Follow by Email

Sunday, December 18, 2016

My Year End Review

The end of the year gives us a chance to evaluate our work to see how we are doing, what changes we want to make for next year and gauge the value we are receiving for our efforts. Nurse Advocate has had the same goal since it started. To share information that consumers, caregivers and all members of the healthcare team can use to improve the delivery of care.

In reviewing my metrics from the various social media sites where I post my Blog, I know that I am reaching a broad audience both national and internationally. Post are being opened and viewed by many. The best and most meaningful metrics that I value are the comments that come from the readers. They are insightful and allows me to know that I am covering the right topics that are valuable to the audience. Not everyone agrees with my thoughts, but those comments are valuable as they help me see the issue from a different point of view and allows me to consider additional points of view.

For the last issue of the year, I chose the top 10 posts for 2016 to share with you as we end the year. If you missed them, this is a chance for you to read them. Please feel free to share with your family members, colleagues, and friends. If you are in charge of professional development at your organization, feel free to use any of the posts from Nurse Advocate as a teaching tool for your staff as appropriate. Ok, let's look at the top 10 posts for 2016. 

This post was conceived when I met a friend from nursing school at a wedding. She was with her husband standing off to the side in a quiet part of the church. I went over to say hello, and she had a blank stare when she looked at me. I knew she had early Alzheimer's and had been failing. Her husband shared she does not recognize many people; she is getting worse and needs total support with her ADL's. I asked him how he was doing and he said was tired and sad. I knew he loved his wife with all his heart as they had always been very much in love. During the Mass, as the priest read the wedding vows to the couple getting married it dawned on me how important those vows are and how so many of us take them for granted. My friend was living his vows day in and day out by caring for his wife.  As I was writing this post, an idea came to me to develop a Facebook page so Caregivers could communicate their frustrations and challenges and gain support or information they can use. I knew the message got through from this comment: “Great post-Anne and wonderful idea in providing a way for the caregiver to stay connected!

Caring for the Caregiver: The Unsung Heroes of the Healthcare System  Caregiving struck a chord with many readers as they see the important role they play in advocating and helping their loved ones with so many of the challenges they face. I was glad this post was well received as well as the tips provided hit home with so many people. This comment showed me how we never know when we will have to put our lives on hold to become a caregiver for a loved one or a friendThese are great tips! I know it is not nearly as intense... yet, I had to take care of my husband who burned his hand severely on the job last May. He was out of work for two weeks, and it was a TON of work to take care of him. This is an excellent article. Thank you for recognizing these heroes!”

Reconnecting to your purpose in Healthcare With healthcare in turmoil, this post is worth repeating. I wrote this post after hearing Dr. Don Berwick speak at a conference and urging all members of the healthcare team to take the time to reconnect with their purpose. If we remember why we became in involved in healthcare it will keep us centered regardless of what changes were made. This comment from a physician reinforced the message as he reflected on the importance of working as a team and not going it alone. It takes a team to care for a patient. The better we can work together, the better care we can provide. “I have been blessed with good nurses all my life. When the office has been chaotic or has been made chaotic by supervision or powers that be as you mention, I have been able to focus on patient and team. Forgot that for a while but when it becomes clear that help is not on the way, time to see a patient and get connected to what matters. You often receive back more than you give - and without trying to force satisfaction. Sometimes a particular patient can sustain you through a trying time, like a year of residency.

The Joys of Travel as a Disabled Person Traveling is difficult for the abled body person, yet for someone who is disabled from a heart condition, a respiratory disease, an orthopedic condition, or neuropathy travel is much more challenging. I wrote this article after traveling myself for the first a time. I also had a phone interview with a reporter from the Wall Street Journal who was writing an article on the impact of expanding airports on the disabled. He only used one of the many examples I gave him, so I decided to expand on the topic in this Nurse Advocate. The post inspired comments from professionals charged with helping people with disabilities travel as well those who are disabled themselves. Here is one of the comments that hit home:  “Anne, great post and thanks sharing your experience. As a disabled person, of many years, you are correct, most organizations have expanded the ways and means of assisting disabled folks. A couple of things with air travel, you can identify connection times to make sure you have enough - if you cannot get a direct flight. While travel can change, I always look for at least 1.5 hours. Makes the trip longer but less worry. Also, if I am not in an aisle seat, I inform my seat mates that due to my disability I have to get up quite a bit. Often people will switch with me, and at least they are not surprised. I inform the flight attends too.”

