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3006, 2016

The MRSA Patient in the Hospital Room Next Door

By |June 30th, 2016|Current Health Topics|0 Comments

hipreplacementAs my husband was wheeled into his hospital room after total hip replacement surgery, I noticed a red sign on the patient’s room that was kitty-corner to his. It said, “Stop. Infection risk.” The sign included instructions about donning gloves and gowns before entering the patient’s room.

This was not a good sign.

I waited outside Jamie’s room for a few minutes as two nurses evaluated him. Two medical professionals inside the other patient’s room caught my attention. They were not clothed in protective gowns or gloves, even with the infection risk. They spoke to the elderly patient at her bedside, one with a stethoscope around his neck and clipboard in hand. I overheard them explain to her that they could not release her because of her MRSA infection and that family members had not been reached.

MRSA? I tried to calm myself. Methicillin-resistant Staphylococcus aureus is serious business. MRSA can be life threatening and causes wound infections after surgery, pneumonia, sepsis, and more.

According to the Journal of Clinical Microbiology Reviews, hospital-acquired infections are the fifth leading cause of death in the United States.

I glanced into the patient’s room again, unsure if I’d seen what I thought I had. The clinicians were in fact not wearing gowns or gloves.

According to RID, the Committee to Reduce Infection Deaths, “Clothing is frequently a conveyor belt for infections. When doctors and nurses lean over a patient with MRSA, the white coats and uniforms pick up bacteria 65% of the time, allowing it to be carried on to other patients.”

As I stood facing my husband’s room, the curtain drawn around his bed for privacy, I noticed how close the elderly patient’s room was to his. About three to four feet. I figured that she and my husband might share the same nurses. My fears spiked as I thought about how easy it would be for nurses and other medical professionals to transmit MRSA from one patient to another. In the published study, Hand hygiene for the prevention of nosocomial infections, “Healthcare workers’ hands represent the principal route of transmission of nosocomial pathogens.” Staphylococcus Aureus (MRSA) can survive for over 2 hours on the hands and is found in 10-78% of staff.”

Minutes later, I stood by Jamie’s bed, touching his hand. He looked weary, in pain.

“You okay?” I asked.

Jamie nodded.

I didn’t mention the MRSA patient next door as I didn’t want to worry him. I mulled over how I was going to handle this with his nurses, how to approach them so I could maintain a cordial relationship. That relationship was crucial to his care. But I also wanted him safe.

Nancy, Jamie’s registered nurse, soon entered the room and introduced herself. We chatted about my husband’s surgery, his care, and I asked about dinner for him since he hadn’t eaten since midnight the night before. Nancy was very friendly and exuded an air of confidence, which put me somewhat at ease. I decided to wait to address my concerns about the patient next door.

To say that I was worried about Jamie would be an understatement. His first hip replacement surgery on the other hip 14 months ago had not gone well and had to be redone. After severe pain did not let up for five months after that surgery, we’d met with several orthopedic surgeons for other opinions. Each one recommended revision surgery. We chose the surgeon who performed the most hip replacement surgeries and revision hip surgeries, who had excellent training and education, but who was also a patient-centered physician. He answered all of our questions. He took the time to explain what needed to be done. He made the effort to get to know Jamie, to establish a relationship.

Seven months ago, Jamie’s revision surgery was expected to take about an hour and a half. It turned into a five-hour operation because the previous hip replacement was such a mess. The new surgeon had quite a bit of trouble withdrawing the stem. It would not budge. He had to surgically cut a keyhole into my husband’s femur to pop it out. He was forced to insert a longer stem because of the problems caused by the previous surgery. This surgeon explained in detail what had happened, and that the recovery would be extended.

Jamie’s recovery from the revision surgery was long and arduous. As a previous hockey player for 25 years on a hockey league, and a skier, motorcycle rider and all around athletic guy, he struggled with losing much of what brought him joy.

Because of Jamie’s life-long physical activity, his other hip was also in very bad shape. All of the orthopedic surgeons we met with said that it too would need to be replaced as it was bone on bone. Ongoing pain in the natural hip prompted the current surgery.

