Tuesday, November 06, 2007
Grand Rounds is up
Terry offers a superb version of Grand Rounds this week at Counting Sheep. The topic is pain. In addition to excellent writing, her visual images are superb. Please check it out.
Monday, November 05, 2007
Farewell to Rose
Rose Finkelstein, age 101, passed away last night. She seemed to be an everlasting presence at our hospital, spending over 50 years in one capacity or another. She came here as a young nurse. After retirement, she volunteered in our obstetrics department, where she was particularly known for singing to the babies. Each year, she would win the award for most hours worked as a volunteer -- 629 hours in 2004, 650 hours in 2005. In 2004, we created an award in her name, The Rose Award, established to recognize a volunteer’s steadfast commitment to service. Rose was a sweet, kind, generous person -- with a voice to match! We join those lucky babies who had a chance to hear and know her.
Saturday, November 03, 2007
Dear Board Member:
Apologies to those readers who are tired of the union topic, but there is something going on that deserves public attention. And, if you are on the board of a hospital in Massachusetts, you might want to read closely.
As I have noted elsewhere, a key component of the organizing strategy of the SEIU is to engage in a corporate campaign against a hospital and to put pressure of the board of trustees to agree to concessions during the organizing process. As the situation unfolds at BIDMC, we see the precursors of such a campaign.
Over the last few weeks the SEIU has written letters to board members of Caregroup, BIDMC, and BID~Needham regarding one or another issue -- like accounting, billing, or intellectual property transactions. In each letter, the SEIU will point out a flaw, mistake, or other circumstance that it asserts has occurred. The letter will make the point that the board members have a fiduciary responsibility with regard to the issue raised and the broader issue of supervising the hospital and encourages them to look into the matter in more detail.
Interestingly, SEIU has not sought press coverage or public disclosure of all of these items as they are filed with the boards. Instead they are simply mailed to the board members. What is going on here?
One has to predict that these issues will be raised by the union, but in what forum and in what way? One possible use could be in filings made with federal or state governmental bodies claiming that the boards of the hospital are not carrying out their fiduciary responsibilities and therefore the hospital (1) should not be permitted to issue tax-exempt bonds to support hospital capital programs and/or (2) should not be permitted to continue to receive state or federal reimbursement for patient care and/or (3) should not be permitted to continue to receive federal research funding and/or (4) should be stripped of its tax-exempt status. Another way is to simply try to embarrass the board members in the community.
Now, our boards, like most hospital boards, have all the governing structures in place that are designed to properly fulfill their fiduciary roles: Committees for compliance, audit, finance, research supervision, compensation, and the like. The board members take their responsibilities seriously and work hard at doing the job well for the community. And there are external reviews by accounting firms and audits as well by state and federal agencies, as well as bodies like the Joint Commission that review the actual delivery of patient care.
Nonetheless, in a large organization, there are be certain to be mistakes. When we find them or hear about them -- regardless of the source -- we fix them. For example, last week SEIU correctly pointed out an error from several years ago regarding BID~Needham bills to Medicare (just under two dozen patient encounters were billed incorrectly during 2004, resulting in an estimated overpayment by Medicare of approximately $569,000). Informed of the issue, we reviewed the records, notified Medicare immediately, and asked them for the best way to repay the dollars.
But sometimes we disagree with claims that have been made. A few months ago, for example, SEIU made assertions about our filings under the state's uncompensated care pool, and we readily met with the relevant state officials to explain why we felt their assertions were incorrect.
On this blog and elsewhere, you have seen the utter transparency with which BIDMC conducts its business. This transparency is fully endorsed and encouraged by our governing bodies because they understand that we are ultimately accountable to the public and that we will do a better job for our community if we admit our mistakes and try to continually improve. It would be a sad irony, indeed, if that approach were thrown back in their face in the pursuit of campaign to organize workers.
The particular issues raised by the union and any mistakes that might have been made do not indicate a lack of fiduciary controls by the boards. They indicate that in the complicated world of health care, there can be both actual mistakes and also disagreements about the interpretation of rules and regulations. I think it is fair to say that if the intensely involved and diligent BIDMC boards are accused of not carrying out their fiduciary duties on the basis of the kinds of issues raised by the SEIU, every single hospital board member in Massachusetts is vulnerable to a similar charge.
As I have noted elsewhere, a key component of the organizing strategy of the SEIU is to engage in a corporate campaign against a hospital and to put pressure of the board of trustees to agree to concessions during the organizing process. As the situation unfolds at BIDMC, we see the precursors of such a campaign.
Over the last few weeks the SEIU has written letters to board members of Caregroup, BIDMC, and BID~Needham regarding one or another issue -- like accounting, billing, or intellectual property transactions. In each letter, the SEIU will point out a flaw, mistake, or other circumstance that it asserts has occurred. The letter will make the point that the board members have a fiduciary responsibility with regard to the issue raised and the broader issue of supervising the hospital and encourages them to look into the matter in more detail.
Interestingly, SEIU has not sought press coverage or public disclosure of all of these items as they are filed with the boards. Instead they are simply mailed to the board members. What is going on here?
One has to predict that these issues will be raised by the union, but in what forum and in what way? One possible use could be in filings made with federal or state governmental bodies claiming that the boards of the hospital are not carrying out their fiduciary responsibilities and therefore the hospital (1) should not be permitted to issue tax-exempt bonds to support hospital capital programs and/or (2) should not be permitted to continue to receive state or federal reimbursement for patient care and/or (3) should not be permitted to continue to receive federal research funding and/or (4) should be stripped of its tax-exempt status. Another way is to simply try to embarrass the board members in the community.
Now, our boards, like most hospital boards, have all the governing structures in place that are designed to properly fulfill their fiduciary roles: Committees for compliance, audit, finance, research supervision, compensation, and the like. The board members take their responsibilities seriously and work hard at doing the job well for the community. And there are external reviews by accounting firms and audits as well by state and federal agencies, as well as bodies like the Joint Commission that review the actual delivery of patient care.
Nonetheless, in a large organization, there are be certain to be mistakes. When we find them or hear about them -- regardless of the source -- we fix them. For example, last week SEIU correctly pointed out an error from several years ago regarding BID~Needham bills to Medicare (just under two dozen patient encounters were billed incorrectly during 2004, resulting in an estimated overpayment by Medicare of approximately $569,000). Informed of the issue, we reviewed the records, notified Medicare immediately, and asked them for the best way to repay the dollars.
But sometimes we disagree with claims that have been made. A few months ago, for example, SEIU made assertions about our filings under the state's uncompensated care pool, and we readily met with the relevant state officials to explain why we felt their assertions were incorrect.
