Wednesday, August 10, 2011

Does Your Medical Staff Comfort Your Patients?

Psalms 23:4 Yea, though I walk through the valley of the shadow of death, I fear no evil. Thy rod and thy staff, they comfort me.

...thy staff, they comfort me...

Not to take away from the literal context of this passage, but just for the sake of entering a conversation regarding patient care at your facility, let me ask this question. How comforting is your staff and would you, without reservation, volunteer to be a patient there?

An inpatient experience could very well be defined as walking through the valley of the shadow of death. No matter how close the patient comes to death, they stare their mortality in the face just by lying in that bed. The thought, or shadow, of death passes through the patients mind several times during their hospitalization. Even during a joyous occasion such as giving birth, the crash cart close to the bed is a constant reminder that even the best of events has the potential of becoming the worst.

Are your staff members trained to comfort patients emotionally, or do you place the emphasis of patient care only on meeting their physical needs? Do you encourage those giving direct care to spend a few extra minutes bedside to guarantee the patient is comfortable in all aspects? The single greatest mistake a medical facility can make is to overlook the patient and concentrate solely on profit. When you concentrate more on the quantity instead of quality, everyone loses. I don't need to spell out what the implication of quantity over quality entails as this mindset has been King since the turn of the 20th century. It has literally taken the service of health care into the business of health care, and it has produced a generation of dis-satisfied patients. Be the change.

Challenge for the day:
Can it be said that your medical staff comforts? Think of ways you or your organization fall short in the philosophy of patients first and resolve to change them.

Monday, January 10, 2011

Don't Hate Me Because I'm an Addict

I was not qualified to write anything remotely involved with being an addict prior to reading Impaired by Patricia Holloran. I’ve never been addicted to anything but love and coffee, and even now, I use the word addicted loosely. I didn’t know what diverting was (as it applies to the medical field) , that getting caught doing so was a blessing instead of due punishment, what the road to recovery involved, or that returning to that lifestyle after going through the recovery process was not based on a lack of self control.

The medical field as a whole has let down healthcare workers when it comes to stress related issues. It can be argued that those in the medical field generally have the same personality trait-the need to fix other peoples problems-and that co-dependency can lead to stress and personal breakdowns including drug use. Not only do healthcare workers judge patients that present with dependency problems, but they are even harder on coworkers that are found to have the same addictions. Unless, of course, you have been down that road and have recovered. (Or are on the life long journey of recovery) Add the fact that medications are pretty easy to come by in a healthcare setting-think Pyxis machines, and the lack of a strong support system after getting caught diverting…well, the problem becomes complicated on multiple levels.

Sure, there are hospital based chaplains and counselors, but when you are sent home after being told you no longer have a job, or are being suspended indefinitely, no one dares to counsel you on the real task at hand. You need someone shooting straight-advising that you should get an attorney because facing the boards is excruciating, or that recovery is more than going to a support group, that finding a mentor and sponsor is crucial, that urine samples are a way of life for you, that facing this without your drug of choice will be harder than facing each morning wondering how to get your drug for the day, that returning to the healthcare setting after a short intensive recovery process will not be easy, and on and on it goes.

Impaired was also a wake up call to the Christian in me. I have judged far too long. And our churches have totally let down its members. Think about it. When an addict attends meetings, they begin the meeting by everyone announcing their names and saying “and I am an addict”. No one judges them because everyone in that room has the same problem. They find spiritual support, encouragement from others further down the recovery path, and inspiration to make it just one more day. What would church services be like if each member stood up at the beginning of service and announced their name and added the problem weighing heavily on their mind?

“Hi. I’m Mary and today I am overwhelmed. Or “Today I am angry.” What if other members chimed in with encouragement and hope to help me overcome my problem-of-the-day? Now that would be church. No sermon could speak to me so clearly, or help navigate my Christian walk more accurately than mentors that have been there already.

Recovering addicts say that twelve-step programs are some of the most spiritual experiences of their lives. It is because they are accepted, share a common belief in a higher power, and lean on that and each other. Yes, the church needs to take note and change their approach to servant hood. I believe openly admitting our struggles and shortcomings and focusing on how to cope would be a powerful ministry.

I could never do the topic of addiction recovery justice in one blog entry, but do encourage you to read more by consulting the resources below. In some ways recovering addicts are a blessed group of people. With the wonderful support systems in place, they can learn about themselves, implement change, and make friends for life while finding the source and resource for all they will be-God. If, as an addict, you need this kind of help, please make contact with one of the many recovery programs across the nation. If you have made the journey successfully and know of other support networks that can help, feel free to post that information in the comment section.

