HR can be the make-or-break factor in a hospital's disaster preparedness plan. One emergency management professional explains how.
As Hurricane Sandy made its way north along the eastern seaboard in October 2012, one Long Island hospital's police force urgently made last-minute preparations for the coming storm.
Naturally, everyone was feeling a bit edgy, but after years of training alongside both hospital leadership and local law enforcement, the team was ready.
It's a good thing it was, says Larry Zacarese, JD, MPA, CHSP, CHCM, EMT-P, assistant chief of police and director of emergency management at Stony Brook Medicine, a 603-bed facility with over 6,000 employees.
"It was everything you wouldn't want to deal with in a 48-hour period," he says. During the worst of the super storm's onslaught, Stony Brook Medicine's campus, which also houses Stony Brook University, experienced a major network outage. Internet, cable, and phones went dead for 30 hours.
Adding insult to injury, an instrumental part of the hospital's power grid failed during the storm, leaving the entire campus, including the hospital, in the dark for 37 minutes.
But hospital leadership's preparation, its strong relationship with local law enforcement, and the involvement of HR and administrative workers, the hospital was able to get the lights back on, keep the hospital staffed, and be there for the patients.
Whether a disaster is in the form of a hurricane, an earthquake, a terrorist attack, a snowstorm, or something else, hospitals need to be prepared. Here are Zacarese's top tips regarding what HR can do to help get the entire hospital on track.
1. Organize Trainings
The most important thing HR can do to establish readiness is training workers for the worst before it happens, says Zacarese. "You should be doing tabletops and post mortems after incidents."
And don't be shy about advocating for increased funding for hospital safety and disaster preparedness initiatives.
Safety and security are often among most important things to be funded that don't get proper funding, says Zacarese.
"It might be costly, but it's well worth the investment. As an attorney, I can tell you that it can pay dividends in front of a jury."
2. Remember: Workers are People
In the midst of a disaster even the most dedicated healthcare workers are going to have concerns beyond what's happening in the hospital. To maintain proper staffing levels and keep workers focused on their jobs in the middle of a crisis, employers should meet them halfway.
In some situations, this might mean giving employees lodging close to the hospital or providing transportation.
When asking workers to be on duty during a snowstorm, consider offering to pay for a hotel room near the hospital, meals, and a safe ride to and from the hospital. Not only will this boost attendance, but it will also minimize concerns about commuter safety.
In other situations, workers will have concerns around the safety of their families, especially children and the elderly. One solution is to create a temporary family area for watching TV and reading books.
3. Reach Out to Local Law Enforcement
Don't wait until the crisis strikes, Zacarese advises. The time to reach out to local law enforcement and emergency services is now.
"There should be a relationship between the organizations," says Zacarese. "The hospital CEO should never should be meeting the local police chief for first time when something bad happens… they should be on each other's speed dials."
It's key to remember that disaster preparedness is something that never ends; it's a continuous process. But that's something most HR professionals will find to be second nature. "HR knows this is something to take seriously," says Zacarese.
What does the future of workplace wellness programs look like under the GOP's plan to replace the ACA? Look for consumer-driven growth, says one expert.
Borne of the Affordable Care Act, wellness programs are favored by employers as a mechanism to keep healthcare costs down and employee engagement up.
But what does the future of workplace wellness programs look like under the American Health Care Act, the GOP's plan to replace the ACA?
Mary Coleman has some thoughts about the future of wellness plans. She is manager of government affairs and consumer engagement at Centura Health, a non-profit health system based in Colorado. It employees more than 17,000 workers.
The transcript below of Coleman's recent conversation with HealthLeaders has been lightly edited.
HealthLeaders: Why did employer-sponsored wellness proliferate during the Obama administration?
Mary Coleman: I've given this a lot of thought. We always try to decide if the growth of these programs is politically motivated, or if there is some other reason. I do think they grew under the Obama administration, in large part due to the Affordable Care Act.
There was a push from employers, insurance carriers, health systems, patients, and providers to really get innovative and bring down the cost of care and increase quality of care.
