In Healthcare: Respect= Safety

Written by Deborah Caputo Rosen, RN, PhD

Finally!  Respect= Patient Safety. From that wise purveyor of direct- to- consumer information and education, Consumer Reports, comes a report written in easily understandable language that underscores the message of the Wilson-Stronks advocacy program: Improving Healthcare by Putting Patients in Patient Safety (How Not to Get Sick(er) in the Hospital).

Consumer Reports conducted a survey, of 1,200 recently hospitalized patients, funded by the Gordon and Betty Moore Foundation.  It demonstrated a clear link between participants’ perceptions of respectful treatment and their safety during the hospitalization. The survey defined measures of respect, including:  “the ways staff members and physicians communicated and, whether they acted with compassion, honored patients’ wishes and acknowledged mistakes”.

Whether it is called patient satisfaction, patient engagement, or patient and family-centered care, people who are actively involved in their own healthcare, experience better outcomes and have lower health costs than those who are not (Dentzer 2013). In the Consumer Reports survey, one-third of respondents felt doctors and nurses did not always listen to them without interrupting, 25% said staff did not always treat them as adults able to be involved in their own care decisions, and 34% felt their expressed wishes were not honored. Twenty-one per cent felt they experienced actual discrimination in their care.  Those who rated their experience of respect poorly were two and a half times more likely to experience a medical adverse event than those who described usually being treated respectfully.  And dismissive or poor treatment made survey respondents feel uncomfortable asking questions about their care and the steps being taken to keep them safe. Those who did not “Speak Up” were 50% more likely to have experienced at least one medical error during their hospital stay.

The Consumer Reports article also includes a table called Top and Bottom Scoring Hospitals for Safety and Respect. The data are drawn from the organization’s hospital ratings tools and are based on January 2014 data from CMS . Reported safety scores are based on mortality rates, infection rates and hospital readmissions.  Patient experience (respect) scores include doctor and nurse communication, communication about discharge and overall impression of the hospital.

Many consumers will benefit from the wide availability of this Consumer Reports coverage.  Their recommendations parallel what Wilson-Stronks teaches patients/families and providers in our advocacy curriculum: “Know-Ask-Speak”!

  • Choose the right hospital
  • Help providers see you as a person
  • Invite your doctor to have a seat
  • Have “Your People” with you
  • Know when errors tend to occur
  • Find a “Troubleshooter”
  • Be assertive and prepared but courteous
  • Keep the concept of partnership in mind
  • Write things down
  • If you don’t understand, ask again

Once healthcare consumers recall that they are the CEOs of their own healthcare teams; are purchasing services from healthcare professionals, and have choices, rights and clear expectations about the outcome of care, more than half of the work is done! Then, some expert coaching of necessary communication skills, negotiation skills and facts about their diagnosis and treatment options can restore a balance of power and assure a safer, more respectful healthcare experience.

Contact us to learn more about how we are “Putting Patients in Patient Safety”.

Work Cited:

Dentzer, S. Health Affairs. February 2013, 32:202. Accessed January 10, 2015
“How Not to Get Sick(er) in the Hospital”. Consumer Reports. February 2015, p. 32-37.)

Perks as an Intern: ACA Open Enrollment Call with First Lady Michelle Obama

Written by Kayana Marks
January 30, 2015

Over the past few months I have been granted many opportunities working as the intern for Wilson-Stronks, LLC. Many of these opportunities allow me to learn so much about many aspects of healthcare. When I was asked by Amy to join the call with First Lady Michelle Obama about Open Enrollment during the LGBT Week of Action I was thrilled because I knew I would learn so much more about the Affordable Care Act. Dialing into the call on January 15 I had an open mind and a willingness to learn as much as I possibly could about my future career field.

First Lady Michelle Obama was the opening speaker and she was very grateful for all the work healthcare advocates had done so far. She emphasized that because of the Affordable Care Act (ACA) millions of Americans have healthcare coverage for the first time. In light of the LGBT Week of Action, First Lady Obama mentioned that the ACA bans health insurance companies from charging LGBT persons higher rates. She stressed that now is the time for advocates to reach further back into their communities for Open Enrollment. As advocates for healthcare we are the leaders of our communities and the people trust us. First Lady Obama closed out her segment of the call by reminding us that we are indeed changing lives by making sure that every American has access to healthcare.