Normally, a patient with MRSA in the hospital room next door might not have prompted as much concern on my part. But Jamie had been through so much—3 years of chronic pain. 3 surgeries. I just wanted him to get his life back without complications.

Nancy was very attentive to Jamie and brought him pain medication almost immediately when she realized he was suffering. She also informed us that dinner was on its way. I liked her already and thought about what I could bring the next morning for her and the other nurses that might show our appreciation for their care.

But the MRSA issue burned in my brain. As soon as I sensed we had developed a good rapport, I asked her the question. “The patient next door,” I said, “She has MRSA, right?”

Nancy appeared a bit startled. “How did you know that? “

I explained that I’d seen the sign on the door and overheard the medical professionals’ conversation in her room as I’d waited for Jamie to be evaluated.

“Is my husband at risk for contracting MRSA since her room is so close?” I asked gently, trying to conceal my worry. I apologized for asking, not wanting to doubt her professionalism.

Nancy explained the protocol for donning protective clothing and gloves before entering the other patient’s room and outlined what needs to happen upon leaving it. She added, “We also use the hand sanitizer every time we come into your husband’s room and again before we leave.”

It had been a while since I’d done research on hospital-acquired infections for both of my books, The Take-Charge Patient and Critical Conditions, but I didn’t think that hand sanitizers killed MRSA. I blurted out, “Does that hand sanitizer kill MRSA?” See this article, The FDA Wants Proof Hand Sanitizer Works.

Nancy hesitated for a split second, motioning to the hand sanitizer dispenser on the wall. “Yes, it does.” She probably hadn’t encountered many loved ones who asked that question. And then she whispered to us, “I’m not taking care of her anyway. I won’t be going into her room.”

I exhaled.

Two days later, Jamie was home from the hospital and recovering. He still has no signs of infection. A nurse visits him twice a week and he has in-home PT three times a week.

A week after the surgery, I felt able to do some research on hospital-acquired infections. The CDC states that hospital-acquired infections affect 1.7 million people annually and kill 99,000 people each year. A common statistic that many are familiar with.

But what I discovered that was new to me is that hand sanitizers used in hospitals must have a 65%-100% alcohol content to be effective against MRSA, according to the published study, Effectiveness of various hospital-based solutions against community- acquired methicillin-resistant Staphylococcus aureus. I have to wonder if all hospitals provide hand sanitizers with that level of alcohol content. Hand washing is still considered the gold standard for preventing transmission of infection. But with understaffing, lack of time and patient emergencies, it’s a wonder nurses have time to hit the restroom.

Then, I looked up the patient safety grade of the hospital Jamie had been in. I could have researched this before his surgery but I’d decided against it.

Why?

My husband’s surgeon has privileges at that hospital and could not have performed the surgery in another facility. We were committed and very confident in this surgeon. My husband was not going with anyone else because of a hospital’s infection rates. He had been through too much. Besides, I knew this hospital to be much better than the other one covered by our health insurance.

Hospital Safety Score  for the hospital my husband was in?

Grade C.

However, it was a relief to see that their safety scores for MRSA were higher than most.

 

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2806, 2016

Calling the Shots in Your Medical Care by Beth Gainer

By |June 28th, 2016|Book Reviews & Awards, Current Health Topics|0 Comments

13563483_10206104729407913_459234551_nBeth Gainer’s book, Calling the Shots in Your Medical Care, is a must-read for every patient and caregiver. Written with a straightforward and compelling voice, Gainer offers sound advice to get the best medical care. She should know. She is a breast cancer survivor who lived through and overcame many challenges in her medical journey.

Calling the Shots in Your Medical Care focuses on the all-important doctor-patient relationship, showcasing the quality of that relationship and it’s direct connection to good medical care. Through interesting stories, Gainer illustrates how to find a truly great doctor. We recognize physicians who treat patients with respect and who value patient participation in care. Armed with her own strategies and checklists, Garner finds some amazing doctors to treat her.

Through the author’s journey, we also recognize arrogant doctors who don’t listen to patients, those who aren’t interested in a collaborative relationship with patients. Gainer admits that a patient-centered, caring physician is not easy to find but emphasizes the importance of locating one.

