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In the 20th century, pharmacists were professionals who formulated medications based upon physician prescriptions and provided advice to patients regarding dosing, self-administration and potential side-effects. In the 21st century, pharmacists are essential members of the healthcare team to provide invaluable expertise and input into the increasingly complex management of patients with acute and chronic diseases to achieve optimum outcomes at the lowest possible cost.
Why the dramatic change in the pharmacists’ role?
First, healthcare has become exponentially more complex. There are now tens of thousands of prescription drugs and hundreds of thousands of over-the-counter medications available in the United States with an infinite number of potential interactions. In addition, there are often dozens of steps that separate a doctor’s decision to order a medication and the nurse delivering the medication to the patient, with myriad opportunities for process failure.
by Barry Ronan
When I was asked if I would blog about pushing the healthcare industry into a new era, I agreed based on my own personal experience. At the time, I wasn’t aware of Don Berwick’s recent commentary in the Journal of the American Medical Association on the subject. Fortunately, I can certainly relate to his commentary since I have been living his “Era 3” for the last several years.
Berwick states that healthcare needs to be pushed into a new era. He writes about Era 1 when medicine was good and depended on self-regulation. Then Era 2 evolved once the flaws and contradictions of Era 1 became apparent. Era 2 saw the need for accountability and measurement. Era 3, though, will require a combination of Eras 1 and 2, but emphasizing less measurement related to cost and volume and more measurement related to quality and value; moving away from maximizing revenue; focusing on care improvement as a core competency for healthcare leaders; and complete transparency with the communities that we serve.
I have always contended that the experience of care is the total experience, and I go out of my way in my keynotes to look at how the experience impacts everything--billing, patient safety and quality, discharge and transitions. Yet HCAHPS only looks at a small slice of this, if any at all.
I also spend a lot of time talking about family caregivers. Just one in three physicians ask for their input into a loved one’s care, and only one in six physicians ask the caregiver themselves how they are doing. My doctor, on the other hand, called me back four months after my annual physical because he was concerned about my stress level as a family caregiver to my 94-year-old mom.
Consider further that according to an Experience Innovation Network (EIN) study only 13 percent of organizations were giving top priority to patient and family voice in 2015. And a Beryl Institute benchmark report showed slightly better scores with 37 percent of responders committed to giving priority to patient and family engagement. This further reflects in other EIN data that shows very little patient and family caregiver engagement in discovery and data gathering, implementation, testing, process mapping. And of course, family voice is not measured by HCHAPS.
by Leon Owens
Finding a general surgeon to be on-call for the emergency department (ED) is becoming increasingly difficult. A 2011 Robert Wood Johnson Foundation survey found that 75 percent of EDs had inadequate surgical call coverage, and estimates are that it is only going to get worse with ongoing shortages of qualified surgeons.
Not only do such shortages have the potential to impact patient care and already over-burdened ED staff, they also compound the challenges hospitals face in today’s era of value-based purchasing (i.e. meeting requirements for achieving high-quality surgical care, reducing complications and meeting pay-for-performance goals).
In response to these challenges, the acute care surgery model has emerged. It applies trauma surgery standards to emergency general surgery patients to reduce the time non-trauma ED patients have to wait for a surgeon.
Honor knows no statute of limitations. ~ Samuel E. Moffat
The bar was dark, loud and smokeless.
The table set with a glass of pinot noir and a non-alcoholic fruity beverage.
The voices of the two healthcare quality leaders were hushed but steady.
“Once we have a financial model in place, our ability to improve healthcare provision will be much more attainable.”
“It requires a financial model to be in place prior to doing the right thing? We cannot wait. Patients are being wounded. Families are being harmed. Communities are being hurt. Over 50 percent of inpatient adverse events are preventable. The harm rate in healthcare is staggering. Yes, a financial model aligned with our aims is important, but doing the right thing should not be dependent on it. We need to identify those people who truly value patient safety--those people who are not reliant on a new financial incentive to do what is right, those people who truly care--and ensure they are positioned to both lead and serve in an effort to improve the healthcare system. A financial model is important. It is also a technical fix to an adaptive challenge. We cannot wait.”
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