When all of the interested parties started putting our heads together around the employee wellness piece, we began asking how we could best help our employees by getting people more engaged, better educated, and more empowered about healthcare decisions.
When the ACA came about, people were overwhelmed with information about healthcare, but not sure what to do with it.
HealthLeaders: Do you believe that employer-sponsored wellness programs will continue to grow during the Trump administration?
MC: My opinion is that they will continue to be popular, because we now have healthcare consumers that are aware of the impact that their access or lack of access and the cost of healthcare have on them individually.
As employers, providers, healthcare systems, and a community in general, we will have to stay focused on the foundation we've built for consumers.
Trump has some plans to modify HSA contributions. What this will do is say to consumers, "Hey, we know healthcare is expensive, we're giving you a better way to make it more affordable."
[Wellness plans] will continue to grow, but [the growth will be] consumer-driven rather than driven by any political administration.
HealthLeaders: What impact will the potential repeal and replacement of the ACA have on wellness programs?
MC: We have to be very thoughtful regarding how the Affordable Care Act is going to be repealed, replaced, or reformed over time.
The initial focus of the American Healthcare Act [the Republican house bill intended to replace the Affordable Care Act] is tax relief, elimination of mandates, patient protections, and amendments to HSAs. It doesn't really target wellness programs.
HealthLeaders: How are federal standards likely to change under the current administration? Have you heard any rumblings about changes yet?
MC: We've heard nothing but rumblings of change since the beginning of this administration! This has given us an opportunity to pause and think about where healthcare is headed in the United States.
There are rumblings, but not a lot is focused on employer-sponsored wellness programs. Health systems and providers, and healthcare delivery in general, will continue to charge ahead and try to do the right thing for our patients and workers.
HealthLeaders: Any parting thoughts on employee wellness programs under the Trump administration?
MC: At the end of the day, whether you favor the Trump administration or the Obama administration, the one thing we have to do is clear: We must bring down the cost of healthcare, deliver very high quality, and be innovative with the care that we are offering and the way that you are engaging employees.
The role of HR is changing, staffing challenges will continue, and smart leaders will be well-versed in the need to address issues surrounding a diverse workforce.
What keeps you up at night? If you have repeated nightmares about handing the wrong envelope to Warren Beatty and Faye Dunaway, I'm afraid I can't help you.
But if staffing challenges, succession planning headaches, or increased pressure to find diverse and culturally competent workers are on your mind, rest assured that you're in good company.
The American Hospital Association recently published its annual healthcare workforce report, a snapshot of current issues troubling hospital human resource leaders, and there are fresh issues on the plates of all HR leaders.
"We are really trying to look at how hospitals and health systems must align to move forward," says Kimberly McNally, MN, RN, BCC. She is a trustee at the AHA and chair of the committee report, and president of the consultancy, McNally & Associates, headquartered in Seattle.
"This report aims to elevate the conversation and amplify it as we begin to talk about future workforce needs, and set the stage for the longer term, bigger picture."
Below are four takeaways from the report.
1. HR's Role is Changing
One major shift McNally and her colleagues noticed is the changing role of HR in healthcare business. In short, expect to be invited to the join other C-suiters in the boardroom and be asked to weigh in on policy more frequently.
"HR now has a seat at the table," says McNally. Healthcare administrators are finding value in creating roles in upper management for HR professionals, including C-suite positions such as chief human resource officer, she says.
McNally sees this as a positive, and not just for HR itself. "HR leaders are really the translators of the C-suite's work. The C-suite develops policy, while HR ensures its implementation, and helps to close the gaps between planning and implementation."
"There are definitely physician shortages in certain areas," says McNally. Medical schools have a limited number of residency slots and regulatory challenges such as restrictions on allowing clinicians to practice in states in which they are not licensed exacerbate the problem.
"The key takeaway," she says, is that there are "barriers to people being able to practice at level of license, and limitations to number of physicians that can be trained, which increases problems related to the shortage."
3. The Growing Importance of Community
Healthcare leaders cannot afford to live in a bubble, says McNally. Not only does intimately understanding the local community assist an organization's population health initiatives, but embracing a diverse community is vital for healthcare organizations.
