ClickCare Café

Is the 2019 Outlook for Nonprofit Hospitals as Bleak as it Appears?

Posted by Lawrence Kerr on Thu, Jan 03, 2019 @ 06:00 AM

brooke-lark-194254-unsplashMoody’s Investors Service came out with their 2019 projections and predictions for nonprofit hospitals.

And unfortunately the summary is: things don’t look great.

Although I don’t put tons of confidence or stock in this type of projection, I do think that the report captures many of the challenges that nonprofit hospitals face.

Fierce Healthcare does a good job summarizing Moody’s report: Moody’s says that nonprofit hospitals are on an “unsustainable path” because of “soft revenue growth, weak inpatient volumes and single-digit reimbursement increases in the coming year.”

Other challenges in 2019 may include lower cashflow, an increase in bad debt, lower inpatient admissions, and pressures like nursing shortages and increasing wages.

So much of healthcare is conservative. We don’t change until we need to. And for many nonprofit hospitals, there has been a consistent tendency to maintain the status quo in an almost superstitious fashion — if I don’t change, then nothing will change around me.

Reports like this demonstrate that things are surely changing around us. Our only choice as healthcare providers, as hospital administrators, and as citizens is whether and how to act proactively so that the things that matter to our organizations and to ourselves can be supported and pursued.

Healthcare is changing around us -- for better and for worse. 2019 will bring new technologies, shifts in reimbursement, demographic changes, and developments in our own practice as healthcare providers. Our goal can't be to not change within that. Our goal has to be to change towards what we envision for ourselves and for our patients. And with the new year here already, I encourage all of us to take the opportunity to reflect on what that might look like this year.

 

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Tags: telehealth, good medicine, telemedicine reimbursement

Why Medical Collaboration Can Help Us Lead With Our Values

Posted by Lawrence Kerr on Wed, Dec 05, 2018 @ 09:41 AM

vidar-nordli-mathisen-537587-unsplashIn our community, there are two nonprofit community hospitals and one Catholic hospital. All are excellent. Each has slightly different founding values and ways of operating. All three have a strong heart and soul, which has been more or less apparent at different times depending on leadership.

So a recent article exploring the shift in how Catholic Hospitals have approached their values and leadership — and the effect that can have — certainly caught my eye.

Catholic Hospitals used to be run, of course, by nuns. Increasingly, however, as the Fierce Healthcare article describes, “Catholic hospitals are much more likely to be run by lay executives who don’t serve as a human embodiment of religious roots.”

There may be multiple positive aspects of this shift. Perhaps the hospitals are able to serve a broader base of people with a greater diversity of religious backgrounds or values. Perhaps the lay leadership is stronger in some technical aspects of running or managing the hospitals. But the author of this article points out that the shift away from hospitals’ original values “can actually hurt their bottom line, as Catholic hospitals lose the loyalty of community members who sense an erosion of the values that were long integrated into their care.”

In other words, although it may seem that the immediate effect is one of broadening and strengthening, there may be side effects — as of any strong medicine — that outweigh the positives. As the author concludes, we in medicine are in a unique place that is at the intersection of art, science, morality, and human caring. Indeed, “hospitals are seen as more than just a business – they are often seen a reflection of the overall health of a community.”

I don’t have a detailed understanding of the specifics of Catholic hospitals and how these shifts to lay leadership have affected them. That said, I have found on a personal, business, and medical level — that when you dilute or don’t lead with your values, it may seem practical but leads to negative consequences.

Collaboration is about declaring to ourselves and our colleagues that we have a unique perspective, unique skills, and unique values as individual providers. We’re not a generic “healthcare provider” that can be swapped in for any other provider. If that were the case, any provider could provide the same care as any other — and collaboration would be far from necessary.

Let there be no mistaking it: when we lead with our values, and care for patients from our unique set of strengths, weaknesses, and values — we are more interdependent with our colleagues and we end up with a more unique role in the process. For providers who want to see themselves as invincible, this can be uncomfortable. But, as with the example of the hospitals, there may be immediate, short term benefits to diluting our values and trying to be all things to all people — but ultimately, it results in weaker care.