The author’s many triumphs throughout her medical journey are not without horror stories and common frustrations with our healthcare system. The way Gainer handles the pitfalls had me cheering for her. I’ve not read a book thus far that empowers a patient as much as this one. She encourages patients to listen to their gut instincts, to speak up, to become informed, and to engage in care.

Having fully researched a treatment to prevent a reoccurrence of breast cancer, Gainer shows us by example how to achieve “doctor buy-in” on the medical treatment she believes is best for her. At the helm of her care, Gainer works in partnership with her chosen medical professionals. “A wonderful physician will also be open to the patient’s input,” she writes. This is key to patient-centered care and Gainer knows it.

The author admits to being somewhat intimidated by certain doctors, just like the rest of us. Her story about her oncologist who encourages her to speak up, to stand for herself as a patient, is the best example of patient empowerment I’ve read. Gainer is realistic about the demands and frustrations of dealing with time-pressed medical staff but gives herself permission to ask for what she wants anyway. Patients need to hear this more than ever now.

Beth Gainer’s personal journey with breast cancer also opens the door to her personal suffering with treatments, revealing just how difficult it can be to undergo chemotherapy and surgery with all the trappings of a complex and often frustrating medical system. Her story is one of triumph.

Calling the Shots in Your Medical Care is both an emotional and captivating read. It is packed with effective strategies for patients to get the best care while maintaining their sanity.

Calling the Shots in your Medical Care will be available July 5, 2016 and can be found at Beth Gainer’s website, www.BethGainer.com and on Amazon.

 

1206, 2016

Cash Pay Patients: tips to beat high deductible health insurance plans

By |June 12th, 2016|Current Health Topics|0 Comments

patientsmedbillMany of us now have high deductible health insurance plans, which makes us “cash pay” patients until we meet our deductibles. The higher the deductible, the lower the monthly premium. If you have a high deductible and don’t consume much medical care, you are most likely a cash pay patient. You might even avoid medical care because of the out of pocket cost. I know I have.

As health insurance premiums increase each year, so do deductibles. Across the country, rates have increased 20 to 40 percent and up, making it difficult for many of us to afford anything but a high deductible plan. I talked with a friend yesterday who has a $9,000 deductible. She has a torn meniscus. She is avoiding the surgery because she isn’t even close to hitting her plan’s deductible. I suggested she try asking for a “cash pay” price from her surgeon and the hospital or surgery center where her procedure would be performed.

Negotiating cash pay prices for medical treatment has become a common practice. Even if you have health insurance you may want to pay cash. Often a cash pay price for medical care can be less than what you’d have to pay if your health insurance gets involved.

But be aware, cash pay discounts only work if your provider does not submit your bill to your health insurance company.

According to Gerald Kominski, director of the UCLA Center for Health Policy Research “If your insurance has a high deductible you should always ask for the cash price.”

After my family’s past health insurance company pulled out of the health insurance market at the end of 2015, we went with a Blue Shield plan. Our premium increased $125 a month and the plan covers less. Our deductible is higher. And they deny most medications.

This year, Blue Shield denied a medication I’ve been taking for years. Even after my doctor filed an appeal, they refused, suggesting I try similar medications that are obviously less expensive for them and not what my doctor prescribed.

I decided I was not going to let Blue Shield dictate my treatment if I could help it. I spoke to my pharmacist and asked what the cash pay price would be for the medication without submitting to our health insurance. The quote was too expensive to pay on a monthly basis. So I called a few pharmacies and asked for their cash price for my medication. I took the lowest price back to my pharmacy and asked if they would match it. They agreed.

You too can shop around for cash pay prices and not just for medications, but for other medical services. For example, if you need an MRI, call a few imaging centers and ask for their cash pay price. Be sure you make it clear you do not want it submitted to your health insurance. You can then negotiate with the provider of your choice.

