Have a Story to Tell? Had a medical error?

This blog is about patient safety, medical malpractice, staying healthy, and preventing future errors. Help & empower someone else, Teach a lesson, Bear witness, Build our community - Email us or call 781-444-5525.

Frustrated with a health problem?

Need an ally in your health crisis? Call 781-444-5525, or learn more.

Friday, July 22, 2016

A Patient Family Advisory Council’s reduction of waiting room anxiety: I think about who’s coming after me

Mal’s story on the Patient/Family Advisory Council:

I’m the Co-Chair of a Patient/Family Advisory Council (PFAC) at Beth Israel Deaconess Medical Center in Boston.  

Several of us on the PFAC who’d been through the surgical experience at BI, in the waiting room as a patient and as a family member, found it was not a very comforting or personal experience, but was rather stressful.  One of our projects was making that experience less stressful for the loved ones waiting.  A doctor and an I.T. [Information Technology] staff member came to the PFAC and asked for our input.  Several of us shared how impersonal it was.  It was an open area, at the main entrance to the hospital.  It created extra stress with all the people coming and going constantly.  

Now there’s a new waiting area that was created, away from the main entrance, that also has a newer technology of communicating to people where their family member is in terms of the surgical process.  It’s an electronic board, so I can see, for example, my spouse is in Surgery, or, they’re in Recovery.  They give each patient a special code on the screen, so it’s HIPAA compliant [to protect privacy].  And there’s an actual person to talk to when they want to check in and a person who knows the information about their family member.   
In my volunteer work on the Boards of nonprofit organizations, when I feel strongly about something, I jump into it.  I got really great care at the hospital, and I also saw room for improvement.  I think about who’s coming after me.

Read another story about a Patient/Family Advisory Council.

Wednesday, July 20, 2016

Staff training with patient stories: It’ll fall flat

Caroline Moore’s story:
I’m the Program Leader for Patient and Family Engagement at Beth Israel Deaconess Medical Center.  The Radiology department had just established new goals and their Service Excellence Program Manager was trying to find ways to drive them home to her staff.  She said, “I don’t want to just go into staff meetings and say, ‘Here are our goals.’  It’ll fall flat. I need something more patient-centered, from the lens of the patient to help them understand why that’s important.”

So I sent out a question to 80 of our Patient/Family Advisors.  They’re actively involved as members and consultants on task forces, hospital committees, and boards at every level.  I got back some very poignant quotes.  A blind patient had said, 
“I would like to comment on patients with visual impairment going into an area such as Radiology. Even with a little sight, it can be difficult to know where to stand and who is open next during the registration process. Vague directions such as "gowns are over there", and "go over there when you're done getting dressed" are not helpful.  It is also important for healthcare workers to introduce themselves and tell us what their role is, especially in this day and age when everybody seems to be wearing scrubs.”  They really need to be mindful, since I can’t see.”   I got other quotes about how anxious people are to walk into Radiology if they are going there for a procedure that may reveal cancer or a recurrence of a cancer that had been in remission.  We’re making a training video for the orientation and training of front-line staff in Radiology and hopefully it will be used in other departments.  The blind woman who was a patient will be in it, as it’s really important to personalize the experience.  

In the last year, the Service Excellence Program Manager has been coming to me more and more, saying, “You really have something here, with people who were so vulnerable and are willing to share their stories.”  So she is planning to embed our advisors in more of her meetings.

Ken’s Note:  This is an inexpensive way to make staff training much more vivid and memorable, and to increase patient engagement.

Tuesday, July 5, 2016

Patients' use of care plans: A ten-minute engineering fix

Libby Hoy’s story:
I was brought in as the patient/family advisor for a Lean event, a one-week rapid cycle improvement event addressing the wait times in the outpatient clinic my kids were served in.  I was with the clinicians, nurses, administrators, the assistants who bring you back to the exam room, and the front office staff, so all three of the gears in our company’s emblem were represented on the team.  

We identified some of the deficiencies.  In the middle of the week, a conversation came up about a physician’s frustration with families not following their care plans.  The care plan had made sense, he said, but the family had not called back.  He proposed that the families didn’t really care about their kids.  

I spoke up and said, I’m very invested in this. Sometimes we don’t get the call back either. It’s very frustrating when you can’t get in touch with folks.  Others joined in.

The team realized that in the office’s phone tree, when patients called in, the call was routed to a voice mailbox of nurses and staff members who were no longer with the organization, so our messages were sitting in unchecked mailboxes.

There had been assumptions about miscommunication, with team members thinking that patient education might be needed to emphasize to families the importance of following the care plans.  Instead, there was a ten-minute engineering fix to route the phone calls to the right mailboxes.  That improved follow-up and the continuity of care, etc.  If all of us hadn’t been there, this would have gotten lost in translation.

This is an example of the value of co-design, and representing all the voices in the room, not just the patient’s perspective, but their interaction with clinicians and administrators.  That’s so important.  We’ve worked so hard over the last ten years to get the patient’s voice into the conversation.  The secret is in the interactions together to highlight the opportunities for co-design and improvement.  The pendulum is swinging, but in some ways having just the patient or family’s perspective is of as little use as just having the clinician’s viewpoint.  The interdisciplinary approach is better.

Libby is the founder and CEO of PFCCpartners, based in California.

Read a story of the co-production of medical care.

Friday, July 1, 2016

Planning hospital discharge with the patient: I wanted to watch him another day

Another story from Dr. Maren Batalden:
A few months ago, I treated an elderly gentleman with cancer who was getting chemo, so his immune system was compromised.  He got a urinary infection and ended up in the ICU [intensive care unit] with sepsis, needing specialized attention to support a very low blood pressure.  He got better surprisingly quickly with antibiotics and fluids.  He came to the regular medical unit late the following afternoon where I became the doctor in charge of his care.  I met him the next morning and he told me he felt fine and was ready to go home.  He’d been quite sick, so I wanted to watch him another day, especially because we didn’t yet have the culture results from the bacteria which caused his infection and we didn’t know which antibiotic would be safe for discharge.

I explained my concerns to him. “When will you have the culture results that describe my bacteria?” he asked.  I said tomorrow.  So he asked, “How about if you give me a dose in the hospital of an IV antibiotic that works for 24 hours, give me a prescription that is your best guess about an antibiotic pill that you THINK will treat my infection, let me go home, and call me tomorrow if we need to change the antibiotics. If we need to change it, we’ll change it then.”  I thought it was a great idea!  He said, “Why should I sit in the hospital waiting for lab results?!  If I feel terrible, I’ll come back.”  He did great!  I called him the next morning; the culture results confirmed that his bacteria was sensitive to the antibiotics I had prescribed. He felt well and continued his recovery without complication at home.

It used to be that when it was time to discharge someone, I figured it was largely my decision to make.  Many patients assume the same.  “You’re the expert, doc.  You tell me.”  But I have come to realize that it’s NOT my decision; it’s a shared decision. I understand what the labs and the physical exam are telling me.  But I don’t know really know how the patient feels compared to his or her usual state; I don’t really know what kinds of supports they have or don’t have at home.  Decisions about whether and when to admit a patient to the hospital and whether or when to discharge have to made together. To my surprise this framework has pretty significantly changed my practice.  I find myself keeping people in the hospital for another day or two, when left to my own devices, I might have discharged them earlier, or vice versa.  The best care, I have come to believe, is always “co-produced.”  

Thanks to Dr. Maren Batalden for her story. Read her article in the British Medical Journal on co-production of medical care.