Immediately following First Lady Michelle Obama, Sylvia Burwell, the Secretary of Health and Human Services, addressed the audience. Mrs. Burwell wasted no time in reminding everyone that the ACA has assisted many people in experiencing greater equality and greater healthcare coverage. Mrs. Burwell brought this to life by sharing a story of a lesbian woman who once said, “health insurance was always out of reach” for her. Now that she has more options she finds that “the relationship [with her partner] is respected”. Mrs. Burwell also pointed out that healthcare coverage can also be affordable now. Eighty-seven percent of those that have signed up for insurance have financial assistance. The many millions of Americans that the ACA has helped has shown to be the greatest increase in the last four decades. Mrs. Burwell noted that the Affordable Care Act has helped healthcare all around; from quality to equity.

As the call rounded up with questions I realized that we have come a long way, but we still have a long way to go. As an intern in the healthcare field, as a future medical student, and as a future physician I could not help but think of my role in healthcare. I appreciate what I am learning now and I look forward to how I will apply my acquired knowledge to improve healthcare.

*This blog entry ONLY reflects the views and experiences of Kayana Marks.

Ferguson

The following post was written by Ken Haller, MD a pediatrician in St. Louis MO.  It is  used here with permission.

Follow Ken’s blog at http://drkenhaller.blogspot.com/ 

#ferguson

In the coming days no one knows what exactly is going to happen when the Grand Jury in the Darren Wilson case hands down its recommendation regarding whether he should be indicted for the killing of Mike Brown. I daresay we all hope for peace and justice, and we all hope that everyone will remain safe.

I have been a pediatrician for just over thirty years now. I moved to Missouri in 1986 and practiced in East St. Louis for ten years. For the past eighteen years I have practiced in St. Louis at SSM Cardinal Glennon Children’s Medical Center. I have always worked in what are euphemistically called “underserved communities.” This usually means people who are poor. This usually means people who are black. This usually means people who are both. I have seen parents endure terrible hardships to keep their families together. I have seen grandparents heroically taking on the care of children years after they thought they were done with childrearing. I have been humbled by seeing kids who have done remarkable things under circumstances that, as a kid, would have sunk me.

Sadly, I have also seen families who have not been able to withstand the pressure of being poor, overworked, and marginalized. I have seen families fall apart. I have seen kids who have developed behavior problems because their brains have to be on high alert because of various ongoing threats in their environments. I have seen parents unable to continue to be parents because of the constant strain of wondering how they can feed their kids and keep a roof over their heads while working two or three minimum wage jobs that do not make ends meet.
I have also read posts on Timelines all over Facebook saying that these people just need to “get a job,” “calm down and go home,” “pull their pants up.” These commentators have all been white. They do not understand, and do not wish to understand, what it is like to live another reality, one where you are always, automatically suspect, one where you will not be shown houses in certain neighborhoods, one where your family had no alternative but to send you to a crappy public school. They know that they are doing better than the African-Americans who live a few miles away, and they actually believe they deserve it. They believe that their relative success is all due simply to their work ethic and their good choices. They do not believe in White Privilege, i.e., that being white in America confers certain advantages over non-white persons, because, when you have it, it is nearly invisible, and if you know you have it, your first reaction is to feel really guilty about it. So they deny it because it’s initially too painful to accept it.
But it’s true, and I know how I benefitted from it. I grew up in a safe, white, middle class suburb on Long Island, with excellent schools (our high school had a full time Russian language teacher), lovely parks and beaches, dependable pubic services, where my dad had a good-paying job as an aerospace engineer that he got as a result of a college education on the GI Bill. All that prepared me to go to an excellent college where I got scholarships and to medical school to do the work I am privileged to do today.

I could tick off, one by one, how many of those advantages are withheld from the kids who come to my office, as well as from their parents and families. The strange thing is not that Ferguson is happening; it’s that it’s taken this long to happen.

