Health Care “Places” Are Multiplying

April 25, 2008 at 3:26 pm · Filed under Business of Health, Hospital Administration

Almost 25 years ago, I recall reading an article with the title “The Hospital: Is it a Place or a Thing?”.  The author argued that hospitals and health care in general had espoused the “place” option, concentrating in urban “pill hills” and focusing their investments on building facilities of eminence and technology.  This was fine, but it ignored opportunities to think of themselves more as “things” that could develop ways to deliver health care in far more ways and settings.

Since then, hospital places have persisted, though many have moved from urban centers to the suburbs, chasing affluent patients in hopes of competing with physician-owned specialty hospitals, ambulatory surgery and diagnostic imaging centers.  But most of the new places where health care is available have been developed by non-hospital organizations, even non-physician organizations in many cases.

Closest to hospitals in concept, free-standing emergency rooms have appeared, the one example of new places usually owned and operated by hospitals.  As traditional ERs have become overcrowded with poorly paying patients, hospitals have opened free-standing alternatives in shopping centers and similar convenient locations to both attract better-paying patients, and relieve the hospital-based ERs. [J. Appleby “More Emergency Rooms Open Away from Hospitals” USA Today, Apr 24, 2008]

Next in terms of similarity to ERs are physician-staffed “urgent care centers”, which have also been growing of late.  These were being developed as early as the 1970s, though many fell out of favor, but they have enjoyed a recent resurgence.  The “new consumerism” that is demanding greater convenience of care is finding waiting for appointments with traditional physician practices onerous, and has created a new wave of demand for these “walk-in clinics”.  M.J. Feldstein “Time-Strapped Patients Feeding Growth of Urgent Care Centers” STLToday.com, Jan 9, 2008]

Many of these centers are owned and operated by hospitals, such as St. Anthony’s Medical Center and St. Luke’s Hospital in St. Louis, cited in the above story.  But more often, they are developed by physicians or physician-owned (at least partially) companies.  Their resurgence came after roughly 15 years of decline following their initial emergence, and there are reportedly 12-20,000 such centers in operation according to a report by the California Health Care Foundation.

Competing with the physician-staffed urgent care model are nurse-practitioner-staffed “retail clinics”, typically small “kiosk” or minimal-space operations inside pharmacies and retail stores or superstores.  These also number in the thousands, though not yet as many as those reported for urgent care models.  They are growing faster, however, as major chains such as Minute Clinic and RediClinic link up with pharmacy and superstore chains throughout the US.  These are rarely linked to hospitals or physicians, except as sources of oversight and support, though many create working relationships with physicians their patients report using.

An old style place option is the worksite medical clinic.  Originally, and these go back many decades, they were simply places where workers who were otherwise far from medical care could get it without having to travel far, such as the medical facilities that Kaiser Permanente created for workers during WWII.  Most provided routine primary care, though many included immunizations and physical exams related to work.  But their resurgence has gone well beyond “occupational health and safety” to include proactive health management aimed at reducing risks plus preventing disease and injury, as well as treating people for them.

The most recent development moving away from traditional healthcare places is e-health, where online and phone communications with nurses and physicians take the place of visits in many cases, include advice on the type of care needed including self-care options, and may include health coaching as well.  What has made this development possible has been the growth of new methods by which healthcare providers can generate revenue thereby, including, but not limited to, consumers’ out-of-pocket payments.

Initially, physician practices charged patients a little extra, perhaps $25 per month or so, to cover any and all online communications, or phone for patients without Internet access.  Concierge physicians have routinely included such communications under their annual retainers, usually one or two thousand dollars.  But increasingly, third-party payers are catching on to the advantages for them in paying for such contacts, and covering selected types of “placeless” visits.

While payers are split on covering retail clinic services, many have realized they cost less than traditional sources, particularly ERs.  Payers are generally opposed to concierge practices that include placeless visits in their extra services, but generally support the idea of patients being able to avoid visits by accessing online consultations.  Many have begun paying a pre-determined fee for online visits, for example.

As the “medical home” idea catches on, one element common to the model amounts to turning patients’ homes and workplaces into places where people can get medical advice, plus screening and coaching, from physicians or health management suppliers.  People can already get home, worksite or hotel visits from physicians who specialize in such services on a fee-for service basis, or from their concierge physician, covered by the annual fee.  At least one physician, Jay Parkinson, MD in New York City, offers an entirely online plus home visit practice, where there is no physician practice location other than where patients live.

