)
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  • Hospital Impact - Modeling behavior to improve care
    as they establish their own footing So this past September when my daughter told my wife and I that she was scheduled to go to modeling school as she continued on a new path birthed through her hard work and her reign as Miss Maine USA and with Kristen Swanson s care model in mind I pondered How does a dad see this new world of modeling through his daughter s eyes How does a dad be with his daughter in this new world And then answered This dad goes to modeling school Now one might think that an almost fifty year old healthcare executive doesn t belong in modeling school And yet there I was And it was an amazing experience Sammy and I learned which colors to wear for go sees tax implications of modeling in multiple states how to slate and which states to focus significant energy and attention on and which not together I saw Sammy in her element and I got to know my daughter in a far more complete way as I was seeing her world through her eyes So why do I tell this story I often write of the importance of time relationship and trust at each and every healing encounter of hearing the patient s whole story of both knowing the patient and being with the patient to use Kristen Swanson s words and the impact of doing so Improved patient and physician engagement Better adherence to co created care plans Improved patient safety Improved outcomes e g patient s emotional health symptoms pain levels The bottom line Better care My daughter telling me about her experience in less than 10 minutes with me interrupting within the first 23 seconds would not have allowed for optimal communication and would only provide part of the full picture It would only provide me with a tidbit of an amazing and educational story which I would then try to use to inform decision making Less than ideal for sure and yet that is our current healthcare model Sammy s modeling career is very important to her and my role as a father necessitated me following the path above so that I am best positioned to support and honor Sammy as she continues on her journey As healthcare leaders we must create paths care models which allow clinicians to be with and know their patients if we truly want to improve care provision Doing anything less does a disservice to our patients families and communities and we can clearly do better Thomas H Dahlborg M S M is chief financial officer and vice president of strategy for NICHQ National Institute for Children s Health Quality where he focuses on improving child health and well being Leave a comment 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

    Original URL path: http://www.hospitalimpact.org/index.php/2014/11/13/modeling_behavior_to_improve_care (2016-02-10)
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  • Hospital Impact - Develop patient engagement tools for optimal care, satisfaction
    with special health needs created the This Is Me tool in partnership with medical professionals to help caregivers get to know their patients both personally and medically thus engaging both caregivers and patients A patient should always be seen as more than a cluster of symptoms For patients with special healthcare needs a holistic view is even more critical This tool s elegance is in its simplicity The two page guide focuses first on the patient s personal information including life goals preferred activities communication style and interaction tips strengths preventative behavior supports and includes a spot for a photo Information a caregiver typically will not have easy access to and yet critically important for engagement of both caregiver and patient and holistic view of the patient The second page focuses on medical and school information and the tool in its entirety is adaptable to a variety of settings including schools and hospitals and to suit any child with special needs Innovative and simple Its development itself a testament to the importance of patient and family engagement for without the engaging parents of children with special health needs we would not have such an innovative tool which will benefit many Also within this realm of patient engagement tools the National Quality Forum NQF and its Patient and Family Engagement Action Team will roll out a Patient Passport the first engagement tool in hardcopy and application of its kind to be nationally vetted and piloted This Patient Passport was also created in partnership with patients families and medical professionals and was designed to communicate patient needs and preferences quickly and easily so patients can have the most healthy and satisfying medical experience possible with optimal mutual engagement The objective is for the patient to own this information and ideally share it with each health professional in the hospital doctor s office or in any medical related setting Most importantly the intention of the Passport is to initiate a conversation an authentic connection between caregiver and patient not replace it with more forms These are only a few examples of patient engagement tools With each of these tools the patient will no longer be just a diagnosis but rather a whole person providers can honor and treat with dignity and respect The patient will have a tool in which to share the most accurate and timely information with their provider and with this information the patient can better tell their whole story and the provider can listen and engage with more pertinent information leading to shared decision making better engagement compliance outcomes and less preventable errors As healthcare leaders what tools approaches or system changes have you developed and implemented to better engage your patients and their families How do you ensure the tools don t replace authentic human connection What impact have these improvements made How do you measure it And what lessons have you learned It s clear patient and family engagement is critical to ensuring optimal healthcare and health