As I said above, I am a pediatrician. And in that role, I just want to make one plea to anyone who reads this about what may happen in the coming days: I would ask everyone who may be involved in public displays over the next few days to be aware of how this will affect the children in your lives.

Children are not just small adults. As we learn more about child development, we know this to be true on every level: physical, psychological, cognitive, emotional. What children need – and the younger they are the more they need this – is stability, predictability, and a feeling of safety. As a species, humans are altricial, that is, we are born more immature than just about any other mammalian species our size. That means that babies need nurturing, caring, feeding, swaddling longer than do infants of other species. The payoff, of course, is enormous in terms of intelligence, creativity, and the ability to love. Part of that process, though, requires that children know who will be tucking them in, who will feed them, who will bathe and dress them, when that will all happen, and who will love them. They need this to be the same from day to day, as much as possible. They need all this because they are trying to figure out how the world works. As infants mature from beings who, at about two months, smile at everybody, to babies who, at around six to eight months, begin to know who loves them and to choose them over strangers, to toddlers who will run off and jump and climb and fall at the slightest provocation, children have unique needs are various stages of life. What does not change is that they always need to be supervised, and they always, always need to feel safe.

So to those who will choose to be part of a demonstration, I respectfully hope that you will choose not to bring your children. While I completely understand the desire that your children should be witnesses to history – and I have no doubt that Ferguson will be part of the litany that now includes Selma and Montgomery – young children will not remember this. Their brains are not wired to retain clear memories during the first few years of life. Everyone in St. Louis and around the world knows that the only thing we can predict about the upcoming days is that they will be unpredictable. And that is not an atmosphere that is healthy for kids. If they see their parents yelling, being yelled at, being assaulted, they will experience only fear and threat, and that is never healthy for a child. I know you love your kids, and you are doing this to make a better world for them. Please leave them with a responsible adult. Please make sure you get home to tuck them in. Please tell them the stories of these days when they are old enough to understand the sacrifices you made for them.

And to those in law enforcement, if you encounter demonstrators with kids, please be aware of how your interactions will affect these children. One thing that has amazed me, both before August 9 and since, is that when I ask African-American kids who come to visit me in my office what they want to be when they grow up, a significant plurality of the boys say, “Police.” So many of these kids already see you as people of power. Please do all you can to make sure that your interactions with them and with their parents leave them with a sense of respect for you and what you do, rather than fear.

I truly believe that both demonstrators and law enforcement want to assure that everyone remains safe in the coming days. I truly believe that both demonstrators and law enforcement are doing what they do to make the world a better place for our children. And I truly hope that everyone will keep their kids at home where they can be safe and be best prepared for this better world to come.

– Ken Haller, MD 11/19/2014

Follow Ken’s blog at http://drkenhaller.blogspot.com/ 

 

Be Very, Very Scared! What You Don’t Know CAN Kill You…

Hospital Associated Infections Part 2: Catheter Associated Urinary Tract Infections (CAUTI)

Posted by Deborah Caputo Rosen

54,500. That is the number of reported urinary tract infections linked to the use of a catheter in acute care hospitals in 2012. (cdc.gov/hai/progressreport/index.html) That is the GOOD news. The number of reported urinary tract infections linked to the use of a catheter was 93,000 in 2011! (cdc.gov/Other/disclaimer.html) Focused efforts to reduce healthcare associated infections such as these helped to reduce the incidence.

In 2008 the Federal Center for Medicare and Medicaid Services announced new rules for payment for the cost of treating “conditions that could reasonably have been prevented” (CMS 2012). Hospitals could no longer bill those e patients for any charges associated with hospital-acquired complications. Catheter associated urinary tract infections (CAUTIs) were identified as among those complications.

Why? Let’s understand urinary catheters.

A urinary catheter is a thin, flexible, sterile tube that is inserted into the urinary bladder through the urethra. Catheters can be used to drain the bladder only once and then removed or they may be “indwelling” and remain in place once inserted.. Indwelling catheters have a balloon that is inflated inside the bladder. This prevents the tube from slipping out of the body. Such catheters (often called Foley catheters) are connected to sterile tubing and a bag to collect and measure urine.