Physicians in traditional practices have been slow and remain somewhat reluctant to offer e-mail or phone consultations to their patients.  Hospitals have moved only a modest amount toward expanding the places where they offer care to patients.  But at least a few thousand physicians and many entrepreneurs have ensured that health care, though not usually hospitals, is definitely not a place but a thing

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Solving the Physician Shortage, or Protecting Their Market?

April 2, 2008 at 3:11 pm · Filed under Chief Medical Officers, Business of Health, Hospital Administration, Retail healthcare

The impending shortage of physicians, particularly primary care specialists such as family practitioners, internists, pediatricians and geriatricians, has been shouted about by medical professionals as well as health care gurus of many stripes.  It has been used as a reason to criticize concierge practices, despite their affecting only about 1/1000th of all physicians so far.  It has also been used as an argument for rescinding Medicare cuts to primary physician payment schedules, and for adding new payments for their “medical home” and “proactive health management” services.

More recently, the medical profession has taken on developments such as retail clinics which use nurses or physicians’ assistants, rather than physicians, on grounds of quality concerns.  The fact that these clinic offer more convenient care at lower prices, hence take away lucrative patients and visits from physicians is by no means ignored, though never mentioned by physicians, themselves, as a reason for their objections.

Meanwhile, the vast majority of proposed solutions to the impending if not already arrived “health care cost crisis” and even the promotion of health insurance for all, depend to a great extent on the mis-labeled health care system actually moving more to health vs. sickness care.  This would normally be the logical jurisdiction of primary physicians, except that there are nowhere near enough of them, and they are not particularly adept at it, plus being the most expensive source of health management care available.  Though some have proven their abilities in disease management, only those functioning in concierge practices, which many physicians also object to, seem to be making a go of health management.

While they may argue as much as they wish about nurses and other non-physicians being involved in sickness care, there are few and far weaker grounds for objecting to nurses, physicians’ assistants, pharmacists, etc. from being primary sources of health management services.  Nurse coaches already function as the main sources of coaching for people participating in health risk and chronic disease management programs offered by insurers, specialized suppliers, and healthcare organizations who provide such services.

Pharmacists have been demonstrating for years their high level of cost-effectiveness in managing the conditions of chronic disease patients, such as diabetics, whose care is largely dependent on medications and adherence to their prescribed use.  The Asheville, NC example of diabetes management using pharmacists has been delivering amazing results for a decade.  The Diabetes Ten City Challenge combines pharmacist diabetes management with value-based insurance operates in ten cities for 29 self-funded employers. [L. Masterson “A Prescription for What Ails Us?” HealthLeadersMedia News: Health Plans, Apr 2, 2008 (healthplans.hcpro.com)]

The use of non-physician health professionals to deliver the vast majority of the kinds of services that will be needed to achieve the kind of reduced incidence of disease and injury on which the survival of our health care system depends is not merely a desirable, but an essential reality.  Perhaps it is time for physicians to work on how to engage and coordinate their special expertise with the rest of the wide range of health professionals out there, rather than devote so much energy to protecting their own jurisdictions.

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Beating Recruitment & Retention Challenges of The Silver Tsunami

February 24, 2008 at 9:30 pm · Filed under Hospital and Health System CEOs, Hospital Administration

Eleven years ago our hospital was confronted with what seemed to be an overwhelming situation. We had a rotating door as employees came to our medical center, finished their certifications and left to work for the three hospitals near us that had higher pay scales.

Employee morale was very low and the employee turn over rate was extremely high. Our first decision was to become a Planetree Hospital, and worked to become the employer of choice for our region.

We began by meeting individually with each and every employee. The result was simple; pay attention to their concerns, their fears, their needs and their dreams. We immediately instituted an administrative Open Door Policy, produced a regular and now web based Newsletter, monthly Birthday Pizza with the President State of the Hospital meetings, quarterly Town Hall Meetings, a recognition program entitled Caught You Caring and a senior leadership policy of Management by Wandering Around.

Then we did something very dramatic. We made arrangements for 37 employees and 11 highly qualified physicians to LEAVE because they were bullies. Bullies have not been tolerated at this facility for over ten years, and our medical staff ensures that they will never again be accepted here.

We began to pay attention to our employees’ health needs by offering them the following programs: an Osteoporosis Program, Smoking Cessation, Eat Well for Life with personal nutrition counseling, StrengthTraining, Cardiac Rehab and Dean Ornish Coronary Artery Disease Reversal Program. We also offered Healthy Choice Meals (fat and trans fat free vegetarian) and Healthy Vending Machine selections.