The Reality of Recovery

Nurses For Nurses

Contact author, RN, recovering addict, and activist Patricia Holloran at

Wednesday, October 6, 2010

What "Dignity" Means to Me

Words mean something to me. I don’t speak them flippantly and I expect others to mean what they say. When I say “a patient deserves dignity” there is a particular meaning I am referring to, and I am finding that the pro-euthanasia community is using that same word-dignity-but in a whole different context. I believe everyone deserves respect whether they are wearing a three piece Italian suit and Rolex or a blue cotton gown. Just because a person swaps their clothes for a hospital issued gown does not mean mutual respect got checked at the door and they are fair game for inhuman treatment from the hospital staff. Whether the patient arrived walking straight-backed or hunched over a cane makes little difference to their worth as a person. Whether they are black or white, American or Asian, the treatment given should be the same. This is my definition of dignity. And if I were to speak of a person dying in dignity, that would include ensuring the patient received privacy, respect, and compassion until they exhaled the last bit of oxygen in their disease ravaged body.

Unfortunately, the pro-euthanasia community believes ‘dying in dignity’ means to put someone out of their misery through lethal injection. Much as you would put down a dog or cat or horse after a fatal injury, they believe a terminally ill patient has the right to ask for a life ending fatal dose of medication. This is humane, in their view, as it avoids unnecessary pain that is sure to accompany the life ending process of some diseases. Much as I would like to debate euthanasia based on several factors, (including I don’t believe in playing God when it comes to intentionally orchestrating death or legalizing the right to allow others to decide when the situation is right to euthanize) I do want to point out that dignity can mean different things to different people and is used in various contexts.

The dictionary defines dignity as “a sign or token of respect”, and respect is defined as “esteem for or a sense of the worth or excellence of a person”. My mission within the world of medical advocacy couldn’t be defined any clearer-I believe a person has worth and is entitled to special treatment based on that worth. It is unmerited and based solely on the fact we are all civilized human beings deserving of such treatment. When you look at my business card and it reads “Everyone has value, everyone deserves dignity” I do not speak in the same capacity as the pro-euthanasia community. My meaning is clear and concise-you have value and you deserve dignity just because you are you. As a patient, you have the right to expect the medical community will do all it can to increase your life, not take it from you. The knowledge and training and technology offered in a hospital should be used to do nothing but enhance life.

If I sound idealistic and unaware of the logistics of the gray areas, trust me, I know. However, nothing can convince me that dignity of a person should include an untimely death based on a lack of will to continue living. I would like to see the medical community fight against the political and social arguments that the best of tools in the right hands should be used for anything other than preserving life.

Make no mistake about the context in which this activist uses the word “dignity”. It includes any and every thing associated with life and love and the power of both.

Thursday, August 26, 2010

Lean Hospitals Drive Profits and Productivity But Leave Questions Pending Regarding Patient Care

I'm having a hard time embracing the idea of Lean Six Sigma in a healthcare setting. After reading the book Lean Six Sigma For Service I am still convinced that there are no short cuts when it comes to patient care and services. Although many say this book provides clear ideas on how to apply the concept in a healthcare setting, and although there are testimonials on the Internet regarding hospitals that turned around due to implementing Lean and Six Sigma thinking, (yes, they are two separate concepts) I have not been convinced there is anything more to this than good old common sense and perhaps an underline beneath the idea that the hospital should operate as a business.

There is an age old question that many shy away from answering-is the hospital providing a service or is it a business? I still cringe when I overhear the opposing viewpoint that hospitals are businesses and are entitled to turn a profit. I respect that viewpoint, however, in all honesty, it negates the roots of the healthcare industry. Every major hospital began with the idea that the service should be offered to those that could not afford the care, or just plain and simple, needed medical attention. What a clever idea-offering a service to those that are in need of it, as opposed to a business where you try to convince your consumer that they need what you have to offer. When a hospital is identified as a business, healthcare professionals will do whatever it takes to drive profits north, sacrificing the patient in the process. Because, after all, stockholders must remain happy with their shares, eliminating the debt within the business becomes priority, and the consumer is nothing but a pawn used to get these jobs done.

"Lean Six Sigma for services is a business improvement methodology that maximizes the shareholder value...." Does that reasoning, taken directly from page 6 in Lean Six Sigma For Service, have any place in the healthcare industry? This mindset promotes productivity-getting more done quicker-for the sake of the shareholder and that is where the patient has gotten lost in the system. When a hospital is viewed as a provider of healthcare service, being efficient is still part of the equation because doing a job quickly while eliminating errors is in the best interest of the patient and hospital. There needs to be that balance brought to the "methodology" while contemplating healthcare and Lean Six Sigma. It can't be a decision between shareholder or patient-and if it becomes that, I hope the decision leans in favor of the patient.