Here’s how:

  1. Offer to pay up front at the time of service in exchange for a discount cash pay price. Medical providers wait long periods to get paid by health insurance companies and some welcome being paid quickly.
  2. Offer to pay the equivalent in cash to the price your doctor or other healthcare provider might receive from your health insurance company. What many patients don’t know is that health insurance companies don’t pay what doctors or other providers bill. Health insurance companies negotiate a reduced fee so the provider is paid quite a bit less than what is initially invoiced. In anticipation of the reduced payment from health insurance companies, doctors and other medical providers increase the amount of the patient’s bill, according to Medical Billing Associates. Cash pay patients will be charged the same fee unless the patient negotiates a cash pay discount.
  3. Do not use a credit card as credit card companies tack on a fee, charging the end user a percentage of the bill. Offer to pay in cash, check or cashier’s check. My husband’s anesthesia bill from his surgery was paid by our past health insurance company with a credit card. The anesthesia group tacked on a $45 additional fee for credit card processing onto our bill. I put a stop to that. So can you.
  4. Go to Healthcare Blue Book, Clear Health Costs or New Choice Health  and look up the desired medical service to get an idea of how much local doctors and hospitals charge for what you need. You might find that there are vastly different prices for procedures done in academic medical centers vs. surgery centers etc.
  5. Negotiate a cash price before you have a medical procedure. Be sure to get the name of the person you negotiated with at the medical provider’s office, and the exact price and date of the discussion.
  6. Ask about cash pay prices for other providers involved in your surgery or procedure. I’ve found that anesthesiologists are often not covered by health insurance. If you are negotiating a cash price don’t forget to ask to speak to the anesthesiologist too.
  7. You can negotiate a cash pay price after a procedure or treatment, but it’s easier ahead of time. If you receive medical bills from a hospital, per say, you can still ask for a discount. Try this: “I can pay 30% of the bill now if you will write off the rest.” If they do not agree, they might come back with an alternative reduction you find acceptable.

If you think that negotiating cash pay prices for medical care has an unseemly quality, you might consider how unseemly it is for health insurance companies to raise their rates at the current pace, how they increase the availability of high deductible plans while making lower deductible plans’ premiums unaffordable to most, all the while narrowing your choice of doctors and hospitals on available plans.

The drawback to “cash pay” for medical services, is that not submitting your claims doesn’t allow you to meet your deductible. If you anticipate a major medical expense, such as a major surgery or hospital stay, you might consider putting your medical services through your health insurance so your high deductible is met. That way the expense has a good chance of being covered. Minus the co-insurance, co-pay, and other deductibles, that is.

Resources for Discounted Medications

Medical Billing/Dispute Advocates

Medical Billing Advocates of America http://billadvocates.com

Advocates for Arbitration, Lack of Access to Care, Medical Debt, and more.

Patient Advocate Foundation http://www.patientadvocate.org

For more information, please go to www.thetakechargepatient.com

505, 2016

Cyber IN-Security: your medical records are gold mine for cyber criminals

By |May 5th, 2016|Current Health Topics, Data Security|0 Comments

CyberInsecuritySome say privacy is an illusion. I hope that isn’t true but I do know that our medical records are not safe. Why do I care? Because our medical records contain our social security numbers, health insurance information, our home addresses, phone numbers, emergency contacts and their phone numbers, our email addresses, possibly our driver’s license numbers, and likely credit card payment information if you’ve ever paid your co-pay with a credit card. I know I have.

Your medical record is worth 10 times more to a cyber criminal than your credit card number. And with healthcare’s mandatory transition to electronic medical records, cyber thieves have taken full advantage.

If you think major institutions are immune to cyber attacks, think again. You might recall the cyber attacks on our U.S. government. One in particular compromised personal information on 22.1 million people and 5.6 million fingerprints were stolen.

No doubt you’re aware of the major ransomware attacks on hospitals across the country where cyber criminals seized patients’ electronic medical records and held them for ransom to be paid in Bitcoin. See article here http://www.wired.com/2016/03/ransomware-why-hospitals-are-the-perfect-targets/

According to the Ponemon Institute’s Fifth Annual Study on Medical Identity Theft, 90 percent of healthcare organizations have been hacked, exposing millions of patients’ medical records.

You probably remember the major cyber attacks on the three major health insurers, Blue Cross Blue Shield where over 10 million patients’ medical records were exposed.

According to Modern Healthcare, nearly one in eight patients have had their medical records exposed in breaches in the United States. Since that article was published in 2014, that number has likely doubled.