In fact, I think that is one reason that iClickCare, and telemedicine-based medical collaboration in general, is so effective. When we are able to collaborate, to reflect on cases, and to lead (and treat patients) with our values, we get better results. As the article author emphasizes, “There’s benefit in continuing to cultivate the essence of local hospital’s unique personality and roots, even as the benefits of system affiliation are stressed.”

It takes courage to practice medicine from your own unique perspective and strengths, rather than from an imaginary “generic” place. But the rewards are great — and so is the care.

For more stories of courage, medicine, and medical collaboration, download our Quick Guide to Medical Collaboration:

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Tags: medical collaboration software, hybrid store and forward medical collaboration, good medicine

Is Gun Violence a Public Health Issue Needing Medical Collaboration?

Posted by Lawrence Kerr on Thu, Nov 29, 2018 @ 06:00 AM

david-leveque-544057-unsplash

After declining steadily through the early 2010s, gun violence has been rising in the US. Mass shootings, while a very small percentage of total gun deaths, have also risen significantly in the past few years — thus the reason that it feels like we hear about a new shooting every week. Of course, the overall numerical significance of gun deaths may not be as sizable as other causes of death -- but gun deaths remain a killer in our country.

For these reasons, gun violence is sometimes seen as a public health issue. Although not an “unpreventable biological disease,” it is a killer and a factor in the well-being of our citizens. Similar to the opioid epidemic, gun deaths have social, public health, political, and behavioral dimensions. So it makes sense that doctors may have perspectives and concerns about gun violence, especially trauma or ER doctors who are literally on the front lines of battling to save patients who have suffered from a gunshot wound. (That said, the overall deaths from gun violence each year are tiny compared to many other public health problems.)

But a recent kerfuffle highlighted how difficult this topic can be to broach.

As is highlighted in a recent New York Times article, Bronx doctor, Dr. Marianne Haughey was outraged when the National Rifle Associated tweeted: "Someone should tell self-important anti-gun doctors to stay in their lane.”

She replied, "I have cared for victims of gun violence for the past 25 years. THAT must be MY lane." 

The politics and practicalities of gun control and mitigation of gun violence are beyond my sphere of expertise. And the analysis of the relative significance of gun deaths relative to other causes of death is a matter of real research to understand -- not something to address flippantly or scandalize.

But regardless of those more specific questions, for me, the conversation brought up an important question -- what does it mean for a doctor to "stay in their lane"?

What is our lane as doctors, generally, and as individual doctors?

Does our “lane”…

  • End after the last stitch is sewn, as surgeons, or does it extend to stopping by to check on the patient post-surgery?
  • End after we refer a patient to a specialist, or does it extend to following up on their care?
  • Include the societal, social, behavioral, and economic determinants of health?
  • Necessitate medical collaboration, or is seeing a patient during the visit the only job we have?
  • End at the end of our shift?

The answers to these questions have evolved for physicians and healthcare providers over time. And the truth is that there are no right answers. There do have to be boundaries to our sphere of influence as doctors -- both to remain within our expertise and to maintain sanity and efficiency. 

But I think that as a healthcare culture, we've drawn our "lane lines" too narrowly. I do believe that doctors have an important voice when it comes to questions of gun violence. I do believe that surgeons have a responsibility to care for patients long after the surgery is complete. And I believe that medical collaboration is a bare minimum requirement for adequate care. 

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Tags: medical collaboration tool, good medicine

One Simple Thing that Makes Patients Happier & Drops Healthcare Provider Burnout

Posted by Lawrence Kerr on Thu, Nov 01, 2018 @ 06:00 AM

rawpixel-674079-unsplashMost doctors I know can’t conceive of doing any more of anything.