On this blog and elsewhere, you have seen the utter transparency with which BIDMC conducts its business. This transparency is fully endorsed and encouraged by our governing bodies because they understand that we are ultimately accountable to the public and that we will do a better job for our community if we admit our mistakes and try to continually improve. It would be a sad irony, indeed, if that approach were thrown back in their face in the pursuit of campaign to organize workers.
The particular issues raised by the union and any mistakes that might have been made do not indicate a lack of fiduciary controls by the boards. They indicate that in the complicated world of health care, there can be both actual mistakes and also disagreements about the interpretation of rules and regulations. I think it is fair to say that if the intensely involved and diligent BIDMC boards are accused of not carrying out their fiduciary duties on the basis of the kinds of issues raised by the SEIU, every single hospital board member in Massachusetts is vulnerable to a similar charge.
Friday, November 02, 2007
White knight for Carney Hospital
I have an idea, and I am going to offer it with all seriousness and with no sarcasm or animosity. In today's Boston Globe, Jeff Krasner writes about the sad status of Caritas Carney Hospital. Of all the hospitals in the Caritas Christi system, Carney seems to be in the most trouble, and it has been for years, notwithstanding millions of dollars of state aid, $4 million this year alone. Nonetheless, the hospital enjoys great local affection and ongoing support from the Mayor and many state legislators.
If today's story is correct, the hospital and the community and elected officials are now courting a suitor to take it over and have it separate from the Caritas Christi system. In the past, nationwide suitors for Caritas Christi actually cited Carney as one of the factors for not taking over the entire system, so it is difficult to imagine any of the hospitals in Boston as being interested. The potential financial liabilities are just too great for most of us, who have narrow operating margins to start with and are facing our own financial challenges over the coming years. And for the Partners Healthcare System, which might have the financial resources, there are already too many concerns about market power in the Boston metropolitan area.
Here's the proposal. There is one organization in town with a strong interest in hospital management and with the financial resources to take this on -- the Service Employees International Union. SEIU has millions of dollars at its disposal (reportedly over $20 million) to organize workers in Massachusetts, a local staff of some 200 people, and a desire to prove that it can improve the working conditions and quality and safety in area hospitals. I am guessing it also has a pension fund for its members, with many millions available for investment.
So why not approach SEIU with a proposal to have the union purchase, own and operate Carney Hospital? Let the union show how it can handle the full panoply of issues of running a hospital and demonstrate how it can profitably operate a neighborhood facility without the kind of state aid that has been pouring into Carney for all these years. Let the union negotiate contracts with the insurance companies, encourage access for low-income patients, maintain high regulatory standards for patient care, and do all the other things required of hospital management, while, of course, providing excellent working conditions for staff members and physicians.
What better way for the SEIU to demonstrate its potential value to the community than to take on this worthy assignment and to do a good job at it? You can read many statements by the SEIU that seem consistent with the mission of the Carney. As I say, although I may be accused of doing otherwise, I am offering this suggestion with no sarcasm or animosity. In terms of financial resources, industry experience, and stated values and mission, there is an obvious white knight in this situation, and it is 1199SEIU.
If today's story is correct, the hospital and the community and elected officials are now courting a suitor to take it over and have it separate from the Caritas Christi system. In the past, nationwide suitors for Caritas Christi actually cited Carney as one of the factors for not taking over the entire system, so it is difficult to imagine any of the hospitals in Boston as being interested. The potential financial liabilities are just too great for most of us, who have narrow operating margins to start with and are facing our own financial challenges over the coming years. And for the Partners Healthcare System, which might have the financial resources, there are already too many concerns about market power in the Boston metropolitan area.
Here's the proposal. There is one organization in town with a strong interest in hospital management and with the financial resources to take this on -- the Service Employees International Union. SEIU has millions of dollars at its disposal (reportedly over $20 million) to organize workers in Massachusetts, a local staff of some 200 people, and a desire to prove that it can improve the working conditions and quality and safety in area hospitals. I am guessing it also has a pension fund for its members, with many millions available for investment.
So why not approach SEIU with a proposal to have the union purchase, own and operate Carney Hospital? Let the union show how it can handle the full panoply of issues of running a hospital and demonstrate how it can profitably operate a neighborhood facility without the kind of state aid that has been pouring into Carney for all these years. Let the union negotiate contracts with the insurance companies, encourage access for low-income patients, maintain high regulatory standards for patient care, and do all the other things required of hospital management, while, of course, providing excellent working conditions for staff members and physicians.
What better way for the SEIU to demonstrate its potential value to the community than to take on this worthy assignment and to do a good job at it? You can read many statements by the SEIU that seem consistent with the mission of the Carney. As I say, although I may be accused of doing otherwise, I am offering this suggestion with no sarcasm or animosity. In terms of financial resources, industry experience, and stated values and mission, there is an obvious white knight in this situation, and it is 1199SEIU.
Thursday, November 01, 2007
Bravo, Rafael
A note from our chief of General Medicine about a member of his faculty:
I write to share the wonderful news that Rafael Campo was just named the recipient of the 2009 Nicholas Davies Memorial Scholar Award by the American College of Physicians This prestigious award is given for outstanding contributions to humanism in medicine and is bestowed on individuals in recognition of their scholarly activities in history, literature, philosophy, and ethics. As the 2009 recipient of the award, Rafael will give a lecture at the Annual ACP Session in 2009. Prior recipients of the award include Rita Charon, Abraham Verghese and Edmund Pellegrino. Rafael was nominated based on his work as a physician poet, writer and essayist, who has advocated for the teaching of humanities in medical school. He has used poetry to teach humanism to medical students here at HMS and his book “The Healing Art: A Doctors Black Bag of Poetry” has served as a model curriculum for teaching humanism to medical students using poetry nationally.
I have written about Rafael previously. Check out his website.
I write to share the wonderful news that Rafael Campo was just named the recipient of the 2009 Nicholas Davies Memorial Scholar Award by the American College of Physicians This prestigious award is given for outstanding contributions to humanism in medicine and is bestowed on individuals in recognition of their scholarly activities in history, literature, philosophy, and ethics. As the 2009 recipient of the award, Rafael will give a lecture at the Annual ACP Session in 2009. Prior recipients of the award include Rita Charon, Abraham Verghese and Edmund Pellegrino. Rafael was nominated based on his work as a physician poet, writer and essayist, who has advocated for the teaching of humanities in medical school. He has used poetry to teach humanism to medical students here at HMS and his book “The Healing Art: A Doctors Black Bag of Poetry” has served as a model curriculum for teaching humanism to medical students using poetry nationally.
I have written about Rafael previously. Check out his website.
Stretch your mind
On to much less serious topics. On a flight to Washington on Monday, I was reading the US Airways magazine and saw an article on rubber bands, entitled "Quite the Stretch," by Kostya Kennedy. Among other things, it noted, In Pittsburgh, some call rubber bands "gum bands" -- the only place in the U.S. where that slang is used.