You might be asking yourself, “What could cyber criminals do with my personal information housed in my medical records?”

Cyber criminals can monetize your personal information to obtain credit cards or loans, to commit tax fraud, send fake bills to insurance providers, acquire government benefits from Medicare and Medicaid, and much more. Your personal information can also be used to purchase healthcare services, prescription medications and medical equipment. It can also be used to obtain your credit report.

The above can also corrupt your medical history with inaccurate diagnoses and treatments.

According to the same Ponemon Institute study, 65 percent of medical theft costs each victim $13,500 to resolve the crime.

This is pretty scary stuff. I’ve heard from friends and colleagues that they can only take in small amounts of information because it’s so frightening and they feel it’s beyond their control.

There is something you can do.

It is up to doctors, hospitals, and other healthcare organizations/companies to secure their electronic medical records, back up hard drives, use secure cloud platforms (if there is such a thing,) encrypt emails, update software and more. Many just aren’t doing it.

According to the HIPPA Breach Notification Rule, a hospital or health insurance company that has been victim to a security breach, must inform patients, if more than 500 people have been affected. Unfortunately most do not. Patients find out about errors on their Explanation of Benefits (EOBs,) in letters from collection agencies, by finding mistakes in their health records or on their credit reports.

As a patient you are at risk. So am I. And we are all patients even if we just see a physician once every year or two. Had a baby? Had a vaccine? Been treated for the flu? All of us are patients and have been since we saw pediatricians as kids.

What You Can Do to Protect Yourself

  1. Read your Explanation of Benefits (EOBs) that come from your health insurance plan. Call your health insurance company if you do not recognize a charge. Check for total amount covered and amount paid.
  2. Get copies of your medical records from doctors and review them for errors. Look out for misdiagnoses, incorrect pre-existing conditions, procedures you didn’t have, incorrect treatments, allergies you weren’t treated for, and more. If you have trouble understanding your medical records, ask your doctor or his/her nurse to help you understand the information.
  3. Monitor your credit reports and billing statements for errors.
  4. Do not give out your social security number to anyone unless absolutely necessary. Often the last four digits will do.
  5. If you have your medical records or any personal information on your smart phone, be careful about using public Wi-Fi. If you send or receive an email or browse the internet while using public Wi-Fi, a hacker can eavesdrop on your transmission and gain access to the information on your device.
  6. Be wary of health apps. Generally, apps are not secure. See article here http://www.martineehrenclou.com/healthcare-data-mining-is-your-patient-privacy-being-breached/
  7. Be wary of public Wi-Fi. This includes any hospital. If you are a patient or visitor at a hospital, make sure the Wi-Fi is encrypted. If it is encrypted it will require a WPA or WPA2 password. Even if encrypted, think twice about sending any personal information via email or text while you are there.
  8. Set your laptop or computer to manually select the public Wi-Fi network in the healthcare facility you are in.
  9. Look for web addresses that begin with https. These are more secure.
  10. Do not share personal information on file sharing sites. Often they are not secure, according to Becker’s Hospital Review, 10 Ways Patient Data is Shared With Hackers.

The FBI recommends:

1. Keep your firewall turned on.

2. Install and/or update your antivirus software.

3. Keep your operating system up to date.

4. Be careful what you download.

5. Turn off your computer at night.

 

For more information on cyber attacks, cyber security, data mining and patients medical records, see the following:

Rapid Increase of Cyber Attacks http://www.martineehrenclou.com/rapid-increase-of-cyber-attacks-on-patients-medical-records-8-tips-to-protect-your-data/

Patients’ Medical Records hacked at Alarming Rate http://www.martineehrenclou.com/patients-medical-records-hacked-at-alarming-rate-tips-to-protect-yourself/

Healthcare Data Mining: is your privacy being breached? http://www.martineehrenclou.com/healthcare-data-mining-is-your-patient-privacy-being-breached/

 

 

2604, 2016

Who Besides the Cleveland Clinic Could Use Improv Teaching Strategies?

By |April 26th, 2016|Current Health Topics|0 Comments

BB-closer-Headshot-1-13-Cherations-350 x 350Guest Post by Beth Boynton

MedCity news reporter, Neil Versal’s article, Improv training helps Cleveland Clinic improve MD communication, describes Cleveland Clinic’s recent workshop to teach clinicians how to improve patient engagement!

