Rants & Musings

Patient Relationship Management, start at the top

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The customer in this news article wrote a letter to Sir Richard Branson, Chairman of Virgin Atlantic. His letter is a must read for anyone who is in need of a smile. The text below is from Fox News. Paste the link-the photos are critical to the story.

A passenger who wrote a letter of complaint to Virgin Atlantic expressing his dissatisfaction with the in-flight food is now being offered the chance to be a food tester for the airline, the Daily Telegraph reported.

The passenger’s complaint to Virgin chief executive Sir Richard Branson was written after a flight from Mumbai to Heathrow on Dec. 7 last year and has been widely praised for its humor.

http://www.telegraph.co.uk/travel/travelnews/4344890/Virgin-the-worlds-best-passenger-complaint-letter.html

saint

 

EHR Tips for supplementing ARRA funding

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tipjar

This one’s on my nickle…

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bob_neighbors

 

 

 

 

There’s a certain luxury to having a blog.  You’re allowed to opine even if you don’t have much worth pining on—probably should have ended in a proposition instead of a preposition.  Oh well.

A while back I wrote this post–https://healthcareitstrategy.com/2009/09/29/social-media-an-example/. As you can see from the title, I pretended it had something to do about social media and healthcare, just to get you to read it.  Actually, the whole purpose for the blog was to rant about my neighbors.  I’ll pause a moment to allow some of you to catch up to the rest of us.

They have become my personal Stasi, our neighborhood brown shirts.  Since the writing of the prior post, one of our dogs died.  My wife is on our neighborhood board, as is our other neighbor.  What makes this doubly delicious is that the brown shirts seem to miss the silliness of complaining to the board about a member of the board.  Perhaps they think my wife takes off her bad neighbor hat and puts on her board member hat to more properly disperse judgment against herself.

So, the board gets another letter from Brown Shirt stating that a member of the community—us—is in violation of some noise clause in the homeowner’s agreement.  I read the letter.  Technically, we are not violating anything.  Our dog is the one making the noise.  I suggested the board send a letter instructing them to correct their syntax.  The suggestion carried no weight with my wife.

Sorry this has nothing to do with much of anything other than writing it probably prevented me from going to the SPCA to get a really, really loud dog.

saint

EHR meeting etiquette and survival guide

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cricket

 

 

 

 

How many times have you been involved in one of those EHR committee meetings whose purported purpose was to elicit ideas?  I find it to be a helpful barometer to scout the room and see if the person who offered an idea at last month’s meeting was invited to this month’s meeting.   To survive across months of meetings requires a lemmingesque ability to walk in silence to the edge of the cliff.

Don’t be fooled into offering an idea simply because the leader is doing that tricky thing about using silence to see who will get so uncomfortable that they just need to hear a voice–their own.  Mistakenly, you believe that someone is actually interested in what you have to say, and you toss your idea into the black hole that used to be your career. Your idea is met with silence, the kind of silence you hear on a warm summer night. You swear you can discern the chirping of individual crickets outside.

Those voices you’ll been talking about in counseling are trying to warn you.  But to no avail, out it comes; “How come we’re not doing those work flow things they talked about?”  “Why did Our Lady of Perpetual EHR Hospital use and RFP to select their EHR vendor?”  “Why is radiology bulding their own EHR?”  “How come nobody is worried about whether this system will allow the referral docs to connect?”

You notice that your brother-in-law, the CMIO, has moved his chair away from yours.  Your best friend’s eyes are locked on his Blackberry.  It’s only then you learn that you and your colleagues aren’t petting the same dog. I think EHR implementations are a lot like that. There’s a lot of talk about doing something new, but more often than not it’s just talk.

sainttop5

EHR: shift happens

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After several years of therapy, I’d begun to accept that I might not be the “Voice of Reason” for all things, maybe just for the important things.  Laugh all you want—most of you have been here, you just don’t blog about it.  To fully grasp the import of what I’m about to write, for the newbies, there’s benefit in reading https://healthcareitstrategy.com/2009/09/19/ehr-how-to-recover-from-poor-planning/.  If there was ever déjà-vu all over again, this is it.  It takes an idiot to be this stupid once.  I’ve managed to refine the process.

At some point, there may be benefit to society as whole for someone to do the math and holler above the fray, “he doesn’t get it and he never will.”  This is not a discussion about what is PC, it’s about my ineptitude.  I have become my own euthanasia moment.

The chicken breasts are moved from the freezer to the sink to be thawed by water because the energy used to heat water is cheaper than energy used to run the microwave.  Forgive me for tearing.  (I am at an impasse between tear and tear.)

