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Quote of the Month
"Don't worry about people stealing your ideas. If your ideas are any good, you'll have to ram them down people's throats."
- Howard Aiken
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Nerd nurse is quite a case
Greg Alexander, a professor in the University of Missouri's Sinclair School of Nursing, integrates nerdy technological expertise into his health-care career.
Using technology to improve lives
A nurse with an interest in engineering may seem to be a strange mix, but Alexander uses information technology for early intervention to help keep older people out of the hospital and improve their ability to age in their places of residence.
With a focus on the nursing-home industry, Alexander studies interrelationships among people, their environment, the technology they use and the tasks they perform. He then creates interfaces to make the data usable. In a current project, he is creating an interface to remotely detect the decline and monitor the health of elders, a new approach that is revolutionizing traditional eldercare.
"Greg is brilliant," says Associate Research Professor Bonnie Wakefield, who shares research interests with Alexander. "He understands how electronics work in the clinical world. For someone who is a recent PhD, he's well recognized in the field of nursing informatics."
Alexander leads a group of multidisciplinary researchers in a motion-capture technology project at TigerPlace - an aging-in-place, seniors' apartment complex linked to the nursing school. He's responsible for creating a computer interface between data gathered from sensors in the residents' apartments and the resulting displays of information that eldercare providers and family members can use.
Such technology offers help for "Aunt Edna" before she falls and can't get up.
To preserve her privacy, the program uses pixels and computer angles to display Aunt Edna's image as a silhouette, rather like an unidentifiable blob. Sensors in test rooms at TigerPlace monitor how often she opens kitchen cabinets, refrigerators and doors or uses the bathroom. A device near her bed measures her heart rate, breathing and restlessness. By studying data displays of her activity patterns and daily routine, caregivers can predetermine her risk of falling when changes in normal activity become apparent.
Alexander collaborates on the human-computer interaction with several specialists in eldercare, including engineers, social-services personnel, psychologists, physicians, geriatricians, information scientists, interior designers, usability experts, physical therapists, architects, veterinarians - patients' pets are residents, too - and students.
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"The achievement of excellence can occur only if the organization promotes a culture of creative dissatisfaction."
- Lawrence Miller
"Creativity is thinking up new things. Innovation is doing new things."
- Theodore Levitt
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The Top Eight Reasons Six Sigma Projects Fail
The data was based off a survey of nearly 150 of Minitab's customers at nearly 100 different companies. And yes there were more than eight reasons for failure cited by respondents. There were actually 42 reasons, but the top eight represented 62 percent of the total.
The Top Eight Reasons Six Sigma Projects Fail...
# 8 - The project solution was not implemented
# 7 - Project scope too big
# 6 - Not enough training
# 5 - Project too small for DMAIC rigor
# 4 - Project forced into DMAIC
# 3 - Project had no data or bad data
# 2 - Project not linked to Finances
and the #1 reason Six Sigma projects fail...
No management support
The biggest takeaway was:
"Rule #1: Pick the right project."
iSixSigma Magazine, March/April 2005
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BIRTHDAY
USA
July 4, 2009
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Got Silos?
Many hospitals are known as places where communication all too often does not flow across the organization because of the walls built up between departments. Those silos and walls make it very difficult to improve communication, improve quality, improve customer service and even reduce expenses. If everyone continues to "just do their job" and then figuratively throw their work or their patient over the wall to the next department it becomes very difficult to make lasting improvements.
silo
kept separate from similar items, especially in the case of funds, a budget line item, a department, etc.
Communication, quality improvement, productivity improvement, cost saving ideas all thrive in an organization that is more transparent and has fewer silos. Changing the organizational culture so that staff concentrates on customer issues rather than employee issues, is a journey that requires planning, patience and perseverance. It doesn't happen overnight, but when it does happen it is very rewarding to see employees take ownership of the customer experience. The main danger, the biggest obstacle, generally turns out to be management however.
Executive leaders at Hartford Hospital, a 900+ bed teaching hospital and trauma center in Hartford, CT, were concerned about silos and two-way communication up and down the organization. In addition, they wanted to improve patient satisfaction scores and overall customer service. By utilizing departmentally based Work Groups and cross-organizational Action Groups, all guided by process facilitators, they started focusing on common themes and opening up the mystery of a complex budget process. Early results show a wide and deep acceptance and even excitement on the part of front line staff and management. I'll continue to discuss their process - known as How Hartford Hospital Works or H3W in future newsletters.
Have a safe and fun summer!
 Ken KenBast@MgtConsultinginHealthcare.com |
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Doctors deeply divided over national health care reform
The American Medical Association is one powerful voice on the subject, but it's far from the only one. The AMA opposes President Obama's public insurance option, which he will try to push through Congress this year. But the AMA represents only 20 percent of physicians.
By CHEN MAY YEE, Star Tribune
Last update: June 27, 2009
Dear AMA: I quit!
With that letter, a young Mayo Clinic physician named Chris McCoy removed himself from the membership rolls of the American Medical Association this month -- and plunged himself into a roiling national debate over the future of American health care.
The cause of McCoy's ire?
The AMA's opposition to a new public insurance option as part of President Obama's plan for health-care reform.
