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  • Hospital Impact - The power of healthcare's 3-letter words
    new era of policy choice perception versus process and implications versus intricacies Choice In discussing the patient experience with healthcare leaders above all else our actions are truly about choice While some may argue we have no choice as a result of regulations I would counter by asking is that the true reason to act or are we committed above all else to health well being and healing of all in our care Choice is perhaps the most powerful tool at our disposal in addressing experience as it signifies leadership commitment to a vision it exemplifies staff willingness to act and it engages patients and families in their own care encounter The implication of choice was explored in a recent Hospital Impact blog post Perceptions versus process In healthcare we have mastered the science of process designing systems structures and even buildings to support an effective process of delivering care While not a negative it poses significant challenges if this is the only point of focus While we want to ensure a safe and efficient delivery mechanism this is often designed with the deliverer in mind not the perspective of the patient and family At The Beryl Institute we define patient experience as the sum of all interactions shaped by an organization s culture that influence patient perceptions across the continuum of care At the heart of this statement is that for all we do in healthcare we must be aware of and informed by the very perceptions of those for whom we care In a recent blog post I offer that it is perception that will shape a healthcare organization s reputation and ultimately influence the bottom line Implications versus intricacies Regulations such as those described by our three letter words often take on an air of inevitability and we tend dive into the weeds on the operational intricacies needed to get them right I think we would be better served by spending time working on the implications for why we should act For example in a recent study a focus on experience measures were seen to be a better driver of reduced readmissions rates If we spend all our time on getting the rules right we may actually overlook the path towards the best potential outcome for patients and families overall In the end we must look beyond our thoughts or feelings about the three letter words and recognize we have huge opportunities When we take choice perception and implications together we have a serious prescription for focused intentional action that moves us beyond the compelling force of policy to one in which you can be clear you are doing the right thing For most healthcare wasn t an industry we joined to drive efficiencies or find great wealth though these are both potential results Fundamentally it was about the opportunity to make a difference in the lives of the patients and families we serve That trumps policy every day Jason A Wolf Ph D is executive director

    Original URL path: http://www.hospitalimpact.org/index.php/2012/11/28/healthcare_s_3_letter_words_and_the_pati (2016-02-10)
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  • Hospital Impact
    caused disdain for others Most recently requirements associated with these policies have created a backlash of commentary on the purpose of these regulations and their potential impact on healthcare overall Read more Leave a comment The importance of patient voice in value based purchasing October 16th 2012 by Jason A Wolf This October brings the reality in the United States that the Centers for Medicare Medicaid Services is now determining reimbursements via its Value Based Purchasing VBP program Whether its impact on your organization is big or small this milestone in the measurement of patient perspective reignites what I believe to be a critical consideration for healthcare overall First there is no better time to reassess your driving motivation for patient experience improvement If the emergence of HCAHPS Hospital Consumer Assessment of Healthcare Providers and Systems or now VBP driven reimbursement has been the reason for action you may already be behind on this journey Patient experience is much more than a survey or the resulting dollars it impacts All too often in healthcare we are moved by the latest policy popular practice or trend Patient experience while it may feel like all of the above is actually none of them Read more Leave a comment Patient experience The power of perception September 25th 2012 by Jason A Wolf Perceptions may be your greatest ally or challenging foe in telling your organization s patient experience story The patient experience is most often explored through the lens of the actions being taken such as strategies an organization has in place or tactics being implemented This focus reinforces the idea that the patient experience is something provided TO a patient and their family It is critical that we recognize patient experience is something much greater than just these actions Patient experience should be first and foremost about the experience itself Those in healthcare do not necessarily provide an experience Rather we create the circumstances reinforce the behaviors and manage the interactions that allow a patient and family to have an experience grounded in their own viewpoint Read more Leave a comment How can hospitals drive good patient experience July 31st 2012 by Jason A Wolf In an earlier Hospital Impact post I stressed that the healthcare sector recognizes patient experience not only as a phase or the latest management fad but as a central component of all we do In defining patient experience as the sum of all interactions shaped by an organization s culture that influence patient perceptions across the continuum of care we reinforce the incredible responsibility healthcare leaders have to think and act comprehensively to ensure the best experience possible for patients and families This commitment is not only about making people happy it also is about considering the comprehensive nature of experience which I suggest represents the critical interplay of quality safety and service We can no longer consider these distinct efforts but rather must strive to structure opportunities in which we can create unparalleled care encounters and

