By Randall B Charpentier, Peggy Berry, & Beth Boynton
Randall Charpentier: Healthcare recently is raging with headlines as institutional leaders transform their business model to a quality-based, financially incentivized system from a quantity-based reimbursement model. With this rapid transformation, another disturbing trend in the healthcare industry is noted. Dating back to mid-summer 2014, healthcare industries made headlines on several crucial issues: the lack of preparedness with the Ebola threat, being fined by CMS for high readmission rates with reimbursements reduced for services provided, the VA Healthcare scandal, and the high incidence of flu, measles outbreaks, HIV’s re-emergence, drug resistant super bugs, and contaminated endoscopes. Not only are these facilities facing negative publicity in the press, but the financial pressure is also elevated as evidenced with the 72 hour rule. One facility took a $ 4 miillion dollar hit over a weekend period. Widely publicized, the community based rural hospitals are facing enormous pressure to join new ACO networks or face closure because of their inability to comply with the new market trends. Clearly these issues create very challenging moments for consumers and providers of the U.S. healthcare services.
Since collaborating with Beth & Peggy on blogging, there always is an exciting ride to share with our viewers an insider view into the healthcare industry. After extensively writing on the challenges, barriers, and obstacles with healthcare, our shared goals are to present potential solutions to combatting these complex issues. What is particularly compelling to me, is not only observing others’ views through articles and blogs via the mass/social media network and worldwide web on the challenges the ACA is bringing to bear on the industry, but how others are revealing additional issues that have not been previously uncovered/reported on.
For instance, The Joint Commission has recently published several articles regarding non-compliance with healthcare facility standards on “Hand Hygiene” , “Environment of Care,”, Endoscope Decontamination/Disinfection and “Accelerating the Adoption of a Safety Culture“.
One has to ponder the question, are these new/emerging issues or long standing issues finally publicized? After reading the articles, it is extremely apparent that these are long-standing issues not publicized. As CMS continues to assess healthcare quality, the transformation for some organizations from quantity to quality will be a struggle. Will organizations adapt to the new cultural environment shifting to a proactive and positive staff and patient safety model or continue a culture of reactive, regulatory mindset, hiding the issues associated with staff and patient safety. It will be an interesting ride.
Peggy Berry: As quoted by a prior OSHA whistleblower investigator “lots of things are not reported”. In this day and economy, any healthcare professional who becomes a whistleblower faces the potential loss of credibility, their social group, and, in some cases, their license to practice. The Occupational Safety and Health (OSHA) Fact Sheet further clarifies unfavorable personnel actions associated with retaliation when an employee repeatedly pushes up the ladder policies, procedures, or actions that affect their, or others’, safety and health. Unfavorable personnel actions to hide extremely serious issues have been illuminated at the 2011 Dayton VA Hospital outpatient dental clinic where vets where exposed to Hepatitis B and C by a dentist who failed to sterilize dental instruments or change gloves between patients. An internal investigation substantiated the firing of a technologist for exposing the issues.
In order to improve patient care quality and increase the psychological safety and health of their employees, healthcare leaders need to embrace an open, calm, “active listening” communication style. If employees were encouraged to bring forth concerns and solutions, there would be no whistleblowers. There would be more quality healthcare at the most cost effective price from quality improvement projects. Although the focus is towards healthcare, all industry leaders and administrators should adopt the worldview and culture change that employees are shareholders and invested in making the industry better, not to tear it down. Embracing those individuals will encourage others to come forward to make change more positive.
Beth Boynton: It sure can be frustrating to see such pervasive brokenness and be so slow to change. We’ve known for over 10 years that issues with the hierarchy, communication, and organizational culture are pervasively involved in medical errors. We’ve also known that systems thinking is essential for fixing our incredibly complex system(s). Paul Plesk’s Appendix B in the Crossing the Quality Chasm is a great read for understanding the application of the principles of complex adaptive systems to healthcare. Sure, systems thinking includes acknowledging we’re human and designing systems that make it impossible to do things wrong, but that is only part of what systems thinking involves. It also involves emergent properties that can be nurtured, taught, supported, but not controlled. Human behavioral components that involve relationships and empowerment of patients and health care staff are both essential for our system to evolve.
Yet there are fundamental disconnects between leaders and staff, doctors and nurses, and patients and healthcare professionals. Here are two examples that illustrate underlying core issues that plague us.