Their patient visit slots are completely maxed out. Lunch is nonexistent. Every day, it seems like managers and administrators have a new request, demand, or memo to share about yet another thing that must happen during the visit, during the workday or at home.

So a recent article in Fierce Healthcare made me both nod in recognition and cringe with concern.

The takeaway of the article is that patients wished their doctors would talk to them about — and perhaps even support them with  more non-medical or quasi-medical issues. The Harris Poll surveyed over two thousand adults. Those adults shared that doctors (of course), tend to focus on physical health, even though the most common health issues were actually depression, anxiety, chronic pain, and diabetes. According to the poll, however, doctors touched on the mental, behavioral, or spiritual components of health, less than half as frequently (sometimes as little as 10% of the time), as more cut-and-dried physical components of health.

Of course, these “soft” elements — mental, behavioral, or spiritual components of health — are often the things (like exercise, sleep, etc) that can prevent illness or treat chronic conditions. Also, they often relate more intimately to issues like addiction or suicide which are, of course, epidemic in the US. So it could be deeply helpful to patients if doctors were able to broach more of these subjects.

“With what time?!”  I can hear doctors exclaiming in my head. I know from experience that within the visit time allotted by our bosses and by the healthcare industry, it’s difficult to cover even the basics of the patient's complaint and to satisfy all of the EMR’s buttons and requests. When we read an article like this, we feel like one more thing is being demanded from us that may as well just be deducted directly from our sanity.

Interestingly, an article in the New York Times that came out around the same time looked at doctor burnout and may indicate different conclusions. Dr. Mukherjee reminds us that burnout can be predicted by three things (termed the “Maslach Inventory”):

  • Emotional exhaustion (being “chronically overextended”)
  • Depersonalization (“becoming disconnected from the recipient of your services”)
  • Lack of personal accomplishment “a feeling that nothing is being achieved.”
I think many of us tend to talk about and experience the first one — that of being chronically overextended. But the truth is that depersonalization and lack of personal accomplishment are equally important to remaining satisfied and having longevity in our work.

Ironically (or perhaps predictably), the very things that our patients want more of from us — more engagement, more deep interaction, more holistic care — are the very things that would keep us from getting burned out. And so perhaps there is a bit of a chicken-and-egg situation. We feel overworked (emotional exhaustion), so we pull away from the personalization and sense of personal accomplishment that would keep us from getting drained. In the process, we miss the very things that could treat our patients more meaningfully.

It's true that most elements of the medical system right now do not support us in this pursuit. Productivity metrics, EMRs, and decreasing visit times all hinder us in this kind of approach. But the truth is that we still have the autonomy to take an extra 45 seconds and ask that softer question. Or to try a new medical collaboration tool for a week, if we think it would help us feel supported by our colleagues and give us some followup. The changes, perhaps, don't need to be as dramatic as one might initially think -- to be deeply satisfying to both our patients and to ourselves.

 

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Tags: good medicine, healthcare provider burnout

The Best Way to Help Young Patients? Get Them Back to Playing Faster

Posted by Lawrence Kerr on Thu, Sep 20, 2018 @ 06:00 AM

jelleke-vanooteghem-578746-unsplashAs you probably know, our cofounder is a pediatrician.

As someone who has treated children across socioeconomic groups for decades, she found that having a playhouse in the waiting room created a sense of normalcy, fun, and respect for the children she saw. She found that patients looked forward to their visits, since they could play in the playhouse -- and parents had a few unexpected moments of respite.

Of course, that was just one detail out of thousands as to how she cares for children in ways that are deeply effective and respectful of who they are as children -- but it highlights the ways that play are important in medicine.

Perhaps it’s eye-rollingly obvious, then, that the American Academy of Pediatrics would release a statement affirming the role of play in children’s lives. Perhaps their suggestion that doctors need to write a “prescription for play” is a good one.

But I also wonder whether, as healthcare providers, we should think less about prescribing play to parents who are already likely doing the best they can. And we should think more about how we, and the medical system, can get out of the way so that our patients can get back to play and learning.