Catheters are inserted when a patient cannot urinate normally. Catheters can prevent damage to the urinary tract (bladder, ureters and kidneys) caused by retained urine. They may be used when a patient is anesthetized for lengthy surgery, for reconstructive surgery to the urinary tract, and when normal urination is not physically possible due to spinal cord injury.

Catheter associated urinary tract infections result from microorganisms entering the body via the catheter during insertion or handling of the tube. The system may also become contaminated by opening the collecting tubing and/or drainage bag. The drainage system works by gravity and must be kept below the level of the patient’s bladder to avoid backward flow of urine. Many of the common organisms that cause infection form “biofilms” on the catheter and are difficult to eliminate with antibiotics.

Catheters should be inserted only for appropriate medical indications and left in place for the shortest period of time necessary. Skin and mucous membranes that remain intact are good barriers to microorganisms. It is critical that the professional who inserts a catheter utilizes proper sterile technique and minimizes irritation to the lining of the urethra and bladder. All healthcare staff caring for patients with a catheter system always must practice correct hand hygiene, assure that the drainage system is not opened and maintain it below the patient’s bladder.

One challenge faced by patients is that the doctor or clinician who prescribed the catheter may not remember or notice that a patient remains catheterized; resulting in longer than necessary catheterization. As a precaution, patients and family members should be prepared to remind the healthcare team. The nurse caring for you should assume responsibility to obtain orders to remove the catheter.

Know, Ask, Speak

Wilson-Stronks advises all patients and their care companions to keep in mind the Wilson-Stronks patient safety mantra of “Know-Ask-Speak” to decrease risk of healthcare acquired infections, including catheter associated urinary tract infections (CAUTIs). When you or a patient you love enters the hospital….

Know:

  • What a catheter associated urinary tract infection or CAUTI is.
  • Why a catheter is being recommended/was used.
  • The name and credentials (MD, RN, PA, NP, medical or nursing student)) of the professional who will/did insert the catheter.
  • The difference between a single catheterization and an indwelling catheter.
  • This fact: The risk of CAUTI increases after 24 hours with an indwelling catheter.
  • This fact: If you/the patient is older than 60 years or has had a compromised immune system the risk of CAUTI is increased.
  • Fever is one sign of infection.
  • Collection of urine specimens (if indicated) should be done without opening the drainage system.
  • Urine should drain freely. Debris from the body can sometimes collect and obstruct a catheter. If the catheter is still necessary it must be replaced, not irrigated.

Ask:

  • Are there any alternatives to catheterization?
  • Can an ultrasound of the bladder can be done before catheterizing to measure the volume of urine and allow safe waiting for natural urination?
  • If a catheter must be inserted, can a single (“straight”) catheterization be performed instead of an indwelling type? When will the catheter be removed? And who will remove it?
  • Every day: Why the catheter is still in place and when it will be removed.
  • Whether you/the patient has a fever.
  • How the any required urine specimen will be collected. (It should be done without opening the collecting system and should follow sterile procedures).

Speak:

  • Request that providers wash their hands in front of you.
  • If a collection system is above your/the patient’s bladder insist that it is relocated correctly below the bladder to prevent back flow of urine.
  • If a specimen of urine is needed, insist that it is collected with sterile procedures without opening the collecting system.
  • Refuse to allow anyone to disconnect the drainage system.
  • Refuse to have the catheter irrigated because it is “clogged”. If it is still medically necessary, it must be replaced.
  • Tell your nurse and doctor if you have pain or feel feverish or achy.
  • Tell your nurse if you/ the patient seem(s) confused or unusually restless.
  • Notify your nurse if the urine in the collection bag appears cloudy or unusual in color.
  • If you/the patient may have fluids, drink as much as possible.

Be Very, Very Scared! What You Don’t Know CAN Kill You…

Hospital Associated Infections: “C. Diff”

Posted by: Deborah Caputo Rosen

What do Harvard Magazine and AARP: The Magazine have in common? In the past five months both have published articles about “Superbugs”. “Superbugs” are those microorganisms that have developed resistance to commonly- used antimicrobial medications. “Superbugs” are dangerous and difficult to treat.

