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Improving the Experience of Care: “The Secret”

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Robert Frost’s poem “The Secret Sits” is two simple lines of poetry, a couplet:

“We dance round in a ring and suppose,
But the Secret sits in the middle and knows.”

The meaning is left up to the reader. In healthcare, the “Secret” is the person at the center of care. The patient, their family, and their caregivers. They sit in the middle and they know, they just don’t have effective ways of sharing what they know or want, and healthcare is not very good at listening and responding accordingly.

During a recent conversation with a client hospital executive, she shared some findings that shine a light on this disconnect between what patients want and what leaders think patients want.

When she asked her leadership peers to list the priorities to improve the experience of care, they said:

  • New facilities
  • Quiet-time to ensure rest
  • Private rooms
  • Food on demand
  • Interactive bedside computers
  • Eliminate visiting hour restrictions

When the patients of her organization were asked to list the priorities they sought in order to improve the experience of care they receive, they responded:

  • Treat me with more respect
  • Communicate better between each other
  • Listen to my needs / requests / concerns
  • Be more happy
  • Show more empathy

Are you surprised?

The reasons behind this disconnect run deep. For many hospitals, clinics, and doctors’ offices the methodology for capturing the voice of the patient (the data) is broken, the tools are clumsy, and what leaders are doing with the data is not resonating, not effecting change, and not very sophisticated.

If I ran a restaurant in a like manner, it would go something like:

You’re served a cold tasteless entrée, on the menu as a ‘hot delicious special’. You have no opportunity to share your feedback with your server; they’re too busy with other patrons, appear far from approachable, and don’t ask you whether this is what you thought you ordered. When you do muster the courage to say something you’re told that you’ll receive a survey in the mail, and you can provide your feedback there.

Several weeks later the survey arrives in your mail box. You try and remember the meal you’re being asked about and reality kicks in; you’re likely remembering one or two experiences blended together, or you’re still so upset about the meal that you just let the restaurant have it…

The restaurant owner and manager receive the survey, identify the waiter and ask him or her to improve their service…

Without weaving this analogy further, you get the idea, oh and by the way, my restaurant would quickly go out of business if this was how I responded/reacted to such service failures.

The signal, response and desired change feel like they are all disconnected. This is how many hospitals currently “measure” the experience of care, this is the data they use to reward and recognize, and this is the data that they use to “drive change”.

What’s missing is an effective system for better capture of operations data. We need practices that capture feedback as close to real time as possible and that use this information to inform operations. The data should be used to inform where training and education is needed to close the gap between the current state and desired state.

Are you listening to “the secret” or dancing around the ring?

Black Box Enabled Surgical Suites?

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Medical errors are estimated to be the third leading cause of death in America. This is worth repeating – the THIRD leading cause of death in this sophisticated, educated, economic power house of a country is mistakes, errors, mishaps…

Why aren’t we outraged? Why aren’t we paying more attention?

I understand that healthcare, as a “system”, is a complicated, ever changing industry that relies on fallible human beings to work well in complex, difficult to repeat situations each and every day. But, here’s the reality – healthcare is NOT alone! There are industries equally as risk-filled with far better safety records! Why is it that the same level of safety we demand for our automobiles or airline travel is not demanded to protect a life, our’s or a loved one’s, when we enter a hospital?

There are many industries, other than healthcare, that work in complex environments where the actions of one human can impact the life of another. Healthcare leaders need to acknowledge the reality that we have much to learn from other industries. While we cannot mimic others entirely, the same general operating principles (including mindfulness that serves as the overarching organizational spirit) that are the foundation for other high reliability organizations (i.e.: aviation, nuclear power) can work just as well to prevent harm from occurring in health systems.

One example of a safe practice or technology that could shared across industries is the in-flight data recorder found on all commercial airliners. It was because of the in-flight data recorder on board the two Boeing 747s that crashed into one another on the island of Tenerife in 1977 that we learned so much about the decisions and behaviors resulting in that game-changing airline disaster.  The time stamped voice commands of those at the controls were captured in real-time, and provided a blueprint of what “not to do” along with a snapshot of what needed to be changed.

Now envision this: following a surgical procedure, regardless of the outcome, we have the opportunity to review every piece of data related to the procedure.

We currently have the technology by which we can go back and look at thousands of time stamped data points to review and/or recreate events as they transpired in the operating room. We can capture voice, video, blood pressure, oxygen levels, numbers of plasma/blood transfusions. The data would stream from the medical equipment in the room, from the microphones, the cameras, and any other sources that we choose to capture, into a device that allows playback, review and re-enactment.

We could assess team work, learn from the practice of those at the top of their game, and use this data to improve. We could revisit poor outcomes and learn what should be done differently in similar circumstances. This is not a pipe-dream, nor is it my idea; it has been developed and is currently being used and piloted by Dr. Teodor Grantcharov, a general surgeon at St. Michael’s Hospital in Toronto, Canada.

