The following email message was broadcast last week in a Boston hospital. Of course, you can guess my view of this: Any form of communication (even conversations in the elevator!) can violate important privacy rules, but limiting people's access to social media in the workplace will mainly inhibit the growth of community and discourage useful information sharing. It also creates a generational gap, in that Facebook, in particular, is often the medium of choice for people of a certain age. I often get many useful suggestions from staff in their 20's and 30's who tend not to use email. Finally, consider the cost of building and using tools that attempt to "track utilization and monitor content." Not worth the effort, I say.
Good morning,
Effective immediately, the Hospital is blocking access to social networking sites including Facebook, MySpace, and Twitter from all Hospital computers.
The decision is based on recent evidence that some employees have been using these sites to comment on Hospital business, which is a violation of the Hospital’s Electronic Communications policy and a potential HIPAA violation.
The Executive Team will be working in the coming months to ensure that we have written policies in place that articulate the appropriate use of social networking sites while on duty at the Hospital. Once these written policies are in place, we have educated all employees about expectations and disciplinary action associated with violating the policies, and we have the appropriate IS tools in place to track utilization and monitor content, we will consider once again providing access to these sites. We expect this will take a period of about 6 months.
In the interim, please note that the Electronic Communication policy states that “incidental personal use of electronic communications systems may be allowed so long as such use does not consume more than a trivial amount of resources, interfere with staff productivity, preempt any business activity or violate Hospital policy”.
Employees are free to use Hospital computers during their break periods to check personal email, or access the Internet, but you should be aware that the policy also states, “employees should not have any expectation of privacy with respect to any information on Hospital electronic communication systems or the contents thereof, including email, internet usage, voicemail, fax or other similar vehicles. [The hospital] reserves the right to monitor, review and inspect all uses and the contents thereof.
Should you have any questions or concerns, please feel free to contact me.
Tuesday, October 13, 2009
Monday, October 12, 2009
On the day of judgment . . .
We've just returned from a jaunt to Italy's Amalfi Coast, a celebration with friends of one of those special birthdays of my wife. Here's a typical coastal scene along with a plaque near the main piazza in the town of Amalfi. Take a moment to figure out the translation, and you'll get a sense of the place and why it has been a tourist destination for several centuries.And below, why you never gain weight even though you eat very well.
"Ground level"
To briefly continue the travelogue from above, consider the hillside construction of the towns along the Amalfi Coast. One of the natives gave us a short lesson in real estate advertising: "Anything within 150 steps up or down is considered ground level."
Here's a photo essay of the steps we walked each day.
Thursday, October 08, 2009
Wednesday, October 07, 2009
Kaizen Corner -- standardized work
A late September edition of Mark Zeidel's weekly tutorial on Lean process improvement. See this pig exercise for a great example of this week's principle.
We have been describing the strategies for improving patient care, called, in Toyota parlance, “countermeasures.” Last week we described visual systems as tools towards standardizing processes and improving reliability. This week and next, we discuss standardized work. If we do not have a stable, standardized way of doing our work, we cannot develop ways to improve it.
Standardized work is a form of “playbook” for workers, defining the methods to be used, and the outcomes that we expect each person to reach, each day. Standardized work spells out the number of workers needed and what each needs to do, and in what order, to make sure that defined customer expectations are met.
The workers must understand the need for standardization. They must be trained and practiced in the expected methods to do the work and they must have the ability to improve and adjust the processes as they gain experience with them. Unfortunately, in much of what we do, any two people trained to do the same task likely perform it in completely idiosyncratic manners. Interestingly, we have policies and procedures manuals that fill shelves of storage, but these do not specify how the work is done.
Standardized work is the best way we know today to do the job to ensure that desired outcomes are met. In part because we have standardized the work, we are able to experiment with changes in the process, and then to modify the process of work to make it more effective. Without standardization it is impossible to improve.
There are many benefits to standardized work:
1. Improved process stability: Stability means repeatability and the ability to meet quality, cost, lead time, safety and environmental targets every time.