This is twice in fewer months than it takes not to approve healthcare reform.

I am watching, “Trauma in the ER”.  It’s part of my MD correspondence course.  I’d just about learned to insert a chest tube when something reminded me of running water.  I ran to the kitchen.  The water is running. The chicken breasts are floating. Hawaiians are surfing the curl in my kitchen.  We have so been there done, that.  I am stupefied.  The last time I did this, I was able to hide it from my wife.  The oak floor boards are now warped to the point where they now look more like bread bowls from the Plymouth colonies than boards.

I wish I spent my days inventing this material.  It’s difficult to understand, but in spite of my ineptitude, I am allowed to vote to determine who will be the next president.  I have become a Mensa wanna-be gone amuck.

Where does this leave us?  There are no second chances with healthcare reform, EHR, or HIT.  We are talking about gazillions of dollars and people whose lives depend on the outcome.  This is an economy shifting moment.  This is our paradigm shift.  ess it up and we will all be saying, “shift happens”

saint

The real role of the C-suite in selecting an EHR vendor

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coolhandluke4

 

 

 

 

Cool Hand Luke.  Great guy film, not on Oprah’s chick flick list.  “What we have here is a failure to communicate.” That’s the line spoken by the captain of the prison pronouncing his summary judgment of the problem between he and Luke—Paul Newman: the line refers to Luke failing to understand the one-way nature of the communication between the chain gang prison captain and Luke. The line is an opening for a second speech directed to the other prisoners who are watching the abuse. The captain goes on to say “Some men you just can’t reach.”

A failure to communicate. Indeed. It’s not always obvious where to place the blame. For example. I had pulled together a pile of my clothes to donate to Goodwill; suits, blazers, pants—the usual mélange. Next to them, several feet away, on top of the ironing board, were two of my new suits, a taupe, double-breasted Jones of New York, and an Ungaro Uomo Parisian pinstripe—they were destined for the cleaners. Stop me if you’ve heard this one before. Seeing the pile on the floor, my wife offered to drop my donated items at the Goodwill.

It wasn’t until later that same day that I thanked her for dropping my suits at the dry cleaner, at which point the quisling replied with a look that told me she did not know that of which I spoke. A failure to communicate. All of my suits, those destined for Goodwill, and the two destined for the drycleaner had done an Elvis and left the building.  Poof, nada, nothing.  Disappeared into the fashion catwalk abyss.  Never mind that I was planning to wear the pinstripe to a rather important meeting.  Wave goodbye to the suits.

Two intelligent people separated by a common language.  Dictionary dot calm defines that as marriage.  Mars and Venus.  In our case it was Goodwill versus Chin’s drycleaner—that’s not racist, just the name of the business.

Two intelligent people separated by a common language.  Like healthcare providers and vendors. Like the IT and the hospital’s C-suite. If A implies B, and B implies C, then maybe B is just intended to be a clever roadblock. Maybe the C-suite invented B so they didn’t have to deal with A—vendors. It sure seems like it sometimes. If the C-suite was really interested in selecting the best EHR, they should start by listening and learning to the clinicians and those in IT.

black saint 2

Stilleto Change Management

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I just returned from the Prada show in Milan. Not really—that was the opening line from a piece on NPR. Apparently this year’s runaway hit on the runways has to do with high heels, with the emphasis on the notion of high.

The following comes from the UK Telegraph: The girls looked like rabbits trapped in the headlights; their faces taut and unsmiling, their eyes wide with fear and apprehension. Were they about to undertake a parachute jump? Abseil down a 1,000ft mountain? None of the above. All they were doing was trying to negotiate the catwalk at Prada during this week’s Milan fashion shows in shoes that were virtually impossible to walk in. At least two models tripped and fell on to the concrete floor; others wobbled and stumbled, teetering and tottering, clearly in agony, and all the while their minds were fixated on just one thing: reaching the sanctuary and safety of the backstage area without suffering a similar fate.

According to the NPR reporter, the heels are so high that regular people—women people that is—can’t seem to walk in them without falling. This problem has led to the creation of an entirely new micro-industry. In L.A. and New York, there are classes to teach ladies how to walk in very high heels without hurting themselves. These classes are being offered through dance schools that couldn’t fill their dance classes—they are now booked solid.