St. Luke's Hospital is excited that Lean helped them treat heart patients more effectively. "Studies show us time and again if you walk into the emergency room with chest pains there’s a 90-minute window where you get the best outcome … This lean system has helped us hit that target every time now for 10 months." No hospital worth it's name would allow a heart patient to wait in the Emergency Department without immediately providing basic treatment. If ED's are still that negligent and slow, there is a triage issue but not necessarily a Lean issue. This is not a firm argument for Lean Six Sigma in the healthcare setting.

I'm not saying hospitals shouldn't concentrate on greasing their system to insure patients get care as quickly as possible. I'm not saying that thinking in terms of good business practices (like cost reduction, error proofing treatments ect) is a bad thing. I do believe there is an error in judgement when you make the conscious effort to place your shareholders higher than your patient. What if law enforcement, firemen and our military began talking in terms of "profit, shareholder value, and business methodology"? It seems like a contradiction when these are primarily thought of as public servants. If the local ambulance service decided to cut back on service days because of the cost of fuel, many patients would be in trouble. There is a time and place for thinking in terms of business related profits and shareholders, but my belief is that the healthcare industry is not the time or place. Hospitals can make a profit-I'm not opposed to that. But when a profit becomes more important than the patient, that is when the objective needs to change.

A service structure that places the emphasis on the patient seems to be smoke in mirrors. Many healthcare institutions claim the patient is high on their priority list but when I see the emphasis on the happiness of the shareholder through programs such as Lean Six Sigma in the healthcare setting, it saddens me. I believe within the healthcare crisis, among the conversation of offering care to those that need it, there is too much talk of funding the care in terms of turning a profit-not necessarily funding the care in terms of meeting costs. There is more than enough money in our country to fund good care-think St Judes Hospital that operates entirely from private contributions. Our healthcare system is as sick as the patients it endeavors to treat, but trying to fix that system by turning profits is a mistake. A mistake that I believe has sacrificed the patient as well as the American way of healthcare service.

Thursday, August 19, 2010

Surgery on Sunday

Surgery On Sunday, Inc. works closely with community partners to provide essential outpatient surgical procedures to income-eligible individuals. Patients are referred to Surgery on Sunday, Inc. by numerous partner agencies.

Featured in People Magazine Heroes Among Us

How Our Program Works
In today’s world, many people in America simply do not have adequate medical coverage. This means that basic outpatient medical procedures are out of reach for millions of Americans.

Surgery on Sunday, Inc. is a non-profit organization that provides essential outpatient surgical services for free for those in need who cannot afford insurance and who are not eligible for federal or state programs. Patients are referred from existing organizations in the community and receive much needed surgical procedures.

Our services are provided by doctors, nurses, and other medical professionals who volunteer their time and expertise to reach out to those in need. If you need medical assistance and wonder if you qualify for our program, please check out the Referral Agencies link to find agencies in your area. If you are a member of the medical community and would like to become involved with our program and donate your time please check out the Volunteer section for information.

Surgery On Sunday is a proud partner of United Way of the Bluegrass. Dependent on the generosity of private foundations and donors to help clients receive the surgeries they require, Surgery On Sunday is also honored to receive funding from The Samaritan Foundation, Rotary Club of Lexington, Fayette County Medical Society, and The Keeneland Foundation.

Wednesday, August 11, 2010

Hospitals and Facebook Under Fire in HIPAA Related Dispute

William Wells arrived at the emergency room at St. Mary Medical Center in Long Beach on April 9 mortally wounded. The 60-year-old had been stabbed more than a dozen times by a fellow nursing home resident, his throat slashed so savagely he was almost decapitated.

Instead of focusing on treating him, an employee said, St. Mary nurses and other hospital staff did the unthinkable: They snapped photos of the dying man and posted them on Facebook.

Four staff members were fired and three disciplined, according to a St. Mary spokeswoman. At least two nurses were involved, but none was fired, a union spokesman said.

read full story here

This story has recently sparked outrage directed at facebook and medical institutions. To solve the problem, some feel facebook should not be accessed within a hospital setting. They further argue hospitals don't do enough to zip the lips of employees. After all, 14 year old Stephanie also had her picture plastered across facebook back in 2008. What about the EMT that took crime scene photos of 26 year old Caroline Wimmer-taken less than an hour after her death-and posted those to facebook?