This got me wondering, can you come up with other items that have a particular slang version in a unique part of the country? Please submit them here. (Don't tell me about a sub being a hero in some areas and a hoagie in others. Please only submit examples of a single moniker for an item that is totally different from what is used in the the rest of the country.)
Another assignment: Provide examples of words that mean their opposite. For instance, cleave means both to join together and to pull apart. Extra credit: Provide the term that describes such words. Try this without using the web to find them, ok? Honor system.
This got me wondering, can you come up with other items that have a particular slang version in a unique part of the country? Please submit them here. (Don't tell me about a sub being a hero in some areas and a hoagie in others. Please only submit examples of a single moniker for an item that is totally different from what is used in the the rest of the country.)
Another assignment: Provide examples of words that mean their opposite. For instance, cleave means both to join together and to pull apart. Extra credit: Provide the term that describes such words. Try this without using the web to find them, ok? Honor system.
Wednesday, October 31, 2007
How a CEO learns
As you can tell from this blog and elsewhere, we are pursuing a very strong quality and safety agenda at BIDMC. Our progress to date has been good, but we have a long way to go. It is very satisfying and helpful for me to get to know people around the country who are doing the same, as we learn a lot from one another.
An example. Every time I hear Jim Conway from IHI give a talk, I learn something or am reminded of something important. He recently helped us during a joint retreat of the boards of BIDMC and our community hospital BID~Needham. The focus was the role of the board in governing quality and safety, a topic I have covered here earlier, but dealt with so much more effectively by Jim.
And then yesterday, he and I were making presentations at a different kind of meeting, and he repeated some of themes raised at our board retreat. He reviewed the lessons learned by the Dana Farber Cancer Institute in the ten years following the tragic death of a patient from a chemotherapy overdose. As a CEO, it helps me to hear these things again and again to really have the lessons from others' experiences sink in and to help consolidate my own thinking, and I am always grateful for the opportunity. Here are some highlights, in shorthand, without Jim's eloquence.
Key points about a culture of safety:
Based on trust, human rights, repentance, and forgiveness.
Patient and family centered.
Supports staff, enabling and motivating the highest levels of performance.
Acknowledges the high-risk and error-prone nature of health care.
Ensures individual and shared acceptance of responsibility and accountability.
Encourages and facilitates reporting and open communication about safety concerns in a fair and just environment.
Ensures that organizational structure's processes, goals and rewards are aligned with improving patient safety.
Learns from errors.
Shares stories.
And here are key points about actually implementing change. The theme is for the leadership of the place to force a kind of creative tension based on seeing what we want to the organization be -- our vision -- and telling the truth about where we are -- our current reality. That creative tension can only be resolved in two ways: (1) raising the current reality towards the vision, or (2) lowering the vision towards the current reality.* Of course, we aim for #1! (By the way, this involves particular challenges in academic medical centers, where the role of the CEO is somewhat different from other types of organizations.)
How you cultivate this creative tension over time:
Benchmark against the best practices.
Search for opportunities to be humbled.
Learn from the tragedies of others.
Keep patients and direct care staff "in the room", i.e., engaged in evaluation and decision-making.
Conduct critical risk assessments.
Story telling and learning.
Constantly look for trouble.
Be transparent.
Get information to those who need it to drive change.
I particularly like the idea of "constantly looking for trouble." Here's how you do it. Ask the staff on the floors the following questions:
What's keeping you awake at night?
What's your favorite work-around?
What kept you from giving the kind of care you want to give?
The folks in the room yesterday were slightly taken aback because an inherent characteristic of this approach is its transparency. In particular, your activities, flaws, and failures are open for the world to see. And they raised issues of the inappropriate portrayal and use of that information by those on the outside seeking commercial or political gain. Jim and I pointed out that there were some risks along those lines but that, for the most part, our ultimate constituency -- the public -- wants hospitals and doctors and other caregivers to succeed and believes in their good intentions. Transparency is consistent with maintaining that trust and indeed reinforces it because it sends a message that the organization is willing to hold itself accountable.
*This is based on the work of Peter Senge at MIT.
An example. Every time I hear Jim Conway from IHI give a talk, I learn something or am reminded of something important. He recently helped us during a joint retreat of the boards of BIDMC and our community hospital BID~Needham. The focus was the role of the board in governing quality and safety, a topic I have covered here earlier, but dealt with so much more effectively by Jim.
And then yesterday, he and I were making presentations at a different kind of meeting, and he repeated some of themes raised at our board retreat. He reviewed the lessons learned by the Dana Farber Cancer Institute in the ten years following the tragic death of a patient from a chemotherapy overdose. As a CEO, it helps me to hear these things again and again to really have the lessons from others' experiences sink in and to help consolidate my own thinking, and I am always grateful for the opportunity. Here are some highlights, in shorthand, without Jim's eloquence.
Key points about a culture of safety:
Based on trust, human rights, repentance, and forgiveness.
Patient and family centered.
Supports staff, enabling and motivating the highest levels of performance.
Acknowledges the high-risk and error-prone nature of health care.
Ensures individual and shared acceptance of responsibility and accountability.
Encourages and facilitates reporting and open communication about safety concerns in a fair and just environment.
Ensures that organizational structure's processes, goals and rewards are aligned with improving patient safety.
Learns from errors.
Shares stories.
And here are key points about actually implementing change. The theme is for the leadership of the place to force a kind of creative tension based on seeing what we want to the organization be -- our vision -- and telling the truth about where we are -- our current reality. That creative tension can only be resolved in two ways: (1) raising the current reality towards the vision, or (2) lowering the vision towards the current reality.* Of course, we aim for #1! (By the way, this involves particular challenges in academic medical centers, where the role of the CEO is somewhat different from other types of organizations.)
How you cultivate this creative tension over time:
Benchmark against the best practices.
Search for opportunities to be humbled.
Learn from the tragedies of others.
Keep patients and direct care staff "in the room", i.e., engaged in evaluation and decision-making.
Conduct critical risk assessments.
Story telling and learning.
Constantly look for trouble.
Be transparent.
Get information to those who need it to drive change.
I particularly like the idea of "constantly looking for trouble." Here's how you do it. Ask the staff on the floors the following questions:
What's keeping you awake at night?
What's your favorite work-around?
What kept you from giving the kind of care you want to give?
The folks in the room yesterday were slightly taken aback because an inherent characteristic of this approach is its transparency. In particular, your activities, flaws, and failures are open for the world to see. And they raised issues of the inappropriate portrayal and use of that information by those on the outside seeking commercial or political gain. Jim and I pointed out that there were some risks along those lines but that, for the most part, our ultimate constituency -- the public -- wants hospitals and doctors and other caregivers to succeed and believes in their good intentions. Transparency is consistent with maintaining that trust and indeed reinforces it because it sends a message that the organization is willing to hold itself accountable.