Children have important work to do — learning and playing being two big parts of it. And one part of the tragedy of sickness — and the hospital stays, doctors' visits and long car rides that accompany it — is that children are removed from that important work of play. If play is so important, it’s crucial for our pediatric patients that we limit time in the hospital so they can spend more time “doing the work of childhood”

Sometimes the simplest solution is the most effective. In fact, I was reminded of this story of a terminally ill 2-year-old who loves Christmas. Realizing that he wasn't going to live until December 25th, his parents decided to recreate Christmas early that year. His neighbors, hearing the idea, decided to join suit. So the little boy's neighborhood became filled with lights, decorations, good cheer, gifts, and even a Christmas parade, even though it's only September. 

To me, allowing children to get back to play means different things in different situations -- sometimes a playhouse; sometimes a neighborhood teaming up for Christmas. But most of the time, in a medical setting, it means that we are doing care coordination and healthcare collaboration effectively enough that our young patients are spending less time in the doctor's office, waiting room, car-ride, and hospital. That means coordinating care so they can be released from the hospital 6 hours sooner. It means a team approach to care so that they're not bouncing from doctor's visit to doctor's visit with no resolution. It means using telemedicine to get a consult so that the child doesn't need to leave school to see yet another specialist. It means school-based health centers (linked to specialists by telemedicine) so that kids can get healthcare during the school day. 

Our view as providers must be broad enough to include an understanding of care that isn't simply about curing disease -- but about cultivating health in our patients (young and old). And that starts with getting patients back to their lives as quickly as possible. 

For stories of how medical collaboration can work in the real world, download our Quick Guide: 

ClickCare Quick Guide to Medical Collaboration

Tags: healthcare collaboration, care coordination, good medicine

Surprising Study Shows Doctor’s Race Crucial in Health Outcomes

Posted by Lawrence Kerr on Wed, Sep 12, 2018 @ 07:00 AM

rawpixel-744343-unsplash

Black men have the lowest life expectancy of any ethnic group in the United States. Chronic disease — like diabetes and hypertension — play a big role. But the path to reducing rates of those maladies can seem unclear.

A new study by researchers in California showed a shocking finding in one parameter that could dramatically influence outcomes — the race of the doctor. 

The study itself was pretty simple and looked at the likelihood of patients to accept preventative measures, comparing the likelihood with a white doctor and with a black doctor. The study participants were 702 black men in Oakland, California, who came to a clinic for a free health screening. They were randomly assigned to a black male doctor or one who was white or Asian.

The results were pretty stark (as elucidated by The New York Times):

— 63 percent of the black men assigned to a black doctor agreed to a diabetes screening. Just 43 percent of those assigned to a doctor who was white or Asian consented to be screened.
— Some 62 percent of black men with a black doctor agreed to cholesterol tests, compared to 36 percent assigned to a doctor who was not black.

These rates might not sound world-changing, but the consequences of them are. If black patients were to agree to preventive care at these rates in the real world, researchers estimate that the gap in cardiovascular mortality between black men and the rest of the population could be reduced by 20 percent.

So was it the race of the provider itself that made the difference? Or was it something that black doctors were doing differently, or more effectively, than the white doctors?

There’s no hard evidence to answer that question, but one telling component of the findings are the comments written by both patients and doctors in the study. Black patients had equally positive comments of doctors, regardless of their race. But of black doctors, their comments skewed more emotional and effusive. Similarly, the notes on  the white doctors tended to be shorter and dryer. Black doctors’ notes were more detailed and more holistic, including comments on elements of the patient’s experience and overall life.

One of the black doctors in the study really affirmed that ultimately, it’s not about race — it’s about good care. “It’s something they don’t teach you in medical school — taking that extra step because you appreciate there have been barriers in the past,” Dr. ChaRandle Jordan said, saying that white doctors can reach out just as well and that a lot depends on how familiar a doctor is with black patients.

