Monday, October 14, 2013

REPOST: How social media, mobile are playing a bigger part in healthcare

Kate Freeman of discusses the growing role that social media connectivity plays in changing the face of health care.  
Google search has become part of our medical check-up these days. If you browse WebMD, Google or various online forums for answers before a doctor visit, you're not alone.

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It's tempting to see if we can find an answer to our health questions in an instant when a world of information is at our fingertips, rather than leaving work or home. Flawed and inaccurate as some of that information may be, there are also many useful sites and forums with advice from actual doctors.

 A study compiled by Demi & Cooper Advertising and DC Interactive Group shows that more than 90% of people ages 18-24 said they would trust health information they found on social media channels. One in two adults use their smartphone to look-up health information.

Patients are also taking to the Interwebs to talk about the care they received: 44% of people said they would share positive or negative experiences of a hospital or medical facility, and 42% said they wouldn't hesitate to post comments about a doctor, nurse or healthcare provider on social media.

More than a quarter of hospitals have a social media presence. And 60% of doctors say social media improves the quality of care.

There's no doubt hospitals and doctors benefit from social media — at least when patients leave them good reviews and talk about their positive experiences.

But since doctors are required to keep healthcare information private, in accordance with HIPAA laws, it's essential that they are aware of boundaries while using social media, says Ryan Greysen, assistant clinical professor in the department of medicine at University of California, San Francisco.

Greysen tells Mashable doctors should be careful with what information they give to patients on social networks. The security of such sites is important to consider since medical advice and information should be completely private.

"The great thing with social media is it can be shared, but that's the downside [for health information]," he says. "Healthcare is very new in this area."
Greysen says he suspects it will only be a couple years until more secure technologies for doctor and patient sharing will be available.

Doctors commenting on public forums offering medical advice can present liability issues, too. However, "secured patient portals are a great way to leverage mobile technology to promote healthy behavior." Healthcare providers often offer these through their websites.
Sometimes consulting a forum for a already diagnosed condition can be reliable, especially if a doctor is involved in monitoring it. But there are no studies that show patients with access to medical forums have better care than those who don't, says Greysen.

Plus, the web may not always be the best place to go for a diagnosis.

"A lot of medical conditions require much more detail and dialogue between the patient and physician," he said. "In many cases it [a website] doesn't substitute for an in-person visit."

"We haven't turned the corner to where we can say social media have changed people's outcomes, but there are some really interesting projects out there that are changing that," he says. "I think we're within a couple years of having secure sites and capturing more details about patient circumstance."
Terry Lambert, formerly of Newman Regional Hospital in Emporia, is adept at hospital administration. Follow this Twitter account for more updates on healthcare management.

Tuesday, September 17, 2013

REPOST: What's The Role Of A Hospital In 10 Years?