An innovator if ever there was one.

The choice to innovate is not, in fact, a choice – it’s an imperative.

I firmly believe we have the expertise, the intelligence, the resources, and the creativity to make healthcare less costly, more effective, more patient centered, and far better. We need to give ourselves the permission to try, to innovate, to disrupt our environments in ways that lead to safer, more effective and more humane healing environments.

Reduce Non-Clinical Classroom Time for MDs

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MD per 100,000 population by state
Physicians per 100,000 population by state (2011)
Physicians are some of the most time squeezed professionals on Earth. Whether practicing at a hospital, or as part of a care delivery organization, physicians must keep up to date clinically while they serve their panel of patients. Additionally, many physicians are doing research or have management responsibilities within their organization. Lastly, in order to be a practicing clinician within their organization, these same physicians are required to learn the technology systems used in order to document their clinical encounters (mostly EHRs). How do most organizations train their physicians? In classrooms watching trainers move through PowerPoint slides while lecturing. Do we want our physicians spending up to 20 hours of their time in classrooms learning to use an administrative system? Physician staffing shortages are a reality. Utilizing their time for non clinical activities only exacerbates a bad situation. Most believe there are not enough Primary Care Physicians in the U.S. today, and the situation is only getting worse. (See Chart) According to the Association of American Medical Colleges, there were 744,224 licensed and active physicians in the U.S. in 2011. Of those, 208,802 were aged 60 or older. At the same time there were 80,279 enrolled in the 137 accredited U.S. medical schools. Assuming no attrition, medical school graduates transitioning into their clinical residency (3 to 7 years) will average 20,070 per year, fewer than those retiring. There must be a better way to train physicians then spending the equivalent of 1,875,000 eight hour shifts (750,000 physicians times 20 hours training divided by 8 hours per shift) learning how to properly document a clinical encounter. Virtual Immersive Learning is one solution. Can you recommend others?

2 Modalities, 1 Goal: EHR Learning

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Maximize your training $ ROIRecently, I was talking with a top tier EHR trainer at a very large regional health system. She told me that while their EHR vendor had a strict requirement for all trainees to take the standard EHR training courses, including eLearnings and classroom training, when a team of Emergency Department clinical staff began to use the new EHR they were unable to efficiently and effectively apply what they had learned. Why? Because they were so lost they didn’t know where to begin. According to Wikipedia, “E-learning(or eLearning) is the use of electronic educational technology in learning and teaching.”  (http://en.wikipedia.org/wiki/E-learning ) But “e-Learning” is frequently as simple as a few PowerPoint slides with a simple test to take at the conclusion of the slides. Static PowerPoint based eLearning gives you assurance that your staff has seen the material. They have probably even understood some of the information. But this modality gives you no insight into whether or not the staff can apply what they’ve learned in a realistic, job-oriented scenario. In contrast, adaptive or virtual immersive training provides adequate integration, realism and immersion (the learner must engage with their full focus to make it through the training) that you will know for certain that your staff is ready to go.According to Wikipedia, “immersion into virtual reality is a perception of being physically present in a non-physical world. The perception is created by surrounding the user of the VR system in images, sound or other stimuli that provide an engrossing total environment.” In layman’s terms: when your staff has experienced Virtual Immersive Learning they have already worked with your new EHR in their actual work role.

3 Benefits to Virtual Immersive EPIC Training

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9-info-tech-e1389127561311Many hospitals are implementing or updating EPIC EMR software. When we inquire as to what clients need they tell us that they need training that is engaging, effective and efficiently delivered. Historically, go-live has meant resources working at sub-optimal levels as users ramp up their knowledge and comfort with the EPIC system. The cost, in efficiency, of this learning curve is substantial and incremental to the already extraordinary out-of-pocket costs associated with the classroom training that is the current industry standard training approach. There is an alternative. WP Virtual Learning has built and delivered a virtual, interactive training capability that replaces classroom training. Where individual instruction is required, avatars, videos and scenes with voice overs replicate the true-to-life where the learner actually works. This is far more realistic than a classroom setting. The learner responds to “live” patients, the actual screen they will be using and the correct workflow exactly as they will be doing when the software is implemented and “live”. A few reasons why this approach is more effective and cost efficient: • In one example, we reduced a 4 hour classroom training session (exclusive of travel time) to 2.5 hours • The training will be available for refresher courses, new hires, job changes, etc. • The learner is fully engaged at all time, not waiting for instructors or classmates to catch up, not checking email or texting a friend. The learner must stay engaged throughout the training to move forward with the session This new-to-healthcare paradigmof training will change the way training is delivered throughout the industry. Why? Because the current classroom-based training is just not up to the task of delivering what healthcare organizations need.