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Moving beyond centeredness in patient experience

January 29th, 2015

by Jason A. Wolf

Last year I had the honor to co-author an article, Defining Patient Experience, for the inaugural issue of Patient Experience Journal, of which I also serve as editor. The exercise in conducting the research review and construction of the piece reinforced a fundamental shift I have seen occurring as we work to push the patient experience movement forward. That is, we are entering an era when the concept of centeredness, while critical and central, is no longer enough.

In our article we identified "experience" to encompass personal interactions, organization culture and patient (and family) perceptions, and reinforced that it crosses the continuum of care to include not only clinical encounters, but also the edges and transition points that bind the system together. Woven into these framing concepts were three key ideas:

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How monitoring low-acuity patients improves health outcomes

January 28th, 2015

by Michael Wong

Vanderbilt University Medical Center (VUMC) is a highly respected comprehensive healthcare facility in the mid-southern region of the United States. Facilities like VUMC lead the way for safer patient care and improved health outcomes.

So when Brian Rothman, M.D., an associate professor in the Division of Multispecialty Adult Anesthesiology and medical director of perioperative informatics, recently spoke at the inaugural meeting of the National Coalition to Promote Continuous Monitoring of Patients on Opioids about VUMC's experience with continuous monitoring of low-acuity patients, I took the opportunity to interview him about this experience and what advice he would give to other healthcare facilities looking to similarly improve patient safety and outcomes.

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Does decision support actually work?

January 27th, 2015

by Lynn McVey

The medical imaging website Aunt asked the question, "Does decision support work?" I got tricked at first, because I thought it was a question about decisions. Aunt Minnie's question was about the appropriateness of imaging ordering, which happens to be experiencing growing pains.

For years, I've always questioned the accuracy of "decision support." When we play the game "Telephone," even the simplest phrase, "The moon is made from green cheese" ends up as "The cream cheese on the spoon is creamy." I exaggerate, yet something always gets lost in translation.

This is why I always perform my own decision support. Years ago, for many months, the emergency room's volume differed between our internal data and the ER physicians' external billing data. It drove me crazy. I finally drilled down the data to the individual patient names, and reconciled one list against the other. They say the "joy is in the findings," and this brought me joy, plus a good night's sleep at last. Our internal decision support team was counting the volume of ER patients upon discharge. What else would a non-clinical/IT-decision-support-staffer count? Luckily, I'm a clinical COO who knows 20 percent of ER patients get admitted, and will subsequently be defined as an IP (in-patient). This was the discrepancy the two teams argued about for months. It was fixed immediately.

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Hospital reputation lessons from the football field to the tennis court

January 26th, 2015

by Kent Bottles

Hospital leaders can learn a lesson about reputation management from two current sports stories. The first story is the well-known "Deflategate," and the second is the less-publicized example of sportsmanship from the Australian Tennis Open.

Even those who don't follow the NFL have been inundated with stories about how the New England Patriots played the first half of their AFC championship game against the Indianapolis Colts with footballs that had been deflated. Patriots quarterback Tom Brady has in the past stated that he favors footballs that are underinflated, and numerous former players have noted that deflated footballs are easier to catch and hold onto in rainy conditions. When Patriots coach Bill Belichick and Brady held separate news conferences to say they had no idea what happened, many newspaper, radio and television commentators said they didn't believe them.

Contrast the NFL story with what 112th-ranked tennis player Tim Smyczek did while nearly upsetting third-ranked Rafael Nadal in the Australian Open. In the fifth set of a close match, Nadal's serve was affected by a fan's loud shout, and Smyczek immediately told the umpire to let Nadal serve again because of the distraction. "I know my parents would have killed me if I didn't. It was the right thing to do," said Smyczek, according to the New York Times.

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Healthcare reform, rising costs: A conversation with Paul Keckley about America's 'Bitter Pill'

January 21st, 2015

by Ilene MacDonald

Journalist Steven Brill has been making the rounds promoting his new book, "America's Bitter Pill: Money, Politics, Backroom Deals and the Fight to Fix Our Broken Healthcare System."

The book details the behind-the-scenes political infighting and industry lobbying over the Affordable Care Act (ACA). This week my colleague Ron Shinkman gave his take on Brill's latest piece and the different light it casts on healthcare finance from the prism of his social status.

Last week Brill published a piece in Time about his personal experience of being a patient at New York Presbyterian where he had open heart surgery. It's a fascinating account--one that health economist and policy expert Paul Keckley, Ph.D., writes in MedCity News is a piece worth reading because, "It reminds us that healthcare is a different industry more than any other, not simply because of its size and complexity but also because in times of need, like his, none of that matters."

"For Brill, the $190,000 price tag for his heart surgery was money well-spent: he survived," Keckley, managing director of the Navigant Center for Healthcare Research and Policy Analysis, writes. "But he concedes much could have been saved had it been delivered in a different system of care. And that's the bitter pill he swallowed."

Recently I spoke to Keckley about Brill's latest book and some of the author's assertions that the ACA doesn't address cost containment and that the healthcare reform law will not lower the country's healthcare costs in the long term.

>>Read the full commentary at FierceHealthcare

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