With many processes that traditionally required face-to-face interaction being replaced by digital solutions, the question of a physical hospital building's necessity has sometimes been raised.  This Forbes article outlines a few ideas from the healthcare industry's leaders.
Dr. Eric Topol was named #1 Most Influential Physician Executive in Healthcare of 2012 by Modern Healthcare so his views are closely watched. In addition to his role as a cardiologist, geneticist and author of the Creative Destruction of Medicine, he’s also the Editor-in-Chief of Medscape (WebMD’s leading physician offering). Every health system CEO I’ve spoken with readily admits that we’ve essentially had a hospital building bubble with an over-capacity of 40-50% of hospital beds as we shift from the “do more, bill more” fee-for-service system to the “no outcome, no income” fee-for-value era.
Topol has gone on the record stating that in the future, the only real reason to have hospitals is for their Intensive Care Units if digital medicine is adopted. His recent tweet of his vision was provocative comparing it to Wired’s vision. Despite the widely held view of over-capacity and alternative scenarios such as Topol’s, I have yet to hear about the health system board thinking in these terms. With the board’s fiduciary responsibility to think further out than the CEOs since their tenure usually outlives CEO tenure, is this not a dereliction of their duties?
While some healthcare leaders may dismiss Topol, his ideas aren’t without precedent. In Denmark, they realized that most people weren’t having their end-of-life wishes met — generally speaking people want to be with family and friends at home while being warm, dry and pain free.  A shift in approach shifted the norms from well over half of people dying at hospitals, to 92% dying at home according to their wishes. A mix of remote monitoring, video conferencing and house calls enabled this. This also happens to be far less expensive — not an insignificant point in these budget-constrained times.
“History doesn’t repeat itself, but it does rhyme.” - Mark Twain
Lessons From Newspapers For Health Systems’ Immense Challenge
Health system CEOs and board have an immense challenge I have heard described as the equivalent of going down a rough river with one foot in one canoe called fee-for-service (FFS) and their other foot in another kayak called fee-for-value (FFV). The objectives of FFS and FFV are diametrically opposed and puts hospitals in an untenable situation. For example, in one they operate like a hotel wanting to have heads on beds maximizing occupancy. While in the other, a hospitalization represents a failure in the system to be avoided.
In theory, a non-profit health system board has an easier decision to make since topline revenue shouldn’t matter as much as long-term economic sustainability. Thus, they could make decisions that would harm their topline revenue as long as it was economically sustainable. Unfortunately, health organizations are dooming their innovation to failure the way they are going about their reinvention.
While no analogy is perfect, health system boards would be well advised to study what newspaper industry leaders did (or perhaps more appropriately, didn’t do) when faced with a dramatic industry change. Turn back the clock 15 years and the following dynamics were present:
  • Newspaper leaders knew full well that dramatic change was underway and even made some tactical investments. However they didn’t fundamentally rethink their model beyond window-dressing.
  • Newspapers were comfortable as monopoly or oligopoly businesses allowing for plodding decisions. Their IT infrastructure mirrored the plodding pace with expensive and rigid technology architectures.
  • Newspaper companies bought up other newspaper chains and took on huge debt.
  • Owning printing presses was a de facto barrier to entry allowing newspapers unfettered dominance.
  • Depending on one’s perspective, it was the best of times or the worst of times to be a leader of local media enterprise.
Before they knew it, owning massive capital assets and the accompanying crushing debt became unsustainable. The capital barrier to entry transformed into a boat anchor while nimble competitors dismissed as ankle-biters created a death-by-a-thousand-paper-cuts dynamic. Competitively, newspaper companies worried only about other media companies or even Microsoft, but their undoing was driven by a combination of craigslist,,, eBay, and countless other substitutes preferred by the majority of their customers. In addition, there were easier ways to get news than newspapers. Generally, the newspaper’s digital groups were either marginalized or unbearably shackled so that the encumbered digital leaders left to join more aggressive competitors. The enabling technology to reinvent local media didn’t come from legacy IT vendors who’d long sold to newspaper companies, but from “no name” technologies such as WordPress, Drupal and the like.
The parallels with health systems today are clear. Consider the present dynamics:
  • The handwriting is on the wall for health systems but there is little evidence that organizations are aggressively moving at a scale corresponding to the enormity of the change.
  • Health systems have been aggressively gobbling up other healthcare providers and frequently taking on debt to finance the growth. Concurrently, health systems often have capital project plans that equal their annual revenues even though no expert believes the answer to healthcare’s hyperinflation is building more buildings. Consider the duplicative $430 million being spent in San Diego to build two identical facilities just a few miles apart as Exhibit A of the problem. Studying other countries that shifted from a “sick care” to a “health care” system, more than half of their hospitals closed. They simply weren’t needed or appropriate.
  • Until recently, complex medical procedures always took place in an acute care hospital setting. Increasingly they are being done more and more in specialty facilities that can do a high volume of particular procedures at a signifiantly lower cost. With “hospital at home” programs proving to be move effective than regular hospitals for an increasing number of procedures, Topol’s view of only needing hospitals for ICUs starts to come into view. Company-sponsored Centers of Excellence programs are rapidly growing with companies ranging from Boeing to Lowes to Pepsico to Walmart further obviating the need for duplicative infrastructure for non-emergent surgeries. The byproduct is making every community hospital in competition with Mayo and Cleveland Clinic with inferior outcomes in most cases. [See graphic below]
  • Just as newspapers were implementing multimillion dollar IT systems while nimble competitors were using low and no cost software to disrupt the local media landscape, health systems are similarly implementing complex systems to automate the complexity necessary in a multi-faceted system. Meanwhile, disruptive innovators are implementing new models at a fraction of the cost and time. For example, it’s well understood that a healthy primary care system is the key to increasing the health of a population. Imagine if a fraction of the billions being spent by mission-driven, non-profit health systems on automating the complexity of the old model was redirected towards the reinvigoration of primary care. They’d further their mission and lower their costs. Of course, they’d likely see revenues drop but presumably maximizing revenues isn’t the mission of a non-profit. See Health Systems Spending Billions to Prepare for the “Last Battle” for more.
  • The plodding pace and scale of innovation at most health systems isn’t up to the enormity of the task. The vast majority of health system innovation teams are constrained by how they have to fit innovation into an existing infrastructure. That approach rarely, if ever, leads to breakthroughs, as its true intent is to make tweaks to a current system rather than a rethink from the ground up.
Innovator's Prescription
New Wave of Disruptive Models in Healthcare
Image source: Forbes