The Centers for Disease Control and Prevention (CDC) has been in the news providing guidance on the prevention and science of Ebola infection. But Ebola, although terrifying to many, has sickened only a handful of Americans, and only one person has died in this country of Ebola.

Scarier than Ebola is that on any given day about 1 in 25 hospitalized patients has at least one healthcare-associated infection (HAI). In 2011 there were 722,000 HAIs in hospitals. About 75,000 people died from these infections¹.

What does this mean? It means that people are admitted into hospitals without infections but develop an infection during their hospital stay.

Some of the types of infections patients and healthcare workers need to be vigilant about include: catheter-associated urinary tract infections, central-line associated bloodstream infections, ventilator-associated pneumonia, surgical site infections and hospital-onset Clostridium difficile infections (CDI or “C. diff” infection).

Why do patients acquire infections in the hospital? Let’s use C. diff as our example. In 2012, 107,700 cases of C. diff were reported in acute care hospitals². Often, these cases are preventable.

C. diff is the most common cause for infectious diarrhea in hospitals. Long-term care (LTC) facilities may be at even greater risk. In 2003, 2% of patients discharged to long-term care carried a diagnosis of C. diff infection.

There are people who carry C. diff without symptoms. These bacteria produce spores that are shed in feces. The spores can persist for 5 months on hard surfaces that have not been adequately cleaned. They are transferred on the hands of healthcare workers and are not adequately removed with alcohol-based hand rubs. Alcohol-based rubs do not kill the spores. Using them alone, without soap and water washing, merely spreads spores around on the hands but does not completely remove them.

C. diff spores are dormant in the colon until the normal bacterial environment is disrupted. The usual culprit is an antibiotic. Antibiotics can kill harmless C. diff spores. When that happens, C. diff transforms into a form that inflames and damages the colon, causing colitis of varying severity.
C. diff requires both exposure to antimicrobial agents and new acquisition of the organism. This occurs by transferring fecal spores to the mouth, usually by touching contaminated surfaces. Symptoms begin soon after infection; with watery diarrhea 3 or more times per day, cramping pain and tenderness, and fever. If unrecognized and untreated, the symptoms worsen.

The mortality rate for CDI varies. Some patients may recover without therapy other than discontinuation of antibiotics. That is the appropriate first step. Although it may seem counter- intuitive, additional antimicrobial agents are usually prescribed. Elderly patients who are frail and who do not respond to the first or second medications frequently used to treat the infection and supportive therapy for dehydration may become seriously ill, with a mortality rate as high as 25%.³

CDI recurs at least once in 50% of people, either because the first infection was incompletely treated or because of a new exposure. Highest risk groups include the elderly, those taking antibiotics and those with long and/or frequent hospitalizations. Virtually every antibiotic can increase the risk. The risk of acquiring the infection increases with time and can be as high as 40% with prolonged hospitalization. This is due to exposure to healthcare workers’ hands as they care for infected patients, touch contaminated surfaces and experience failures of correct hand washing technique.

Breaking the cycle requires proper hand hygiene, environmental decontamination and a hospital program of antibiotic use monitoring (“antibiotic stewardship”).

Know, Ask, Speak

Wilson-Stronks advises all patients and their care companions to keep in mind the Wilson-Stronks patient safety mantra of “Know-Ask-Speak” to decrease risk of healthcare acquired infections, including C. difficile. When you or a patient you love enters the hospital….

Know:

  • What C. diff is.
  • What the symptoms are.
  • How it is transmitted.
  • How to properly wash your own hands and when to do so.
  • Whether you/the patient has been taking or is now being given antibiotics.
  • Whether you/the patient has had a long or recurrent hospital or LTC stay.
  • If you/the patient is older than 60 years, has had a compromised immune symptom, or recent gastrointestinal surgery.

Ask:

  • Why antibiotics are being prescribed?
  • Whether and what tests will guide antibiotic selection?
  • Whether the symptoms could be C. diff?
  • How the C. diff will be treated?
  • If your room has a patient with C. diff in it?
  • Whether disposable equipment can be used?

