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Hearing the Patient’s Voice

Mother with daughter

My dear friend Carol is very ill. She's been in the hospital in the intensive care until (ICU) for over two weeks, and though there are small signs of improvement in some areas, there are also setbacks in others. What is most frustrating for me is the inability to communicate with her. Although she is sometimes aware loved ones are with her, she's unable to participate in her care—unable to speak, write or let us know what she's thinking.

As is the case with many who end up in the ICU, she didn't have an advance directive, living will, Physician Orders for Life Sustaining Treatment (POLST) form, medical power of attorney, do not resuscitate or other instrument that contains the voice of the patient.

As I concern myself about what Carol would want, I also think about what I would and wouldn't want under similar circumstances. I know I wouldn't want my husband and sister to have to "guess" my wishes.

  • I would want them to have a starting place
  • I would want them to know there is a plan I have thought about that provides a guideline for their decisions
  • I would want to help make their choices as easy as possible

It's confusing though—does a person need to have all of the documents mentioned above? What's the difference between them? How are they used?

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Keep Calm and Innovate with Technology

Doctors with laptop

Innovate - to make changes in something established, especially by introducing new methods, ideas, or products. -Merriam Webster Dictionary

Here at HealthInsight we often work with a wide variety of clinics, settings and providers to help them to evaluate their internal processes and potentially improve them through the use of technology such as electronic health records (EHRs). Establishing these systems is often times a difficult and time-consuming experience. For those involved, it can be a very disruptive task. During those times though, I imagine motivations and possibly some internal mantras often reflect on the potential improvement the providers are moving towards to help keep people calm and focused on the future.

Technology can be, all by itself, a disruptive medium. It can cause delayed meeting starts as we attempt to get everyone connected, it can experience failures that impact communication and collaboration, and it can impede learning, as well as cause numerous other negative impacts. On the flip side, however, technology champions positive disruptive innovations such as EHRs, patient portals, data sharing and accessibility, mobility and the blooming field of the Internet of Things that's increasing our interconnectedness to everything.

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Helping Caregivers Cope

Couple

Family caregivers are the most important source of support for people with chronic or other health conditions disabilities or functional limitations. Millions of family caregivers help their loved ones live at home and in their communities, providing the bulk of this assistance. There are about 40 million family caregivers currently caring for adults in the US.

Family caregivers help with activities such as eating, bathing, dressing, transportation and managing finances; perform medical and nursing tasks such as wound care and managing multiple, complex medications; arrange and coordinate care among multiple providers and settings; and pay for home modifications, transportation or home care assistants. This helps to delay or prevent their loved ones from needing more costly nursing home care and helps prevent unnecessary hospital readmissions. On average, family caregivers spend 24 hours a week caring for their loved one for four years; almost one third of family caregivers provide an average of 62 hours of care a week.

Family caregivers experience more injuries, anxiety, depression and poorer health than non-caregivers. Family caregivers generally do not receive training and other assistance to help them provide care. Navigating, locating and coordinating fragmented services is too often bewildering, complex and very time-consuming. There is nothing worse than watching someone you love suffer and not knowing what to do.

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Bright and Hot: Spotting Success

Report Card

What do you do when your child comes home with a report card? Do you celebrate the A's or do you narrow in on the F's? If you're like most people, you probably narrow in on the F's. It is common for our rational brains to focus on problem areas, and problem solving in health care is no different.

In their book, "Switch: How to Change Things When Change is Hard," Dan and Chip Heath promote an idea called "bright spots." The idea is to look for instances of success in order to learn what is working so it can be applied to areas that are struggling. The report card is an example from their book. The Heaths contend that during times of great change, there will never be a perfect report card. However, there will be successes. In the example, the A is a bright spot, a success. Parents may zero in on the F, but what can they learn from the A that can help improve the F? And, how does this apply to health care?

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W. Edwards Deming - Let's Not Miss the Quality Boat Twice

W Edwards Deming

I have a couple quotes from W. Edwards Deming, an American engineer, statistician, professor, author, lecturer, and management consultant, on the white board in my office that read "drive out fear" and "encourage effective two-way communication and other means so everyone in the company can be effective." I was intrigued by how many of my health care quality improvement co-workers commented on the quotes and in return, shared one of their own favorite Deming quotes. One co-worker shared "Inspection is waste"; another co-worker shared "A bad process will beat a good person every time." Another shared "In God we trust; all others must bring data" and "If you can't describe what you are doing as a process, you don't know what you are doing."