Image is courtesy of Jason Hwang, M.D., M.B.A.  Executive Director, Healthcare of the Innosight Institute and co-author of The Innovator’s Prescription.
Compared to newspapers, the scale and importance of the challenge is far greater for health systems so they must aggressively take action or risk their future viability.
Rx for Healthcare From a Newspaper Industry Executive
In the midst of the newspaper industry disaster, there is one notable bright spot from an individual who has gone against the conventional wisdom that newspapers are doomed to fail. His name is John Paton and he’s reinventing local media. Highlighted below are some of what he’s done to turn a bankrupt (creatively and financially) enterprise into a profitable, dynamic and rapidly growing enterprise attracting the all-stars of the industry such as Jim Brady. It hasn’t been without continued challenges as he transparently reports on hisblog.
There has been an expression in traditional media that analog dollars are turning into digital dimes. Rather than lament that, here’s John Paton’s response:
“And it is true that print dollars are becoming digital dimes to which our response at Digital First Media has been – then start stacking the dimes. All of that requires a big culture change. A change that requires an adoption of the Fail Fast mentality and the willingness to let the outside in and partner. Partnering is vital to any media company’s growth whether it is an established media company or start-up. We are going to marry our considerable scale with start-up innovation to build success.”
It’s worth noting that those “digital dimes” are often more profitable than the “analog dollars” of the past because much less overhead is required. It’s well understood that hospitals are shifting from revenue centers to cost centers so it behooves healthcare provider leaders to adopt new models that are well-positioned to be profitable in the fee-for-value era.
The following is John Paton’s 3-point prescription for reinvention that led to a 5x revenue increase and halving of capital expenses. This resulted in his organization going from bankruptcy to $41 million of profit in two years.
  1. Speed to market: One new product launched per week.
  2. Scaling opportunity: Sourced centrally, implemented locally. Ideas can come from all over. Identify the best ideas/people from all over.
  3. Leverage partners: Feed the fire hose of ideas from outside.
Unfortunately, before John Paton was able to affect this level of change, scores of newspaper employees lost their jobs while traditional newspaper executives dawdled. It is the rare leader that can create the sense of urgency necessary to affect this scale of change before the enterprise is a hair’s breath from extinction. It might be one of those tough-as-nails nuns running a health system that isn’t concerned about bonuses that refocuses their mission from growth to health. As the old oil filter ad says, “you can pay now or pay later” – of course, the cost is much greater if change is delayed. The only question is whether health system leaders will have the courage to make the change before the inevitable hurricane hits with full force.
Applying Reinvention Lessons into Healthcare
Listed below are some ideas and examples of how this approach can be applied to tackle the enormous challenge facing health system leaders. The wave of disruptive innovation is building with pioneers such as WhiteGlove Health and Qliance forging new territory and then others putting their own twist on it.
[Disclosure: The company where I’m CEO, Avado, provides Patient Relationship Management technology for some of the organizations mentioned which is why I have a view into their projects.]
Fresh, Outside Perspective is Imperative
As John Paton brought in outside advisors such as Jeff Jarvis and Jay Rosen, health systems would be well-advised to do the same. They can go a step further and partner with innovators driving new models. They can be project managers or partners. One example is Dr. Rushika Fernandopulle founded Iora Health and was highlighted in now-famous The Hot Spotters article linked to in The Hot Spotters Sequel: Population Health Heroes. Iora Health has partnered with hospitals such as Dartmouth-Hitchcock. From reports I hear, their CEO is using Iora Health to catalyze change amongst his medical staff as they can see a modern delivery model in action that is unencumbered by the flawed fee-for-service model.
Like local media executives in the late 90’s, healthcare leaders can view the present time period as either the best or worst time to be in their role. The health system leaders who believe it’s the best of times would do well to ask themselves “What Would John Do?” John Paton demonstrates how a strong leader can reinvent and reinvigorate a lumbering giant turning it into a dynamic organization.
Terry Lambert of Emporia was formerly a hospital administrator.  He writes about developments in the health care industry on this blog

Saturday, August 10, 2013

REPOST: Doctors working in fast-food restaurants

Immigrants are forced to make do with whatever job is available for them. Take for instance the doctors mentioned in this CNN article. While educated and trained in medicine in their own country, moving to the US saw them doing jobs that are far from their specialization.