From our perspective, there are several key implications of this study for our work with medical collaboration and care coordination:

— A team approach is important. Sometimes the background of the provider can make a difference, and where that's true, having a diverse team working together closely, is a key asset. 

— Good care is about more than the facts. Simply offering the appropriate preventative screening isn't enough. In this study, it appears that the black doctors' efforts to build rapport and even to push back on patients' initial reticence were a big part of their good outcomes. Having the perspective and tools to work with a more holistic sense of the patient is key.

Obviously, we believe that great care can happen among providers and patients of any race. But looking at race and differences in engagement and interaction shouldn't be taboo. We often say that "no one of us is a smart as all of us."  And this is one more example of how our colleagues down the hall may have a lot to teach us — if we are open to learning. 

For stories of medical collaboration, download our Quick Guide: 

ClickCare Quick Guide to Medical Collaboration

Tags: medical collaboration, care coordination, good medicine

New Pay Structures May Make It Harder to Care for Poor Patients

Posted by Lawrence Kerr on Thu, Jul 19, 2018 @ 07:00 AM

matt-collamer-555626-unsplashCaring for everyone has always been a core part of our practice of medicine.

Whether or not you can pay, and the complexity of your condition (medical or social) has never been a factor in whether we are willing to treat you, or in the quality of care you receive. 

In both of our community medical practices — Cheryl as a pediatrician and Larry as a reconstructive surgeon — this is just how we’ve done medicine, and it’s been a core part of what we did from the beginning. It’s not that we make money during our regular practice and then volunteer for the “disadvantaged” a few weeks per year — rather, we know that no one gets truly great care if a doctor is picking and choosing who to care for. The slope of that line of thinking is simply too slippery.

The truth, though, is that caring for people in this way used to be easier.

It’s certainly not impossible now. But taking payment from a patient in the form of chicken eggs (if that’s what they had to pay with) is almost impossible given the insurance and regulatory context we’re currently in. And that used to be somewhat frequent in my practice. Furthermore, the tools and workflow structures that orchestrate our day generally work against thoughtful, deep, individualized work with patients — driving us towards testing and diffusion of responsibility and fast, solo decisions.

So I do think that an article that came out in the New York Times recently is an important one.

Overall, the author, Dr. Dhruv Khullar, makes the point that “Doctors who care for disadvantaged populations need more resources to produce comparable health outcomes, but they’re less likely to have them.”  Further, that the current drive toward a fee-for-performance system is going to deeply dis-incentivize care of patients who have especially complex social, emotional, or economic needs. In a fee-for-service system, there are many inappropriate incentives — but at least doctors are compensated fairly for patients who have external circumstances demanding more time.

I think this perspective, in which we consider how new structures will affect all of our patients, is important. It’s not discussed enough, though. That said, I also worry that the framework of the discussion has some flaws. First, the framing of some patients as "poor / disadvantaged / complex" and others as "wealthy / straight forward" neglects to acknowledge that on any given day, even the wealthiest among us may experience complex social or economic constraints that make them the complex patient. Further, the truth is that the richness of our healthcare practice comes from treating all patients to a single standard  not to dividing up and choosing our standard of care (or who we treat) in any way.

Second, I believe that medical providers should view the imperatives of good medicine as outside of  and above  any fluctuations in payment or even workflow tools. We are each responsible for the hippocratic oath we took; we are each responsible to the human being sitting in front of us. It is up to us to find or create the tools and structures we need to do medicine in the ways that our conscience demands. 

That's why we believe so strongly in our work with iClickCare. The healthcare providers who use iClickCare to do healthcare collaboration, to improve medicine, to make their workday more satisfying do so because it's important to them  and they need wait for no one to start using it. It's affordable enough, and the ROI is so extreme, that it is a choice we can each make, on behalf of our patients  without anything else structural changing at all. 

You can try iClickCare today, for free, here: 

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Tags: healthcare collaboration, good medicine

Is Medical Training About Rigor… or Bullying?