Speak:

  • Request that providers wash their hands with soap and water in front of you, reminding them that alcohol rubs do not kill C. diff spores.
  • Learn how equipment, including BP cuffs, portable commodes and rectal thermometers are disinfected.
  • Learn how surfaces, including floors, bedrails, bedside tables, call buttons and bathrooms are cleaned.
  • Tell your nurse and doctor if you have cramping pain or watery diarrhea, especially if you are taking an antibiotic.
  • If you become infected with C. diff: learn if you will be in a private room or with another patient with C. diff, if contact isolation precautions will be observed, if visitors should follow such precautions.
  • Learn what the likelihood of recurrence is and how to reach help if you have symptoms after discharge.

¹/hai/eip/antibilotic-use_techinfo.html

²/hai/progress-report/index/html

³Cohen S, Gerding N, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol. 2010;31(5):431-455.

 

Healthcare Horrors!

This Halloween we are launching the first in a series of blog posts about something really SCARY – Healthcare.

HEALTHCARE HORRORS!!

You may be surprised to learn that medical errors are the 3rd leading cause of death in the United States surpassed only by cardiovascular disease and cancer.
Hospitals can be scarier than any house of horror. It is estimated that more than 130,000 errors occur each month in the nation’s hospitals. Each month!!!

Deaths due to medical errors have increased to about 210,000-440,000 per year.
Some of the most common medical errors—and this is scary–

  • Medication errors-
  • Infections
  • Falls
  • Wrong site surgery
  • Misdiagnosis
  • Failure to identify the correct patient — Care provided to the wrong person

Unlike cardiovascular disease and cancer, there are few public campaigns aimed at preventing the occurrence of medical errors. Efforts to reduce medical errors are leaving out the most important stakeholders: PATIENTS!

Wilson-Stronks is changing how medical errors are being prevented. Learn more on our Advocacy Page and our Advocacy Blog.

Putting Patients in Patient Safety

It is time for us to become smarter about our healthcare! Many medical errors are preventable, and patients are a key element to creating systems of care to minimize error and improve safety.

A few tips for protecting yourself and those you care about:

  • Don’t go alone! Just as we don’t allow children to trick-or-treat alone, anyone receiving healthcare is by definition vulnerable and should have a care companion/support person with them. Learn more
  • Wash away the scary bugs! Make sure that all caregivers including your physician wash their hands before they touch you. Who knows what monster they were treating before they arrived to care for you! Learn more
  • Don’t be afraid to ask! If something doesn’t make sense, ask. Healthcare is complicated and confusing. Bring a list of questions and paper and pen to write down notes about your care. Learn more

Learn More: Our Patient Advocacy Program Continue reading

Have Soapbox; Will Travel

By Amy Wilson-Stronks

Last month I delivered the keynote address at the American Medical Association’s Fall 2014 Commission to End Health Care Disparities Meeting. I was flattered to be asked to speak to a room of accomplished healthcare professionals who are leading efforts to improve healthcare by addressing healthcare disparities. I envisioned this as an opportunity to share some observations made during the years that I have been working toward the same goal/directing efforts in the same direction.

Specifically, I saw this unassuming audience as an opportunity to get on my soapbox, a position I find myself on with increasing frequency as I continue to work in healthcare. The title of my talk was Putting Patients in Patient Safety: Lessons Learned.

When tasked with delivering the keynote, I was told to “ ‘ignite’ the audience; give them something provocative to consider, something that will keep them awake during this dinner time presentation”. Since the focus of this group is the reduction of health disparities with the ultimate goal of eliminating disparate care, I believed I could deliver.

Why? Because fundamentally, our current systems are so flawed that none of us will EVER be able to eliminate disparities for any vulnerable or underserved group. I envisioned this message: Give up, we are wasting our time!

No, that was not my opening line. But beneath my remarks, that sentiment muttered like a mantra; it was the gist of my talk, whether articulated or not.

Why am I so negative? Several reasons. And, yes, these are points I shared with my esteemed colleagues.

There is no such thing as racism, sexism, (Insert any “ism”) .
“Not in my backyard,” “We treat everybody the same.” It would be short sighted and inaccurate to blame healthcare organizations for racial, ethnic, and other healthcare disparities. However, since health care is received at healthcare organizations, they necessarily are essential to the solution. Yet, many do not believe that they are culpable, nor do they think it is a problem that they need to address as a priority.