"People have a more sophisticated, comprehensive view of diversity than they did in past," she says, adding that communities expect a culturally competent workforce that helps them to feel welcome when they seek care.
Expect greater demand for clinicians who have multicultural experience, and more roles oriented toward promoting cultural competency, such as chief diversity officer.
4. The Need for Leadership Succession Planning
Don't get caught unaware—start planning for the next big leadership change today.
Upper-level departures are famously difficult to predict and fill. "Many people are caught a little bit unprepared, or are a little surprised," McNally says. "Many organizations are now realizing that investment in leadership development really is paramount for these upper-level positions."
Unfortunately, organizational inertia doesn't always make that easy. Many healthcare organizations have heavily structured cultures, which can make it a challenge to think outside the box. But these difficult conversations need to happen, says McNally.
The best takeaway might be this: Whatever concern your organization is having, chances are, you're not alone. "Many organizations feel like they're working without a play book; things are just changing so much," McNally says.
HealthLeaders Media Council members discuss how they enhance patient experience in their organizations.
This article first appeared in the March 2017 issue of HealthLeaders magazine.
Rachel Provau
CNO
Bayfront Health Spring Hill
Spring Hill, Florida
We subscribe to Studer Principles at Bayfront Health Spring Hill, and we follow them very closely. They focus on patient experience, with the pillars of quality, people, growth, finance, and community service. We call our program Community Cares. I think adhering to these principles has helped us to be successful and to better engage with patients.
I think it's important to remember that we see patients who are at their worst, and are not in their own environment. Going out of your way to make the environment comfortable, ensuring that you're not walking into a room with a clipboard and looking down at patients in the bed instead of meeting them at eye level, and always applying the practice of reminding yourself that it could be your family member in the bed will lead to effective communication with patients.
We also teach all of our staff an acronym, SAFE, which stands for "support the team; ask a question; focus on the task; and effective communication." If you take those components, you have the key to being successful in 99% of patient encounters.
We have utilized nurse leader rounding and nonclinical directors to visit patients' rooms, introduce themselves, and ask how it's going. We have made a significant improvement in patient engagement and communication over the last 12 months.
Deborah Visconi
Director of Operations
Morristown Medical Center
Morristown, New Jersey
We've implemented electronic rounding tools through mobile technology using tablets. That allows anyone, from nurse managers to care coordinators to hospital leadership to round on a patient and get that patient's immediate feedback on anything.
These are new tools we recently rolled out. We're learning how powerful they are. We are able to address patients' concerns and needs while they're still in the bed, which gives us more accountability and a more transparent culture.
Other new methods we've implemented to enhance the patient experience include utilizing patient TVs. It allows patients to communicate their needs, including environmental issues such as temperature control or if they need another blanket and other comforts. They make a request using their television controller, and that request goes to the appropriate department or to a nurse to follow up on it.
The patients are very pleased; the feedback that we're getting is that they like that we can act on their concerns right in the moment.
A more old-school strategy we're using on our outpatient side is a simple comment card system that allows patients to give us feedback. It allows us to address any needs the patients might have before they leave, and to recognize staff members who stood out.
Patricia Boeckmann
Vice President, Hospital and Specialty Services
Titus Regional Medical Center
Mount Pleasant, Texas
Titus is using tablets and in-house-developed survey tools to ask patients about their experience. We gather that input before the patient leaves. We can use the real-time information to make changes quickly, do immediate service recovery if necessary, or redirect patients as needed—for example, if the patient needs additional treatment sooner than originally anticipated, we can use these tools to set that up. It allows for real-time direction and validation.
Work has been done by our chief nursing officer to pay attention to our outgoing patients and any needs they might have prior to discharge. We are able to take that information right from the bedside to leadership, which helps support the staff and make changes more quickly. We also depend heavily on our case management department and our hospitalists to communicate with patients, and then provide us with that feedback.