Posted by Lawrence Kerr on Wed, Jun 20, 2018 @ 06:00 AM

matteo-vistocco-424475-unsplashI played college football at a Division III school. That means there were no scholarships or cheerleaders, and high levels of academic work were requisite to playing on the team.

But the rigors of the team — sprints and pulling heavy objects up a dusty hill and doing two practices a day in the heat of late summer — were intense and real. Our coach was certainly not always polite, and part of the reason he was able to extract such hard work from us was that we were scared of him. There was a lot of shouting, quite a bit of belittlement, and frequent exertion past the point of exhaustion.

But I, like most of my fellow players, look back on that time with the fondest of feelings. It was a time when I knew I was getting the most out of myself, getting out of my own way, and contributing to something bigger than myself.

In a similar way, I look back on my medical training — as taxing and exhausting as it was — with fondness and respect. So I was interested to read an article in the New York Times characterizing much of medical training as bullying and harassing.

A recent New York Times article, by Dr. Mikkael A. Sekeres, M.D., looked at whether the US medical training system, especially for doctors, is marked by bullying, belittlement, and harassment. He cites a study that surveyed 1,387 American medical students in their final year of school finding that 42 percent reported having experienced harassment and 84 percent experienced belittlement during medical school. And he shares his experiences in medical school and residency, with doctors pulling rank, obsessing about his perceived faults, expecting inhuman work hours, and unattainable ideals of precision. In other words: he had normal training for a doctor.

Dr. Sekeres’s experience didn’t surprise me, of course, and indeed makes me remember many of my own teachers and experiences — things that these days might be called bullying or even harassment.

The recent tendency in medicine has been to soften the system a bit. The hours' cap has dramatically changed the face of residency and not always for the better. Along with more reasonable work hours, I’ve observed a lower level of felt personal responsibility — the resident's hours are up for the week, so he is signing out, whether or not that’s what’s best for the patient.

For that reason and others, I have to admit that when I read Dr. Sekeres’s article, my response wasn’t primarily agreement — it was concern. My concern is that as doctors, we have a duty to care for our patients at the highest levels of rigor. And the medical training — the long hours, the unreasonable standards, and the exacting mentors — supports that in many ways.

But the more I thought about it, there more I realized that while rigor is crucial, there is a difference between rigor and bullying. I even see it in my own medical teaching. While other surgeons were known for loud operating rooms — music and shouting and even throwing things — my OR was always quiet and calm. Similarly, my relationship with the medical students was always calm, precise, friendly, and even relaxed — we collaborated from a love of learning and a love of work done well. And they worked very hard. So even my own experience contradicts this idea that rigor goes hand-in-hand with bullying.

Especially in the medical landscape in which we find ourselves today, healthcare collaboration is deeply important, possibly the most important thing that can happen on any given case. The truth is that the time of the Lone Wolf Doctor is over, and so if the bully-them-until-they-shine approach was ever effective, it’s certainly not effective in an age when collaboration and coordination calls for teamwork, respect, and collegiality, all of which can be taught and modeled just like surgical techniques.

My takeaway? We benefit from rigor but we don’t benefit from our teachers pulling rank, creating an un-collaborative environment, or not valuing every member of the medical team. We don’t benefit from teaching new doctors that they are alone in their work, must solve every problem on their own, and can disrespect their colleagues when it suits them.

Yes, demanding high standards of care and work ethic alongside high standards of professionalism and collegiality is a very high bar. But our patients' lives require it, and I believe that each of us is up to the task.

 

For more stories of how doctors are doing healthcare collaboration, download our Quick Guide: 

 

ClickCare Quick Guide to Medical Collaboration

Tags: healthcare collaboration, medical collaboration, good medicine

The Royal Wedding and Healthcare Collaboration

Posted by Lawrence Kerr on Tue, May 22, 2018 @ 06:00 AM

marko-pekic-145777-unsplashOne of challenges, and frankly, frustrations, of what we do at ClickCare is communicating the value of collaboration. The rewards (both emotional and tangible) to providers, patients, and institutions, are profound and meaningful. But to the uninitiated, healthcare collaboration can seem idealistic and impractical.

