Re-Inventing Discharge: Your Hospital’s New Job

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by Nance Goldstein, PhD, ACC-Working Wisely Group

money pillsEighty-six cents of every healthcare dollar in the US goes to treat chronic disease. Chronic illness causes ¾ of all deaths. And over the next 10 years, our chronically ill population will increase dramatically.

Dr. Richard Milani, Chief Clinical Transformation Officer at Ochsner Health System, calls chronic disease “the epidemic of our time.”

Research suggests that the current healthcare system hardly influences our health status – only 10%. Genetic predisposition 30%. Behavioral patterns? 40%! (Schroeder 2007).  At the Massachusetts ACHE spring conference on technology and innovation, Milani argued that behavioral change is singularly powerful in improving medications adherence, and reducing smoking and obesity. So reducing readmissions and system costs.

What changes behaviors? Financial incentives may work a little, then they backfire. “Social contagion” really works, that is, social connections, what one’s friends do and say, encouragement, and support.

Milani cited research that tested a range of messages to see what influenced household energy consumption. Information, environmental dangers, even appeals to self-interest each had little effect. The only thing that reduced household usage a lot was comparing customers to the Jones’. Household energy consumption dropped like a rock when they found out that their neighbors were more efficient than they. When these same poor performers reduced their energy usage, they received reports of how much better they now were than their efficient neighbors. They got a note of “Great!” and a smile-y face. Being noticed, praised and doing better than the Jones’ powerfully changed people’s behaviors. (Nolan 2008)

Another conference presenter, Mike Doyle, CEO of QPID Health, worked with Massachusetts General Hospital to predict hospital readmissions. The most important factors keeping patients out of hospitals did not happen in the hospital! A prime influencer was the level of support they had in their community.

And the more social connections the patient has, the lower the total costs of chronic care.

What does this mean for hospitals?

Milani created a specialized integrated patient unit that gathers people, expertise and tools to support chronically ill patients. That IPU offers education, diet planning, exercise plan, medication assistance, wearable and home monitoring technologies and health apps on the phone to gather data.

The IPU creates at least of a support network. Hospital staff can help patients find, participate in and enjoy their social network. Hospital success depends on connecting people with lots of others who will notice patient progress, join with them through the challenges, and have a stake in their health and well-being.

For clinicians? Clinicians’ conversations must go far beyond “Here are your prescriptions, twice a day and call the ER if you get a fever” at discharge. They ask whom the patient knows who can help them, how will they help, and how and when patients can find others as resources of all sorts. That means talking together throughout the patient’s stay, not just 30 seconds with forms for the discharge hand-off.

Hospitals that create active, generous communities of support and tools for connection will promote healthier patients who won’t come back soon.

Nance Goldstein, PhD, ACCnance goldstein

Resident Scholar, Brandeis University WSRC

Working Wisely Group


Nance’s healthcare leadership research and coaching give her an inside view of the turbulence that now rocks healthcare. Clinical frontline and middle managers prove critical to implementing healthcare change and innovation. Yet many feel uncertain, unprepared and isolated in dealing with their care teams in today’s uncharted world of care delivery. Innovation and continuous change demands more and different from us. Nance, a credentialed leadership coach and trainer, helps managers quickly find successful ways to relax and respond to the torrent of challenging workplace situations. Partnering with Nance, her clients get great results for their team, organizations, and patients… and for themselves.

Her clients and hosts include Harvard University, Institute for Electrical and Electronic Engineers, Society of Women Engineers, Women in Management, Women in Technology International, New England Human Resources Association, Boston Society of Architects, Women in Design, Massachusetts LeadingAge, BU School of Medicine, Boston Oncology Nurses Society, Boston Young Healthcare Professionals and Case Management Society of New England.

She’s a Resident Scholar at Brandeis University’s WSRC; a member of the Advisory Board of Boston Young Healthcare Professionals, and an active participant in American College of Healthcare Executives. For clinical manager resources and free ebooks, go to her group’s website: Working Wisely Group

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