2. Clear start and stop points for each process: These plus an understanding of the customer’s rate of demand allow us to see if things are on track, ahead or behind, and to divide work among people in a sensible manner.
3. Organizational Learning: Standardized work permits us to preserve know-how and helps avoid problems that occur if work methods are not documented and key employees leave.
4. Audit and problem solving: Standardized work makes it easier to define the current condition and identify problems.
5. Employee involvement and error-proofing: If we have a stable process, then those doing it can improve it and can build in visual systems and other devices to avoid errors.
6. Kaizen: Standardized work provides the baseline against which to measure improvement.
7. Training: Standardized work makes it possible to train new people effectively.
Next week we will discuss the elements of standardized work, and approaches towards standardizing where possible the clinical care of patients.
We have been describing the strategies for improving patient care, called, in Toyota parlance, “countermeasures.” Last week we described visual systems as tools towards standardizing processes and improving reliability. This week and next, we discuss standardized work. If we do not have a stable, standardized way of doing our work, we cannot develop ways to improve it.
Standardized work is a form of “playbook” for workers, defining the methods to be used, and the outcomes that we expect each person to reach, each day. Standardized work spells out the number of workers needed and what each needs to do, and in what order, to make sure that defined customer expectations are met.
The workers must understand the need for standardization. They must be trained and practiced in the expected methods to do the work and they must have the ability to improve and adjust the processes as they gain experience with them. Unfortunately, in much of what we do, any two people trained to do the same task likely perform it in completely idiosyncratic manners. Interestingly, we have policies and procedures manuals that fill shelves of storage, but these do not specify how the work is done.
Standardized work is the best way we know today to do the job to ensure that desired outcomes are met. In part because we have standardized the work, we are able to experiment with changes in the process, and then to modify the process of work to make it more effective. Without standardization it is impossible to improve.
There are many benefits to standardized work:
1. Improved process stability: Stability means repeatability and the ability to meet quality, cost, lead time, safety and environmental targets every time.
2. Clear start and stop points for each process: These plus an understanding of the customer’s rate of demand allow us to see if things are on track, ahead or behind, and to divide work among people in a sensible manner.
3. Organizational Learning: Standardized work permits us to preserve know-how and helps avoid problems that occur if work methods are not documented and key employees leave.
4. Audit and problem solving: Standardized work makes it easier to define the current condition and identify problems.
5. Employee involvement and error-proofing: If we have a stable process, then those doing it can improve it and can build in visual systems and other devices to avoid errors.
6. Kaizen: Standardized work provides the baseline against which to measure improvement.
7. Training: Standardized work makes it possible to train new people effectively.
Next week we will discuss the elements of standardized work, and approaches towards standardizing where possible the clinical care of patients.
Tuesday, October 06, 2009
Kaizen Corner -- Visual Systems
Mark Zeidel's Kaizen course continues:
We resume this week with a discussion of Visual Systems. In the effective work place, things are self-explaining, self-ordering, self-regulating and self-improving. We described previously the approaches toward organizing the workplace (5S, which stands for: Sort, Set in Order, Shine, Standardize and Sustain). Our goal is to assure that material and information have been organized to support worker productivity by providing everything needed to get the work done in a predictable place.
Visual Systems help us achieve 5S in the workplace. They are designed to make vital information known, at a glance, to those who need to know it. They tell us what we need to know and what we need to share. There are four types of visual devices that comprise visual systems:
1. Visual Indicator: This provides key information in the workplace, like a street sign or a room number on a patient’s room. The information is useful, but we must seek it out.
2. Visual Signal: This grabs our attention. A traffic light is a visual signal. When it changes from green to yellow we are supposed to notice and slow down (Of course, many Massachusetts drivers regard this transition as a stimulus to accelerate). Many of our clinics use a visual signal such as color coded door labels, to indicate when a patient is in a room and ready to be seen, or when a room needs to be prepared for the next patient.