Collaboration is given lip service (Chronic Care Management CPT code XXXXX) but not truly cultivated or supported. It is not taught in medical schools, as there is such a competition for time in a curriculum. It seems to be taught better in nursing schools, but the experienced nurses are known for “eating their own”.  Pharmacy schools rarely produce graduates with a true intent on fitting into a team, and when they do, it's despite their training, not because of it.

Because of this conventional bias against healthcare collaboration, it takes true leaders (whether those leaders are aides or specialists or nurses or patients) to foment it. True leadership doesn't have to be sanctioned by an institution or lauded in a newspaper -- sometimes it's just simple acts of asking a question of a colleague or taking a moment to try something new. But true leadership does tend to take courage -- and it can give us courage to see other leaders, acting bravely.

So, when I find an example of leadership, I feel it should be acknowledged, celebrated, and learned from -- even if from an unlikely source.

I'll be honest -- I wasn't planning to wake up early to watch the royal wedding. Like many Americans, I often feel conflicted about the Royals -- and (not being very interested in fashion) wouldn't expect to find much of significance in such a seemingly frivolous event. 

But I ended up watching it from start to finish, finding myself drawn into the tradition, the ceremony, and the powerful lessons of both collaboration and leadership that made themselves known in subtle, but deeply significant, ways. 

A few leadership and healthcare collaboration lessons I learned from watching the royal wedding:

  1. Lead by inclusion and by example. 
    The bride and groom chose to include an American Episcopalian pastor in the African American tradition to give a sermon, something that had never been done before. They included an African American choir singing Stand By Me and Amen, Amen alongside the traditional songs. Instead of demurely hiding Meghan's African American heritage, they wove it artfully into the ceremony. And although surely not all of the tradition-bound attendees were fully supportive, the bride and groom were grounded and joyful throughout the event, not scurrying around for approval, but standing firm in the choices they made to honor tradition, honor both of their heritages, and perhaps bring the monarchy into a new age. This seemed to me an example of the best kind of leadership by example, not by rhetoric or coercion.

  2. Don't be afraid of the big issues.
    By acknowledging Meghan's heritage and country of origin throughout the event, the royal couple certainly took on the "elephant in the room," which could be an element of contention for such a tradition-bound event and context. Similarly, the beautiful sermon by Bishop Michael Curry made unflinching reference to the history of race relations in the US, including the Civil Rights Movement and slavery. Throughout, there was a willingness to take on what might be considered "difficult" or fraught topics, but to do so in elevated, inclusive ways.

  3. Remember that nothing big happens without collaboration.
    Yes, Saturday's event was a wedding. But it was also a massive event involving thousands of people, viewed by millions, and costing close to $50 million. It's staggering to imagine the massive collaboration that must have been needed -- to have each person contribute and be truly honored as important, but also have their contribution blended to become the whole. From the Kensington gardener who nurtured the flowers that Harry chose for Meghan's bouquet, to each musician that shared their song, to the members of their families, to the bride and groom themselves. Just the existence of such a scale of event is testament to the power of collaboration.

  4. Love is all you need.
    It seems sentimental and perhaps even unprofessional to speak of love in a blog post for a telemedicine company. But Bishop Curry's sermon reminded us of the transformative power of love in the creation or recreation of a culture, society, and world. He reminded us, as the royal wedding did, that love can be a catalyst for profound change and the driver of things that would be unimaginable without love's transformative power. Maybe in medicine we should talk more about love. And leave the medical jargon behind.

 

Will this event actually be remembered and change something, as the new couple wishes? Maybe or maybe not. But I do believe that in its example, this event gave us a shining example of a way forward. We need to respect each other; we need to find a greater cause in our duty; we need to compromise; and we need to be steadfast in our choices.

