By Nicholas Dowd, Senior Consultant (HCAHPs and other Surveys), HealthStream
We Need to Focus on More Than "Winning" and "Losing" in Healthcare
There was a plaque affixed to the wall high above the scoreboard in my high school gym. As a teenager I didn’t really pay much attention to it. Though I walked past it nearly every day and played basketball in its shadow on Tuesday and Friday nights, I didn’t think about it. I really didn’t notice it. At sixteen, of course, I was convinced there were many more “important” things with which to be concerned.
Engraved on that plaque was a poem penned by Grantland Rice:
For when the One Great Scorer comes
To write against your name,
He marks-not that you won or lost-
But how you played the game.
Like people in every walk of life, we healthcare people are attuned to successes and failures – wins and losses. But, perhaps more so than people in other occupations, we are also traditionally very sensitive to how we do what we do – that is, in Rice’s view, how we play the game.
Data and Metrics are Only Part of the Healthcare Story
What positive impact did you make in someone’s quality of life? What did you say to an anxious family member that calmed them? What kind word did you use? What small touch did you give at just the right time? What empathetic nod signaled that you understood someone’s pain? What quiet little differences have each of us made along the way, the impact of which can never be fully measured or counted or reported to a “scorekeeper” in a cubicle thousands of miles away?
Little Victories are as Important as Big Wins in Healthcare
Whether a nurse, physician or any employee of a hospital or clinic, we are all conditioned to measure success by how well our patients fare. Positive outcomes are vital, of course. After all, we’ve been patients, too. We’ve had those times when we ourselves have wanted to get well, sometimes desperately. We’ve wanted to win our battles. Whether we are the caregiver or the patient, we want to beat whatever challenges us.
Big or small, there are many ways to win. But, some triumphs can’t be readily measured or programmed on a dashboard or quantified for reimbursement purposes. Of all people, healthcare people know it isn’t always about winning or losing in dramatic fashion. We well understand the need for little victories. We try to make them happen every day.
Let’s Not Let Numbers Make Us Forget That We are Caring for People
Regardless of how healthcare ultimately gets financed or how many laws are formulated, no matter how wins or losses are defined by those who make the rules, life and health can never be reduced to a number. The score on the scoreboard will take care of itself when we do the right things the right way.
As Grantland Rice might see it, when the One Great Scorer comes to write against our names, we will be known not by whether we won or lost – or got fairly reimbursed. We will be known by how we played the game.
HealthStream helps our customer hospitals assess, understand, and improve patient experiences. Learn more.
By Kim Clark RN, Senior Product Manager, HealthStream
It’s Time to Move Beyond Ineffective Computer and Paper-based Performance Evaluations
In most healthcare organizations, performance evaluations still occur in the traditional way. They are a frustrating and time-consuming (and often still a paper-based) process, where a form is filled out manually, completed in tandem with the involved employee, and filed physically with the human resources department. Both employee and manager approach the process with apprehension, dreading the time it takes, frustrated by the lack of value derived, and questioning the ultimate purpose and results.
Automated Online Performance Assessments Can Benefit Your Organization
Healthcare organizations that adopt tools like the HealthStream Performance Center to streamline performance appraisals find they create a more dynamic and productive performance review system. Assessments completed with automated tools are more likely to be completed – and completed quickly and easily. Automated assessments also keep employees focused on their careers and performance, attentive to developing their skill-base and expertise, as well as the talents that will allow them to be an asset to your enterprise.
Giving Structure to Performance Reviews Makes Them Shorter and Easier
A tool that supports and controls the interaction between manager and employee is one that takes away the negative connotation surrounding the review process. You can turn the annual assessment into a more productive moment for the company, one that can be focused on identifying employee strengths and weaknesses, creating goals and follow-up development plans – all in support of your organization’s objectives. Best of all, in a healthcare environment where time is always in short supply, managers can use the HealthStream Performance Center to quickly and effectively complete employee performance appraisals.
The Clear Advantages of the HealthStream Performance Center
Customers of the HealthStream Learning and/or Competency Centers can implement the HealthStream Performance Center with very little additional effort. And with learning and performance activities linked through the same system, hospital human resource departments can use the same system and features to guide, assign, and control the assessment process as well as link training assignments to position requirements and even individualized needs identified through the performance evaluation process. Our healthcare-exclusive experience with a customer base of over 50% of the hospitals in the United States has led us to design the a performance management solution with attention to the unique needs and concerns of hospitals and other organizations that deliver care. From cost-effective pricing options and manageable implementation to availability of pre-built assessments and strong reporting capability, we have set it up to work “right out of the box.” That way your managers can spend their valuable time managing people, not paperwork.