We also use Press Ganey surveys to get feedback and identify missed opportunities. We're going to be rolling out leader rounding as well. This is important for many reasons, but I like to point out that there's ample evidence that engaged patients will better follow through on postdischarge recommendations for care, are more compliant with medication, and are more dutiful about seeing their physician after the discharge. I also believe through data we can show a direct correlation between patient engagement and staff engagement, as well as readmission and almost every other quality metric.
We have just extended an offer to bring on a patient experience coordinator. This professional will be working with the staff, including physicians, to really improve our culture and our awareness of patient experience.
Marilyn Daniels
Director, Case Management
Methodist Stone Oak Hospital
San Antonio, Texas
On effective rounding: We do leader rounding every morning at 10 a.m., Monday through Friday. If you're a director or above, no matter which area you work in, you go to roll call every morning and are then assigned a group of patients to round on.
At that time, every patient in our facility is visited, touched, and talked to by one of our leaders. This interaction includes senior leaders—everybody who is director level and above is required to come to roll call unless they are on vacation or have a major off-site obligation that day.
If a patient has a complaint or concern that relates to another department, we contact the director of that department and do service recovery at that time. This has been beneficial; we've been doing this for about a year now. Our satisfaction scores are now in the 81st percentile for HCAHPS—previously, we were in the 68th-70th percentile.
On engaging patients: We always make sure to ask patients open-ended questions, and to talk to them about their plan of care as it appears on their whiteboard. We'll say things like, "It looks like you're getting pain medication every four hours. How is that going for you?" and ask if we're responding to their needs, ensure they know how to use their call light, and inquire about how long it takes for the nurse to arrive when called. They open up once you start asking questions.
Errors are known to spike during the late night hours, but guidance from administration and HR can help shift workers adjust.
Hospitals are a 24/7 business, but errors and on-the-job injuries both spike after hours, says Ann E. Rogers, PhD, RN, Edith F. Honeycutt chair of nursing and professor and director of graduate studies at the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta.
"We know that during night shifts, no matter how well rested you and your colleagues are, everybody will experience some fatigue and may have to fight sleep. You simply are not as alert as you should be," says Rogers, who researches the effects of sleep deprivation and shift work on nurses.
Even seasoned night shift workers can experience sleepiness while on the clock.
Acknowledging that working at night presents special challenges is an important first step toward supporting nightshift workers, says Rogers. She offers three steps management can take to help them.
1. Look for Signs of Fatigue
"All of us can hide the symptoms [of sleep deprivation] with coffee," says Rogers. But being under the influence of caffeine only masks the symptoms of fatigue.
Caffeine doesn't restore attention to detail, grant patience in the face of frustration, or improve coordination, which are all consequences of sleep deprivation.
Other signs of fatigue include slowed reaction time or responses, irritability, poor memory, lack of attention to detail, and excessive consumption of caffeinated beverages.
If a usually calm and collected worker shows signs of fatigue, it wouldn't be out of line to ask him how he's adjusting to working the night shift.
2. Tamp Down External Cues
Imagine a clinician wrapping up a 12-hour shift at the hospital to go home and get some rest, only to feel themselves suddenly perking up as they walk outside and are greeted by sunshine and bustling streets.
That wakefulness will likely persist once the worker is at home, lying in bed, desperately trying—and failing—to fall asleep.
Along with circadian rhythms, people rely on external cues to tell them when it's time to get up, go to sleep, or eat meals. Even if a worker has been awake for a long time, it can be difficult to fall asleep after exposure to bright sunlight and street noise.
Rogers suggests encouraging shift workers to wear dark sunglasses on their way home from the hospital and discouraging caffeine use during the latter part of their shifts. She also advises that workers use earplugs to block out daytime noises and to hang dark curtains in their bedrooms if they need to sleep during daylight hours.
3. Set Rules for Shift Work
Even with environmental checks in place, it's up to hospital managers and administrators to set rules that can protect workers and patients.
The first is to ensure proper scheduling so workers can get the proper amount of sleep, says Rogers. She has written that the likelihood of a clinician making an error can increase by as much as 36% after working 12-hour shifts on consecutive days.