Tell me this isn’t the same as trying to walk and chew gum at the same time. Multitasking. Now before I make fun of some thirty year-old that has to relearn how to walk, let us turn our attention back to those dancing—cum—walking schools. From a consultant’s perspective what makes this story interesting is that those businesses saw a need and re-engineered a part of their operation to meet that need, sort of like we’ve been discussing regarding the impact EHR and reform can have on your organization.  With the implementation of EHR, many things will change.  If they don’t require change, you probably wasted your money on the EHR.  What’s important is having a plan to define the change and manage it.  Rework work flows, remove duplicated processes and departments.

Now I’m going to go saw the heels off my wife’s shoes before she hurts herself.

saint

A few thoughts on ethics

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Leigh Fazzina pointed me to this posting on ethics and suggested I may wish to comment.  You know me, I can’t resist a keyboard.  Here’s the link.  http://comprehension.prsa.org/?p=792&cpage=1#comment-2877

Ethics–if all it required was an understanding of the English (the language, not the British) then there wouldn’t be much to say.

I am not someone who believes there is a need for ethics training. The rules for what constitutes ethical behavior have not changed. Something is either ethical or it isn’t. What has changed are the boundaries. Individuals constantly shift the boundaries, expanding the realm of what is ethical. In the minds of most individuals, those boundaries differ by person and by situation.

I operate from a mindset that ethical boundaries are fixed. As an example, consider the boundaries between the US and its neighbors. Those are fixed. That doesn’t mean there aren’t those who don’t like where the boundary is between the US and Canada, or those who would argue that the boundary should be different, or those who believe the boundary is different. Disliking the positioning of the boundary, or disbelieving the positioning of the boundary does not invalidate the boundary.

When people expand the boundaries for what they choose to call ethical behavior, they rarely do so at their own peril. Generally, they do so for their own convenience, they do so to remove any latent feelings of guilt. Each time they move the boundary, it makes it that much easier to move it the next time. Taken to its limit, at some point there are no boundaries.

Setting larger boundaries in some sense allows people to draft their own sets of Commandments, like little mini-Moseses descending from Mount Sinai with their sets of ethics. Unlike Moses’ stoned-carved commandments, the mini-Moseses draft theirs on an Etch-A-Sketch, making them much easier to change.

However, I don’t think ethical behavior need stem from nor be limited to any religious belief. It need not be employed because of some fear of punishment, but because of a love of righteousness and out of respect for others.

My perspective is integrity is doing what’s right even if nobody is watching. A person of ethics knows what’s right even if nobody is asking, and ethical behavior requires action in order to be expressed.

saint

Patient Relationship Management–why patients and hospitals collide

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Rod

 

 

 

 

When universes collide, or is universi the plural? Not that is matters. I was watching NOVA.  The show focused on the lead singer of the Indie group The Eels.  The show walked through the singer’s attempt to understand was his father had done for a living.  His father was a physicist, in fact he was the person who came up with the notion of colliding universes. Colliding universes has something to do with quantum mechanics and cosmology—did you also wonder what makeup had to do with particle physics? In its rawest meaning, parallel universes have something to do with the notion of identical worlds living side-by-side, with no notion of each other, with differing outcomes from similar events. Got it?  Me either.

I’ll try to illustrate if for nothing else than my own attempt to understand. Let’s say I’m concurrently teaching my two sons to play two different card games, Poker and War. Poker, albeit a game of chance, is heavily rules-based—when to bet, when to fold, when to raise. On the other hand, War is purely a game of chance. The poker player likes rules and order. The one playing war—he’s seven—likes to win, and will do what is required to bring about that outcome. Each one plays independent of the other, using the tools at their disposal to direct the outcome of the game in their favor. They are oblivious to the goals and tactics employed by the person sitting beside them. Parallel universes.

What if we allowed these two universes to collide, to come into conflict with one another? For example, let’s say I have them play each other and I re-deal the cards, giving one the cards he needs for a poker hand, and the other the cards to play war. I then instruct them to play one another. The poker player becomes focused on the rules, and the one playing war has a laser focus on one thing—winning. The poker player quickly caves, knowing that he is engaged in a futile endeavor. This does not bother the other one whose only focus was to win.

Imagine if you will—sort of Rod Serlingish—two other games going on simultaneously, one team whose sole focus is winning, the other whose focus is on the rules. For the rules-based team there is no winning. The best they can ever hope to do is to measure up to the rules by which they are judged. Millions have been spent on technology to help ensure that adherence. Adherence to the rules will be monitored, recorded, reported, and measured. The rules-based team’s ability to continue to play the game will be based solely on how well they follow the rules. Now imagine that the universes in which these two teams are playing collide and these two teams play their separate games but against each other. One team having never been told how to win, never been instructed to win, never even given permission to win. The other team’s only purpose is to win.