(CNN) -- Landor Sanchez wants to practice medicine again.

But instead, he's laboring at an asbestos removal company in upstate New York. For five years, Sanchez was a family medicine doctor in Cuba. He moved to the United States in 2011 with the dream of being a doctor there.

Like many immigrants, he had a plan to live with friends to save money and to study for the exam to become medically licensed in the United States.

But soon, his money ran out. And Sanchez found himself with less time to study and instead taking any job he could get -- from painting, to fast-food restaurants, to, now, asbestos removal.

A doctor, not practicing medicine, in a country that is short of primary care physicians.

Sanchez's story is common among Latino immigrant doctors.

In Southern California alone, there are an estimated 3,000 medically trained Latino immigrant doctors who aren't practicing medicine.

"We had always wondered, where are the (immigrant) doctors from Latin America?" says Dr. Patrick Dowling, chairman of UCLA's Department of Family Medicine. "And we stumbled upon them working in menial jobs."

Instead of treating patients, Dowling says, many doctors spend years cleaning houses or working on construction sites and in fast-food chain restaurants.

"We heard from one woman working at McDonald's in Colorado," says Dowling. "So she is selling fast food to people, and if she were licensed as a physician, she could be educating those same people, those same patients, on what a good diet is."

Latino immigrant doctors have a harder time than other immigrants transitioning into the U.S. health system, according to Dowling.

"Often they work in their own country for 10 years and then come here and they aren't licensed, and then they see how hard the process is and they have to get an odd job to support themselves."

It's a costly, time-consuming process that most immigrants aren't prepared for. From migrant worker to neurosurgeon

That's why Dowling and his colleague, Dr. Michelle Bholat, have developed a program at UCLA that helps fast-track Latino immigrant doctors into the U.S. health care system, the International Medical Graduate program.

The IMG program provides test prep classes and clinical observations with UCLA doctors. It also covers the cost of the U.S. medical board exam and provides a monthly stipend.

Funded by private donors, the program has helped 66 Latino immigrant doctors pass the board exams and get placed into residency programs in California. In return, the doctors commit to working three years in an underserved area.

Dr. Jose Chavez is one of those graduates.

He was a doctor in El Salvador with more than eight years of medical training when he moved to the United States in 2005.

But prior to last year, he wasn't working in a U.S. hospital -- or any hospital. Instead, he was cleaning houses and installing flooring.

"I would do anything you asked me to as long as it was legal and you paid me for it," he says.

Chavez says without the help of UCLA's IMG program, he would still be working odd jobs to pay the bills while juggling his time to study for the test at night. "It requires you study at least 10 hours a day," says Chavez. "Imagine you are working 10 hours a day, and then try to study 10 hours at night. It is really impossible."

The stipend allowed Chavez to stop cleaning homes and focus solely on his studies. He passed the U.S. medical board exam just six months after being accepted into the program.

Today, he is a first-year resident at Riverside County Regional Medical Center in California -- a place in desperate need of doctors. Riverside County has just one primary care physician for every 9,000 residents, according to the hospital. "I personally know at least 20 more (Latino immigrant) doctors who are delivering pizza, and instead they could be working as doctors if they had the help I had," say Chavez.

And with Obamacare potentially adding 25 million to 30 million people to the health system, the doctor shortage is going to get worse before it gets better. "When 2014 rolls around, they (Americans) may have an insurance card, but where are they going to get care?" says Bholat. "It is not enough to just issue an insurance card."

Your health care is covered, but who's going to treat you?

The problem is compounded in California because of the large immigrant population. "Forty percent of the population here is Hispanic, but only 5% of our doctors are Latino. That is an amazing gap," says Bholat.

Dowling and Bholat say while their fast-track program may make only a small dent to help the primary care shortage in America, it's a critical start.

"We're getting dozens of applications daily, and we accept as many candidates as we can financially support in the program," says Bholat "We need these doctors in America."

Sanchez has applied to the UCLA IMG program and is waiting to hear if he gets accepted.

Until then, he'll continue to work at the asbestos removal company during the day, and study for the U.S. medical boards at night.

But he says no matter how long it takes, he won't give up on his dream to practice medicine in the United States.

As a former hospital administrator, Terry Lambert has extensive experience in running healthcare institutions. Follow this Twitter page for more news and updates on the medical industry.