"We know that workers only use half of their time off to sleep," says Rogers. "If a nurse has 10 hours off, they will sleep for about five hours, which is not enough rest for anybody," she says.
It's also important to ensure shift workers take breaks. Because fewer restaurants and shops are open at night, many shift workers neglect taking lunches and scheduled breaks. Have clinician supervisors and managers encourage their reports to take their scheduled time off, and keep an eye out for workers who skip lunches or work through their breaks.
Additionally, most hospitals don't allow workers to nap during breaks, says Rogers. She believes this policy is a missed opportunity. "Allowing a nurse to do that will encourage alertness for the rest of the night," she says.
The night shift may not be the first choice for most healthcare workers, but by acknowledging its unique challenges, hospital administration can help keep workers awake, alert, and present in their jobs.
The demand for locum tenens services is growing. Assignments for physicians are getting longer and there is a rising demand for specialists in primary care, emergency medicine, and behavioral health.
A temporary staffing solution with roots in the 1970's has evolved to meet the changing needs of the healthcare industry.
Forty years ago, locum tenens physicians were commonly called on to fill short-term gaps in staffing for a week or two. Today, they are in great demand for a wide variety of situations says Sean Ebner, president at Staff Care, a locum tenens staffing firm headquartered in Dallas.
The results of Staff Care's annual survey revealed that 94% of healthcare facility managers used locum tenens during the last 12 months.
Improved access and demand for care has given physician hiring and staffing a boost, but the healthcare industry's needs have evolved. The way hospitals and health systems use alternative staffing arrangements and locum tenens resources is shifting.
Ebner believes the real driver of demand for locum tenens docs is scarcity. "[It's] high, and it continues to get more severe," Ebner says.
Here are four ways the use of new locum tenens has changed over the decades.
1. Longer Assignments
Old Way: Locum tenens placements typically lasted a couple of weeks to relieve short-term gaps in employment, such as vacations.
New Way: Assignments are getting longer. Nearly 40 percent of the clinicians surveyed by Staff Care said their ideal assignment would last between one and four months; 16.5% said an ideal assignment would last between nine and 12 months.
Some organizations might bring on a locum tenens physician while searching for a permanent hire; hospitals located in resort areas or college towns will use them to beef up staffing during the busy season.
2. More Flexibility From Physicians
Old Way: Clinicians were either locum tenens or weren't.
New Way: Some locum tenens docs are also employed physicians willing to pick up extra shifts for extra cash.
Because of the structure of clinicians' shifts, many doctors and nurses can easily augment full time employment with locum tenens assignments, Ebner says. "We see many physicians that are fully employed or have their own practice, but pick up additional shifts through an agency."
3. Demand for Specialists
Old Way: Locum tenens physicians were generalists.
New Way: Locum tenens staffing firms are recruiting specialists to meet demand.
From surgeons to oncologists, many types of specialists are available on a locum tenens basis. Nurse practitioners are among the most in-demand. Twelve percent of respondents to the Staff Care survey looking to bring on locum tenens staff said they plan to bring on locum tenens nurse practitioners.
Hospitalists (22.2%) and behavioral health specialists (23.3%) are in even greater demand. Other specialties in demand include urgent care and anesthesiologists.
There's also been a jump in demand for emergency medicine practitioners. "ED visits have been significantly on the rise, which lends itself to a raise in locum tenens staffing of emergency physicians."
One thing that hasn't changed much: Primary care physicians have long been a mainstay of locum tenens resources. They still are. As the demand for greater preventative care has grown, demand for primary care physicians has grown along with it, says Ebner.
Healthcare leaders discuss what key metrics their organizations use under value-based care.
This article first appeared in the January/February 2017 issue of HealthLeaders magazine.
Glenn Sumner
CEO
OrthoTennessee
Knoxville, Tennessee
There are several metrics we prioritize. Our highest priorities are outcomes of quality, and metrics that reduce cost. The most important metric, therefore, is readmissions. We are cognizant of readmissions in our bundled payment programs. Another metric we are also cognizant of is surgical-site infections. Both of those are issues that we work on and look at regularly.