    Original URL path: http://www.hospitalimpact.org/index.php/2014/10/02/develop_patient_engagement_tools_for_opt (2016-02-10)
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  • Hospital Impact - Lessons on patient-centered care
    at that time was God doctor to tell him what he needed to do I can only imagine this surprised those who knew this physician as both a patient and a clinician For someone to not only advocate for but also to live every day providing patient centered care that positions patients to engage in their own care this just doesn t make sense or does it Perhaps this physician even through his own illness journey continues to teach us all what patient centered care truly is In fact I believe that he is Lessons he teaches are A patient s activation and engagement will vary over time and perhaps from visit to visit based on many factors One example is the physician becoming seriously ill himself Another example is a patient who may be 100 percent activated and engaged in their own care at their most recent appointment who has learned just after this visit that their parent is now seriously ill and requiring significant support The next time you see this patient the level of activation and engagement may significantly decrease due to such factors as stress worry exhaustion etc Continuing to assume that the patient is activated at the previous level based on the most recent visit and data points will be detrimental to the patient s health and healthcare outcomes To truly provide patient centered care providers must understand the patient s whole and ever evolving story What was true last week may have changed significantly and thus no longer holds true as well as the patient s level of activation and engagement Patient centered care includes determining what your specific patient needs at that specific time and not assuming not strictly relying on tools and not focusing exclusively on data points previously inserted into an electronic health record 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 What is true for most patients may not be true for the patient sitting in front of you and it is our responsibility to determine their truth and also recognizing their truth will change As healthcare leaders our responsibility is to develop care models that allow for true patient centered care clear understanding of the patients whole and ever changing story modify care and engagement approaches informed by these data and of course position all caregivers to provide this patient centered care with compassion Much gratitude to the physician referenced above for continuing to teach us all as he faced his own healthcare challenges And lastly let s not get so focused on tools and measurements that we lose sight of patients Let s harness the power of tools and measurement to enhance patient centered care provision not replace it Thomas H Dahlborg M S M is chief financial officer and vice president of strategy for NICHQ National Institute

    Original URL path: http://www.hospitalimpact.org/index.php/2014/06/18/lessons_on_patient_centered_care (2016-02-10)
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  • Hospital Impact - Support patients emotionally to foster full recovery
    explained the technical details of my aneurysm and the treatment options brain surgery or coiling He showed me the chance of it rupturing and he informed me that if it did there was a 50 percent chance that it would kill me and another 50 percent chance if I were to survive that I d live with some sort of disability Yes the facts are important and yet again a lost opportunity Most of our patients are not medical students nor are they machines We are all complex adaptive humans with physical mental emotional and spiritual sides We get scared We fall in love We get anxious We find peace Data and data collection is important but it does not replace the need for a shared human connection or compassion He didn t ask if I was scared He didn t ask if I was anxious or depressed about this news or the prospect of brain surgery to fix it He gave me the facts I would have appreciated it if he had realized that I was fragile and that I was about to break down Hope had her surgery and by most standards it would be considered a success Her inpatient post surgical nursing care was phenomenal Her nursing care team listened and they demonstrated that they heard They provided the human connection and support she needed And yet the system was still broken and they were not part of the discharge process After five days in the hospital my wound was healing My pain was under control But my emotional state was a wreck I got asked a few questions about anxiety but no one probed deeper There wasn t an option to see a therapist or social worker As healthcare leaders we talk consistently about patient centered care and patient engagement and yet we still have not created the systems to ensure throughout the continuum of care we are ensuring we are honoring our pledge In this instance the patient s needs were lost What I needed was someone to really sit down and ask questions and listen to the answers I needed discharge planning that included mental health care I needed someone to see that even though they fixed my head I was very broken Many of us go beyond touting the need for patient centered care We talk of the need for compassionate care The Schwartz Center for Compassionate Health Care states When asked whether good communication and emotional support can make a difference in whether a patient lives or dies 81 percent of patients said Yes But what s really shocking is that 71 percent of doctors also agreed That means that the vast majority of patients and doctors believe that compassionate care defined as an emotionally supportive provider who actually talks and listens to his or her patients can mean the difference between life and death Hope agrees It s not brain surgery it s the common compassionate sense about people and their