*This is based on the work of Peter Senge at MIT.
Tuesday, October 30, 2007
Grand Rounds Volume 4, Number 6
Welcome to Grand Rounds, a traveling road show of commentary from a variety of bloggers on a variety of topics. I was honored to be asked to host this week's edition.
During my relatively brief blogging experience, I have noticed that people hardly ever comment on my posts that are related to broad policy issues or scientific advances. Instead, it is the highly personal stories that seem to generate the most interest. So I asked people to submit articles with the following theme: A personal experience I (or a loved one) had at a hospital and how it caused me to change my behavior or beliefs. We got lots of submissions, and I am very pleased to share many of these with you.
As you might expect, many of these stories deal with physical or emotional pain, from the patient or the provider perspective, so be prepared to cringe from time to time as you empathize with the writer.
I'll start with Terry, just to prove I can be open-minded, in that she submitted her entry with a "Go Rockies!" closing comment! She notes: "I am a nurse anesthetist, and my blog is about my experiences delivering anesthesia care. My article is about a personal experience with anesthesia, and how it changed my life forever." I am willing to bet you cannot read it without feeling something. And here is another one from Bongi involving anaesthesia with a similar theme in a similar setting.
Barbara movingly writes about an unexpected conversation while a patient in a waiting room and how it taught her about hope.
Bruce tells us how an unnerving and awful early experience with a more senior physician when he was a nursing assistant made him into a better provider. Likewise, Tom shares how his time with a more positive mentor helped him be a better hospital administrator.
In another geat story from a current trainee, medical student Thomas Robey relays how the emotional roller coaster of witnessing a Caesarian delivery of an at-risk fetus changed his perspectives about the invasiveness of modern medicine.
Sid, who had a warm spot for the Red Sox during the World Series -- "I'm rooting for Boston in part because my wife went to Harvard and went to Fenway a few times, and in part because any team that betters the Yankees is my next favorite team" -- relates the story of what he learned while operating on another doctor. No short-cuts, no assumptions: Treat them like "regular" patients.
Susan notes: "I'm a volunteer ER chaplain who's written a post about how several visits with hospital patients have helped widen my definition of 'scripture.' And since this post prominently features Buffy the Vampire Slayer, it's also perfect for Halloween!"
Kerri Morrone, type 1 diabetic for over 21 years, finally finds a member of the medical community who actually listens. It makes all the difference. On that theme, Amy looks back on her two-year anniversary of her diabetes diagnosis, noting "the LIFE that I now appreciate as a gift worthy of celebration every single day."
Speaking of time, Laurie tells of her gratitude for providers who did a great job on a relative, but the real theme is her reflection on timing, self-care, and the fact that illness is never convenient but always illuminating. And I offer my own story about my mother that reminds us that there is no time like the present to prepare living wills and advance directives.
As usual, there are a bunch of people who submitted entries that are not related to this week's theme, but are really thoughtful or otherwise well done. Please give them a look. For this week, I have not included some very nice pieces on policy, pricing, management, transparency, and the like. As noted above, I was trying to change direction from those types of topics. Sorry to those authors.
As we consider the effects of the California fires on people's lives, check out this post by Dr. Paul Auerbach on how to survive in this fiery environment. He notes: "Given the awful situation we currently have in southern California with wildfires, every opportunity to distribute this sort of information on personal safety and what to do in an emergency situation is a big help to our firefighters, citizens, etc. Perhaps this advice will keep someone out of the hospital..." I am pleased to spread the word, Paul.
During my relatively brief blogging experience, I have noticed that people hardly ever comment on my posts that are related to broad policy issues or scientific advances. Instead, it is the highly personal stories that seem to generate the most interest. So I asked people to submit articles with the following theme: A personal experience I (or a loved one) had at a hospital and how it caused me to change my behavior or beliefs. We got lots of submissions, and I am very pleased to share many of these with you.
As you might expect, many of these stories deal with physical or emotional pain, from the patient or the provider perspective, so be prepared to cringe from time to time as you empathize with the writer.
I'll start with Terry, just to prove I can be open-minded, in that she submitted her entry with a "Go Rockies!" closing comment! She notes: "I am a nurse anesthetist, and my blog is about my experiences delivering anesthesia care. My article is about a personal experience with anesthesia, and how it changed my life forever." I am willing to bet you cannot read it without feeling something. And here is another one from Bongi involving anaesthesia with a similar theme in a similar setting.
Barbara movingly writes about an unexpected conversation while a patient in a waiting room and how it taught her about hope.
Bruce tells us how an unnerving and awful early experience with a more senior physician when he was a nursing assistant made him into a better provider. Likewise, Tom shares how his time with a more positive mentor helped him be a better hospital administrator.
In another geat story from a current trainee, medical student Thomas Robey relays how the emotional roller coaster of witnessing a Caesarian delivery of an at-risk fetus changed his perspectives about the invasiveness of modern medicine.
Sid, who had a warm spot for the Red Sox during the World Series -- "I'm rooting for Boston in part because my wife went to Harvard and went to Fenway a few times, and in part because any team that betters the Yankees is my next favorite team" -- relates the story of what he learned while operating on another doctor. No short-cuts, no assumptions: Treat them like "regular" patients.
Susan notes: "I'm a volunteer ER chaplain who's written a post about how several visits with hospital patients have helped widen my definition of 'scripture.' And since this post prominently features Buffy the Vampire Slayer, it's also perfect for Halloween!"
Kerri Morrone, type 1 diabetic for over 21 years, finally finds a member of the medical community who actually listens. It makes all the difference. On that theme, Amy looks back on her two-year anniversary of her diabetes diagnosis, noting "the LIFE that I now appreciate as a gift worthy of celebration every single day."
Speaking of time, Laurie tells of her gratitude for providers who did a great job on a relative, but the real theme is her reflection on timing, self-care, and the fact that illness is never convenient but always illuminating. And I offer my own story about my mother that reminds us that there is no time like the present to prepare living wills and advance directives.
As usual, there are a bunch of people who submitted entries that are not related to this week's theme, but are really thoughtful or otherwise well done. Please give them a look. For this week, I have not included some very nice pieces on policy, pricing, management, transparency, and the like. As noted above, I was trying to change direction from those types of topics. Sorry to those authors.
As we consider the effects of the California fires on people's lives, check out this post by Dr. Paul Auerbach on how to survive in this fiery environment. He notes: "Given the awful situation we currently have in southern California with wildfires, every opportunity to distribute this sort of information on personal safety and what to do in an emergency situation is a big help to our firefighters, citizens, etc. Perhaps this advice will keep someone out of the hospital..." I am pleased to spread the word, Paul.
Speaking of prevention, David Williams offers advice about avoiding the norovirus. It is a really good thing to avoid.