Then we added staff members to offer the following to our patients, staff and volunteers: pet, aroma and music therapy, acupuncture, drumming and massage. We built walking trails, labyrinths, and made available a ten dollar a month payroll deductible admission to our workout facility for all employees and physicians. Included are classes in aerobics, water aerobics, yoga, tai chi, ai chi, spin classes, kick boxing and added over seventy pieces of workout equipment, an exercise pool and a walking track.

On the personal side we took away sick, personal and vacation days and gave back in a block that gave the employees freedom to use their time as personal time. We also permitted our employees to donate PTO days for their fellow employees in their time of need and offered additional grieving time for the loss of in-laws and grandchildren as well.

We added fresh flowers from our own greenhouse, a relaxation room, healing gardens, gazebos, counselors and clergy. We began baking bread on each floor, carefully placed artwork and decorative fountains throughout the campus. We also placed a popcorn machine in the main lobby. Just for good measure we added skylights, plants, fish tanks and two functional fireplaces. During times of extreme patient activity we began having ice cream socials, special pizza and grinder’s days. We now provide a trip to a professional baseball game, tickets to the symphony, the opera, local theater, hockey games, and plenty of fund raising dinners.

Finally, we enhanced our employee recognition dinner, initiated a hospital week cookout and put thousands of extra dollars into a holiday party. We increased our training and input into the employee assistance program, stress reduction classes, DisneyTraining, EQ2/Emotional Quotient training, Planetree and Dale Carnegie training programs.

This work has resulted in nearly a tripling of our business, our infection rate is below one percent and our length of stay is approximately 3.4 days as opposed to the 4.6 days that is the norm for hospitals our size. Oh, yeah, and the new low turnover rate . . . Priceless.

If you would like your organization to stabilize and to improve morale with your employees and physicians while growing the satisfaction of your patients, just follow the road map above.

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Are Incremental Assumptions About the Future of Health Care Plausible?

January 29, 2008 at 4:09 pm · Filed under Policy Makers, Facility design/management, Business of Health, Hospital Administration

David Lawrence, former CEO, and chairman of the boards of Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals, speaking yesterday at the Estes Park Conference in Wailea, Maui asks:

Are incremental assumptions about the future of health care plausible?

This question is especially acute when it comes to planning a hospital which could take anywhere from five to ten years to build. Lawrence lays out a number of a propositions that you would have to assume if you were building a hospital today and believed in incremental change in health care.

• Your margins will hold up
• You will recruit and retain critical manpower
• Your customers will remain indifferent to value
• You will meet changes in demand and volume
• Your legal, regulatory and ethical (public) accountability will not change
• You will use new science and technology effectively
• You will respond effectively to competitor threats and external changes
• You will have no alternatives

He prods his audience will questions as to how likely all of or any of these will occur over the next decade? Not likely he says. Uncertainly requires you plan for multiple futures, not one, build flexibility to respond to several possible future scenarios and create institutional capacity to change and adapt. Few blueprints exists for the possible futures that are now in the making for health care.

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Where Does Hospital Care Begin and End?

January 28, 2008 at 1:50 pm · Filed under Hospital and Health System CEOs, Business of Health, Hospital Administration

Fred Fortin’s posting on this subject on Jan 28 described how Leland Kaiser at the Center for Health Design described the “place” challenges facing hospitals as centers for transformation and healing. But it is an unfortunate reality of hospitals and the Center, itself, that they are both overly concerned about hospitals as places rather than things. Clearly, when any organization defines its mission and vision, it makes sense for it to indicate what it aims for, but also what it does not aim for, both hospitals and the Center seem concerned with health, not merely sickness.

The Center, for example, is clearly concerned with how the design of hospitals, as workplaces, affects the health of those who work there, in addition to the effect of place factors on the health of those treated there. It has published a report “The Role of the Physical and Social Environment in Promoting Health, Safety, and Effectiveness in the Healthcare Workplace”, for example. Another promoted a broad view of health including the total environment. “T. Schettler “Toward an Ecological View of Health” Kaiser, himself, has argued that hospitals must concern themselves with what patients’ do and experience before they are admitted to, and after they are discharged from the hospital.

While this concern may focus solely on the extent to which the “before” experience best prepares patients for their sickness care, and the “after” follow-up enables them to optimize their recovery, there are certainly added elements that could be included in follow-up care. Why shouldn’t hospitals concern themselves with preventing repeats of the same causes that led to the patient’s admission in the first place? It would certainly be in the best interests of that patient, and the community at large, if repetitions were avoided, or at least minimized.