If our care organizations are not interested in evaluating the care they provide to various population groups that have been identified at the national level as suffering from health and healthcare disparities, then how will we recognize when we are doing things right? I have found that many healthcare organization leaders are not aware what is happening across their organization during patient-provider interfaces. They may set expectations that all patients are treated with dignity and respect, but they aren’t told, nor do they observe the Emergency Department staff comment, “Oh no! Not another Ebonics. I wish my shift would end already!” They don’t realize how unconscious and conscious bias can create a chasm between providers and patients from different racial and ethnic groups. And the bias isn’t only between providers and patients, but also among employee groups, as one HR professional once confided to me when asked about the lack of racial diversity in his organization,

“You know, the blacks (employees) really need to get over (themselves); Slavery was over a hundred years ago.”

Yeah, I guess we all need to get over it. But that won’t eliminate disparities.

Meaningful Use isn’t Meaningful
Meaningful Use is designed to establish a degree of data accessibility across the healthcare system to support care transitions, improve data access and communication, and improve systems for monitoring and evaluating quality by introducing uniformity and compatibility. This makes sense. And it is necessary for us to really understand how healthcare disparities present, what causes them, what removes/improves them, etc.

Unfortunately, the data necessary for us to address healthcare disparities are rarely captured, and if captured, they are rarely accurate.
“Only Press Ganey Data Matter”
“We have the data field right here.”

We need to incite collective action to incentivize the vendors of Electronic Health/Medical Record (EH/MR) systems to create adaptable programs for the collection of data on patient race, ethnicity, and preferred language. To the AMA, NMA, NHMA, AHA, and all others working to improve healthcare and advance equity– please join us on our soapbox.

If we still can’t get this right after more than 10 years, how are we ever going to effectively collect data on sexual orientation and gender identity?

Our Systems of Care Aren’t Designed by Patients
“If you listen to your patients CAREFULLY they will give you the diagnosis; if you listen a bit longer they will give you the treatment”

“Only physicians are capable of judging what is or is not good medical practice. Patients and hospital personnel may learn to recognize good practice but only the physician can accurately evaluate its quality.”-Explanatory Supplement to the 1965 Joint Commission Hospital Standards.

“Well, when I am in their room and they are all talking in another language I feel uncomfortable. I feel as if they are talking about me. I don’t like that.”

“Although my doctor knew all about me, each encounter with new people—with blood draws, ultrasound, breast x-ray, etc.—had the basic anxiety of the procedure and layered on to that, the possibility of homophobia and having to watch out for myself” ¹

If patients cannot communicate with their caregivers, then caregivers can’t do their job.

Unfortunately, many things complicate communication, such as trust, fear of hospitals, cultural beliefs and practices, conscious and unconscious bias as well as basic human assumptions. Healthcare professionals must involve the patient in every aspect of their care and not make any assumptions.

This drives the work we do at Wilson-Stronks. We want to Improve Healthcare. And we know that the only way to do so is to work collaboratively and act collectively. This collaboration and collective action must involve our patients. We were honored to be asked to share some of our experiences “in the world” with the AMA Commission to End Health Care Disparities.

¹ Margolies L, Scout NFN. LGBT Patient-Centered Outcomes: Cancer Survivors Teach Us How To Improve Care for All. April 2013.

Note: All other quotes are reflections of my thoughts from information that others have shared with me.

The Mock Medical School Interview

Posted by Kayana Marks

I could feel the nervous energy circulating around the room as each of us waited. Waited for the opportunity to get it right, to learn, to correct our mistakes before we could even make them. We were all silently, nervously waiting for our mock medical school interview to begin. This was the time for each of us to learn how to dazzle our future medical school interviewers and secure that spot that was almost in our grip.

As the intern at Wilson-Stronks, I was invited to attend the American Medical Association, Commission to End Health Care Disparities (CEHCD) meeting along with Amy Wilson-Stronks, MPP, CPHQ, who served as the keynote speaker at this event. I had the greatest opportunity, as an aspiring medical student, to round out the weekend by participating in the Mock Medical School Interview Program that the CEHCD conducts at their meetings. This program gives students “the opportunity…to experience what it takes to successfully prepare for a medical school interview…[by] meet[ing] with physicians and health care professionals”. I am so thankful that I was able to participate in this event because walking into an interview not knowing what to expect can always be a scary thing.