Five Incredible Gifts of a Life Changing Illness Sometimes time gives you a clearer perspective on what is important when diagnosed with a life changing illness. Many of the comments were 'thank you' messages to me for sharing my story and how my words have empowered others. But for me being able to share my experience has been therapeutic and a reason why I had to go through such a difficult time. I am grateful to have come through my journey on the positive side. Here is one of the comments that touched me:Anne - this post is a gift, too. We're all so happy and grateful you came through all your treatment as well as you did. It's so good to have you "back"! Thank you for sharing your experiences and resulting gifts - all good reminders as we live through the difficulties of life, no matter how big or how small.”
Medical Errors: A Matter of Life and Death I wrote this post after I experienced a Medical Error. I was ok, but the experience showed me the importance of direct communication with the physician versus the medical assistant who ‘runs the office.' I was surprised that so many people shared their story of their medical error experience. I should not have been surprised because I know that Medical Errors is now the 3rd leading cause of death in this US. To me, this is unacceptable that with all of the expertise in healthcare, we cannot get a handle on medical errors. We have to do better. Here is one of the comments: Everyone has to be vigilant, be alert and speak up and ask questions to help bend this curve. We are living in a dangerous time, and it will take the entire healthcare team to change the course. Hi, Anne. I am so sorry to hear that you had to go thru this. I too have been a victim of a medical error. It took place at my podiatrist's office - a "routine, simple incision" which became infected in that office due to the unsterile environment. The bacteria latched onto a small screw I had in my foot. The result was two surgeries where they dug out the infection leaving a large open wound that needed to heal from the inside out. A 5-day hospitalization and umpteen appointments with the infectious disease doc. A port was placed in my arm delivering two daily one hour drips of vancomycin into my heart as I had developed osteomyelitis. I couldn't walk on my foot for weeks. It was a painful, scary and angry time in my life and I now do everything I can to keep others from having to go through that or anything similar. We need to speak up about the dangers of medical treatments and try to make it a safer place for patients.”

 The Last Dance: Encountering Death and Dying, this post was written after a friend of mine suddenly lost her mother. Coincidently, during a meeting for a project I was working on, I met the creator of the Actual Dance on a teleconference call. He shared a link so we could all watch the Dance to decide if we wanted his to present at the upcoming conference. I learned he wrote the Dance when his wife was diagnosed with Breast cancer and how hearing those words changed his life. He put his feeling into the project and has taken it around the country to support caregivers who hear life changing news and wonder what they are going to do next. Here is what one reader shared in her father's end of life experience. "Thanks for sharing this article. I experienced the power of the advance health care directive document with my Dad's passing last week. It was comforting to witness that his end of life wishes was respected and he had a peaceful journey. It was also a great opportunity for me to reinforce the conversation with my Mom, my siblings, and my family regarding our end of life wishes. We need not be afraid to talk about death as it is part of life.” I think the message is to be prepared and share with our loved one what those wishes are. This will allow a peaceful transition to our next step in the circle of life. 

Moving Forward, I wrote this article after the recent presidential election to ‘put out a call to action' to all as our new president makes his cabinet selections and to be vocal about policy changes that impact our lives. I hope the President-Elect Trump does well, because if he does, we all do. As he an outsider to politics it is my hope he surrounds himself with people who do have expertise in the individual areas of Government they have been asked to serve. I was impressed with comments as many people are being open minded and keeping a positive attitude as we move forward. Here is an example; “I think many nurses are anxious to see how health care will be transformed under this new administration. Let's keep a positive attitude into the New Year and beyond!”

The Teachable Moment As a nurse who became a patient I realized the more information I received, the better I understood the plan of care and what to expect. It took some of the fear out what I was experiencing and allowed me to regain some control over my life which helped me cope. The comments from readers let me know I hit a cord and showed me that many healthcare professionals are looking for those teachable moments. “Fabulous "Teachable Moments" Anne it is wonderful how you can turn your experiences into more of them! :) In reading your examples, I could almost FEEL a shift as you went from being an object of care/treatment to being engaged in an active roll. I could ALMOST put myself in your shoes and hope this post is spread far and wide. Reminds me of a Plato quote: "All learning has an emotional basis"! Involving and empowering patients is so critical to providing excellent care!”

Nursing Claims Data: What does it tell us? I wrote this post after a webinar on nursing claims data. The goal of the program was how using data to identify liability patterns and trends to help nurses understand their areas of greatest vulnerability and to take appropriate action to protect patients from harm and nurses from potential litigation. Today, we have a way to evaluate how we are doing, where areas of strength and where weaknesses are so we can make corrections as part of our processes improvement efforts. Those who commented on the post shared their insights on the topic which made the post valuable. Here’s one, “Great advice. This is something that all new grads need to be educated about. They also need to have the opportunity to get familiar with policies and have the opportunity to spend time with a Risk Manager.”

In 2017 I plan to continue the mission of Nurse Advocate but with more ‘calls to action’ so all readers (consumers, caregivers, and all members of the healthcare team) are empowered to do their part to improve the role they play as members of the healthcare team. I hope you will join me on the journey!

Thank you for being a loyal reader of Nurse Advocate. If you have topics you would like to see covered in Nurse Advocate. Please feel free to email your ideas and comments to 

So as I close out 2016, I wish you and your families a Merry Christmas and a Happy New Year.

See you in January! 

Friday, December 9, 2016

Value: The Missing Piece to the Puzzle to Improving Our Healthcare System

According to the latest news reports, National health expenditures will hit $3.35 trillion this year, which works out to $10,345 for every man, woman, and child in the United States. As a result of escalating healthcare costs, there is a mandate for all healthcare providers to demonstrate value for the services and products they provided.