When the cause of the original admission, as so many are, was an existing chronic condition, there are proven methods of reducing future crises, complications, and worsening of such conditions, for example, though the patients’ own physicians would have to be involved in this as well. Fortunately, a great number of hospitals own or have strong affiliations with primary physicians who can handle what they do best in preventing repetitions, while hospitals can focus on what they do best.

When the cause of the original admission is an acute illness or injury, hospitals also have the opportunity, with the help of patients’ physicians (if any) and patients, themselves, to discover what led to the illness and injury, and prevent repetitions of that. They could then use the same information about populations of patients to reduce the incidence of acute and chronic disease in the community, in a true, comprehensive, and proactive mission of protecting and improving health, not merely the reactive mission of treating disease.

Arguably, the Center for Health Design — despite the use of the word “health”, rather than “hospital”, “healthcare organization” (it has published papers on physician practices and long-term care organizations, as well), or even “healthcare” – may logically limit itself to “places”, and to healthcare places, at that. But hospitals, despite predictions of continuously growing sickness care demand, are only part of the problem, not part of the solution, when they restrict themselves to sickness care.

Fortunately, dozens, if not hundreds, perhaps even thousands of them (I know of no count made by their trade associations) are already engaged in proactive health efforts. These may be limited flu shot campaigns, health screening fairs, fitness center operations, executive health programs, etc. They may be workforce health management efforts aimed at their own employees, at the workforces of local employers, or in the case of Mayo Clinic, for example, the workforces of large employers throughout the country.

Hospitals deal with patients, plus family members, friends, and co-workers who visit patients, at arguably one of the best “teaching moments” that anyone concerned with promoting and maintaining health ever enjoys – a time when they are seriously ill, in most cases. This gives them a unique opportunity in their follow-up care, and in their before and during contacts, to learn about the causes of their patients’ sickness, and to approach them at a time when they might be most interested in learning ways to avoid repetitions thereof.

Hospitals, as places, are not usually the best places to carry on proactive health management initiatives. They are hugely expensive places, and severely limited regarding convenience of both place and time. But they could certainly be part of the proactive health solution, given their professional staff capabilities, diagnostic testing/scanning technologies, and teaching moment advantages.

Many have made at least a start, though usually only a toe-in-the-water beginning, and often as is commonly the case with occupational and proactive health services aimed at local employers, only designed as part of a strategy to attract more well-insured sick patients. But as more employers shift the costs, and even move their employees into individual vs. group insurance, this tactic will not work as well. And self-insured may not be nearly as profitable as those who have traditionally been members of group insurance populations.

Hospitals, even if they never get over their “edifice complex” focus on their places, have the capabilities to function as an important thing element of comprehensive, proactive health management strategies, tactics, and interventions. Doing so could mean significant cost savings in terms of their own labor costs, and improvements in their own workforce (and therefore their own) performance. It could certainly mean significant and potentially far more profitable revenue from local employers, since they can afford to be more generous to hospitals that become cost-saving vs. just cost-increasing centers.

Perhaps even better, proactive health management will go far more in hospitals’ and physicians’ avowed, though perhaps only rhetorical and PR commitment to community health than does their current dominant focus on reactive sickness care. If they choose, the Center for Health Design may even look for ways to make hospital places, and perhaps even people’s work and home places, more conducive to health, rather than solely to healing.

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Where Do Hospitals Begin . . . and End?

January 28, 2008 at 2:21 am · Filed under Hospital and Health System CEOs, Hospital Administration

Wailea, Maui - I’m attending an Estes Park Institute conference listening to a short presentation by Leland Kaiser, a Senior Fellow at the Institute, talk about “evidenced-based environmental design” a new, emerging perspective when it comes to hospitals and their healing potential. Besides hospital design being functional and aesthetic, he argues that hospitals have to become “transformative and healing”; the hospital, in and of itself, should be evocative of the individual’s health potential.

Kaiser believes hospitals should move from being a “service industry” to an “experiential” industry. They should be much more than “containers” of the sick, he says. Hospitals are active health agents, whose responsibilities begin before the patient is admitted and extend to after patients are discharged. A re-visioning is in order, and a big part of that process is designing hospitals to fit with patients, their families and, their employees. Whole courses of disease, he believes, can be altered by changing environments. More research and advocacy like that being at the Center for Health Desig is need says Kaiser.