The third most important metric for us would be complications; in other words, do we have to go back and do some manipulation where there's a dislocation or some other kind of possible postoperative problem that requires additional care and, therefore, additional cost?
These metrics are always weighed against less objective but still important metrics such as patient satisfaction, and our ability to provide an experience to our patients that's acceptable.
We have two sources for metrics. The first is through professional societies our physicians belong to. They are regularly identifying new metrics and making suggestions. They're generally not mandates, just suggestions, about the kinds of things they consider important.
Our mother source of metrics is a group of orthopedic practices called the OrthoForum, which we were a founder of and are regularly involved with. We have an outcomes committee initiative that identifies measures that are important to us, and we as practices have all agreed that we will use those metrics, which include patient-centric outcomes.
Nancy Wexler
Director, Innovation and Collaborative Care
University of Arizona Health Plans
Tucson, Arizona
We are a Medicaid health plan in the state of Arizona offering Medicaid managed care, and we started our value-based contracting in 2015. That was the first time we used quality metrics in this space. We developed them first in primary care with our high-volume and safety-net providers, and we designed them to have an incentive component and a shared savings component with a gateway of quality measures. We targeted the triple aim, and we were looking at finding things focused on experience of care, access to care, utilization measures, and health outcome.
We offer 10 measures, and most providers only had to have between two and four measures to qualify that first year. The measures we chose were a set of four child's measures that were largely preventive in nature. Those measures were well-baby visits, six or more visits before six months of age, an annual well-child visit between age 3 and 6, an annual adolescent well visit, and, from ages 2 to 20, an annual dental visit.
We chose those measures because they were in line with what our state Medicaid objectives are. We wanted to choose targets that both aligned with state goals and our health plan's goals, and were also measureable. Those child measures were all about prevention. We added some other measures about utilization—readmission rates and adult and child emergency department utilization. We also wanted to address the triple aim. In our provider-centric approach, we selected measures that would be helpful, acceptable, and doable for everybody involved.
Chet Johnson, MD
Vice President
Olathe Health
Olathe, Kansas
Developing value-based performance metrics is a big one for us. We have those metrics both with our physicians and with our payers. I think that with every major payer in our market we have some kind of collaborative relationship. For example, a common quality metric would be the completion of an annual Medicare wellness visit.
All of our physicians have performance metrics, which include patient satisfaction. In primary care, we choose two more—this year, we decided to go with management of hypertension and management of diabetic nephropathy. We change those metrics every couple years in order to keep them fresh.
We have about 120 employed physicians, and we look to encourage alignment in a couple of ways. We have a physician executive council, which helps to set policy and communicate with other physicians. We also have a primary care leadership committee. We run our primary care policy by it, which can be anywhere from things like changing our walk-in policy to one that's more inclusive, to how we manage no-shows, to how we reset the performance metrics for the next year. For example, we recently started using smoking cessation as a metric. We chose it because it's a patient-centered medical home metric, and it's going to be an important part of the quality performance program. And we wanted to find something that would help us reach those goals but would also help our physicians to increase their compensation for quality.
Barclay Berdan
CEO
Texas Health Resources
Arlington, Texas
I would say that there are standards and metrics associated with the standards in a number of groups or areas. One area would be operational; one would be member experience. One would be physician quality and efficiency.
Under the operational standards, those are along the line of how available the provider organization is, whether that's a physician or hospital, to patients. We are looking for electronic health record participation and adoption. I would say member experience indicators are kind of obvious—things like member satisfaction, engagement in clinical programs, but also a measure of what I'd call network efficiency and using the network that has agreed to cooperate and provide value-based care. Also, on the clinical efficiency side, the standard set of utilization outcomes—hospital admits per thousand, readmits per thousand, those kinds of things.
On the importance of standardization. This is one of the great challenges right now. Different organizations define the details of measurement in some of these metrics differently. There's an effort underway to adopt a standard across the country so everybody's measuring things the same way. We're supportive of that, because we occasionally find ourselves measuring the same metric three different ways, depending on how a certain organization might want to define certain values.