This is a nonsense game. One we play every day.  One team is the hospital’s patients the other team is the employees who are tasked with patient customer care, patient relationship management (PRM).  The patients are focused on winning, those tasked with customer care or PRM are not permitted or equipped to win.

It’s possible for these two groups to change the outcome, to take away the nonsense.  To make that happen, the rules must change.  PRM can be very effective provided that it is designed to help the patients “win”, designed to facilitate favorable outcomes for patients.  The trick to changing the outcome is that the hospital must understand that a win for the patients in most cases is also a win for the hospital.

saint

The effect of healthcare reform on others

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"Not a real boy"

"Not a real boy"

Somebody had to do this, so it may as well be me.  Sometimes to bring clarity to issues, it helps me if I dumb-it-down.  Which got me to wondering, how would the whole healthcare reform debate play out with Mother Goose?  Here’s what I was able to learn from my interviews.

Jack & Jill went up the hill, Jack fell down, and learned Mother Goose’s insurance wouldn’t cover him because he’s not a real boy.  Having recovered, Jack was soon found not so nimbly jumping over the candlestick.  His charred wooden body is being sanded in an effort to heal the burns.  Not only is Jack not a real boy, he’s also not a candidate for Mensa.

They sent the Little Old Woman who lived in the shoe home with a can of Desenex because her AARP insurance had expired and Medicare told her she already used her share of the money.  Afterwards, she was interviewed by Planned Parenthood for an episode of “I didn’t know I was pregnant.”

And remember that tuffet upon which Little Miss Muffet sat?  It wasn’t the spider who frightened her away, it was the deductible she’d hay to pay to cover the rash she got.  She tried sussing out her own treatment using social media on WebMd.

Jack Sprat could eat no fat, but he forgot to disclose that when he completed his insurance application.  He now suffers anemia anonymously as his not so lean wife left him.

How about Peter Peter Pumpkin eater?  All that fiber blocked his colon—a little personal prevention could have saved him a lot of time posed in the Thinker position.

Mary and Little Bo-Peep had a little mutton for dinner which after having sat on the counter all day produced various toxins which were absorbed into their bloodstream.  This resulted in them being rushed to the Mother Goose Clinic with a case of food poisoning.

Simple Simon met a pieman who knew nothing of pasteurization.  Simple is sitting three seats away from Mary in the waiting room.  The Clinic has been unable to locate either of their records on their EHR which cost in excess of one hundred million dollars.

Old King Cole called for his pipe even though he had a severe case of sinusitis.  CVS was out of Z-packs, and home he went with just a tin of Prince Albert.

All the king’s men tried to make a meal out of Mr. Dumpty.  Several were to learn later that one can get Salmonella from eating a raw egg that had been tromped on by horses.

Pat-a-cake.  The baker’s man, not one for washing his hands before pattying his cakes, caused Tommy to be seen by an internist.  Apparently neither real men nor cartoon men wash there hands.

The Butcher, the Baker, and the Candlestick-Maker, were being treated for nontuberculous mycobacterial disease for poor hygiene having been found bathing together.

It was reported that Georgie Porgie who’d been kissing girls had made them cry when they discovered they had contracted the herpes simplex virus.  Their mother, embarrassed by the turn of events, reported to the school that her twins were out with the H1N1 virus.

The Three Blind Mice were found to have stitched themselves together after unsuccessfully trying to sew back on each other’s tails.  It was later discovered that the tails had been cut off by the Farmer’s wife with the Butcher’s knife.  The mice are suffering from septicemia.  The Crooked Man and Yankee Doodle are trying to ascertain why the Farmer’s Wife and the Butcher were later found hiding in the barn.  The Farmer’s wife is being treated with Effexor on an out-patient basis for clinical depression.  The Farmer was not available for comment.

It’s believed that Willie Winkie is suffering from a plantar wart after running through the town in just his nightgown.  Uninsured, he tried removing the wart with the knife he’d borrowed from the Butcher, only learn the knife had been recently use to amputate the tails of some handicapped mice.

Old Mother Hubbard, a spinster of questionable repute, upon learning that there were no bones in the cupboard for her dog Hannibal, began to get hungry herself.  She settled for a meaty broth, and fava bean soup, and a nice Chianti.  Polly was seen putting on the kettle.  The SPCA continues to look for Ms. Hubbard’s dog.

saint