3. Visual Control: These cues limit or regulate our activities. For example, we do not park in areas with yellow lines or in front of fire hydrants because the visual cues make it clear that we can expect a parking ticket if we do. Similarly in hospital work areas we can make it visually clear that some areas are sterile, thatsharps go into particular containers and the like. If we organize our work space we might have specific, very clearly labeled bins for specific forms; these bins tell us where to put the forms within the work area.
4. Visual Guarantee: This is the most powerful visual device, which actually prevents us from introducing defects into patient care. An example of this sort of device is a forcing function in the
electronic record, which requires that a field be filled out before the computer will move to the next step.
In the factory setting, visual systems alert workers to stoppages in the line, help assure that parts are put in the same place every time, and, in some cases, ensure that parts are snapped into place only in the correct configuration. Try to think about your own work areas. Are there visual cues that might enhance patient care? One thought would be a visual signal on patient rooms that would alert interns and residents that a new admission has arrived, who needs to be evaluated and admitted.
We resume this week with a discussion of Visual Systems. In the effective work place, things are self-explaining, self-ordering, self-regulating and self-improving. We described previously the approaches toward organizing the workplace (5S, which stands for: Sort, Set in Order, Shine, Standardize and Sustain). Our goal is to assure that material and information have been organized to support worker productivity by providing everything needed to get the work done in a predictable place.
Visual Systems help us achieve 5S in the workplace. They are designed to make vital information known, at a glance, to those who need to know it. They tell us what we need to know and what we need to share. There are four types of visual devices that comprise visual systems:
1. Visual Indicator: This provides key information in the workplace, like a street sign or a room number on a patient’s room. The information is useful, but we must seek it out.
2. Visual Signal: This grabs our attention. A traffic light is a visual signal. When it changes from green to yellow we are supposed to notice and slow down (Of course, many Massachusetts drivers regard this transition as a stimulus to accelerate). Many of our clinics use a visual signal such as color coded door labels, to indicate when a patient is in a room and ready to be seen, or when a room needs to be prepared for the next patient.
3. Visual Control: These cues limit or regulate our activities. For example, we do not park in areas with yellow lines or in front of fire hydrants because the visual cues make it clear that we can expect a parking ticket if we do. Similarly in hospital work areas we can make it visually clear that some areas are sterile, thatsharps go into particular containers and the like. If we organize our work space we might have specific, very clearly labeled bins for specific forms; these bins tell us where to put the forms within the work area.
4. Visual Guarantee: This is the most powerful visual device, which actually prevents us from introducing defects into patient care. An example of this sort of device is a forcing function in the
electronic record, which requires that a field be filled out before the computer will move to the next step.
In the factory setting, visual systems alert workers to stoppages in the line, help assure that parts are put in the same place every time, and, in some cases, ensure that parts are snapped into place only in the correct configuration. Try to think about your own work areas. Are there visual cues that might enhance patient care? One thought would be a visual signal on patient rooms that would alert interns and residents that a new admission has arrived, who needs to be evaluated and admitted.
Monday, October 05, 2009
Kaizen Corner -- for lack of a battery
Mark Zeidel's commentary continued in late August with actual application of Lean principles.
As we move into our efforts to enhance the flow of patients from the Emergency Department to the medical floors, I have had the privilege of visiting with multiple people in the ED and Admitting. I have done Gemba’s at ED signout, with an ED core nurse, with an ED charge nurse, with Triage, and with the Admitting Office. I have been enormously impressed with the ability and dedication of these people.
At the same time, ED people are and will be, observing our admissions and patient care processes on the floor. From what I haveseen I have no doubt that we can reduce markedly the time it takes for many of our patients to transit the ED and reach the floors.
Last week we discussed Toyota’s approach to problem solving. We expand on this topic this week by describing how Toyota employees reach the root cause of a problem, with the goal of seeing that it never recurs. The idea is to keep asking why (the 5 why’s) until they discover the root cause, which is defined as that level of understanding that will permit development of a countermeasure that will prevent the problem from occurring again.