It is super exciting to hear about because it means that powerful experiential teaching methods inherent in improv are reaching mainstream healthcare! Teaching methods that can help us with recalcitrant issues such as; patient safety, workforce health, and toxic cultures. And these claims are supported by research presented at the National Academies of Practice this past April by Candace Campbell, DNP, MSN-HCSM, RN, CNL, FNAP. Dr. Campbell’s poster presentation summarized her USFCA Doctoral Thesis entitled, “Improv to Improve Interprofessional Communication, Team Building, Patient Safety, and Patient Satisfaction”.

As a specialist in communication and collaboration, I’ve been integrating interactive improv activities into workshops with nurses for over a decade and in the last few years have decided more of an improv focus. Healthcare professionals already know what respectful listening and speaking up is supposed to look like, but we don’t the opportunities to practice building the skills and relationships we need. People are tired of taking typical communication courses and if we look at our patient safety data communication is a pervasive and chronic problem!

I had the pleasure of attending the first “Medical Improv” Train the Trainer at Northwestern University in 2012 led by professor and improvisor, Katie Watson, JD who has developed a curriculum for medical students.

I take improv for personal and professional development and have for over ten years. The activities are a lot of fun and I’ve grown a lot personally and professionally! We can take the emphasis off of comedy or performance and put it on the process, there is a rich gold mine of learning! In fact, you can’t participate in an improv activity without developing the emotional intelligence and interpersonal skills that we desperately need in healthcare!

 It seems like a ‘no-brainer’ that all hospitals, clinics, and nursing homes should get some of this training, right? Ah yes, but we need more research, more trainers, more money, which could take years, right?

WRONG!

We can create a train-the-trainer resource this year through the crowdsource funding project, “Improvoscopy: Serious Play for Safe Care”. Please take a few minutes to explore the idea and consider a contribution. We don’t need to wait!

Bio

Beth Boynton, RN, MS, author of Successful Nurse Communication: Safe Care, Healthy Workplaces, & Rewarding Careers, is a speaker and medical improv trainer. More information about her work can be found on at www.confidentvoices.com and she can be contacted at beth@bethboynton.com.

404, 2016

Why We Need Build an Emotionally Intelligent Healthcare Workforce & an Innovative Way to Do It!

By |April 4th, 2016|Current Health Topics|1 Comment

Guest Post

By Beth Boynton, RN, MS

BB-closer-Headshot-1-13-Cherations-350 x 350As a consultant and author specializing in teaching emotional intelligence (EQ) and communication skills to healthcare professionals for over a decade, I can attest to the critical need for and barriers we face in developing them. Further, it is important for all stakeholders to understand these challenges so that we can work together effectively for positive change. In this post I want to discuss these issues, share an exciting crowdsource project, and ask for your help. (If you already believe that promoting EQ will help us solve problems in safety, patient experience, and workforce harm, skip down to the section on “Good News”!)

EQ is all about self and others. It includes the ability to show empathy, honor other points of view, and empower others, and acknowledge accountability. In a service industry so focused on human beings it seems obvious that nurses, physicians, and other healthcare professionals should be proficient in this skillset. Yet many are not and given the ‘high-stakes’ work of healthcare, ensuring the workforce has related training is a call-to-action for all of us.

How Does Emotional Intelligence Manifest in the Workplace?

Whether highly developed or lacking, EQ is an underlying theme in human interactions. For instance, as an RN, I need to show empathy for patients and be able to listen to their concerns not only to make clinical assessments, but to understand their needs and worries. I must also be self-aware of my own limitations associated with fatigue, overwhelm, and/or tragedy. I need to trust that I will be respected and heard if I report a problem and able to set limits, ask for help, and delegate tasks respectfully while in an environment where my limits are respected, help is available, and there are staff to delegate to. I need to be respectful of others’ limitations and be in tune with their social cues. Also, my ability to give and receive constructive feedback is fundamental to ongoing quality improvement which is a cornerstone to a culture of safety.