Healthcare professionals are turning to each of us (the end user and consumers of health care services) to learn what we expect from the healthcare providers? What constitutes value for you in health and healthcare?  

Measuring the value of health care services is difficult as value is different for each person. This is because most people do not equate health care services the same way as we do other services. For example, if you go to a restaurant and do not get good service you probably will not go back to that restaurant. In healthcare, we (the consumer) tolerate long waits and what we may consider inferior services because we don’t feel there is any recourse. We tolerate things in healthcare, or at least we used to.

Today, consumers are responsible for more of their healthcare costs. As a result, they are demanding more from providers. They want to receive information that allows them to make decisions on care options. They also want to be treated with respect and receive timely communications about their care. They want to be valued as a person. Individuals who don't feel appreciated by members of the healthcare team are changing providers. When a person does not feel valued, they will seek out providers who they can communicate with and who shows concern for them as a person. In other words, consumers are starting to treat healthcare like other services they receive and expect more from the health care providers they choose. Those who can meet these demands will do well. Those who do not provide value in the services they provide will not do well in today value-based healthcare system.

In a post a few months ago in Nurse Advocate, titled the Waiting Game, I shared a frustrating experience I had when I was made to wait to see my doctor with no word from the staff as why or how long I would have to wait. I wrote I did not feel valued by the healthcare team at the clinic where I was receiving care. I wrote this post because I know waiting is a common problem many people experience and wanted to call out to fellow patients, caregivers, and other healthcare professionals that this type treatment is not acceptable and needs to be recognized and corrected.  One of the comments I received from the post that was eye-opening to me and showed me that we, as a customer, should expect more from healthcare providers who care for us. We all have choices as to where we receive care and should exercise our options when we do not experience the type of care we expect.   

Here is the comment: Anne, I have to wonder why you continue with a doctor who treats his patients this way. I see a fine cardiologist and never, ever wait. I even stopped bringing a book to read. I asked him why I never wait and he said because he waited once for 2 hours to see a doctor and swore he would never do that to his patients. I switched all my doctors who made me wait and found perfectly competent clinicians AND feel respected. Long waits don't automatically mean they are "good." It can mean that they are careless, unorganized or don't care. When I was pregnant, I was often the cause of doctor back-ups. My complications (which often led to miscarriages and early deliveries) allowed me preference, and I would go right in. If this is the case at your doctor, and they told you there was an emergency, it would be another story, and you might be grateful for a caring physician. If there is no reason, and we allow doctors to treat us this way, we are part of the problem.

The comment raises important points that we as consumers of healthcare should keep in mind. Our time is valuable and should be respected. Providers should keep us informed when there is a delay in an appointment time and offer alternatives if the wait is excessive. This is common courtesy that should be standard of care for all healthcare providers and organizations. 

Currently, the system is set up to meet the needs of the providers and not the consumer. This is changing, and your input when problems occur is important to share so that providers know what you expect from a provider. If we want the system to be better, it is up to each of us to make our concerns heard. Here are some the ways you can address issues and challenges when you use the healthcare system. 

·        Talk to a member of the staff in a position to address a challenge that you are facing. Most physician offices have an office manager who is in a position to hear patient concerns and take action. The office manager is usually in the background so you will have to ask to talk with the office manager. Don't be intimidated; it is like asking for a supervisor when you call a vendor on the phone, and you are not getting the information you need.
       If you are a patient or a caregiver in the hospital and have a concern, ask for the Hospital Patient Advocates or the Patient Representative. Many people are afraid to tell a nurse or the doctor about a problem they are having as they fear retaliation. Today, most hospitals have Hospital Patient Advocates who are in place to address patients and their caregiver concerns or complaints. Hospital Patient Advocate is available in place to resolve issues and bring these matters to the people in charge who can correct situations.  
       When you are asked to share your opinion in a survey please take your time and answer the survey honestly and make recommendations that can improve the system. Sometimes you can see a solution better than the people who work in the system.  There is lots of attention paid to patient surveys as reimbursement is tied to them. 

·       To ensuring patients and caregivers have a positive patient experience, many organizations now have put into place, a Patient Experience Officer. The Patient Experience Officer many times can be a physician or someone in a high-level position who is responsible for addressing concerns from patients and caregivers. Check to see if the hospital you use has a Patient Experience Officer. They are another good contact for you to keep in mind.

·       Many organizations have put into place Patient and Family Council Meetings. In these groups, patients and caregivers come together and share information with the principal members of the team to improve processes and services. Your opinion is critical as many times the staff at the hospital, clinic or doctor's office do not see how the system works from your point of view. 

Organizations are taking an active role in educating patients, caregivers and all who use the healthcare system on Patient Safety. Many patient safety offices and risk management professionals know that getting the patient more involved in their care is critical to decreasing medical errors.

One organization doing good work in this area is PULSE: Patient Safety, Advocacy, and Support. PULSE provides patients, and the family and friends of patients, the opportunity to partner with their health care providers, to help to ensure the best possible outcomes in a person’s medical care.

In closing, keep in mind we are all consumers of healthcare. Therefore I urge you to use your voice and be part of the process to ensure our health care system is delivering valuable services and products to all.

Have a good week!