As an example:
Symptom: Mrs. Jones’s discharge was delayed for 3 hours until the medicine orders could be written.
Why #1? The intern could not get the orders written during work rounds, wrote down the medicines on a piece of paper, and did not have time to enter them into the electronic order
set until later in the day.
Why #2? Work rounds were rushed because the team needed to gather the data on each patient by hand.
Why #3? The team needed to gather the data and could not easily enter orders because the computer on wheels was not available.
Why #4? The computer on wheels was not available because its battery has run out and must be replaced.
Why #5? No one is responsible for regularly checking and maintaining the computer on wheels to ensure that it is always working.
An analysis like this would develop a standard that each team making work rounds must have (and use) a functional computer on wheels, and would assign the maintenance of the computer on wheels to appropriate staff. Coupled with this would be the expectation that the vast majority of orders should be written on patients by the end of work rounds, so that tests and discharges can occur promptly. We have a group which is developing Lean improvements to work rounds.
As we move into our efforts to enhance the flow of patients from the Emergency Department to the medical floors, I have had the privilege of visiting with multiple people in the ED and Admitting. I have done Gemba’s at ED signout, with an ED core nurse, with an ED charge nurse, with Triage, and with the Admitting Office. I have been enormously impressed with the ability and dedication of these people.
At the same time, ED people are and will be, observing our admissions and patient care processes on the floor. From what I haveseen I have no doubt that we can reduce markedly the time it takes for many of our patients to transit the ED and reach the floors.
Last week we discussed Toyota’s approach to problem solving. We expand on this topic this week by describing how Toyota employees reach the root cause of a problem, with the goal of seeing that it never recurs. The idea is to keep asking why (the 5 why’s) until they discover the root cause, which is defined as that level of understanding that will permit development of a countermeasure that will prevent the problem from occurring again.
As an example:
Symptom: Mrs. Jones’s discharge was delayed for 3 hours until the medicine orders could be written.
Why #1? The intern could not get the orders written during work rounds, wrote down the medicines on a piece of paper, and did not have time to enter them into the electronic order
set until later in the day.
Why #2? Work rounds were rushed because the team needed to gather the data on each patient by hand.
Why #3? The team needed to gather the data and could not easily enter orders because the computer on wheels was not available.
Why #4? The computer on wheels was not available because its battery has run out and must be replaced.
Why #5? No one is responsible for regularly checking and maintaining the computer on wheels to ensure that it is always working.
An analysis like this would develop a standard that each team making work rounds must have (and use) a functional computer on wheels, and would assign the maintenance of the computer on wheels to appropriate staff. Coupled with this would be the expectation that the vast majority of orders should be written on patients by the end of work rounds, so that tests and discharges can occur promptly. We have a group which is developing Lean improvements to work rounds.
Saturday, October 03, 2009
Friday, October 02, 2009
Kaizen Corner -- Inaugural edition
Our chief of medicine, Mark Zeidel, was one of our senior management group who took a course in Lean process improvement philosophy and techniques. He decided he would share what he was learning with his faculty and students, in the form of a section of each week's departmental newsletter named "Kaizen Corner".
Mark is an enthusiastic and excellent teacher, and there are already reports throughout his department of lots of use of Japanese terms! (Courses for the residents and interns will expand and reinforce these messages.) I reprint excerpts here from his June 9 inaugural edition and will give you some later editions for each of several days next week.
The hospital has engaged Greater Boston Manufacturing Partnership, Inc., to partner with Alice Lee and her staff in developing training in Toyota production and process improvement techniques for BIDMC. I am enjoying the privilege of taking one of the first courses, a series of 8 or 9 six hour sessions, (with homework) focused on the fundamentals of continuous improvement. The course is terrific, and is beginning to point to the way in which we can become a self-learning, continuously- improving organization of the kind that Steven Spear, our recent visiting lecturer, outlines in his book, Chasing the Rabbit. Members of our Department who are taking these initial courses include Ken Sands and Julius Yang.