Monday, July 29, 2013

A look at the country’s best hospitals

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Every year, U.S. News releases a list of the country’s Best Children's Hospitals in the following practices:

Cardiology & Heart Surgery
Diabetes & Endocrinology
Gastroenterology & GI Surgery
Neurology & Neurosurgery

The distinction between adult and child hospital services must be awarded because of the delicate care children require when battling common diseases. While illnesses are somewhat predictable for adults, the effect of more serious diseases or cancers on younger, less developed bodies, cannot always be pre-determined. Facilities that cater to the needs of children are generally more expensive. Not all hospitals invest in them.

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With type 2 diabetes becoming an epidemic among children in America, Boston Children's Hospital, a teaching hospital in Massachusetts, and the Children's Hospital of Philadelphia in Pennsylvania, earned the top spots for their advanced facilities supporting pediatric endocrinology, blood disease research, and cancer care for children. The Cincinnati Children's Hospital Medical Center in Ohio topped the charts for pediatric cancer specialties. Its 506 physicians and 512-bed capacity give inpatients almost a 1:1 doctor-patient ratio to ensure maximum attention per case.

For more common pulmonary disorders, such as cough and the common cold, the Texas Children's Hospital ranked third among the 87 hospitals reviewed. This non-profit facility stands out with zero employment for full-time doctors. It is staffed by medical students and other medical professionals.

To see more of the list, visit the U.S. News website.  

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Disease control and prevention are one of the fastest cures for children with weaker immune systems. Former hospital administrator Terry Lambert of Emporia gives tips on how families can maintain healthy lifestyles and avoid diseases on this Twitter account.

Wednesday, May 29, 2013

REPOST: Maternal Health Startup Makes History As First 'Do-It-Yourself' Benefit Corporation In Michigan

A Michigan startup company founded by University of Michigan students has made legal history by becoming the first “do-it-yourself” benefit corporation in the state. This Forbes article reports more about this innovation.

Design Innovations for Infants and Mothers Everywhere Inc., or DIIME, was founded in 2010 by a group of eight students in the University of Michigan’s Global Health Design program. The high rate of maternal mortality in the developing world was the health issue that grabbed the attention of the founders of DIIME. Every year between 300,000 and 500,000 women die due to complications related to childbirth and pregnancy, while four million infants die every year before reaching four weeks of age.

Image source: Forbes
DIIME founders resolved to create a company that would develop low-cost medical devices to improve maternal and infant health in Ghana and other parts of the developing world. At the same time, the company would have to earn sufficient profit to be sustainable and be able to raise capital from socially oriented investors. DIIME would be a “social enterprise,” in other words, a business dedicated to generating both financial and social returns.

Like many social enterprises, DIIME quickly discovered that the existing legal entity forms were not a good fit with its “double bottom line” objectives. DIIME’s profit-making goals would be problematic in a nonprofit corporation, while DIIME’s social mission seemed equally out of place in a for-profit corporation, where company directors typically pursue profit maximization. To solve this problem, since 2010, legislatures in 14 U.S. states, including most recently Delaware, have adopted statutes expressly permitting the creation of a new type of legal entity: the “benefit corporation.” Benefit corporations are for-profit businesses dedicated to providing benefits to society while also protecting company directors from liability to shareholders for not maximizing profits. (A benefit corporation bill was introduced in Michigan in 2011, but the Michigan legislature has not yet taken action.)

DIIME turned to the International Transactions Clinic (ITC) at the University of Michigan Law School for advice. DIIME and law students enrolled in the ITC worked together to organize the legal formation of an entity in Michigan, create a capital structure, protect the company’s intellectual property, and move DIIME’s international business plan forward. Most recently, the company took the decisive step: DIIME included in its new articles of incorporation key “benefit corporation” provisions of the Model Benefit Corporation Act. This allowed DIIME to pursue its social mission, take into account interests other than profit maximization, and protect its directors to the extent possible from any resulting liability, all in the context of a for-profit corporation organized under the existing Michigan Business Corporation Act. DIIME’s articles of incorporation were formally accepted by the Michigan Corporation Division on April 30, 2013.

“We were delighted to be able to incorporate DIIME in our home state of Michigan without having to sacrifice our company’s double bottom line mission,” said Gillian Henker, one of the founders and current president of DIIME. “We’re thrilled to pave the way for other social enterprises wishing to incorporate here in Michigan. This is a big step forward not only for our company, but for any company that sees its role in society as being bigger than simply maximizing profits.”

