Many times I have heard physicians and other providers lament that the outcomes for their patients would be so much better if they could “get them to listen and follow instructions.”  They understand that they can be most effective in treating patients if the patients would follow all of their directions. Do the physicians’ or care providers’ responsibilities end with this wish?  Can physicians do more than just hope and pray ...

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If you are a healthcare provider -- physician, administrator, or some other leader at a healthcare site -- then you know that you face many challenges.  Some seem overwhelming and you may be thinking that you may not be able to handle some of them well.  Perhaps the transition to ICD-10 coding is your main concern right now. The solution to difficult challenges begins with the first step.  I am taking ...

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Health care providers want their patients to have the best outcomes possible.  They know that for this to happen that the patient must be engaged in managing his or her condition, whether it is an acute or chronic condition.  Patients need to follow the provider’s directions and orders.  If they do not, then the outcomes will be sub-par. For instance, if you the provider give a patient a prescription then they ...

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If you are a healthcare provider—physician, administrator, or some other leader at a healthcare site—then you know that you face many challenges.  Some seem overwhelming and you may be thinking that you may not be able to handle some of them well.  Perhaps the transition to ICD-10 coding is your main concern right now. The solution to difficult challenges begins with the first step.  I am taking the liberty of adapting ...

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shutterstock_119156143 Most clinical providers are aware of the more common capacities of EHRs.  However, there are many capacities that are being underused that can be of great assistance in providing safe care that avoids waste and identifies best practices.  Electronic communication with providers outside of one’s clinical setting, clinical decision support and improving the body of knowledge of best practices are three of ...

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shutterstock_118348960 Quick!  Can you name the leading cause of accidental death in the United States now?  It is prescription drug overdose.  Since 2009 death from legally prescribed narcotics has led auto accident deaths as the number one cause of accidental death in the United States.  More than 15000 die now annually. On October 5, 2012 the Wall Street Journal on its front page published ...

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Do you read the comic strip Dilbert” by Scott Adams?  I read it most every day.  It tells the story of an engineer named Dilbert and the people with whom he works, including notables such as Wally, Alice and the pointy-haired boss.  Mr. Adams daily relates amusing situations of the dysfunctional relations at Dilbert’s work site.  While the situations are hilarious at times, they reflect the actual work processes at ...

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“What we have here is a failure to communicate.”  A famous quote from the movie Cool Hand Luke.    As many know poor communication is common in healthcare. Consider the following examples. According to Charles Duhigg in his newly released book, The Power of Habit, Rhode Island Hospital was one of the nation’s leading medical institutions.  It was the teaching hospital for Brown University and the only Level I trauma center in southeastern ...

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Obesity is becoming a major health issue in the United States across all age groups.  It is well known that obesity is a major contributor in the occurrence of type 2 diabetes and heart conditions.  Although physicians and other clinicians are often called upon to become the primary players in the prevention and treatment of chronic conditions, it is not possible for them to do so alone when it comes ...

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Recently I was asked, “How can I improve my Press Ganey scores?”  Presently this question applies mostly to hospitals as CMS is requiring hospitals to use the HCAHPS as a part of their quality reporting. Press Ganey can manage the HCAHPS for hospitals.  Few physicians or physician groups presently survey patients for satisfaction; they should begin thinking about doing so in the near future as it seems likely that CMS ...

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Based upon the past and the current state of affairs in healthcare, healthcare reimbursement will change dramatically in the future.  I believe that reimbursement based upon fee-for-service will gradually disappear and be replaced by models based upon the ability to better manage patient diseases and conditions.  That is, reimbursement will be based upon the quality of service delivered by the provider.  For insurers, whether private or governmental, I believe that ...

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My primary care physician, the last time I was in for a checkup, had not adopted ePrescribing or started using an electronic health record (EHR).  My understanding is that the medical group to which he belongs had not rolled out these capabilities to him yet but was planning to do so.  Hopefully, this summer when I see him again he will be plugged into the electronic health record that the ...

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W. Edwards Deming is recognized as one of the driving forces that led the Japanese in the 1950’s to become a world-class manufacturing nation.  The Japanese through the implementation of his principals became leaders in the manufacture of automobiles and electronics.  One of his cardinal principles was that a company must delight its customers.  It is not enough for a company that wishes to excel to meet the needs and ...

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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. ...

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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 ...

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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 ...

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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. ...

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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 ...

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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 ...

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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 ...

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