To help spread an understanding of the principles of the Toyota system, I will outline elements in the Newsletter each week. We start with the Japanese term, kaizen: This means, “incremental improvement.” Kaizen is the continuous pursuit by all employees of ways to do their jobs better (more safely and reliably), faster (more efficiently, with less strain) and cheaper (at lower expense because there is less waste).
We will go forward with four critical concepts:
1. Customer first.
Customers may be our patients, or referring physicians or the physicians we sign out to.
We strive to provide to each customer exactly what is needed and desired—immediately. This is summarized by the directive, “Produce the customer’s exact order immediately.”
The only acceptable level of quality from the customer’s standpoint is zero defects.
2. Employees are the most important resource.
This means that we must strive to engage each and every employee in helping improve the work we do. We must help each employee to work creatively in our environment.
3. Direct observation as the path to improvement.
Even after years of observation of a process, new discoveries as to how it can be improved can occur every day. If you want to improve something, go and see for yourself how it is working now, with an eye toward how it can be improved
4. Kaizen is for everybody, every day.
We must make improvement part of everyone’s job, something that they do as part of their job, every day. This is the key to becoming a self-learning organization. We must make it possible and normal for people at the front lines to recognize when a process is not going as well as it could go, call it out and work with coworkers or management to fix it as soon as possible.
There is an enormous amount of content in this one page. Over the next series of newsletters, I will try to outline many of the critical elements of the Toyota system. I hope that these descriptions will help people become acclimated to some of these concepts, so we can move them from the minds of a few to the practice of all.
Mark is an enthusiastic and excellent teacher, and there are already reports throughout his department of lots of use of Japanese terms! (Courses for the residents and interns will expand and reinforce these messages.) I reprint excerpts here from his June 9 inaugural edition and will give you some later editions for each of several days next week.
The hospital has engaged Greater Boston Manufacturing Partnership, Inc., to partner with Alice Lee and her staff in developing training in Toyota production and process improvement techniques for BIDMC. I am enjoying the privilege of taking one of the first courses, a series of 8 or 9 six hour sessions, (with homework) focused on the fundamentals of continuous improvement. The course is terrific, and is beginning to point to the way in which we can become a self-learning, continuously- improving organization of the kind that Steven Spear, our recent visiting lecturer, outlines in his book, Chasing the Rabbit. Members of our Department who are taking these initial courses include Ken Sands and Julius Yang.
To help spread an understanding of the principles of the Toyota system, I will outline elements in the Newsletter each week. We start with the Japanese term, kaizen: This means, “incremental improvement.” Kaizen is the continuous pursuit by all employees of ways to do their jobs better (more safely and reliably), faster (more efficiently, with less strain) and cheaper (at lower expense because there is less waste).
We will go forward with four critical concepts:
1. Customer first.
Customers may be our patients, or referring physicians or the physicians we sign out to.
We strive to provide to each customer exactly what is needed and desired—immediately. This is summarized by the directive, “Produce the customer’s exact order immediately.”
The only acceptable level of quality from the customer’s standpoint is zero defects.
2. Employees are the most important resource.
This means that we must strive to engage each and every employee in helping improve the work we do. We must help each employee to work creatively in our environment.
3. Direct observation as the path to improvement.
Even after years of observation of a process, new discoveries as to how it can be improved can occur every day. If you want to improve something, go and see for yourself how it is working now, with an eye toward how it can be improved
4. Kaizen is for everybody, every day.
We must make improvement part of everyone’s job, something that they do as part of their job, every day. This is the key to becoming a self-learning organization. We must make it possible and normal for people at the front lines to recognize when a process is not going as well as it could go, call it out and work with coworkers or management to fix it as soon as possible.
There is an enormous amount of content in this one page. Over the next series of newsletters, I will try to outline many of the critical elements of the Toyota system. I hope that these descriptions will help people become acclimated to some of these concepts, so we can move them from the minds of a few to the practice of all.
Thursday, October 01, 2009
Can you help me find these people?