Learn How the HealthStream Performance Center Can Help You
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- A Medical Simulation-Based Training Success Story for Allina Hospitals & Clinics, Minnesota & Wisconsin, U.S.
Both mother and baby can experience significant harm if they experience Shoulder Dystocia (SD), a serious obstetric emergency. Injuries of this sort are among the leading causes for hospitals to be involved in obstetric litigation cases in the United States. Among Minesota- and Wisconsin-based Allina Hospitals & Clinics, a simulation customer of HealthStream partner Laerdal Medical, SD occurred between under 3% of the time, which left obstetric clinical professionals feeling inadequately prepared for this emergency event. The obstetric management staff introduced simulation training so that clinicians could practice their learned skills, experience the condition, and make mistakes in its treatment safely.
Positive feedback During Simulation Training Helps Clinicians Get it "Right"
Hands-On Simulation Training supplemented films and literature review and discussion for each training class. Physicians and nurses, who understood their roles and how they should act in this sort of an emergency, communicates and performed the same as if this were a actual patient situation. During the ‘hands-on’ training, the PROMPT Birthing Simulator from Laerdal Medical was set up in a delivery room. In a hybrid simulation environment, a nurse acted as the delivering mother, sitting in the bed behind the simulator and enhancing the experience of a live clinical environment. As the simulation progressed, the acting “mother” positioned the infant in the birth canal and the simulator measured how the strength with which physicians worked to extract the baby as delivery occurred. Different maneuvers and techniques were used by individual clinicians, including breech, vacuum, forceps, normal delivery, and SD.
Simulation-Based Training Improves Quality & Speed of Response to SD & Other Birthing Complexities
Adverse events occurred with much less frequency during the simulated delivery and in actual practice thereafter:
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10.5% of all SD babies had an APGAR score less than 7 at 5 min. in 2007. Only 1.2% were scored below 7 in 2009.
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Maternal hemorrhage subsequent to SD delivery fell from 10% to 6.7%
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brachial plexus injuries and uterine ruptures were diminished
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At least one facility measured a decrease in the amount of time that occurred between identification of SD and delivery
Physicians gave high marks to the simulation-based training program
Five PROMPT Simulators placed in three Allina metro hospitals as well as at the corporate offices for training use. Allina's Pregnancy Care Council strongly recommends training participation; some hospitals make it a requirement for credentialing. Even physicians who were initially recalcitrant now have come around to an endorsement. And, all participants said the hands-on training was particularly beneficial. Many said, “this was the best class I’ve been to in years.” “The data is dramatic,” said a hospital representative. “We’re strong believers. It has worked out very well for us.”
Learn More About Improving Outcomes with Simulation.
Visit SimCenter to Learn More About Simulation.
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By Angie Harville, Senior Account Manager, HealthStream
Online Device and Drug Training Benefits Hospitals and MedTech Companies
Innovation and product development are a key function within the medical technology and pharmaceutical industries. As these companies continue to launch new equipment and products aimed at improving patient care and treating illnesses, effective training for any new device or drug is essential. Every physician, nurse, clinician, or technician must be able to use a product correctly in order for its introduction to be a success.
Traditional PMD Training is Expensive and Difficult
Traditional training methods for medical technology involve sending a company representative onsite to conduct live training. This method can be expensive and present challenges in terms of travel, training time, facility space, attendance, and tracking. Getting everyone necessary to take part often becomes a logistical nightmare. In addition, staff who fall through the cracks and miss training potentially represent a significant risk for healthcare organizations.
Medical Technology Companies Can Do More with Less by Using Online Training
A blended learning environment that includes online training as part of medical technology and pharmaceutical implementations makes a great deal of sense for the industry. E-learning can complement or even replace in-person training for many companies. The added benefits of e-learning, from cost to compliance, are numerous:
- COST -- Training is significantly decreased as a company expense and makes training a set cost item.
- SPEED -- Customers can begin to use products faster, without waiting for an available training representative.