McCoy's solo protest is just one sign of deepening fissures among America's doctors at a time when the country is hurtling toward big changes in the way it pays for and delivers health care.
Obama stood before the AMA's annual meeting in Chicago to promote his ideas on health reform. Support from the biggest, most influential physician group is thought to be crucial if Obama is to muscle a bill through Congress this year.
But with 250,000 members, the AMA represents just 20 percent of physicians, down from 75 percent in 1960.
Far from being a monolithic group, the nation's doctors reflect a spectrum of views -- based on personal experience, mission and financial self-interest -- that mirrors the way Americans in general have different hopes for health care reform.
"The AMA has stolen the headlines with Obama's visit," said Dr. Jean Silver-Isenstadt, executive director of the National Physicians Alliance, a four-year-old group that favors a public insurance plan. "But there are many physicians ... and the majority feel that our patients really can't wait anymore."
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How Long Can You Wait for Change to Happen?
by Ken Bast
As a consultant I often hear clients say that they can't take on another thing right now because they are already swamped with multiple, critical projects that must get finished before any new thing could be started. That makes sense - at least on the surface. Why take on more when you're not finishing what you've already committed to? However, the major unspoken assumptions expressed here are that priorities (including the new thing) have been reviewed and set and that the rest of the world will stand still and wait for you to finish what you're doing before the world demands that you change or worse, passes you by.
Hospitals and other healthcare organizations too often tend to be slow moving and risk averse. Now granted, you really want them to be risk adverse when it comes to patient safety and patient care, but when it comes to waste, inefficiency and poor communication between silos (see introduction above) you want them to move quickly to remove obstacles. Unfortunately, real movement takes more than a memo or two from the CEO, it takes hard, long-term work to change a culture.
Management Consulting in Healthcare has a unique approach which gives culture change a chance to root and thrive. Contact me, let's talk.
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July 2, 2009 New York Times
Op-Ed Contributor
The Patients Doctors Don't Know
AS they do every July, hospitals across America are welcoming new interns, fresh from medical school graduation. Given how much these trainees have yet to learn, common wisdom holds that it's not a good time of year to get sick. This may be particularly true for older patients, because American medical schools require no training in geriatric medicine.
Often even experienced doctors are unaware that 80-year-olds are not the same as 50-year-olds. Pneumonia in a 50-year-old causes fever, cough and difficulty breathing; an 80-year-old with the same illness may have none of these symptoms, but just seem "not herself" - confused and unsteady, unable to get out of bed.
She may end up in a hospital, where a doctor prescribes a dose of antibiotic that would be right for a woman in her 50s, but is twice as much as an 80-year-old patient should get, and so she develops kidney failure, and grows weaker and more confused. In her confusion, she pulls the tube from her arm and the catheter from her bladder.
Instead of re-evaluating whether the tubes are needed, her doctor then asks the nurses to tie her arms to the bed so she won't hurt herself. This only increases her agitation and keeps her bed-bound, causing her to lose muscle and bone mass. Eventually, she recovers from the pneumonia and her mind is clearer, so she's considered ready for discharge - but she is no longer the woman she was before her illness. She's more frail, and needs help with walking, bathing and daily chores.
This shouldn't happen. All medical students are required to have clinical experiences in pediatrics and obstetrics, even though after they graduate most will never treat a child or deliver a baby. Yet there is no requirement for any clinical training in geriatrics, even though patients 65 and older account for 32 percent of the average doctor's workload in surgical care and 43 percent in medical specialty care, and they make up 48 percent of all inpatient hospital days. Medicare, the national health insurance for people 65 and older, contributes more than $8 billion a year to support residency training, yet it does not require that part of that training focus on the unique health care needs of older adults.
Medicare beneficiaries receive care from doctors who may not have been taught that heart attacks in octogenarians usually present without chest pain, or that confusion can be due to bladder infections, heart attacks or Benadryl. They do not routinely check for memory problems, or know which community resources can help these patients manage their conditions. They're uncomfortable discussing goals of care, and recommend screening tests and treatments to patients who are not going to live long enough to reap the benefits.
I was part of a group of doctors and medical educators who recently published in the journal Academic Medicine a set of minimum abilities that every medical student should demonstrate before graduating and caring for elderly patients. Nicknamed the "don't kill Granny" list, it includes being able to prescribe medicines, assess patients' ability to care for themselves, recognize atypical presentations of common diseases, prevent falls, recognize the hazards of hospitalization and decide on treatments based on elderly patients' prognosis and their personal preferences.
The 2008 Institute of Medicine report "Retooling for an Aging America" resolved that all licensed health care professionals should be required to demonstrate such competence in the care of older adults. But this resolution lacks teeth. Medical resident training programs that receive Medicare money should be required to demonstrate that their trainees are competent in geriatric care. Medicare should finance medical training in nursing homes. And state licensing and medical specialty boards should require demonstration of geriatric competence for licensing and certification.
Basic geriatric knowledge is preventive medicine. Nurses, social workers, pharmacists and other health care professionals should have it, too, in order to improve care for older people. But until doctors get this basic training, we can't even begin to give 80-year-olds the care they need.
Rosanne M. Leipzig, a physician, is a professor at Mount Sinai School of Medicine.
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