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China to Rank Physician Ethical Behavior

December 23, 2007 at 8:56 pm · Filed under Policy Makers, Consumer Engagement, Transparency/Public Disclosure, Hospital Administration, International Health, Ethics

From a China Digital Times post translated from the China News Service:

China’s Ministry of Health and Chinese Medicine Administration have jointly issued a regulation that aims to set up a evaluation system to tally the medical ethics of doctors in various hospitals and other health care providers in the country. There are three components in the evaluation regime: self-assessment, departmental assessment and institutional assessment. A filing system will also be set up to store the records, in an effort to link the ethics scores with the doctor’s compensations and promotions. But there is one thing missing, as some commentaries point out: opinions from the patients and their families.

If I were a physician in China, this new initiative would make me extremely uncomfortable for a couple reasons. First, physicians working in a health care system characterized typically by a heavy top-down management style, and absent a strong peer advocacy group, are at a distinct disadvantage when it comes to disagreements about professional behavior. And second, political intolerance of dissent and social action is often framed as action against ethical misconduct. I do recognize that medical leaders and institutions do have responsibilities when it comes to the ethical behavior of those whom they oversee. But it is the cultural and political context that surrounds this new ranking approach that makes me uncomfortable.

As far as the absence of the public ranking of physicians in this new scheme, that, my friends, is simply a matter of time.

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On the Coming “Everyware” Bubble in Health Care

October 1, 2007 at 2:07 am · Filed under Policy Makers, Health IT, Transparency/Public Disclosure, Business of Health, Hospital Administration, Electronic Medical Records, Ethics

Last week AT&T Inc. announced it is now selling “a complete portfolio of radio frequency identification (RFID) tracking offers for health care providers. The RFID solution will enhance visibility into the operations of hospitals and other health care facilities.”

“The company is offering the devices, infrastructure and systems needed for full-scale tracking applications — everything from tags and software to networks and data storage”. . .providing “a Wi-Fi-enabled location-based service to track equipment, devices and patients. . .”

In an interview with Tim Cunningham, Director of RFID development at AT&T, specific solutions for their customers would differ since “it all depends what is being tracked, and whether that includes patients or not,” he said. Intel’s Director of Research, Andrew Chien, speaking at the MIT’s Emerging Technologies Conference this week, talked about “terascale computing”. Chien is looking at how to use these future machines.

“One of the things we’re very focused on is this idea of inference and understanding the world. The big idea is all about this question of whether inference and sensors are really the missing piece to make ubiquitous computing come to fruition.”

Ubiquitous Computing (pervasive computing, physical computing, tangible media) or “Everyware”, as critical technology futurist Adam Greenfield describes it, is here. Today. And while the promoters of Health 2.0 feel there is gold in “them thar hills”, but are still looking around for a business model, ‘everyware’ developers are already mining the health care industry’s deep pockets who, in turn, are being driven by a number of more immediate concerns such as patient safety and cost.

So what is ‘everyware’ when it comes to health care? Well, let’s take something we are starting to get a handle on, Electronic Medical Records (EMR). We’ve already mentioned the evolution we see happening towards an intelligent EMR (see earlier post).We now think of the EMR as a snapshot of someone’s medical history and current status. What if the EMR was more of a movie instead: a continuous, real time flow of information from the source, the patient’s body, to an intelligent networked system geared to flag critical indicators and thresholds and whatever else, for that matter, that needs monitoring?

Medical vigilance technologies, for example, hook up the body’s formidable medical information production capabilities to wireless, networked and intelligent systems — whether you’re in the hospital, at home or on the go. Tracking technologies can also tell where you are, or have been, in each of those settings as well.

For hospitals, tracking applications, like that of AT&T, can both save lives and money. Beyond knowing instantly where emergency personnel and equipment are, for example, surgical teams can track things like sponges or instruments to ensure that nothing is left in places where they not ought to be.

For our growing population of elderly, wearable biometric devices, voice and gesture recognition interfaces, memory augmentation systems — all these may be essential (and cost-effective) tools in managing future complex health conditions while maintaining as much patient autonomy as possible.

Along with intelligent bathtubs, toilets, beds, refrigerators, rooms, and entire homes — literally anything that can be “colonized” by sensors, or “ambients”, which wirelessly port information over to an intelligent network — ‘everyware’ is slowly insinuating itself into what we can call “smart” health care.