    Original URL path: http://www.hospitalimpact.org/index.php/2014/09/04/support_patients_emotionally_to_foster_f (2016-02-10)
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  • Hospital Impact - Kindness, humanity are best healthcare business solutions
    check in on me and get me settled she was sure to keep the lights off except for when absolutely necessary e g to see where to put in the IV Putting in needles is always tricky with me I have small veins but she talked me through it keep breathing you re OK this is going to be over soon always providing comfort She got me warm blankets a pillow and an ice pack for my head She got a bucket for me in case I threw up and also some ice chips because she figured I was feeling dehydrated too She was anticipating my needs knowing how vulnerable I felt She squeezed my knee looked me in the eyes and said We re going to get you feeling better right away The doctor will be right in Is there anything else you need The doctor did come right away she immediately took the letter from my specialist that I carry with me read it asked me what I needed and then ordered my meds There was no questioning of my decision making power as a patient or the validity of my neurologist there was a dialogue an agreement and immediate action to make me feel better The other gift the doctor and nurse gave me that day was to let me sleep as long as I needed This is incredibly important but tough to get doctors to understand If I get discharged too soon I usually get readmitted within six to eight hours Long story short my doctor and nurse gave me more than just the drugs I needed for the pain to ease They gave me the gift of their human compassion and kindness and I truly felt loved that day I remember as I drifted off to sleep I actually started crying with gratitude thinking I don t need to call anyone All my friends are right here I m good I felt like those clinicians gave me an immeasurable gift that day Many hospitals focus on HCAHPS Hospital Consumer Assessment of Healthcare Providers and Systems surveys to measure quality Linda s story highlights that care provided with compassion humanity and kindness not only aligns with the Hippocratic Oath but also serves as a pathway to improving quality and yes HCAHPS scores while decreasing costs in this example as defined by readmissions There are flames simmering throughout the healthcare system and as healthcare leaders it is incumbent upon us to fan these flames and ensure they spread Want to innovate and transform healthcare to benefit all Help caregivers serve and provide compassionate and kind care with humanity Not only is it the right thing to do it is also the right business solution Thomas H Dahlborg M S M is chief financial officer and vice president of strategy for NICHQ National Institute for Children s Health Quality where he focuses on improving child health and well being Leave a comment Please enable JavaScript to view the