While physicians and other healthcare professionals have different roles and perspectives, this complex realm of EQ poses similar needs and challenges. For example, a physician must be able to show confidence, authority, and directive leadership while always being open and respectfully responsive to input from others.

What Happens When Emotional Intelligence is Lacking?

 In a general sense, individuals who lack EQ are not able to take good care of themselves and/or work effectively and respectfully with others. This results in poor communication, teamwork, and leadership which in turn contribute to mistakes, poor patient experience, and/or harm to the workforce. Here is a some relevant data to drive this point home.

Patient Safety

 

 

Patient Experience Surveys

 

  • The Hospital Consumer Assessment of Healthcare Providers and Systems’ (HCAHPS) surveys that measure patient experience are rich with feedback about interactive behaviors of staff.   Of the 32 items surveyed, 14 are directly related to communication and emotional intelligence such as, “During this hospital stay:

 

…did nurses treat you with courtesy and respect?

…did doctors listen carefully to you?

…did nurses explain things in a way you could understand?”

 Workforce Harm

 “Through the Eyes of the Workforce” is a 2013 report from the National Patient Safety Institute that details physical and psychological harm experienced by the healthcare workforce. Some statistics taken from the report include:

  • Health care workforce injuries 30 times higher than other industries
  • 76% of nurses in national survey indicated that unsafe working conditions interfere with the delivery of quality care
  • An RN or MD has a 5-6 times higher chance of being assaulted than a cab driver in an urban area
  • Lack of respect is a root cause, if not THE root cause, of dysfunctional cultures 95% of nurses report it; 100% of medical students; huge issue for patients.

These important issues are often treated as separate phenomenon yet when we consider EQ, a common and underlying problem emerges: we are not doing a very good job working together and the results are very serious!

 Challenges to Developing Emotional Intelligence

As essential as it is to promote EQ, there several challenges we face in training healthcare professionals.

First, is a persistent lack of time. Medical and nursing educational programs are so packed with scientific and clinical studies that there is little time for learning EQ beyond cursory efforts. The lack of time for developing EQ persists once students graduate and begin practice. High-stakes, high-stress clinical issues are always the priority. Time for managing conflict, offering constructive feedback, or coping with tragedy, is chronically unavailable. Some of us may even use this perpetual state of reaction to avoid doing deeper work!

Compounding this lack of time is the need for psychological safety in order to develop and practice the skills. The same environment noted above is not at all conducive to taking emotional risks that can be involved in speaking up and listening. Since speaking up requires the risk of being more accountable and listening requires a sharing of power, either can be very difficult for someone who does not have a confident sense of self. The psychological risks of trying out new behaviors are made even more difficult by blaming or bullying cultures.

Another challenge we face is that the kind of expertise necessary to build EQ is very different from memorizing scientific facts or researching data. Teaching EQ requires skills in facilitation, coaching, conflict management, and the ability to create a safe learning environment. A skill-set not common in clinical leaders.

And so we have a lack of skills, a lack of expertise to teach them, and workplace environments that are too risky to practice them. A perfect storm for the longstanding issues we’re facing.

There is Some Good News

A new kind of experiential teaching called Medical Improv is a growing field of interest. A speicific form of applied improvisation and in my experience, one of the most effective ways to teach EQ, communication, teamwork, and leadership.   If we can help nurse, physician, and administrative leaders learn how to teach some of the fundamental improvisational activities we could create a far-reaching rippling effect.

And that is exactly what Improvoscopy: Serious Play for Safe Care is designed to do. This project will involve filming improv workshops and then editing video bites that emphasize teaching strategies and learning opportunities.   These will be used to build an online library of videos and lesson plans that will empower them to train others. Activities for building EQ can then be integrated into staff meetings, orientation, strategic planning, and clinical inservices. Voila, powerful experiential learning without a huge time or financial commitment! Please consider checking out Improvoscopy project, sharing the idea, and contributing at any level! Thank you very much and if you have questions, please let me know!

 

Beth Boynton, RN, MS, author of Successful Nurse Communication: Safe Care, Healthy Workplaces, & Rewarding Careers, is a speaker and medical improv trainer. More information about her work can be found on at www.confidentvoices.com and she can be contacted at beth@bethboynton.com.