CNN recently posted an article titled "Doctors Going Broke." It described several cases of independent physicians who are near bankruptcy although they once were quite well off. For instance, the article detailed the case of Dr. William Pentz, a cardiologist in a small group practice, who had to borrow money last month to make payroll. He and the other cardiologists have cut their salaries in order to meet overhead. Dr. ...
Donald Tex Bryant
Legislating the duties that can be performed by a nurse
Recently the Michigan Task Force on Nursing Practice hosted a regional forum in my area. I was fortunate enough to attend and hear from the RN’s there the many issues that they face, which are varied and challenging. The state wanted to hear from this forum of RN’s what changes were needed in the state’s nursing regulations so that certification could be updated to reflect the current nursing environment. It ...
Physicians need to understand data to provide better and safer care
Patients expect excellent care from their physicians. Unfortunately, not all receive such care and most of us realize this. Many who do understand the wide variation in patient care probably believe it is due to the clinical knowledge and attitude of the provider—a very knowledgeable physician or nurse who is passionate about his or her job will deliver the best care. Although these ingredients are necessary for excellent patient ...
Ingredients of a good team meeting in a medical setting
At Camden Community Hospital (a fictional hospital), Shana, a senior RN, is leading a team meeting to discuss standardizing the handoff of patients between shifts. She quickly looks over the team members, who are chatting among themselves, some not very quietly. "May I have your attention, please," she says. Some stop talking and others keep on. She raps her hand on the table and now she has everyone’s attention. ...
Staff who resist quality improvement efforts
Perhaps you are just beginning a quality improvement program or project. Perhaps you have several project improvement projects successfully completed at your healthcare site.No matter what your level of experience, you have encountered staff who are roadblocks to your efforts. What are you to do? Ignoring them or doing nothing will imperil your quality efforts eventually. Let me share some ideas on what to do based upon my own ...
Helping acute care patients find the right care in the correct setting
The number of patients with acute care problems visiting the emergency rooms is steadily climbing.According to the article Hospitals Work to Reduce ER Wait Times posted on the ASQ website the rate is increasing at a 3% annual rate. This leads to several problems, including longer waiting time. An analysis of the growth reveals several trends in the demographics ...
Health care coordination under the rules of an ACO
On March 31, 2011 CMS issued its proposed rules for Accountable Care Organizations (over 400 pages).There is now a 60-day comment period. Shortly thereafter, the final rules will be issued. I am sure there will be changes in the proposed rules as there were changes in the “meaningful use” rules for electronic health records (EHR’s). Yet, much of the intent of ...
What you need as a leader of your accountable care organization
The Michigan Medical Group Managers Association had a conference recently in Mt. Pleasant, MI. The theme of the conference was "Medical Management: Coaching Your Team to a Winning Season."Two speakers—Lloyd Carr, former head football coach of the University of Michigan Wolverines, and Lou Rabaut, partner of law firm Warner Norcross & Judd—both delivered excellent lessons on leadership. Several of the ...
Engage employees in healthcare to enhance patient outcomes
It is an axiom of business that employee engagement produces many positive results, no matter what the setting—manufacturing or service. This is true for healthcare as well.Employee engagement produces a better product or service. In healthcare, engaged employees produce enhanced patient outcomes. When employees are engaged there is less turnover, which reduces training costs. Engaged employees are problem solvers.How ...
An ACO primer and get started on forming an Accountable Care Organization
In early 2011 Department of Health and Human Services will be issuing guidelines for the formation of Accountable Care Organizations (ACO’s) for CMS (Medicaid and Medicare).I know of several organizations looking into this type of organization as they anticipate the new guidelines. There seems to be great anticipation of the guidelines in various health care publications that I have recently read. On December 18, 2010 on the Health Affairs website ...
Implementing site changes with Plan-Do-Check-Act
Many healthcare organizations are contemplating making dramatic changes in the way they do business and treat patients. Some of these are driven by the recently passed Accountable Care Act and the Tarp Bill. They are planning on adopting electronic medical records, becoming Accountable Care Organizations or becoming Patient-Centered Medical homes.Unfortunately, like many businesses, they will undergo a lot of stress and loss of resources in time and money in making ...
Clean your healthcare site to become more efficient
Spring cleaning is a tradition in many homes. The occupants open up the home to the spring air, thoroughly clean the home, and sort through the accumulated goods, getting rid of things not used for a long time and which no one wants anymore. It gives one a sense of accomplishment, makes for a more pleasant surrounding and frees up space.Is this something that you do at your healthcare site ...
Embracing the change coming to our health care system
As Bob Dylan sang so long ago, The Times They Are A-Changin’. Some like change; some do not.Consider these change scenarios:* One of the important scenes of change for health care providers is the national debate on health care coverage currently playing out in Washington D.C. Some are very vocal in their support. The media covers many of the vocal opponents. Certainly some sort of change will come out of ...
How eliminating waste and taking fewer steps can improve patient care
Recently I was on a canoe trip in Ontario, Canada with a close friend. As he and I were portaging our gear and canoe between two lakes I was thinking that the uphill path was difficult and wondered how many more steps it would take. The sooner it was done the better.I often find myself counting steps during my daily activities as I know that the fewer physical steps it ...