We find amazing insights in this post by Jon Schnaars. "Amy Stern, one of our writers, had a chance to interview John Elder Robison about his new memoir that focuses on living with Asperger's."
And finally, just for fun, check out this rating system for medical care proposed by the author of How to Cope with Pain.
Thanks to all for your contributions. And, of course, thanks to Nick Genes, our founder. Have a great week. And, for those whose favorite teams didn't quite make it to or successfully through the World Series, wait till next year!
Meanwhile, Grand Rounds continues next week with Terry hosting at Counting Sheep. Please tune in.
Monday, October 29, 2007
Inside Baseball
Congratulations to the Red Sox for their ALDS, ALCS, and World Series victories and to their opponents -- Anaheim, Cleveland, and Colorado -- for bringing us scrappy and well-played October baseball.
Here is the play-by-play of last night's game, as immortalized in text messages between me and one of our nurses. (Everybody at BIDMC will know which one!) Hers in plain text. Mine in italics. Simultaneous messages when on the same line.
Hate towels.
Me 2. I am w John Henry in box in Denver. Not!
U Kill me! Lets parade on Tuesday together.
(Ellsbury double in the first.)
Rookies Rule!
(First Boston run.) Woo hoo.
Mikey next. Watch him 2b or more I predict.
(He's out.)
Well nxt time.
(First Holliday out.) Happy Holliday. NOT.
(Scoops up difficult play at first.) Ortiz is red hot. Awesome Papi.
(Second Holliday out.) Not so happy Holliday.
How r those towels working?
(Strike outs.) Holey. Lester!
(Lowell double in the fifth) XO XO XO XO from me to Mikey. Told u so!
Sweet.
(Lowell slides into home.) Face first! Stunning slide.
Love him.
(Lester leaves the mound after 5 2/3 innings.)
Bravo Lester!
Tip of the hat if he was in Boston.
Canceled OR schedule 4 Tuesday . . . official holiday.
(Lowell home run in the seventh.) XO XO XO XO from me to Mikey. Mikey!
Colorado pitcher pulled after six innings.
Sad way 4 Cook 2 leave.
(DelCarmen succeeds with batter in the sixth.)
Delc snuffs him!
(Hits against DelCarmen) Pity.
Gagne warming up?!
I saw. I could cry.
(Timlin clutch strike out.) Timlin!
Love the hunter! Never want to mess with him!
I lov this.
(Kielty home run.) Kielty! Say Bobby!
Not happy Holliday.
Bad nite 4 him.
(Manny pulled to move Ellsbury to left field, Crisp to center. Scenes of Manny in the dugout.)
Manny's white doo rag a diss on white crying towels.
(Colorado home run -- Atkins in the eighth -- narrows the lead to one run.)
Poor Oki.
Big girls don't cry.
(Top of ninth.)
We could use a run or 2.
Don't worry b happy.
(Bottom of the ninth inning starts.) 1 2 3
(Ellsbury nabs Carroll ball at the wall for second out of the ninth.)
Jake!
God is a sox fan.
(Final Pabelbon strike out.)
Ahh.
Love that dirty water.
Finally back 2 full nites' sleep.
Got 2 b at work at 5:30 ugh.
To bed after trophies.
I wish I was pres [of Red Sox Nation].
Next year.
Mikey as MVP!
MVP my man.
Here is the play-by-play of last night's game, as immortalized in text messages between me and one of our nurses. (Everybody at BIDMC will know which one!) Hers in plain text. Mine in italics. Simultaneous messages when on the same line.
Hate towels.
Me 2. I am w John Henry in box in Denver. Not!
U Kill me! Lets parade on Tuesday together.
(Ellsbury double in the first.)
Rookies Rule!
(First Boston run.) Woo hoo.
Mikey next. Watch him 2b or more I predict.
(He's out.)
Well nxt time.
(First Holliday out.) Happy Holliday. NOT.
(Scoops up difficult play at first.) Ortiz is red hot. Awesome Papi.
(Second Holliday out.) Not so happy Holliday.
How r those towels working?
(Strike outs.) Holey. Lester!
(Lowell double in the fifth) XO XO XO XO from me to Mikey. Told u so!
Sweet.
(Lowell slides into home.) Face first! Stunning slide.
Love him.
(Lester leaves the mound after 5 2/3 innings.)
Bravo Lester!
Tip of the hat if he was in Boston.
Canceled OR schedule 4 Tuesday . . . official holiday.
(Lowell home run in the seventh.) XO XO XO XO from me to Mikey. Mikey!
Colorado pitcher pulled after six innings.
Sad way 4 Cook 2 leave.
(DelCarmen succeeds with batter in the sixth.)
Delc snuffs him!
(Hits against DelCarmen) Pity.
Gagne warming up?!
I saw. I could cry.
(Timlin clutch strike out.) Timlin!
Love the hunter! Never want to mess with him!
I lov this.
(Kielty home run.) Kielty! Say Bobby!
Not happy Holliday.
Bad nite 4 him.
(Manny pulled to move Ellsbury to left field, Crisp to center. Scenes of Manny in the dugout.)
Manny's white doo rag a diss on white crying towels.
(Colorado home run -- Atkins in the eighth -- narrows the lead to one run.)
Poor Oki.
Big girls don't cry.
(Top of ninth.)
We could use a run or 2.
Don't worry b happy.
(Bottom of the ninth inning starts.) 1 2 3
(Ellsbury nabs Carroll ball at the wall for second out of the ninth.)
Jake!
God is a sox fan.
(Final Pabelbon strike out.)
Ahh.
Love that dirty water.
Finally back 2 full nites' sleep.
Got 2 b at work at 5:30 ugh.
To bed after trophies.
I wish I was pres [of Red Sox Nation].
Next year.
Mikey as MVP!
MVP my man.
Sunday, October 28, 2007
On Sidelines Parenting
In previous posts, I have offered comments on refereeing and on coaching in the context of youth soccer. Today I wade into the delicate arena of sidelines parenting.
This is prompted by a game I refereed yesterday in which the parents of a visiting team were not only yelling instructions to their teenage daughters but were "assisting" in making calls. The first was useless, the second counterproductive. On a few occasions, they would yell out "offsides" when it was not, and their daughters would stop running towards the ball after hearing this announcement, leading to at least one goal by the opposition. My favorite parental call was a demand for a free kick when two of the opposing defensive players collided and fell in the penalty area near their player, and their girl with the ball maintained her balance, possession of the ball, and even took a shot at the goal. "Hey, ref, when are you going to call it?"
These and other parental outbursts contributed to a feeling among their girls that they were somehow aggrieved by my calls, and then the girls started focusing on that rather than playing their game. Beyond affecting their performance, this attitude led one to commit a bad foul as she was trying to get even for perceived earlier slights, providing, of course, a free kick to the opposing team near the goal.