First, The Joint Commission has a speak-up campaign that tells patients not to be afraid or embarrassed to speak up. While the general idea behind the campaign seems helpful and well-intentioned, the reality is that telling other people how they should or should not feel is disempowering. Healthier language, would include ownership, reflection, and validation on the part of healthcare leaders and might read something like this: Many people are afraid or embarrassed to speak up and being sick, vulnerable, and in this foreign system can be intimidating. Please try not to let that stop you. Healthcare professionals are trying to become better listeners and you can help us by sharing your questions and concerns. (And using receptive body language and sticking around long enough to give the message that we really mean it!)
Second, there is a lot of emphasis on teaching nurses to be assertive for patients and little focus or worse a counter message about speaking up for themselves, i.e. Don’t do it! By in large, efforts like TeamSTEPPS, Crew Resource Management, standardized communication such as SBAR are more focused on speaking up to report a clinical problem with a patient, but you don’t hear too much about helping staff say “No” to overtime and excessive workloads or creating opportunities to invite input into their own continuing education.
I think part of the problem is that the changes we need to see are behavioral rather than intellectual. They require doctors and senior leaders to let go of some of their power and patients and nurses and other professionals and paraprofessionals need to step up and take on more power. This can be risky emotionally and is certainly difficult in cultures where blaming or bullying are present. Not making these changes will always limit our ability to provide safe, quality, cost-effective, and compassionate care.
Randy, Peggy, & Beth: We summarize by asking, Where does your organization stand with transition/transformation, what steps have you taken, or do you desire to take? What kind of healthcare do we want and are we willing to provide? Also, to let you know that combined and independently, we have in excess of 20 years, of successfully executing our means and methods with implementing best practice in healthcare settings to ensure a safe, healthy, vibrant, collaborative and TJC/CMS compliant patient care environment. Our bios and contact info follow:
–Randall Charpentier is a 20 year experienced, safety and risk management consultant specializing in healthcare compliance and best practice management, and is a Chartered Building Engineer with CABE. Project experience ranges from leading teams on the construction of the west coast space shuttle project, working internationally & domestically for leading environmental engineering firms conducting real estate assessments involving occupational and environmental risks, assessing business operational risks concerning commercial insurance policies, and reducing/eliminating exposures/hazards, to leading world renowned, top ten/one hundred community based & BioMedical Research/Teaching hospitals, with development and execution of best practices with EOC, Fire/Life Safety, Infection Prevention in Healthcare Construction, and Emergency Management programs. HSNE’s/Randall’s passion is keeping patients, staff and visitors safe in a healthcare setting. CMS is measuring safety and quality in healthcare facilities basing reimbursement on healthcare outcomes. Does your facility measure up? If not, you should conduct a risk assessment. Is your facility compliance or results driven? To find out, contact firstname.lastname@example.org or www.hsnellc.com, or LinkedIn profile.
–Peggy Berry, MSN, RN is a PhD candidate with the University of Cincinnati and consultant in occupational health and environmental health. She is studying workplace bullying in healthcare with her dissertation focus on what nurses do to work through, cope, and support each other when bullying occurs. She is certified as a Senior Human Resource Professional, Certified Occupational Health Nurse Specialist, and Professional Legal Nurse Consultant. She has presented programs on benchmarking in occupational health, migraines in the workplace, on pandemic preparedness, communicable diseases, and workplace violence. Peggy has volunteered her time as an examiner with the Baldrige National Quality Program and Ohio Partnership for Excellence and as a volunteer with the Dayton Chapter of the American Red Cross as a Disaster Health Services and Emergency Services leads. Peggy is past president of Ohio Association of Occupational Health Nurses and past national director with American Association of Occupational Health Nurses. Contact Peggy: email@example.com or through her LinkedIn profile.
–Beth Boynton RN, MS is a national speaker, consultant, and the author of “Confident Voices: The Nurses’ Guide to Improving Communication and Creating Positive Workplaces”. She specializes in communication, collaboration, & emotional intelligence for healthcare professionals and organizations and is trained in the Professor Watson Curriculum for Medical Improv through Northwestern University Feinberg School of Medicine. Her video, “Interruption Awareness: A Nursing Minute for Patient Safety” and blog, “Confident Voices in Healthcare” have drawn audiences from all over the world. She is currently writing a core text on communication for nursing students with F.A. Davis Publishing Co. which is tentatively scheduled for publication in the Spring of 2015.