I have to argue in defense of facebook and medical institutions-aka hospitals. First things first. Yes, I believe facebook should monitor closely the content that is posted on their site. However, they immediately took the photos down and even offered a tribute to the victims. They maintained an element of class and did the right thing when presented with the issue. Facebook is a social network-to eliminate its access in a hospital setting, I believe, would cut off great interaction between those in the medical field. There is a camaraderie between health care employees-they get each other. The day to day stress of saving lives and losing lives can only be shared adequately with those that experience the same thing. To share that element of pressure with those outside of the medical field would be, well, like holding a dead fish. No response. There is also a lot of consulting that goes on between the facebook walls of medical professions. I do not encourage the elimination of social networking within the hospital nor do I think it would make the problem go away.

Here is where the breech is occurring-within the employee. If it was within rules, all your hospital human resource department would have to do was state "Do not post photos of patients on facebook. Do not take photos of patients." See how ridiculous that sounds? Some things you should not have to tell a person. Some things lie within the integrity of an individual. If you have to point blank make the ruling "Don't take photos of patients", you have an integrity problem, not a problem within your regulations or within facebook.

You can not legislate compassion. Either your employees have it or they don't. You can't hold their hand and tell them how to act. The responsibility falls in hiring those that you believe will act in a graceful, compassionate, trustworthy manner, and then you fire them when they prove otherwise. You will make a pretty big "no tolerance" statement and those extra rules will be unnecessary.

Employees will talk. I know. I've been there when it happened over the body of a comatose patient, in a public elevator, even in the cafeteria. These are all places where confidentiality is breached. Here the patient is given a piece of paper upon admittance that states your hospital follows HIPAA guidelines, yet by taking locker room talk into the public arena, aren't the employees violating HIPAA? It all goes back to the integrity of the employee. Are they willing to hold to a higher standard of service or are they willing to breech the privacy of patients in the name of gossip? That is the question that needs to be addressed.

If hospitals have contributed, it is not within the context of allowing access to facebook. It lies within the focus and integrity of it's employees. Perhaps that is where this problem should be approached.

Wednesday, July 14, 2010

Medicine, Skilled Hands, Compassion and God

In my short term as a hospital employee, I learned through a crash course how medicine really works. If you think the magic lies in that IV pump, or the OR, or even the skilled hands of a physician, think again. Not that these things don't help-they do. But they aren't the end all to every physical problem. If that was a fact, patient satisfaction wouldn't be so important.

While some may argue that it is technology and medicine we should focas on, I argue it is a combination of medicine, skilled hands, and compassion while God does the real work. This sounds simple, but it took some real bumps in the road for me to come to terms with that. Below is an excerpt from a writing project related to the enlightenment process titled Healthcare That Heals-Reclaiming the Passion for Compassion.

What I needed more than anything was a support group for ducks. Yes, ducks. As graceful as they glide across the lake water who would ever know their little legs are paddling like mad underneath the surface of the water? That was me. By all appearances, I gracefully handled any situation-even death in an elevator- but the truth was that I was struggling. More than just a little, too. It would have been so liberating to have been able to go into a room full of people like me, stand up, and blurt out “I may look like I’m doing ok but I’m not. When you ask if I am alright, especially after I lose a patient to death, and I say I am, how can you believe me? No. I’m not ok. I am struggling. Can’t you see my legs paddling like mad?”

Once you become a duck, you notice other ducks. You walk into a patient’s room that is undergoing chemo and ask how they are doing. “I’m fine. And you?” Sure they’re fine. How could they be when they are engaged in a battle for their life right now? Duck.

You’re standing in line in the cafeteria and over hear two other employees talking. One mentions her husband just lost his job and she is concerned about the stability of her own work. You are elbow to elbow with her at the salad bar a few minutes later and initiate small talk. “So how’s it going, Alice?” She smiles. “Not bad.You? Boy this lettuce looks wilted today.” Duck.

Your pond, the world around you, has more ducks in it than you think. But true to duck behavior, it’s hard to see what others are going through because you are so consumed with keeping your feet moving to keep your own head above water.

My medical career so far had been a baptism by fire. I had the head knowledge of how hospital life and schedules ran, but learning humanity in the midst of crisis was a new lesson altogether. The training of physicians, medical technology and technological advances weren’t powerful enough to have the last word. God was still in charge of life and death and flexed his authoritative muscle often. I was caught between fearing God and not trusting him, while trying to figure out my role in the whole scheme of things if my prayers for patients didn’t get answered. Why was I here? Why did I have a distinct and overpowering desire to work in the hospital if there was no purpose? I believe everything happens for a reason and there is a purpose for each desire of the heart. What was the purpose in my driving desire? Have I mentioned how simple the answer was? That God wanted me to be there to care for patients in distress, not necessarily author the outcome? That idea went over my head for the time being, and so I continued on a self destructive course, perfecting the whole duck act.