There are a number of things I advise parents when I am coaching a team. Here are excerpts of a note sent to parents of a U-12 team a few years ago.
A now, a word on our plans and expectations. Under-12 represents a threshold year for these girls. They are developing physically and emotionally in many wonderful and challenging ways. On the soccer front, they have gotten really good at many aspects of the game, but many aspects remain to be trained before they become really competent players. But they are ready for the next step, both physically and socially. Our goal is to foster individual development as players but also social development as team members. We will do this by creating an environment in which they have lots of fun while learning.
Every girl will play every position on the field, including goalie. Every girl will have approximately equal playing time in all games. Please expect that in the fall, I plan that we will lose many games: That is because we will be working on certain skills that are important in the long run and because I will intentionally assign girls to places on the field in which they are less competent.
Your role as parents is to please make sure the girls get to all practices and games on time, ready to play. If a practice starts at 5pm, please be on the field ready to play by 4:50. If a game starts at 10:30, please be there at 9:45 for a really thorough warm-up.
We expect each player to be at all games and practices unless the player, herself, has called me to explain why she will not be there. This is important. The girls are old enough to take personal responsibility for their commitment to the team: It is not your job to call on their behalf. If your daughter must miss a practice or a game, she should call me and talk to me directly or leave a complete message as to the reasons for her absence.
Your role as parents, too, is to encourage all the players during a game. Please do not engage in sideline coaching. No instructions. Feel free to say, "Good play, Suzie", but do not say, "Kick the ball, Suzie." You will see that I barely talk to the girls who are on the field during a game. Most coaching takes place during the practice sessions or while the girls are on the sidelines during a game. Giving instructions during a game is counterproductive and confusing and robs the girls of the most important developmental tasks: learning to think and communicate for themselves during the game.
This is prompted by a game I refereed yesterday in which the parents of a visiting team were not only yelling instructions to their teenage daughters but were "assisting" in making calls. The first was useless, the second counterproductive. On a few occasions, they would yell out "offsides" when it was not, and their daughters would stop running towards the ball after hearing this announcement, leading to at least one goal by the opposition. My favorite parental call was a demand for a free kick when two of the opposing defensive players collided and fell in the penalty area near their player, and their girl with the ball maintained her balance, possession of the ball, and even took a shot at the goal. "Hey, ref, when are you going to call it?"
These and other parental outbursts contributed to a feeling among their girls that they were somehow aggrieved by my calls, and then the girls started focusing on that rather than playing their game. Beyond affecting their performance, this attitude led one to commit a bad foul as she was trying to get even for perceived earlier slights, providing, of course, a free kick to the opposing team near the goal.
There are a number of things I advise parents when I am coaching a team. Here are excerpts of a note sent to parents of a U-12 team a few years ago.
A now, a word on our plans and expectations. Under-12 represents a threshold year for these girls. They are developing physically and emotionally in many wonderful and challenging ways. On the soccer front, they have gotten really good at many aspects of the game, but many aspects remain to be trained before they become really competent players. But they are ready for the next step, both physically and socially. Our goal is to foster individual development as players but also social development as team members. We will do this by creating an environment in which they have lots of fun while learning.
Every girl will play every position on the field, including goalie. Every girl will have approximately equal playing time in all games. Please expect that in the fall, I plan that we will lose many games: That is because we will be working on certain skills that are important in the long run and because I will intentionally assign girls to places on the field in which they are less competent.
Your role as parents is to please make sure the girls get to all practices and games on time, ready to play. If a practice starts at 5pm, please be on the field ready to play by 4:50. If a game starts at 10:30, please be there at 9:45 for a really thorough warm-up.
We expect each player to be at all games and practices unless the player, herself, has called me to explain why she will not be there. This is important. The girls are old enough to take personal responsibility for their commitment to the team: It is not your job to call on their behalf. If your daughter must miss a practice or a game, she should call me and talk to me directly or leave a complete message as to the reasons for her absence.
Your role as parents, too, is to encourage all the players during a game. Please do not engage in sideline coaching. No instructions. Feel free to say, "Good play, Suzie", but do not say, "Kick the ball, Suzie." You will see that I barely talk to the girls who are on the field during a game. Most coaching takes place during the practice sessions or while the girls are on the sidelines during a game. Giving instructions during a game is counterproductive and confusing and robs the girls of the most important developmental tasks: learning to think and communicate for themselves during the game.
Thursday, October 25, 2007
Grand Rounds coming to this blog soon
Nick Genes created the blogging version of Grand Rounds several years ago. He calls it "the weekly rotating carnival of the best of the medical blogosphere." For reference, here is the current edition on Pallimed. I am honored to be asked to host Grand Rounds Volume 4, Number 6 on October 30.
Each week there is a theme, and I have suggested the following one for this week's edition: A personal experience I (or a loved one) had at a hospital and how it caused me to change my behavior or beliefs.
As I rewrite this on Sunday, October 28, it is too late for more submittals. Looking forward to seeing you on October 30.
Each week there is a theme, and I have suggested the following one for this week's edition: A personal experience I (or a loved one) had at a hospital and how it caused me to change my behavior or beliefs.
As I rewrite this on Sunday, October 28, it is too late for more submittals. Looking forward to seeing you on October 30.
Senator Murray has it right
Our good friends at Health Care for All were quick to jump on remarks made by State Senate President Terry Murray at the Greater Boston Chamber of Commerce and make a pitch for a return to rate regulation of health care in the state. First, to be clear, the Senator did not advocate this policy. Indeed, she had a number of very thoughtful comments about the underlying structural problems in the health care system in Massachusetts, to which I return in a moment.
I responded to HCFA:
Sorry, but rate regulation does not control costs. As a person who was intimately involved in rate regulation for years — of electricity, gas, and telephone companies — I know from experience that rate regulation generally creates a cost-plus environment for those companies subject to such supervision. This is because the legal framework for rate regulation makes it difficult for the regulator to second-guess costs incurred by the regulated entity. So, ironically, it is the high-cost, low-efficiency organizations who benefit relative to the low-cost, high-efficiency organizations.
To expand on this, regulated companies that have the greatest core competence in accounting and legal representation before the regulatory agency do the best under rate regulation. In contrast, those who develop the managerial and organizational skills to improve quality and cost efficiency find themselves relatively unrewarded.
If rate regulation is re-introduced, it will be those entities who enter the newly regulated environment with the highest base of costs who will start out with higher revenue streams. If some type of efficiency-based regulation is put in place, those higher cost organizations will have more to gain from future efficiency improvements than the ones who start out as lower cost providers. In short, regulation produces perverse incentives.