Even the sharpest and most dedicated clinicians can be driven to distraction when it matters most. Focus zones and cross monitoring can help maintain patient safety.
The other day, after reading a vitriolic Facebook post from an in-law which implored me and other "friends" to unfriend this person if we disagreed, I found myself unable to concentrate on my morning routine.
By the time I made my way to the car, my mind was filled snarky comebacks, questions about what might happen at our next family gathering, and thoughts about how unfriending this person might affect my relationship with other family members.
Preoccupied, I hit the highway. When I arrived at my office about half an hour later, I found that my laptop case was not in its usual place in the trunk of my car. For the first time in 10 years, I had become distracted enough to leave it at home.
Michelle Feil, MSN, RN, CPPS, senior patient safety analyst at the Pennsylvania Patient Safety Authority in Harrisburg calls this a prime example of distracted behavior.
"You may not realize you are being distracted by your own thoughts until after the error occurs… If you see a post on social media that you keep thinking about, you may forget that you have to go to a medical appointment, and [you] drive to work instead of the doctor's office."
This drama plays out daily in all industries, and social media is just one distracting factor, says Mindy Yoder, DNP, RN, FNP-BC, dean of the school of health sciences at University of Saint Francis in Fort Wayne, IN.
"There's a lot going on in our culture, and distractions are prevalent. It's a faster-living society…. There is lots of information coming at us," she says. A study Yoder published in 2012 found that nurses are interrupted on average eight to 15 times per hour. Common distractions include call lights, phone calls, colleagues, patients, and their families.
Not Your Average Distraction
The healthcare environment is inherently distracting, says Feil.
"We have technology and processes in place that are actually designed to distract us. We use these to communicate with each other and patients, or for them to communicate with us. These tools (cell phones, pagers, and intercoms) are supposed to distract us to get our attention," she says.
And that's not even taking into consideration self-initiated distractions, such as being preoccupied by politics, family matters, or social media activity.
"Anything that can take a worker's mind off of the task at hand can be a threat," Feil says.
The consequences can be heavy. Few other professions have the lives of others in their hands to the degree that clinicians do. "We've seen examples where patients receive the wrong blood type in a transfusion or have surgery on the wrong side of their body."
Visual Aids
Yoder suggests creating visual cues indicating that a worker is trying to focus is one way to help improve both worker and patient safety.
One way of doing this is to designate an area away from the usual work stations as a focus-zone. "Creating signage around these areas… is very helpful," she says. Yoder also suggests that clinicians and pharmacists wear a disposable bib, hat, or flashing light on their arm while they are preparing medication or doing other tasks that require focus.
These signals are intended to prevent interruptions and a break in focus.
See Something, Say Something
Anyone can become distracted—and it's everyone's responsibility to keep an eye on their coworkers to make sure they're both mentally and physically present, says Feil.
"Everyone should be doing cross monitoring. It's part of constantly scanning for safety risks, and a way of saying to your coworkers, 'I've got your back, I'm looking out for you,' " she says.
It is not just management or HR's responsibility to cross monitor. "All workers should be doing this as a part of safety culture."
A physician leaves behind a careeer at NASA to embark on a different kind of journey—engineering improved patient safety solutions.
James P. Bagian, MD, PE, dreamed of becoming an astronaut from the time he was a child.
As he grew, Bagian decided to pursue other fields: first engineering, then medicine. But his career was altered during medical school when, while waiting for an operating room to be cleaned, Bagian spotted a magazine article mentioning that NASA was accepting applications for astronauts.
He applied and, to his surprise, was selected for training, becoming an astronaut in July 1980.
After 15 years, two space shuttle missions, and 337 hours of logged space flight time, Bagian left his career at NASA and embarked on a different kind of journey—engineering improved patient safety solutions.
In 1999, Bagian became the first chief patient safety officer and founding director of the VA National Center for Patient Safety at the U.S. Department of Veterans Affairs; he is also the founding director of the Center for Healthcare Engineering and Patient Safety and a professor in the College of Engineering and the Medical School of the University of Michigan.