The convergence of these technologies — RFID, ultra-wideband, and IPv6 (new internet protocol) — pointed at the needs of the health care industry, promises great advances in the convenience, cost and quality of care. But this promise also comes with great risks. Greenfield has pointed to many of these risks which can be easily transfered to what’s happening in health care. They include among other things:

• the exponential expansion of “surveillance” (including medical surveillance)
• the consequences of software/hardware failure
• the psychological impact of former latent, unmeasured information being made ‘public’
• the lack of awareness, or understanding, of being subject to these unannounced or invisible technologies
• the unpredictability of how these technologies will act — think HAL 2001 here — when all are interconnected

These technologies will come to us piece by piece, with the impact being a slow emerging boil, rather than a full and obvious onslaught of a total inter-connected system being thrust upon us. But the speed, storage, addressing, display, wireless, and technical standards for these systems already exists. That means ‘everyware’ is already a reality for some.

Yet thinking about these technologies holistically will be difficult. And according to Greenfield, it’s not sufficient simply to say “First, do no harm”. He advises that we take the time now to deliberate on the human consequences of all this and start to think through the social rules of the game. In that light he poses a few principles to be considered.

• Everyware must default to harmlessness
• Everyware must be self-disclosing
• Everyware must be conservative of face
• Everyware must be conservative of time
• Everyware must be deniable (opting out)

The recognition of these principles, along with educating ourselves on these new technologies is the starting position. The race will be long. The outcome will determine, as Greenfield observes, whether we’ll “develop an everyware that suits us, as opposed to the other way around.”

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Interview with Steve Harden, President of LifeWings

September 28, 2007 at 10:31 pm · Filed under Podcasts + Videocasts, Hospital and Health System CEOs, Hospital Administration

Steve Harden started his career as a Navy pilot, with more than 300 aircraft carrier landings. Steve eventually co-founded Crew Training International, where he brought Crew Resource Management training (or CRM) to US and overseas air forces and commercial fleets.

More recently Steve founded LifeWings to bring CRM to health care. Steve spoke with me today about what hospitals can learn from guerrilla warfare tactics, how landing on an aircraft carrier compares with his current work, and the importance of bringing a wingman with you to the hospital

 Interview with LifeWing's president Steve Harden: Play Now | Play in Popup | Download (164)

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Just for FUN …

September 21, 2007 at 8:22 am · Filed under Hospital and Health System CEOs, Business of Health, Hospital Administration

Although a serious issue, while reading an OpEd by Charles S. Lauer in “Modern Healthcare” on hospital infection rates, I had to chuckle.  Mr. Lauer, former VP of publishing for Modern Healthcare, wrote a column on hospital acquired infections,  “Tighten the controls . . . There is no excuse for hospital-acquired infections.”  He reminisced about his multiple joint surgeries and the fact that he had happily dodged the infection bullet.

Then he made a reference to the retiring head of the Joint Commission, Dennis O’Leary. According to Mr. Lauer, Mr. O’Leary had informed him last year that he wouldn’t be a patient in a hospital without being accompanied the entire time by his own personal patient advocate.  No kidding.  That would be like President George W. Bush going to the Fallujah Medical Center for Surgery from an Al-quada sympathizer.  It would be like O. J. Simpson going to Ron Goldman for a laproschopic cholestectomy.  Seriously, if you headed up an organization that charges millions of dollars every year to criticize hospitals, you’d be a little (excuse the reference) o’leery of a visit there as well.

Seriously, the entire infection issue is an amazing problem.  Some organizations are dealing with this by having every human being wash their hands every time they enter a patient’s room.  After watching a physician at one of the other hospitals where I had worked leave the bathroom without washing his hands, I have to agree.  Heck, he would have been fired at Denny’s.

He talked about the rubber glove fallacy where employees don’t wash their hands, but put on the rubber gloves and contaminate them as they are pulling them into place.  He reminded us to ask for antibiotics one hour before surgery, BUT one thing he didn’t talk about was having CEO’s create a healing environment in their hospitals.  We allow the families and significant others to stay 24/7.  We try to have each patient touched multiple times each day by care givers other than just their nurses and physicians.  We work desperately to create a nurturing environment for everyone, and our infection rate has not gone above 1% for nearly ten years.  If you aren’t living in terror, maybe your white blood cells will actually have a chance to do their jobs.

I’m not sure if it is as simple as that.  It probably goes back to the necktie thing.  Ask your doc to drop the tie.  We all know that they spread germs!  So do the neckties.

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