In earlier comments, I addressed the issue of the growth of costs in this state and offered a menu of options for dealing with this. Senator Murray offers her own sensible list of actions that could be implemented or encouraged by state government action. Some of these overlap with the ones I raised. Others are additive. Between these two lists, we pretty much cover the waterfront. Here is her list:
Increase our workforce capacity of nurses and primary care physicians.
Realign payment structures so that our primary care doctors are compensated at or near the same rate as specialists. We should also boost primary care services by carving out a larger role for Nurse Practitioners.
Support the creation of limited service clinics.
Require more public information and transparency. (This would include a public process to document the need for premium increases in excess of 7% in any given year.)
Expand our use of new technology that will streamline administrative functions and reduce the duplication of services.
Readjust the financial incentives that are the foundation of the current system and make smarter use of the money we are already spending.
Redesign the “determination of need” process that is supposed to provide statewide and regional planning for significant health care services.
I responded to HCFA:
Sorry, but rate regulation does not control costs. As a person who was intimately involved in rate regulation for years — of electricity, gas, and telephone companies — I know from experience that rate regulation generally creates a cost-plus environment for those companies subject to such supervision. This is because the legal framework for rate regulation makes it difficult for the regulator to second-guess costs incurred by the regulated entity. So, ironically, it is the high-cost, low-efficiency organizations who benefit relative to the low-cost, high-efficiency organizations.
To expand on this, regulated companies that have the greatest core competence in accounting and legal representation before the regulatory agency do the best under rate regulation. In contrast, those who develop the managerial and organizational skills to improve quality and cost efficiency find themselves relatively unrewarded.
If rate regulation is re-introduced, it will be those entities who enter the newly regulated environment with the highest base of costs who will start out with higher revenue streams. If some type of efficiency-based regulation is put in place, those higher cost organizations will have more to gain from future efficiency improvements than the ones who start out as lower cost providers. In short, regulation produces perverse incentives.
In earlier comments, I addressed the issue of the growth of costs in this state and offered a menu of options for dealing with this. Senator Murray offers her own sensible list of actions that could be implemented or encouraged by state government action. Some of these overlap with the ones I raised. Others are additive. Between these two lists, we pretty much cover the waterfront. Here is her list:
Increase our workforce capacity of nurses and primary care physicians.
Realign payment structures so that our primary care doctors are compensated at or near the same rate as specialists. We should also boost primary care services by carving out a larger role for Nurse Practitioners.
Support the creation of limited service clinics.
Require more public information and transparency. (This would include a public process to document the need for premium increases in excess of 7% in any given year.)
Expand our use of new technology that will streamline administrative functions and reduce the duplication of services.
Readjust the financial incentives that are the foundation of the current system and make smarter use of the money we are already spending.
Redesign the “determination of need” process that is supposed to provide statewide and regional planning for significant health care services.
Wednesday, October 24, 2007
Stranger in a strange land
A note from Dr. Tom Delbanco, the founder of our Division of General Medicine and Primary Care. I received it late last night, but I held for posting until just this moment for reasons that will be obvious.
Cross fingers for my survival. Visiting professor right now at U. Colorado. Grand Rounds tomorrow (Wednesday) at noon. Have decided to lead of with pix of Ortiz and Ramirez. May be shot. Still, it’s important….
Cross fingers for my survival. Visiting professor right now at U. Colorado. Grand Rounds tomorrow (Wednesday) at noon. Have decided to lead of with pix of Ortiz and Ramirez. May be shot. Still, it’s important….
Whew, I thought this was us
I received this email, and I first thought it was a complaint about us. But no, it was about another hospital in town, and the writer was drawing a contrast with our place! We continue to do our mystery shopper program to learn directly about these kinds of service glitches. I am not claiming perfection at our place, but we keep trying to do better and better.
In September, we were very pleased to hold a teleconference explaining our mystery shopper methodology as part of helping 14 hospitals around the country who had requested information after reading the June Boston Globe story. None were from Boston.
Upon driving up to the ambulatory clinic area we encountered heavy traffic, which required 4 Boston PD officers to direct traffic. On pulling into the ambulatory entrance valet parking area, we were told by the valet attendant to move on as the valet parking was full. He did not volunteer an alternative, but when I asked him I was directed to go to the parking structure [a short drive away]. So, I dropped my family member patient off (as she had been instructed to arrive 15 minutes prior to her appointment time, and it was exactly that time) and proceeded to the garage. However, when I reached there, the entrance to the garage was blocked off with a barrier and a sign saying that the lot was full. There was no mention of where patients should go. Had I been a patient from out of the area, I have no idea where I would have parked.
Once I did park and get into the hospital, I had trouble finding the right clinic, and a clinic front desk staff member who I asked had no idea either, offering only the explanation "I just started working here 3 days ago and so don't know these things yet."
On finally reaching the right clinic, I found my family member patient still in the waiting room. She had not been told by the front desk that the doctor was running behind. However, we learned from other patients who had been waiting for up to an hour and a half that she was running behind and that it is possible to give the front desk staff a cell phone number and to leave to get some lunch. We were not offered this option, but when we went to the front desk to ask, we were allowed to do this. On coming back, we still had to wait, and were finally called in at 1PM (for an appointment time that was for 11:00AM!)
In September, we were very pleased to hold a teleconference explaining our mystery shopper methodology as part of helping 14 hospitals around the country who had requested information after reading the June Boston Globe story. None were from Boston.
Upon driving up to the ambulatory clinic area we encountered heavy traffic, which required 4 Boston PD officers to direct traffic. On pulling into the ambulatory entrance valet parking area, we were told by the valet attendant to move on as the valet parking was full. He did not volunteer an alternative, but when I asked him I was directed to go to the parking structure [a short drive away]. So, I dropped my family member patient off (as she had been instructed to arrive 15 minutes prior to her appointment time, and it was exactly that time) and proceeded to the garage. However, when I reached there, the entrance to the garage was blocked off with a barrier and a sign saying that the lot was full. There was no mention of where patients should go. Had I been a patient from out of the area, I have no idea where I would have parked.
Once I did park and get into the hospital, I had trouble finding the right clinic, and a clinic front desk staff member who I asked had no idea either, offering only the explanation "I just started working here 3 days ago and so don't know these things yet."
On finally reaching the right clinic, I found my family member patient still in the waiting room. She had not been told by the front desk that the doctor was running behind. However, we learned from other patients who had been waiting for up to an hour and a half that she was running behind and that it is possible to give the front desk staff a cell phone number and to leave to get some lunch. We were not offered this option, but when we went to the front desk to ask, we were allowed to do this. On coming back, we still had to wait, and were finally called in at 1PM (for an appointment time that was for 11:00AM!)
Tuesday, October 23, 2007
Way to go, BID~Needham!