Many felt joy in watching the royal wedding on Saturday. And I believe that joy is something each of us can access daily (even hourly) in our everyday choices about leadership and about collaboration.

 

 

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Tags: healthcare collaboration, good medicine

Healthcare Collaboration Is No Replacement for Everyday Heroism

Posted by Lawrence Kerr on Thu, Apr 26, 2018 @ 06:00 AM

jessica-podraza-524601-unsplashAs healthcare providers, we have an almost unimaginable level of responsibility. Every day, we use our depth of knowledge, caring, compassion, and skill to cut people open, make life-or-death decisions, and execute sophisticated care plans in endlessly complex contexts. 

For that reason, I think that many healthcare providers start their career with a healthy level of pride about their personal skill and end up having a fair amount of confidence in their own abilities. 

That can mean that when the topic of healthcare collaboration comes up, there is a sense of skepticism. There's a subtle feeling of resistance, coming from the idea that, "If I have to ask for collaboration, it's because I wasn't able to do it on my own." Being passionate about collaboration, at ClickCare, we talk about working together as a team a lot. But does that mean that there isn't any place for individual achievement or even heroism in the work?

Recently, I was reminded that in addition to the deep rewards for teamwork, sometimes the skill and courage of a single individual really does "save the day."

On April 21st, James Shaw, a 29-year-old electrician, and his best friend Brennan McMurry went to a Nashville Waffle House for early-morning waffles. Minutes into their visit, a gunman opened fire. People were running and glass was shattering. But suddenly there was a pause in the shooting and Shaw realized that the shooter was reloading. That's when he leaped on the shooter, grabbed the rifle, and threw it over the counter. Although 4 people died in the attack, we know that the shooter had pockets bulging with ammunition and that Shaw likely saved dozens of lives in that courageous moment.

The week before, on April 17th, Southwest Airlines Flight 1380 was en route to Dallas when an engine exploded and shrapnel hit the fuselage, blowing a hole in one of the windows and partly sucking out one of the passengers (who eventually died.) Captain Tammie Jo Shults was calm and decisive in the cockpit, however. She radioed control without a hint of alarm in her voice. “Southwest 1380 has an engine fire. Descending.”

Guiding the plane towards Philadelphia with one engine out, she arranged for medics to meet the plane on the runway and then guided it to a smooth landing. There were 149 people on board and most thought the plane was not going to make it. But Shults was unfailingly collected and clear and skilled. As the New York Times reports, Captain Shults's reflexes and professionalism were hard-earned. "Captain Shults was well trained to handle stress in the cockpit. She had flown supersonic F/A-18 Hornets as one of the Navy’s first female pilots at a time when women were still barred from combat duty, before leaving active service in 1993." The story of the obstacles she had to overcome to pursue her passion and career are astounding and showed courage, grit, and heroism throughout. As a woman, she wasn't allowed to fly in the Air Force, and was denied combat positions as a pilot in the Navy -- but she flew in increasingly rarified and groundbreaking roles, including Operation Desert Storm.

Of course, in both of these cases, there was actually powerful teamwork behind the scenes as well. In the case of the Nashville Waffle House, Shaw's friend McMurry ushered people to safety and law enforcement hunted down the shooter in just 24 hours. Not to mention the doctors who treated the patients and other first responders. And on Flight 1380, flight attendants, the first officer, passengers, medics, and air traffic control all played a role in the successful outcome. 

And, in neither case was there an unmitigated success. Four people died at the Waffle House and one person died on Captain Shults's flight. Heroes don't always have perfect outcomes.

All of that said, both Shaw and Shults saved lives, showed exemplary action and courage, and gave us examples of what a hero can be, and do -- and what a difference one person can make.

As you find opportunities for healthcare collaboration, don't forget that you're also, so often, a lone hero. Both ways of working are necessary. And you owe it to yourself and your patients to do the right one at the right time. 

 

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Tags: healthcare collaboration software, good medicine

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