This is a personal item, but I am asking help from those of you in the social media world. Curt Bakal, chief of radiology at Lahey Clinic, gave me this old paper from our days in the Oceanside (NY) public schools. We had been on a student research team that studied the properties of RNase, as part of a educational program run by the Waldemar Medical Research Foundation in Woodbury, Long Island. Roy Deitchman, vice president for environmental health and safety at Amtrak, another classmate, gave it to him to pass along to me.By the way, this the first and last bit of medical research that I ever did, but that is another story.
My request is this. I would love to track down the co-authors of the paper and see what they have done in the intervening years. If you know one of these folks or know someone who might know them, would you ask them to please post a comment with a short life history? If we can find all or some, their bios might present an interesting slice of life of the baby boomers generation.
Happy 40th! HCHP->Atrius
Congratulations to Atrius Health, the successor organization, on the occasion of the anniversary of the creation of Harvard Community Health Plan, forty years ago today. HCHP was the the nation's first academic health maintenance organization. It was the brainchild of some of the medical giants of Boston back in 1969, including Robert Ebert, Richard Nesson, Howard Hiatt, Mitch Rabkin, and Joe Dorsey. Starting with 88 patients on the first day, it grew to 30,000 by 1972, and then to hundreds of thousands in the years afterward.
The theory of HCHP was to provide health care at lower costs to patients by concentrating on keeping people healthy in addition to treating them when they became sick. Not a bad idea.
The theory of HCHP was to provide health care at lower costs to patients by concentrating on keeping people healthy in addition to treating them when they became sick. Not a bad idea.
Wednesday, September 30, 2009
Immigrants left in the lurch again
Kay Lazar in the Boston Globe tells a sad story. Several weeks ago, Governor Patrick and his administration pushed through a plan to help assure that legal Massachusetts immigrants would continue to receive coverage under the state's landmark health care access bill. This was a gutsy move, staving off prejudice and xenophobia, and many of us joined in thanking him for his political courage.
Now, in ways the Governor and his folks could never have anticipated, the insurance company that is providing that coverage has decided to limit the network of physicians and other providers these patients can see. Kay's story outlines this problem. Here are more details that apply to BIDMC and the community health centers affiliated with us.
But the same points apply to Cambridge Health Alliance and Boston Medical Center, the major "safety net" networks in Eastern Massachusetts. CeltiCare’s refusal to negotiate in good faith with key providers that serve this population is jeopardizing and severing thousands of primary care physician/patient relationships and also separating patients from their specialty practitioners.
I summarize some information provided to me by Ediss Gandelman, our Director of Community Benefits:
Over the years, BIDMC has worked tirelessly over the years to ensure that the patients served in our affiliated community health centers have seamless, high quality and culturally competent access to primary care, and to tertiary and specialty services when needed. In downtown Boston, the Fenway, Brighton, Chinatown, Quincy, Roxbury, Dorchester and beyond, BIDMC built these affiliations to prevent poverty, fear and isolation from serving as barriers to responding to the persisting unmet medical needs of these communities.
Given the challenge of administrative burdens and delays in access to care for both primary and specialty care appointments, these community-based affiliations have resulted in timely, efficient and meaningful access to needed care in the appropriate setting for our community health center patients. This is the result of a decade’s worth of effort and investment to ensure that our health centers have electronic health records, and a seamless connection to BIDMC for the real-time sharing of needed laboratory and essential clinical information for their patients.
In short, we BIDMC have created an integrated care delivery system that – for our affiliated community health center patients – means timely, efficient, safe, and linguistically and culturally appropriate care and communication between the community health centers’ and BIDMC clinicians. (Paul's note: This integration is at the heart of recent policy standards set forth by the state. It is also what is visualized in pending federal legislation.) It crucial to minimizing opportunities for medical error and ensuring high quality care to these patients.
These patients deserve no less.