DIIME is truly a social enterprise pioneer. To my knowledge, DIIME’s “do-it-yourself” benefit corporation is the first in the country. DIIME has blazed a trail for social enterprises not only here in Michigan, but also in other jurisdictions that also have not enacted a benefit corporation statute.

The ITC team consisted of third-year law students Michael Byun and Gabriel Katz, supervised by David Guenther, a partner at Conlin, McKenney & Philbrick, P.C. in Ann Arbor and an adjunct clinical assistant professor in the ITC.

“There has been a great deal of academic commentary and debate on the purpose of the corporation and whether it’s to maximize profits to shareholders,” Guenther said. “There has been much less commentary on who should answer that question—shareholders, courts or legislators.”

“We looked very carefully at the Michigan Business Corporation Act and concluded there was no reason why shareholders couldn’t include a social purpose and other benefit corporation provisions in their articles of incorporation, even without the existence of benefit corporation legislation here in Michigan. That’s exactly what DIIME wound up doing. Fortunately, the Michigan Corporation Division gave DIIME’s articles a thoughtful review and agreed with us.”

Family- and relationships-oriented, Terry Lambert served as the hospital administrator at Walnut Ridge. Read more about his undertakings on this website.

Wednesday, May 15, 2013

Quick facts about the new home-birth guidelines

Home births used to be the status quo, but the availability of hospitals and the development of more hygienic ways to carry out childbirth have significantly reduced the number of home births over the years. Doctors generally do not prefer to perform home births for a number of reasons largely related to sanitation. Still, they recognize the women who do opt for home birth and have released a set of guidelines published in the academy’s journal, Pediatrics.

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Some of the more obvious and expected guidelines include the following:

• All medical equipment should be tested before the delivery.
• There should be at least one person at the birth who will be solely responsible for tending to the newborn infant. This person should also be trained in infant CPR.
• There should be a working phone line kept open and available for immediate use.
• There should be a plan to transfer the mother to a hospital in case of emergencies.
• The person attending to the infant should perform all the routine tests that nurses perform on a newborn baby: monitor their temperature and heart rate, keep them warm, and administer vitamin K and heel-prick test, which will be sent to an outside laboratory for processing.

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While seemingly standard, the guidelines did include one provision which raised eyebrows among physicians in the field: It is strongly recommended that only midwives who were cleared by the American Midwifery Certification Board could assist in home births because these midwives typically attend deliveries at hospitals and birthing centers.

Interestingly, it was not the fact that home births were still allowed which caused controversy but that one type of midwife should be better than another.

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As a former hospital administrator at Newman Regional Hospital in Emporia, Kansas, Terry Lambert is a strong advocate of accessible hospital services. Follow this Facebook page for more insights from his experience in the medical field.

Tuesday, April 9, 2013

Hospital hierarchy: Ironing out the conflicts within

The concept of a hospital was conceived with the well-being of patients in mind. Ideally, doctors and nurses work together to achieve this goal. Unfortunately, there are many instances when patients do not feel secure even in a hospital, especially when they discover a conflict between the nurse and the doctor.

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The hospital hierarchy was established to promote order among personnel, and to offer a solution to who has the final say on particular cases. Because their training gives doctors the authority to make diagnoses and other major medical decisions, nurses are often seen as the inferior of the two.

But there is little reason to belittle the medical knowledge held by nurses. After all, they were educated just as much as doctors were, and therefore possess a level of medical knowledge roughly similar to many physicians. They even act as the “final check” whether a doctor’s decision is right or not.

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However, there are cases when the boundaries of the individual duties of nurses and doctors collide and overlap, causing conflict. For instance, a nurse may notice something wrong with a prescription. While solving this sort of issue typically takes nothing more than asking the doctor to correct the prescription, the mechanics of hospital hierarchy is not as simple as that.

Many doctors think of themselves as superior to nurses. Most of the time, they are favoured by the hospital administration. For a nurse to question a doctor’s decision takes more than guts—it requires being prepared to lose a job. As physician Otis Webb Brawley observed in his book, “To throw this kind of challenge, you have to not mind being unemployed.”

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Needless to say, this causes a number of problems for patients, including delay and errors in the delivery of treatment. This is all the more reason for the mechanics of hospital hierarchy to be fixed.

A former hospital administrator at Newman Regional Hospital in Emporia, Kansas, Terry Lambert is fully aware of the effective ways to promote harmony in a hospital environment. Check out this Facebook page for more discussion on health care.