Here's a note sent to Jeff Liebman, CEO of our affiliated community hospital in Needham -- a very small hospital with a great ED and a big heart. We currently have plans to expand the emergency room because of the growth in demand we have seen and are projecting in Needham and the surrounding towns. (By the way, use of the ED in this hospital helps relieve pressure on crowded ED's downtown.)
Dear Jeff:
Unfortunately, I had the opportunity to spend another evening in the Emergency Department. Fortunately, it was at Beth Israel Deaconess - Needham!!!
At about 8:30 P.M. on Monday evening, my mother (85 years old & living alone in her home in Newton) tried to avoid/swat a bee in her kitchen, lost her balance, fell backwards against the wall, and thought she had broken her wrist. I was at a business meeting in Hartford, CT with my brother when she called.
What does one do in a situation like that?
I called my sister-in-law and suggested that she bring my mother directly to BID~Needham.
Meanwhile, my brother and and I headed home immediately to help out in any way we could.
Jeff, by the time I arrived at the ED, there was nothing for me to do except watch Dr. U put a splint on my mom's broken wrist, listen to his clear instructions, suggestions and follow-up plan, hear some closing and encouraging remarks from both the doctor and the nurses, and take my mom home.
All of that in under two hours - unbelievable!!! My mother's comfort level was such that she was even counseling one of the nurses on her social life.
The ease, the smoothness, the speed, the attention to detail, the understanding, the clarity, and most of all the care - all were outstanding.
The team who treated my mother were all exceptional regarding not only her care but also their warm, informative approach to my mom, her situation and her condition.
Jeff, I do not want to spend any time in an ED, but if I must, the ED at BID~Needham is the place for me and my family. The entire staff could not have been more kind, compassionate and understanding.
I am sure you hear this often, but I wanted you to know what a great team you have and what a fine hospital you oversee.
Best personal regards,
Dear Jeff:
Unfortunately, I had the opportunity to spend another evening in the Emergency Department. Fortunately, it was at Beth Israel Deaconess - Needham!!!
At about 8:30 P.M. on Monday evening, my mother (85 years old & living alone in her home in Newton) tried to avoid/swat a bee in her kitchen, lost her balance, fell backwards against the wall, and thought she had broken her wrist. I was at a business meeting in Hartford, CT with my brother when she called.
What does one do in a situation like that?
I called my sister-in-law and suggested that she bring my mother directly to BID~Needham.
Meanwhile, my brother and and I headed home immediately to help out in any way we could.
Jeff, by the time I arrived at the ED, there was nothing for me to do except watch Dr. U put a splint on my mom's broken wrist, listen to his clear instructions, suggestions and follow-up plan, hear some closing and encouraging remarks from both the doctor and the nurses, and take my mom home.
All of that in under two hours - unbelievable!!! My mother's comfort level was such that she was even counseling one of the nurses on her social life.
The ease, the smoothness, the speed, the attention to detail, the understanding, the clarity, and most of all the care - all were outstanding.
The team who treated my mother were all exceptional regarding not only her care but also their warm, informative approach to my mom, her situation and her condition.
Jeff, I do not want to spend any time in an ED, but if I must, the ED at BID~Needham is the place for me and my family. The entire staff could not have been more kind, compassionate and understanding.
I am sure you hear this often, but I wanted you to know what a great team you have and what a fine hospital you oversee.
Best personal regards,
Monday, October 22, 2007
Wanna help write my speech?
I have been invited to give the Brunel Lecture at MIT tomorrow (Tuesday) afternoon. This is a nice honor, but I am not so impressed with myself to miss this chance to ask you for help. I told them I would address the issue of process improvement in academic medical centers. If you have any stories about successes or failures in that environment, please post them, and I will try to wend them into my story. It would be even better if they could be somewhat humorous. But be forewarned: I will have a computer with projector tied into the Internet during my talk, so you might find your comment displayed for all to see.
Geekdoctor arrives!
I'd like to recommend a new blog, started by our indefatigable CIO, John Halamka. I am absolutely confident that people in the health care world -- and beyond -- will find it full of extremely useful ideas and thoughtful approaches to the information world of health care . . . and beyond.
Thursday, October 18, 2007
Quick teamwork for one baby
A year ago, I wrote about the really tiny babies in our neonatal intensive care unit. The NICU is a wonderful place, full of optimism.
The other day, I was curious. I received a copy of this email from one of our neonatologists to several nurses and people from several other departments.
I just wanted to say thank you for your hard work and help with this situation. You potentially helped save the life of one our smallest and most vulnerable infants. The teamwork that was displayed and the constant support with this urgent matter was phenomenal. I would just like to say thank you. It is a pleasure to be working with all of you. It is people like you that make BIDMC a special place to work.
I has no idea what it was about, so I asked for an explanation. Here it is:
We had a patient exposed to chicken pox. Since all of my preemies are considered immunocompromised, chicken pox is a potential life-threatening disease. There used to be an immunoglobulin that we could give to patients. It is no longer available. Our only option was to get emergency compassionate use of an experimental immunoglobulin. The hitch was it had to be given in a very short amount of time after the exposure to be effective. That meant we had to get emergency IRB* approval, pharmacy on board, and the company to ship us the immunoglobulin. It all happened within about 24 hours. It was really amazing.
Amazing indeed. That little baby will probably never, ever hear the story of how a group of adults banded together to help make sure that s/he would grow up!
* The IRB is the internal supervisory body of medical staff and outside reviewers that approves protocols for human subject experiments.
The other day, I was curious. I received a copy of this email from one of our neonatologists to several nurses and people from several other departments.
I just wanted to say thank you for your hard work and help with this situation. You potentially helped save the life of one our smallest and most vulnerable infants. The teamwork that was displayed and the constant support with this urgent matter was phenomenal. I would just like to say thank you. It is a pleasure to be working with all of you. It is people like you that make BIDMC a special place to work.
I has no idea what it was about, so I asked for an explanation. Here it is:
We had a patient exposed to chicken pox. Since all of my preemies are considered immunocompromised, chicken pox is a potential life-threatening disease. There used to be an immunoglobulin that we could give to patients. It is no longer available. Our only option was to get emergency compassionate use of an experimental immunoglobulin. The hitch was it had to be given in a very short amount of time after the exposure to be effective. That meant we had to get emergency IRB* approval, pharmacy on board, and the company to ship us the immunoglobulin. It all happened within about 24 hours. It was really amazing.
Amazing indeed. That little baby will probably never, ever hear the story of how a group of adults banded together to help make sure that s/he would grow up!
* The IRB is the internal supervisory body of medical staff and outside reviewers that approves protocols for human subject experiments.
I could have told them that
Our Dr. John Halmaka was just named CIO of the Year by the Massachusetts Technology Leadership Council in their review of all companies and industries in the state. From their website, the MTLC "is dedicated to fostering entrepreneurship and promoting the success of companies that develop and deploy technology across industry sectors."
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