- FEEDBACK -- Customers can provide more feedback on training.
- COMPLIANCE/TRACKING – For risk management and audit purposes, organizations can maintain clear records of everyone who has engaged in training.
Online Training Provides a Positive Overall Learning Experience
Beyond the elements of cost and compliance, medical technology often offers clear advantages in terms of effectiveness. When every learner gets standardized training, organizations and companies can be assured of the competency that results from training consistency. In addition, training that incorporates the best adult learning principles is often more interactive and more visually engaging than much that occurs in a classroom setting. Whether used alone or in a blended learning environment, e-learning can help companies make sure that healthcare staff use their products effectively.
HealthStream’s HospitalDirect combines the benefits of E-learning for medical devices and pharmaceuticals with access to a majority of the nation’s acute care hospitals. In many cases, hospital customers have requested that companies provide their learning through the HealthStream Learning Center, the leading learning management system used by U.S. healthcare providers and organizations.
If you are a Hospital staffer, learn more about HospitalDirect.
If you represent a Medical Device or pharmaceutical company, learn more about HospitalDirect.
Through our collaborative arrangement, SimVentures, HealthStream and Laerdal Medical have launched two groundbreaking tools, SimManager and SimView, designed to revolutionize healthcare simulation education.
Simpler Management of Healthcare Simulation Education
The increased focus on patient safety has stimulated a booming interest in healthcare training through simulation. However, many simulation-related processes remain labor-intensive, and education managers are often already resource challenged. SimManager simplifies administrative tasks; it is a comprehensive application for managing all aspects of a simulation-based training program. Scheduling training, assigning learning activities, coordinating instructor schedules, tracking progress, delivering reports, and managing the logistics of simulation rooms and equipment are all streamlined through the use of SimManager.
Some of the specific capabilities of SimManager include:
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Ability to manage simulation rooms, equipment, instructors, and technicians
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Can track, manage, and report
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Schedule and assign simulation learning activities
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Manage simulation content
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Integrates simulation scenarios into learning curricula
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Can customize role management to create varying access levels for administrators
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Configure and schedule reports for simulator utilization and activity
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Upload and store simulator debriefing files
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Capture simulation activity on learner transcripts
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Integrates with Laerdal simulators
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Integrates with SimCenter product suite, including SimStore, SimDeveloper, and SimManager
As a system for managing simulation-based training and education programs, SimManager is a complete, single source solution. When SimManager is chosen by healthcare organizations using the HealthStream Learning Center™ (HLC), there are added benefits. Approximately half of U.S. hospitals currently utilize the HLC to deliver and track online training programs and manage classroom-based educational activities for approximately 2.7 million healthcare professionals. When SimManager is added as an extension to the HLC, all of the core learning features and capabilities in the HLC are made available, providing a powerful toolset for simulation-based training that is already familiar to HLC users.
More Effective Simulation Training Debriefing
Debriefing is a critical part of simulation-based education, and it is made more effective with SimView, the next generation debriefing tool that was built from Laerdal’s original Advanced Video System (AVS) product. The new debriefing system provides robust tools to accurately replay scenarios where students worked with patient simulators—showing what actually occurred, as opposed to perceptions of what occurred. SimView automatically integrates data from up to four video cameras, a microphone, and patient monitoring with the event log from the advanced patient simulator. Instructors can add comments to the log during a scenario and can easily manage the delivery, storage, and distribution of the debriefing files.
Some of the capabilities of SimView include:
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Captures simulation events with four IP or analog cameras, a microphone, and a computer
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Captures video, audio, data logs, and “patient” vital signs and then replays scenarios with
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instructor annotations
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Creates a single, time-indexed debriefing file for effective evaluation
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Enables viewing of live events while monitoring vital signs, annotating in real-time.
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Provides robust evaluation capabilities via embedded tools and assessment templates
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Integrates with SimCenter product suite, including SimStore, SimDeveloper, and SimManager
SimView offers healthcare providers a highly effective means of maximizing their investment in simulation-based learning. Capturing data through SimView significantly enhances students’ learning opportunities in a risk-free, realistic training environment, contributing to their organizations’ overall goal of maintaining a well-trained workforce to deliver excellent patient care.
Learn more about SimManager and SimView.