We take Deming seriously at HealthInsight. Deming has been given the title of "philosopher of quality" and championed the cause of "statistical process control." Deming was largely ignored by the production-focused United States during the 1960s and1970s. Deming took his quality message to the Japanese industrial leadership and the results produced placed him on a path to stardom in Japan. The Japanese automotive and electronic industries skyrocketed in sales due to higher quality products which were reliable over time. Most experts feel the United States missed the quality boat during this time frame as Unites States sales were down and their products did not last as long. Many industries in the United States have warmed to his quality message over time. In health care, the Institute for Healthcare Improvement (IHI), among others have championed many of Deming's ideas.

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Achieving Our “True North” Vision for Health Improvement

Compass

Just two weeks ago in the beautiful setting of Santa Fe, New Mexico, we met for our annual board retreat. The retreat included HealthInsight's four boards, senior staff, and the invited boards of three other health improvement organizations whom we count as partners. We came to learn, to share, to envision and to consider new plans and approaches.

Over the course of two days of meetings, something special and significant seemed to happen. Perhaps the best way to characterize the outcome of the retreat is that this group of almost 100 leaders-already highly engaged and committed to achieving better health outcomes for our communities-became even more committed; even more motivated to fully realize transformational change. The level of rapport and engagement was palpable and energizing!

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Three Good Things

Change Agents - Learning and Action Network

I recently had the great pleasure of serving as the regional host for a HealthInsight-sponsored learning and action network (LAN) event, "Be the Change: Strategies for Health Care Transformation".

I have been a HealthInsight employee for nearly two decades. Part of my reasoning for continuing to work for HealthInsight for all these years is that I am still able to learn and grow, and think about new possibilities to change the health care system.

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"Be the Change: Strategies for Health Care Transformation" HealthInsight's First Live Multi-state Event

Change Agents

As health care changes providers, clinics, hospitals and insurance companies have to be innovative, efficient and creative in their solutions to the problems facing the American health care system. As a Quality Innovation Network Quality Improvement Organization, HealthInsight has to be at the forefront of the change and offer innovative solutions to the way we help providers understand the changing landscape. Yesterday was a big step in the right direction.

HealthInsight, in Nevada, New Mexico and Utah along with Acumentra Health in Oregon, held our first four-state Change Agent learning and action network event; bringing together nearly 400 participants in five on-site locations and online. We used new technology to broadcast our plenary and breakout sessions live from Las Vegas, including a live chat that allowed online participants to ask questions and be a part of the conversation without being in the room. We used Twitter and the event hashtag #ChangeAgentsLAN to connect online and share thoughts, insights and quotes from speakers. On location in Las Vegas, Albuquerque, Portland, Salt Lake City and St. George, we combined the use of the technology with in-person interaction through group discussions, table-top exercises and get-to-know-you activities. Online participants shared their experience and thoughts through the chat enabling them to connect with the speakers and others attending virtually. The result was a successful event with robust conversations about the way health care is changing and the roles each of us will play moving forward.

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Celebrating 10 Years of National Health IT Week: A Look at How Far We’ve Come

Doctor with Laptop Computer

I recently caught up to an excellent blog post by Dr. John Halamka, Trajectory not Position, in which he reminds us of the significant progress that has been made in health information technology (HIT) in the past 10 years:

"My view is that we must believe in incremental progress, communicate broadly, and focus on our trajectory not our position."

"At age 53, my personal medical data is electronic. That was not true when I was 43."

"At age 22, my daughter has never encountered a paper-based record as an adult. She has always had access to 100% of her healthcare data on her iPhone. That was certainly not the case for me."

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Patient and Family Engagement Council – One Year Later

Group Session

It's been just over a year since I wrote a blog about how HealthInsight Nevada was taking on establishing our own Patient and Family Engagement Council (PFAC). Because we are so proud of our progress, I wanted to provide an update. The hard part was getting started. Now, even though we are only five months into having actual PFAC meetings, it is starting to feel like a sustainable effort.

After much helpful advice from Joan Gallegos and Juliana Preston, our HealthInsight colleagues in Utah, we began our venture. First, we established a core group of staff to represent HealthInsight Nevada. Then we spent a few months going through the Patient and Family Centered Care Partners Gateways Program presented by Libby Hoy. For those that don't know about this, it is a course of five webinar sessions working with a small number of organizations (there were three in our cohort) with Libby's curriculum, homework assignments and feedback. It really provided focus for our group and forced some decisions to be made early.

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