    Original URL path: http://www.hospitalimpact.org/index.php?blog=1&s=Jason%20A.%20Wolfe&page=1&disp=posts&paged=8 (2016-02-10)
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  • Hospital Impact - 4 fixes that will boost your bottom line
    cardiovascular medications While this task force may not seem novel it represented the first time that physicians and administrators at this hospital had worked together to achieve sustainable long term results and represented a cultural change Making hospital physician collaboration work Healthcare Financial Management 2005 59 10 102 108 2 Boost revenues by facilitating discussion between physicians who work at the same hospital or healthcare system regarding referrals Most referrals derive from years decades of collegial interactions and are difficult to change even with data To anticipate the coming bundled reimbursement for episodes of care put physicians in a room together with a trained facilitator who speaks their language and has earned their respect People say different things to people in person than they do outside the room 3 Obtain a palliative care consultation for every patient admitted to the intensive care unit and on all patients for whom ICU transfer is likely Being proactive puts patients and families with caring professionals who can assure families that their loved ones will not suffer and limits the cost of futile do everything care 4 Improve communication between physicians and healthcare administrators by developing a compact As I described in Collaborative Compact a compact is a social contract that clarifies mutual expectations and helps both groups come to a shared vision that will improve care for their community The compact for Wisconsin s Wheaton Franciscan Medical Group provides an operational definition of expectations regarding mutual respect integrity development excellence and stewardship Other examples of compacts available include Gundersen Lutheran Health System and Virginia Mason Medical Center Trying to achieve complete alignment between physicians and hospital administrators goals is unrealistic because physicians and administrators have substantial differences in background training and outlook Because most physicians lives revolve around the immediacy of direct patient care they respond to different pressures than hospital administrators whose responsibilities may demand a more consensus oriented organization focused approach Gaining hospital administrators attention Ways to improve physician hospital management dialogue Surgery 2005 137 132 140 Working harder is not a viable economic solution for either group However effective dialogue is in hospital leaders and physicians self interest because improved communication increases predictability which can help both parties work more productively to build transparency and trust Ken is a practicing general surgeon MBA and CEO of HealthcareCollaboration com who divides his time between providing general surgical coverage and working with organizations that want to engage physicians to improve clinical and financial performance 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 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

    Original URL path: http://www.hospitalimpact.org/index.php/2013/01/16/4_local_fixes_to_help_your_hospital_thri_2013 (2016-02-10)
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  • Hospital Impact - Cut expenses with help from docs
    the cost of surgical care changed from the hospital s problem to a practice improvement opportunity that brought physicians nurses and administrators together Making hospital physician collaboration work Healthcare Financial Management 2005 59 10 102 108 2 Decrease variability by helping physicians make their time count During the report writing phase of a clinical priority setting project at a New England community teaching hospital one of the co chairs expressed his frustration with his colleagues reluctance to even discuss clinical protocols A former Navy surgeon he sputtered There has to be a better way Every time we have a complication because nurses cannot keep track of 30 different ways physicians like to treat patients with the same diagnosis physicians dismiss protocols as cookie cutter medicine or my patients are different As we gazed out the window and saw physicians running across the street to their offices an idea came to us Rather than appeal to idealism why not appeal to their time pressures After all we knew that time wasters frustrated physicians and made them feel disrespected So we piloted a program by starting an anticoagulation clinic that freed clinicians of several calls per day Once that succeeded we developed a weaning protocol for postoperative patients that cut the number of patients staying overnight in the post anesthesia care unit PACU by more than 30 percent that meant a number of surgeons did not need to discharge patients from the PACU at 6 30 a m which gave them more control of their schedules Several years ago physicians and the hospital successfully implemented computerized physician order entry which eliminated calls due to questions of handwriting recognition We learned from these exercises to Start small Focus on the time savings benefit we quip that everyone s favorite radio station is WIIFM short for What s in it for me have people participate in a new program one needs to offer an overt benefit that improves their practice environment Build on and celebrate successes at least quarterly use word of mouth to promote new activities and interest others The Structured Dialogue Process Better Communication for Better Care 2005 Chicago Health Administration Press 10 3 Engage physicians in collaborative supply cost management Regardless of their size hospitals that engage physicians in understanding their clinical cost base especially paying attention to implants have achieved millions of dollars in savings that can subsidize mission critical services Wlison N et al Getting It Done 2011 88 What do you think about managing to Medicare reimbursement Have physicians helped set clinical priorities where you work Has a interdisciplinary task force helped you cut expenses Do you believe that if you treat physicians like adults and act on their suggestions physicians behave responsibly and warrant your trust Ken is a practicing general surgeon MBA and CEO of HealthcareCollobration com who works with organizations that need to engage physicians to improve clinical and financial performance in this era of healthcare reform His latest book Getting it Done celebrates healthcare