On bringing safety engineering to medicine:
Let's say a nurse is stuck with a needle; you don't just treat them for the needlestick. You ask, how are the sharps containers set up? Do the nurses have to reach up blindly to dispose of the needles and end up getting stuck? That's a bad design. The question is, how do we design this sharps disposal system to be safer?
On organizational safety culture:
While I never thought I'd end up in healthcare safety, I always thought about managing risk and defining organizational goals. I was always frustrated and unhappy with the way healthcare did them.
It's not that healthcare safety was never done well, but it certainly wasn't done in a uniform way, and it was hierarchical; whoever was in charge was often considered to be right based on their position, which is ridiculous.
Someone needs to be in charge, but assuming management always knows best about safety is foolish. You want to take advantage of the various expertise and talent people in your organization have, at every level.
On a culture of risk management:
Many of my attitudes on managing risk don't come from having worked for NASA, or being an engineer—a lot of it comes from how my parents raised me. My father was a highly decorated fighter pilot during World War II, and had experienced many demanding situations.
But at home, as a family, when we would talk about anything we were going to do, we would ask what the risks were and decide how we would manage those risks.
My parents were clear that bad things could happen, but always talked about what we could do to get the risk to an acceptable level so that whatever it was that we were thinking about doing could be accomplished.
Executives from Texas Health Resources describe how they have tackled some of the challenges of enabling health system staff to work remotely.
With winter storms in full swing, it's a good time to review the benefits and challenges of enabling healthcare staff to work from home.
"While there are limits, we also have many instances where the work and technology have intersected to make working from home a reality," says Donna Coleman, human resource officer, system services at Texas Health Resources (THR) in Arlington.
Patti Consolver, senior director of patient access at THR, agrees. "There are multiple roles with the ability to work from home." Consolver cites studies that say 80% of employees consider working from home a perk and that workers are 35% to 40% more productive when they work from home.
Coleman and Consolver recently shared their experiences in allowing workers to telecommute. Their responses have been lightly edited.
HLM: Is allowing employees to work from home something your organization was always supportive of, or did you need to do some convincing?
Coleman: As we have moved into a world with various generations working together, we did need to understand that our workforce was changing, and that means we are required to look at how diverse we are becoming, both in terms of our age groups and with different needs and preferences.
Consolver: Advances in technology have certainly enabled us to implement teleworking where we could not have done so before. I'd say that our partnership with HR strengthened. They helped guide us in the process and ensure we are keeping things consistent.
HLM: What were some of HR's greatest concerns?
Coleman: There were some concerns regarding employee injury. These concerns have been met with the requirement of an initial worksite evaluation to assess physical work area safety, ergonomics, and security. Additionally, there is a requirement of an annual attestation that there have been no changes and a requirement of a new worksite evaluation when things do change.
Consolver: Training has been challenging for new hires. Historically, new staff would shadow seasoned staff to learn from the best of the best. With those staff members now working from home, this is a bit more challenging. Utilizing technology has helped in this area by taking advantage of online tools and resources.
HLM: What kind of negative employee feedback, if any, have you received?
Coleman: Our employee feedback has been that while employees love not commuting, they often feel "alone" and "disconnected."
In an effort to address this concern, leaders continue to have onsite meetings monthly or quarterly to bring teams together face-to-face. They may include a pot luck or other team building activities during on site time.
HLM: What kinds of security measures you take to ensure the safety of patient records?
Consolver: In order to get permission to work from home, the employee in question must be a top performer, the best of the best. We also have criteria they must meet. Their home workspace must be in a secure location, and an office environment; they can't just work from their couch.
There must be privacy in that workspace; they can't share an office. We do a home visit in the very beginning to ensure it's working out. From a paper perspective, we do not allow printing. We have a department in-house that will do that for them, and we also allow remote faxing.
We have a firewall set up so that when workers are signed on for work, they cannot access Facebook, Google, and other popular sites. We also have a mechanism in place where if the worker leaves a patient's information on the computer screen for an extended period of time without any activity, the screen will time out and take them off of the screen.
There are systems in place that records the screen history as well as the audio from the phone calls, which discourages workers from using information inappropriately.