Infirmary Medical Provides Lippincott Nursing Procedures & Skills (LNPS) via HealthStream
Customer Infirmary Health consists of four acute care hospitals, one long term care facility, and 30 outpatient clinics in the Gulf Coastal region. Prior to offering Lippincott Nursing Procedures and Skills (LNPS) via HealthStream, they used a standardized text book for nursing procedural reference. Books were invariably hard to find and often quickly were outdated. Because employees wanted access to the most accurate and timely information, it was very important to have a more dynamic and up-to-date resource available to them.
LNPS Works Easily for New Hires and Hospital Acquisitions
Implementing Lippincott Nursing Procedures and Skills via HealthStream was an obvious solution to the need for a consistent, updated reference, as well as to meet the needs of recently acquired facilities. All new hospital employees learn about the link and how to use it in Infirmary Medical’s new-hire training. Likewise, a link to LNPS was added to their new Electronic Medical Record (EMR) system for easy access.
Lippincott Nursing Procedures and Skills Supports the Best Possible, Consistent Care
We are already getting much use out of LNPS as reference material that is available 24/7. The links out of the system to more evidence-based practice information has proved very useful. What benefits the hospital most is that now its clinicians are all looking at the same information so that patients get the best possible and consistent care. With LNPS the hospital supports nursing skill-building, creates assignable learning, implements customized procedures, and easily meets Joint Commission audit requirements.
By Cyndi Tierney, M. Ed., Consultant (HCAHPs and other Surveys), HealthStream
Last January, my husband and I bought a foreclosure and decided to rehab it from top to bottom. Over the past year, we’ve demoed most of the townhouse, moving from room to room as each was finished. When the place was reasonably habitable, we moved in, what we called our “OCCUPY CONDO” movement—feverishly dry-walling, painting, and working out the punch list.
A Hearty Bowl of Alphabet Soup: CG-CAHPS, PCMHs and ACOS
Out there in the effort to assess ambulatory care, there’s renovation work going on as well. The CAHPS survey eventually made it to the medical practice neighborhood, opening the doors to CG-CAHPS 1.0 in 2006. It’s had some rehabilitation along the way, going from C-CAHPS to A-CAHPS, and most recently, a 2.0 version unveiled last November. The biggest impact of this update was the inclusion of advanced practice clinicians. A simple word change from “this doctor” to “this provider” now allows the instrument to be used for the full spectrum of practitioners.
The Patient Centered Medical Home (PCMH), with its 18 item set add-on, is also housed within the framework of the core survey. NCQA has included the PCMH version of the survey as part of their accreditation process. They aren’t the only ones who have pronounced a “passing inspection.” The lights are on with ABMS, the American Board of Medical Specialties, and ABIM, the American Board of Internal Medicine. ACOs have also given a nod to the assessment, stipulating CG-CAHPS for the Patient/Caregiver Experience.
Getting Used to CG-CAHPS Before the Scores Matter
Most of us are aware that there is a gap between closing on a home and the first mortgage payment--isn’t there a word for that?? It’s a grace period of sorts. That’s where we are today with CG-CAHPS--a window of time when no CMS note is due, and scores haven’t begun to affect reimbursements. And even though they haven’t mandated a move-in date, these various governing bodies have taken up residence.
The house of CAHPS may not be ready for a Parade of Homes, but medical practices are starting the survey process ahead of compliance. They are using this interim time to get their houses in order, rethinking delivery of care, revising processes, and retraining providers and staff. The appraiser is coming, and his name is CG-CAHPS.
Are YOU Thinking About CG-CAHPS? You Need to Be.
Request More Information About CG-CAHPS
A Lesson about Hospital Physician Satisfaction
By Hayden McKaskle, Consultant (HCAHPs and other Surveys), HealthStream
As complex as our professional lives can be, especially in dealing with ever growing reams of data, our jobs always seem to boil down to people. Healthcare is, after all, a people business.
Helping Hospitals Focus on Their People
Part of my role as consultant is helping hospital CEOs and senior staff find the story in the various research studies we perform. A Physician Satisfaction report review I recently gave to the senior management of a hospital client provides a great illustration. Their results were generally poor with low scores in many parts of the 120-page report that included administration items and operational categories. The level of satisfaction with nursing, on the other hand, was generally good. It was an interesting case.