    Original URL path: http://www.hospitalimpact.org/index.php/2012/05/16/ways_docs_help_hospitals_cut_expenses (2016-02-10)
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  • Hospital Impact - 3 more fixes that will boost your bottom line
    performance as I described in Collaborative Handoffs Similarly asking patients with congestive heart failure CHF and their caregivers to restate instructions in their own words teach back allowed St Luke s Hospital in Iowa to decrease their CHF readmission rate from 12 percent down to 3 percent 9 percent The variation resulted from patients who were near the end of life but not yet willing to engage in palliative care options as discussed in part one of this blog post 3 Work with your providers to improve the safety culture As I wrote in Getting It Done four steps that organizations can take to build and sustain a healthcare safety culture include Conduct a baseline survey of adverse events and near misses over the past year Look for patterns and common causes that suggest recurring systems issues Gather employees and medical staff to review the data and brainstorm improvement strategies have physicians present data to the medical staff Discuss and evaluate what behavior based expectations might decrease adverse events and near misses Improved communication and collaboration brings about a virtuous cycle of increased revenue lower expenses and most importantly improved clinical outcomes 1 Cohn KH Lambert M 2005 Engaging Physicians in Hospital Operations Better Communication for Better Care Mastering Physician Administrator Collaboration Chicago Health Administration Press 47 48 Ken is a practicing general surgeon MBA and CEO of HealthcareCollaboration com who divides his time between providing general surgical coverage and working with organizations that want to engage physicians to improve clinical and financial performance 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 addiction superbugs Zika outbreak White House

    Original URL path: http://www.hospitalimpact.org/index.php/2013/02/13/3_more_fixes_that_will_boost_your_bottom (2016-02-10)
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  • Hospital Impact - How healthcare leaders can prevent doc suspension
    Medicare Medicaid Services but most are strategic that should be based upon the strategic goals and objectives of the organization Thus management the medical staff and the board should all discuss the relevance and importance of performance expectations and metrics Physicians who take ownership of performance expectations will generally be committed and successful in fulfilling them those who will not or cannot accept reasonable expectations metrics and targets will need to be addressed early so they can either be reoriented to the importance of medical staff approved expectations or asked not to participate at all in a system that they may be unable to support Responding to measurement Most reasonable physicians today understand performance data is imperfect and designed to aid a responsible practitioner in self monitoring and assessing performance Unfortunately some physicians cannot accept what may be a significant pattern or trend in performance that indicates their practice patterns are significantly different from their peers Such issues should be addressed early with both support and assertion Once performance expectations have been accepted early indication that they are not being met must be managed in a way that is positive but leaves no doubt that failure is not an option Providing performance feedback Many physician leaders are not trained in having crucial conversations with colleagues regarding performance issues and it is vital that management provide them with the training to do so Performance feedback is a time to celebrate excellent performance confirm good performance and manage low performers in a constructive and time limited manner This requires the creation of an improvement plan with measurable goals time frames responsible parties both individual and leader and specific consequences for both a positive and negative outcome Measurement is an eloquent expression of what the medical staff feels is most important and failure to address individuals who cannot successfully perform undermines the value and integrity of the measurement system Most reasonable individuals will improve so they are not perceived as a negative outlier by their peers as professional respect is important to most Managing poor marginal performance When a physician fails to successfully complete an improvement plan their performance must be more rigorously managed This requires an experienced leader manager who is understanding empathetic and firm in his her resolve to help the physician Sometimes the physician may not be able to perform certain clinical surgical skills but can safely perform others For instance I once worked with a urologist who did well as long as he didn t extend himself to complex difficult to manage procedures and I encouraged him to voluntarily withdraw those specific privileges so he could continue an otherwise successful clinical career These are difficult conversations to have and are important to the success of an otherwise competent individual Having a frank conversation when performance cannot be successfully managed Some individuals were not meant to practice in certain clinical specialties An old colleague of mine was convinced by his father he should be a surgeon however it was clear