I was interviewed by Dr. Arthur Fleming and I believe my interview went well overall. Dr. Fleming was very personable and had a lot of insight on what to expect as I apply to medical school. He also had a lot of knowledge on the subject I was most interested about, the Medical College Admission Test (MCAT), the test that every student applying to medical school in the U.S. needs to take. With my second testing date around the corner he confirmed the score that I should be working towards and reassured me that it will come with hard work and perseverance.

At the close of the event the healthcare professionals that volunteered their time reminded us of a few key points: always ask questions, be sure to convey deep compassion, know about current events, know how to sell yourself, be ready to explain what is going to sustain you through your journey, and be able to explain what got you to where you are. With all these key points in mind I believe I’m ready to master those interviews.

Citation: “Meetings.” ama-assn.org. American Medical Association, Web. 11 Oct. 2014 <http://www.ama-assn.org/ama/pub/physician-resources/public-health/eliminating-health-disparities/commission-end-health-care-disparities/meetings.page?>

GLMA 2014 Annual Conference and Nursing Summit

Posted by Amy Wilson-Stronks

GLMA Conference September 10-13
The 2014 GLMA: Health Professionals Advancing LGBT Equality Conference and will take place September 10-13 in Baltimore, Maryland. Amy Wilson-Stronks is concluding her board term as Vice President of Education at the conference, but will remain active in GLMA as a member of the new Nursing Section and continue as a member of the Education Committee. GLMA has an increasingly strong interest in facilitating mentoring opportunities for students and young professionals in the health professions, and will be hosting a mentoring event to allow students as well as young and seasoned professionals to network and learn from each other. For more information, please visit the GLMA website at www.glma.org.

GLMA Nursing Summit September 10th
The second annual GLMA Nursing Summit will precede the GLMA conference and take place on September 10, 2014. The nursing summit focuses on LGBT issues in the nursing field and provides LGBT allies and supporters with the tools they need to improve LGBT healthcare. A table topic will be facilitated on the organizational climate around LGBT health and nursing. The conference is highly anticipated after the interest and strong turnout generated in 2013.

Language Access News

Posted by Amy Wilson-Stronks

It has been several years now since new and more specific accreditation standards were implemented by The Joint Commission to support the provision of interpreters, translated written materials, and other communication supports for people who have limited English proficiency (LEP) or are Deaf/Hard of Hearing (DHH). In that time, we have been keeping our eyes, ears, and fingers open for trends in language access. Recently, we learned of a voluntary resolution agreement between Mee Memorial Hospital in California and the Office for Civil Rights that resulted from three complaints “filed on behalf of three Mexican national origin individuals whose primary language is Triqui-Bajo. The complaints contend that MMH failed to provide the affected parties, who are limited English Proficient (LEP), with effective interpreter services and thereby discriminated against them on the basis of national origin, in violation of Title VI of the Civil Rights Act of 1964.”

Citation: http://www.hhs.gov/ocr/civilrights/activities/agreements/mee.html

Through the compliance resolution, Mee Memorial agrees to a number of provisions including establishing a Title VI Coordinator and Coordinating Office, providing a “sufficient number of dedicated staff,” and creating systems that ensure, “that the primary language of each LEP patient is clearly identified in the patient’s medical record” and assuring that language access resources are available and accessed in a timely fashion. The provisions continue, but what is of most valuable note is that these provisions mirror those of a comprehensive Language Access Plan. It is unlikely that Mee had a Language Access Plan in place. If they had, they would have purposefully planned resources and designed policies and procedures based on meaningful data explaining community and patient language needs. Unfortunately, most hospitals and healthcare organizations have a “policy driven approach” that leaves out thoughtful planning for needs, resources, and processes for monitoring for improvement.

If your organization needs assistance with Language Access Planning, please contact us. We would love to help you proactively improve healthcare for LEP patients served at your institution! Contact info@wilson-stronks.com.