The CEO was relatively inexperienced and had only been in place a little over a year and a half. There had been high turnover in his position for the last few years, and trust in administration was very low. There seemed to be so many things to work on that if the administrative team tried to do everything at once, nothing would be accomplished. The CEO seemed discouraged, and it was apparent that he was under considerable pressure to improve on many fronts, including physician satisfaction. He was particularly dismayed that the physicians were apparently not giving the team credit for some of the improvements and positive change they had achieved in the last year.
The Importance of Communication and Following Through on Commitments
The overall tone of the survey results reflected a lack of CEO communication and administrative team follow-through. The verbatim comments from the physicians further reinforced this. With that in mind, I shared something with the CEO and his team. My mentor at Siemens years ago told me that if everyone in an organization would do one thing, that organization would be exceptional. He actually meant three things but prided himself on simplifying suggestions. He said, “Tell your organization (physicians, department, etc.) what you are going to do. Always do what you said you would do. Finally, tell them what you did and then remind them.” It sounds simplistic but it is surprising how such basics can get lost in the daily professional lives of busy people.
Making Worthwhile Changes for Achievable Results
I then tied this approach into regular physician rounding and encouraged the CEO to solicit feedback and suggestions from the physicians. I encouraged him to work with his leadership team and select a handful of achievable requests that also fit within their strategic plan, especially if they address a few of their Key Drivers of Overall Satisfaction. Once the team agrees to timelines, the CEO and team should round to the physicians and communicate their short term goals which are based on direct physician feedback. Once any goal is achieved, the administrative team should immediately communicate this in rounds, by email, and perhaps newsletters, but ideally in more than one mode. Physicians, like most of us, may have a hard time remembering all that is accomplished but rarely forget commitments that go unfulfilled.
This seemed to resonate with my client and the team quickly began discussing ways to incorporate this approach. I have since heard back from my young CEO. Although it is early, he is already seeing encouraging signs and expects to see real improvement in physician satisfaction results during the next annual survey.
Here’s my advice:
Say what you will do. Always do what you said. Tell them what you did.
There may be a bit of prescriptive medicine in there for all of us.
Learn About HealthStream Physician Insights
Certification for cardiac lifesaving skills is required on an annual or biannual basis in hospitals in the U.S., making certification training a significant initiative for many healthcare organizations. When that training occurs in the traditional way, with live, instructor-led classes, the logistics of making sure everyone is trained and certified are daunting. There are often issues with classroom space, finding instructors, coverage for learners’ time away from their regular jobs and responsibilities, and last minute cancellations.
Moving to HeartCode BLS, ACLS, and PALS for online training and manikin-based certification makes a big difference for HealthStream customer Mat-Su Regional Medical Center, in Palmer, Alaska. Faced with the need for more than 50 training classes a year, they needed a more convenient training solution, that was easier to manage. Now the hospital provides certification training that meshes far better with trainees’ schedules. Some find it to be harder, and Mat-Su is pleased that inconsistencies between instructors are no longer an issue. HeartCode is always up to date with the latest standards for cardiac lifesaving, and learners cannot pass without understanding the proper procedures for compression and ventilation.
Reducing the need for live classes has made the work of Mat-Su’s education department significantly easier. In some instances, they’ve even had to cancel live classes for lack of interest. When instructors are required, the commitment is often only 3-4 hours, rather than the two days necessary under the old system. Trainees’ responses that they are pleased with the HeartCode experience are truly the best demonstration of Mat-Su’s success with this adoption.
Market Rewards HealthStream for Solid Performance During 2011
Even in volatile economic times, it's clear that high-performing companies are still valuable in the eyes of investors. For the second year in a row, HealthStream (NASDAQ: HSTM) has led Nashville area public companies in terms of stock price growth. A recent article in the Nashville Post named HealthStream the #1 local stock for 2011—based on growth. Our stock price increased 126% in 2011 alone. This is the 2nd consecutive year that we’ve been at the top of this list.
Here's an excerpt from the article:
"Witness the top of the list, where HealthStream sits for the second year in a row after climbing 126 percent in the past 12 months. That rise followed a 2010 in which the stock (Ticker:HSTM) also more than doubled in value and was powered by the potent combination of earnings beats, the signing of big-name clients and rising awareness among institutional investors."
Read the full article in the Nashville Post:
http://nashvillepost.com/news/2011/12/31/two_in_a_row_healthstream_again_led_locals_in_11