    Original URL path: http://www.hospitalimpact.org/index.php/2013/02/27/how_healthcare_leaders_can_prevent_doc_s (2016-02-10)
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  • Hospital Impact - Why it matters if states don't expand Medicaid
    the PPACA 1 Reduce disproportionate share hospital DSH payments 22 billion annually which reimburse almost 75 percent of U S hospitals for uncompensated care provided to low income or uninsured patients 2 Prohibit cost shifting so those with insurance coverage are not subsidizing uncompensated care involuntarily This provision will require greater price transparency so organizations can only bill an individual the lowest negotiated rate Both of these provisions will have a significant impact on states and their hospitals that choose to opt out of Medicaid expansion 1 First they will lose the 90 percent 100 percent federal subsidy to cover the cost of Medicaid 2 Second the DSH reductions will impact their hospitals without any relief to the number of uninsured patients or amount of uncompensated care It is estimated that between 2014 and 2020 there will be a cumulative reduction of approximately 51 billion in DSH payments that will further exacerbate bad debt and may force some healthcare organizations to tighten their charity care policies and restrict their community benefit programs 3 Most significantly the inability to cost shift will transfer the uninsured and uncompensated care to hospitals physicians and employers as they will provide or fund increasing uncompensated services without the ability to benefit from artificially increased payment or support from the private sector Commercial carriers are dealing with their own PPACA issues including a 20 percent cap on medical loss ratios mandatory coverage regardless of risk and higher risk pools and so they will look to the Centers for Medicare Medicaid Services to set reimbursement rates that are sustainable financially and politically Healthcare organizations employers and physicians make up a significant part of a state s tax base and cost shifting to them will only undermine state revenues while denying the state of its rightful federal subsidy It is time to recognize that healthcare like other complex systems is made up of interdependent parts that are integrally related and cannot be separated Traditional political conflicts around federal vs state individual vs state individual vs federal do not reflect the current necessity to work together Every other successful healthcare system has come to terms with a public private and federal regional delivery system and it is time that we do the same Jonathan H Burroughs MD MBA FACHE FACPE is a certified physician executive and a fellow of the American College of Physician Executives and the American College of Healthcare Executives He is president and CEO of The Burroughs Healthcare Consulting Network and works with some of the nation s top healthcare consulting organizations to provide best practice solutions and training to healthcare organizations 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 addiction superbugs Zika outbreak White House seeks 1 8B to respond to virus More hospitals replace nurseries with rooming in with moms Hospitals must

    Original URL path: http://www.hospitalimpact.org/index.php/2013/01/23/why_it_matters_if_states_expand_medicaid (2016-02-10)
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  • Hospital Impact - Is there life for docs after a Data Bank report?
    most likely to succeed despite past performance or conduct issues Physicians who are willing to accept a measure of personal responsibility for past performance issues disclose them in an honest and transparent manner and work with healthcare organizations and medical staffs in a constructive way are most likely to succeed with or without a data bank report noted Susan LaPenta J D partner at Horty Springer and Mattern in Pittsburgh Pa and Michael Callahan J D partner at Katten Muchin and Rosenman in Chicago This does not mean a physician will have unlimited opportunities following a report and will not have to modify his or her expectations Physicians with a history of corrective action have approximately a 50 percent chance of being successfully credentialed at a respected physician placement service and are better off reestablishing themselves at another healthcare organization with a good record for at least one appointment cycle two years according to Mark Robbins operations manager at CompHealth in Salt Lake City and Christy Potter head of Quality Assurance at Weatherby Health in Fort Lauderdale Fla Realistically this may be a healthcare facility that is underserved and has significant need within a remote rural or inner city area This may be psychologically challenging for some physicians as it confronts them with the stark reality that what was once acceptable performance standards is no longer the case and that they must modify their style of practice if they wish to succeed in today s radically altered healthcare environment Thus physicians who are subject to a report to the NPDB are most likely to succeed if they are willing to Acknowledge past performance issues and take personal responsibility for them Disclose these issues to all relevant licensing boards recruiters healthcare organizations medical staffs to demonstrate a willingness to openly share this information Work with such organizations to constructively address any relevant performance issues Acknowledge that seeking membership and clinical privileges reflects a voluntary desire to work with the organization constructively to continually improve the quality of care conform to standards of behavior and adopt evidence based recommended clinical and administrative pathways as they become available and get approved by the healthcare organization Undergo appropriate remedial training if necessary or required through a formal re entry process to confirm current clinical competence knowledge of contemporary practices e g EHR and willingness to conduct oneself in accordance with professional standards Undergo any required remedial training to address behavioral issues or attitudes that led to the original action This requires significant professional confidence and maturity to be able to acknowledge performance gaps and to address them in a respectful and thoughtful way Those with this strength of character will likely succeed and those fearful of acknowledging changing professional standards will not Thus the final question of life after reporting falls to the individual physician and to healthcare leaders who can hopefully guide the individual to an optimum and mutually beneficial result Jonathan H Burroughs MD MBA FACHE FACPE is a certified physician executive

    Original URL path: http://www.hospitalimpact.org/index.php/2012/12/17/is_there_life_for_docs_after_a_data_bank (2016-02-10)
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