    Original URL path: http://www.hospitalimpact.org/index.php/2014/05/14/kindness_humanity_best_healthcare_busine (2016-02-10)
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  • Hospital Impact - More firsthand symptoms of a broken healthcare system
    physician stated You have a significant arterial blockage in your brachial complex Without further explanation as to what this thing was he then said I ll need to refer you to a vascular specialist Thus more medical jargon about brachial complexes and vascular specialists confused Betty even more Post visit my wife was able to explain The physician continued to access the EHR and suddenly turned to Betty and asked I took you off of gemfibrozol didn t I Betty responded that he had He then said frustrated That medication is still listed here and proceeded to update her record He persisted and reviewed Betty s test results He then realized that one of the most important tests he ordered was never conducted with the other batch of tests he ordered Betty would need to go back to the hospital at a later date for the additional test Lastly at the end of the visit Betty handed her referral slip to my wife as they headed to the car My wife looked at it and noticed that the diagnosis listed on the slip was acute renal failure but interestingly that is not Betty s diagnosis Another unintentional error Have you or a loved one had similar experiences Are you fortunate enough to have a nurse in the family who can attend visits provide support interpret medical jargon assist with prescription directions quell anxieties and fears and provide empathy and love Betty s physician who may be a wonderful doctor is clearly in a broken system Productivity requirements limit his time to establish an authentic relationship with Betty and hear her entire story Technology in his practice is primarily leveraged to quicken the pace of practice that is productivity and revenue generation And specific to his EHR Garbage in garbage out In this example the garbage out is the incorrect medication information which almost proved very dangerous to Betty As another example in a rush to implement a new EHR a local physician practice under a large hospital system recently hired non medical personnel to enter patient data into their new system These individuals did not understand medical terminology and the hospital system did not think it necessary to fund an audit function to ensure all the entered data was accurate In some cases a nurse and or a physician found errors at a subsequent patient visit and remembered that information was not right similar to the situation with Betty above It s not highly reliable and incredibly dangerous Betty is blessed to have a nurse in the family who can advocate for her as a patient and provide support And yet the healthcare system does not need to remain so broken as to require that we all hire a nurse to advocate on each s behalf at every doctor visit We hear the term patient centered quite often as in patient centered medical home and patient centered care but unfortunately these often are just words How can care be patient

    Original URL path: http://www.hospitalimpact.org/index.php/2011/08/17/more_firsthand_symptoms_of_a_broken_heal (2016-02-10)
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  • Hospital Impact
    is patient centered care and this is how to go about improving healthcare outcomes Yes the speaker at this conference had that much clarity and apparent belief that patient activation measures were this important and yes the silver bullet to improving healthcare outcomes If only he had heard another speaker this one at last year s NEHI Network for Excellence in Health Innovation conference in Boston discussing a similar subject This speaker shared a story paraphrased below Read more Leave a comment Kindness humanity are best healthcare business solutions May 14th 2014 by Thomas Dahlborg On a number of occasions I highlighted firsthand symptoms of our broken healthcare system Today I have a story that underscores the flames currently burning beneath the surface of the system Flames that when fanned will truly innovate and transform healthcare and will lead to better patient and family engagement patient and clinician activation health and healthcare outcomes and more all while decreasing costs Linda is an amazing woman and healthcare leader She is full of passion and life caring brilliant articulate and engaging She also deals everyday with three chronic illnesses and was recently kind enough to share a story with me Read more Leave a comment Don t be afraid to commit to hospital values April 8th 2014 by Thomas Dahlborg This past weekend we brought our son to a student acceptance day at a college he is considering attending As we participated in the numerous events of the day I was struck by the similarities between academia and healthcare i e colleges and hospitals We began the day with hundreds of other students and parents listening to the opening presentation where much focus was placed on sharing the history mission good works and values of the school The pride of the president admissions director and other organization leaders was clear And each made note of how they instill these values in each student of this prestigious school Read more Leave a comment Extend focus beyond hospitals to truly improve healthcare March 5th 2014 by Thomas Dahlborg The healthcare industry focuses on clinical quality outcomes at the hospital level especially on preventable readmissions Funders of healthcare implement both carrots and sticks incentives and disincentives to improve quality in this area however this sole approach is not enough Healthcare is a complex adaptive system as is each of our patients practitioners and organizations so a focus limited to hospital responsibility regarding care quality is not enough to truly make a difference For this discussion let s expand our view to primary care as well Primary care physicians miss between 40 000 and 80 000 diagnostic opportunities per year which lead to considerable harm to patients according to a study published in the Journal of the American Medical Association These missed diagnoses often include serious illnesses such as acute renal failure pneumonia cancer angina cellulitis hypertension and urinary tract infections Read more Leave a comment Previous Page Next Page Enter your search terms Submit search

    Original URL path: http://www.hospitalimpact.org/index.php?blog=1&s=Thomas%20Dahlborg&page=1&disp=posts&paged=4 (2016-02-10)
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