Immigrants, many of whom have never benefited from a relationship with a primary care physician or a specialty physician, are especially vulnerable to a disruption of this caring relationship—that hard-earned trust will not transfer easily (or at all) to a new provider in an unknown care delivery system. The medical literature is replete with data about how the
patient/physician relationship impacts health outcomes, including adherence to treatment protocols and keeping medical appointments. Being able to continue care with trusted providers and institutions is critical to the health of these patients.
Another element that affects continuity of care and quality and safety is the institutional support for culturally and linguistically diverse patients. BIDMC has invested deeply in its Interpreter Services department with 47 staff interpreters and more than 54 additional free-lancers. With our health center partners we have also invested significantly in other programs that facilitate access. (For example, Latina and Chinese Cancer Patient Navigators provide compassionate care for vulnerable patients finding their way through a complex medical system). Chinese labor coaches work hand in hand with obstetricians in delivering more than 300 Chinese babies annually, and our Latino mental health team provides invaluable care to the newly arrived who are most prone to depression.
These support systems are not easily replicated and are essential to providing culturally responsive care to CeltiCare members.
Now, in ways the Governor and his folks could never have anticipated, the insurance company that is providing that coverage has decided to limit the network of physicians and other providers these patients can see. Kay's story outlines this problem. Here are more details that apply to BIDMC and the community health centers affiliated with us.
But the same points apply to Cambridge Health Alliance and Boston Medical Center, the major "safety net" networks in Eastern Massachusetts. CeltiCare’s refusal to negotiate in good faith with key providers that serve this population is jeopardizing and severing thousands of primary care physician/patient relationships and also separating patients from their specialty practitioners.
I summarize some information provided to me by Ediss Gandelman, our Director of Community Benefits:
Over the years, BIDMC has worked tirelessly over the years to ensure that the patients served in our affiliated community health centers have seamless, high quality and culturally competent access to primary care, and to tertiary and specialty services when needed. In downtown Boston, the Fenway, Brighton, Chinatown, Quincy, Roxbury, Dorchester and beyond, BIDMC built these affiliations to prevent poverty, fear and isolation from serving as barriers to responding to the persisting unmet medical needs of these communities.
Given the challenge of administrative burdens and delays in access to care for both primary and specialty care appointments, these community-based affiliations have resulted in timely, efficient and meaningful access to needed care in the appropriate setting for our community health center patients. This is the result of a decade’s worth of effort and investment to ensure that our health centers have electronic health records, and a seamless connection to BIDMC for the real-time sharing of needed laboratory and essential clinical information for their patients.
In short, we BIDMC have created an integrated care delivery system that – for our affiliated community health center patients – means timely, efficient, safe, and linguistically and culturally appropriate care and communication between the community health centers’ and BIDMC clinicians. (Paul's note: This integration is at the heart of recent policy standards set forth by the state. It is also what is visualized in pending federal legislation.) It crucial to minimizing opportunities for medical error and ensuring high quality care to these patients.
These patients deserve no less.
Immigrants, many of whom have never benefited from a relationship with a primary care physician or a specialty physician, are especially vulnerable to a disruption of this caring relationship—that hard-earned trust will not transfer easily (or at all) to a new provider in an unknown care delivery system. The medical literature is replete with data about how the
patient/physician relationship impacts health outcomes, including adherence to treatment protocols and keeping medical appointments. Being able to continue care with trusted providers and institutions is critical to the health of these patients.
Another element that affects continuity of care and quality and safety is the institutional support for culturally and linguistically diverse patients. BIDMC has invested deeply in its Interpreter Services department with 47 staff interpreters and more than 54 additional free-lancers. With our health center partners we have also invested significantly in other programs that facilitate access. (For example, Latina and Chinese Cancer Patient Navigators provide compassionate care for vulnerable patients finding their way through a complex medical system). Chinese labor coaches work hand in hand with obstetricians in delivering more than 300 Chinese babies annually, and our Latino mental health team provides invaluable care to the newly arrived who are most prone to depression.
These support systems are not easily replicated and are essential to providing culturally responsive care to CeltiCare members.
Tuesday, September 29, 2009
Prostate teams
I had dinner tonight with a grateful prostate cancer patient who was able to take advantage of our Cyberknife to receive targeted radiation therapy. But what especially impressed him was the fact that he was able to meet with a medical oncologist, a urologist, and a radiation oncologist all at the same time to help him decide on his treatment plan.
Our approach is to help each man understand the nature of his disease and clearly present the relative value of treatment options -- open surgery, laparoscopic surgery, traditional radiation, radioactive seeds, Cyberknife, and watchful waiting -- in a direct, unbiased fashion.
Until tonight, I thought that every place did this, but apparently not. One of our urologists at the dinner told me the story of a friend of his in New York who had been diagnosed and was wondering where to go and what to do. He advised his friend that there were lots of good hospitals and doctors there, and the key was to find a place that offered an interdisciplinary team. His friends searched and searched but was unable to find a place that offered this kind of team. Well, one place offered a team, but did not offer the full range of treatment options.
Now, maybe his friend did not do a full survey or missed some program, but he was clearly an informed consumer, and he could not get what he needed. I'm curious to see if this is typical of other people's experience. Please comment here.
Our approach is to help each man understand the nature of his disease and clearly present the relative value of treatment options -- open surgery, laparoscopic surgery, traditional radiation, radioactive seeds, Cyberknife, and watchful waiting -- in a direct, unbiased fashion.
Until tonight, I thought that every place did this, but apparently not. One of our urologists at the dinner told me the story of a friend of his in New York who had been diagnosed and was wondering where to go and what to do. He advised his friend that there were lots of good hospitals and doctors there, and the key was to find a place that offered an interdisciplinary team. His friends searched and searched but was unable to find a place that offered this kind of team. Well, one place offered a team, but did not offer the full range of treatment options.
Now, maybe his friend did not do a full survey or missed some program, but he was clearly an informed consumer, and he could not get what he needed. I'm curious to see if this is typical of other people's experience. Please comment here.
Hollywood stands up for health care victims
Although I disagree with the policy argument, you have to appreciate the cleverness of this video.
Monday, September 28, 2009
Whose woods these are
When you walk through New England woods, you often come across stone walls. They are a reminder that the region is more forested now than it was 100 years ago. The stone walls used to delimit pastures.This one is in Rocky Narrows, a Trustees of Reservations property in Sherborn, MA. The video below is the view from King Philip's Overlook (with someone flying a toy plane).
Sunday, September 27, 2009
Hub on Wheels 2009
The BIDMC team again joined in the Hub on Wheels, a bike ride through the neighborhoods that is a fundraiser for the Boston public schools. Our team raised about $7000, and we and Cataldo Ambulance Service also donated medical services for the ride. Mayor Menino's bicycling czarina Nicole Freedman visited the medical tent before the ride. BIDMC team captain Michael Keating braved the elements on a wet and windy day.And here's a movie Michael made, the production of which actually sent him to one of those first aid stations.
Saturday, September 26, 2009
SNMA @ BIDMC
We were so pleased that the Student National Medical Association decided to hold its Board of Directors meeting and National Leadership Institute at BIDMC this weekend. SNMA is the nation's oldest and largest independent, student-run organization focused on the needs and concerns of medical students of color. Membership includes more than 8,000 medical students, pre-medical students, residents and physicians.The students were pretty busy, with seminars like:
Knowing vs. understanding: How do you learn, with Dr. Rich Schwartzstein;
Thoughts on selecting a residency program, with Dr. Carrie Tibbles; and
How scientists think, with Dr. Steve Freedman.
There were also demonstrations and practice in our skills and simulation center. See below. The fellow shown here learned how it feels to have splint put on!
And, also there was a poster presentation showing some recent research projects. I was joined by Beverly Edgehill, CEO of The Partnership, Inc., in addressing the students during their dinner session tonight.
Signature collection grows
I have previously written about the email signatures used by some of the girls on the soccer team I coach. Here is another one, from a player with musical talent as well as excellent foot skills.
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