ClickCare Café

The Healthcare Collaborators It's a Mistake to Overlook

Posted by Lawrence Kerr on Tue, Feb 12, 2019 @ 06:00 AM

ben-white-998822-unsplashMost healthcare providers struggle to collaborate with even the most essential of their colleagues. Many of us are stuck in the "dark ages" of phone tag or hoping that the EMR/EHR manages to coordinate different provider visits and perspectives. (I'll give you a hint: it doesn't.) 

While iClickCare is commonly used in hospital settings, private practices, or home healthcare, you might be surprised to know that iClickCare actually originated in elementary schools, with a school-based healthcare program. Our Founder is a pediatrician and she created the tool to collaborate with nurse practitioners at local low-income elementary schools. The goal was to use telemedicine to collaborate, coordinate care, and keep young students in class by resolving health problems more efficiently.

So when I heard about a recent program with similar goals, I was glad to know it is succeeding -- even as there are key aspects of it that fall short.

 

In 2012, Children's Hospital Colorado started a program with school and corporate collaborators -- it works with school nurses to train students to manage their asthma more effectively. 

The question asked in the article, "Are schools part of the healthcare system?” is an important one -- and I would answer with a resounding Yes. As Dr. Deterding said, “Even though schools may not want to be a medical healthcare delivery system, they are. ”In fact, I believe that “the healthcare system” includes far more collaborators than one would think. It’s not just doctors, nurses, and hospitals. Our collaborators in medicine include social workers, teachers, parents, kids, school nurses, home health aides… the list goes on and on and is unique for each patient.

According to Fierce Healthcare’s summary, participants in the Colorado program "experienced a 22% drop in school absenteeism and an 80% decline in hospitalizations and urgent care visits among pediatric asthma patients.”

While this is an exciting program, with strong results, I do think that we can do even better. Ultimately, this program doesn't create a foundation to improve the way we care for young patients overall -- it simply resolves one aspect of a complex care scenario. While results were excellent, I worry that the intervention isn't holistic enough or sustainable because it's not involving the full picture of these young patients' care. That said, I think there are several crucial learnings from this project that we can all take away. 

3 Key Care Coordination Learnings from a School-Based Health Program:

  • The people closest (geographically or emotionally) to our patients may have the strongest ability to support them.
    In this case, the people consistently close to these young patients are school nurses. School nurses are close in terms of physical access, are embedded in the students' community and cultural context, and likely know the students personally. Similarly, it's crucial to recognize the similar closeness of wound care nurses, home health aides, teachers, social workers, and others. Medicine can become very hierarchical, in which specialists are hyper-valued. But the reality is that for the best care to happen, we need to collaborate with the people closest to our patients as well. 
  • Working across the continuum of care can be a powerful way of achieving new results.
    The new world of healthcare requires that we expand our understanding of who is part of the care team. But I believe that it's not enough to simply engage school nurses to execute a program. We must truly collaborate across the continuum of care. We have seen over and over again that this approach yields a strong ROI and best-in-class patient care.
  • Tools used to bridge different aspects of the healthcare system must be robust and flexible. 
    What does that mean specifically? It means that our tools must do more than support us in treating a single disease, as with this asthma program. Rather, we need tools like telemedicine-based healthcare collaboration that help manage asthma today, a cancer scare tomorrow, and a complex broken leg next year. Healthcare is too complex, and our patients are too valuable, to settle for single-use tools.

With the inspiration of both the strengths and shortcomings of this program, I encourage you to look more broadly in your practice today. More broadly in terms of who you see as part of the care team... and more broadly in terms of what you expect from the tools you use in your practice of medicine. Our patients deserve more and better care coordination and healthcare collaboration -- and we deserve more and better satisfaction from the work we do.

 

Learn more about hybrid store-and-forward telemedicine and how it can help you do care coordination across the continuum of care:

ClickCare Quick Guide to Hybrid Store-and-Forward 

 

Tags: hybrid store and forward medical collaboration, nurse practitioners, nurse collaboration, healthcare collaboration software

Two Studies Show Care Coordination Can Be Simple

Posted by Lawrence Kerr on Wed, Jun 13, 2018 @ 06:00 AM

kara-michelle-544960-unsplashThere are certain transition points in medicine that are short in time, but outsized in importance. For instance, the moment of discharge, the moment of intake, the moment the patient arrives home after a hospital stay -- these are all brief periods within the scope of care but all have a big impact on outcomes.

And frequently, these moments of transition are attended by providers on the continuum of care that aren’t doctors and certainly aren’t super-specialists. It’s the aides, the nurses, the pharmacists, and the WOCNs that are there during these crucial moments.

Two recent studies put a spotlight on this truth for us… demonstrating just how important this dynamic is.
As Fierce Healthcare explores, “A nurse is typically the first person a patient interacts with, and he or she can set the tone for the entire visit.”  Because of that frontline position, a nurse can play a critical role in establishing a strong patient-provider, family-organization, relationship and even affecting the chances of a patient embarking on the indicated care plan. Nurses can also become a bridge among care modalities, connecting aspects of care, like behavioral care and physical care. A study they explored found that nurses were the crucial provider in a program that aimed to unify and streamline these two care approaches.

Similarly, Fierce Healthcare looked at an issue at Virginia Commonwealth University, in which pharmacists, a key part of the discharge process, weren’t being communicated with effectively: “Even though they are a key part of the discharge process, they had limited information on which patients were closest to being sent home.”

So Kelley Barry, senior clinical applications analyst at VCU Health, built a new system to indicate whether a pharmacist needs to rush to fill a prescription, whether a prescription is being waited for or delayed, or whether it’s been filled. Of course, “Discharge is a critical time for patients, particularly the elderly, and research shows that a more efficient, coordinated approach can ease the transition from hospital to home.”  VCU’s program lead said that the key step was breaking down the silos between the people involved in discharge.

"If you're not all working toward the same goal, you'll never meet it," Barry said. "If we all join in the conversation in real time, it makes things more efficient. That's what everybody really wants. How do we respect everyone's time and give the most updated information that everyone can act on?" 

In both cases — that of the study of the nurses and that of the pharmacist-oriented program, the solutions used:

  • Were simple and inexpensive.
  • Involved providers across the continuum of care.
  • Prioritized sharing information and bringing more people into the conversation.
  • Allowed participants to engage on their schedule, rather than a rigid way.
  • Didn't wait for change across the system -- they made improvements within an arena they could impact.

These are inspiring examples of people using care coordination, technology, and team-based healthcare collaboration in innovative ways. Did that innovation involve an expensive or technologically-advanced tool?  No. And that's just what makes these solutions so ingenious.

 

For more on simple ways of doing healthcare collaboration, get our Quick Guide for free: 

ClickCare Quick Guide to Medical Collaboration

Tags: care coordination, healthcare collaboration, nurse collaboration

3 Must-Dos From Nurses Creating Healthcare Innovations. Why We Like Healthcare Collaboration.

Posted by Lawrence Kerr on Wed, Dec 20, 2017 @ 10:03 AM

aditya-romansa-117344.jpgAbout a year ago, Maggie McLaughlin, a Registered Nurse, was caring for a baby in the NICU and his IV tube came unhooked. The baby started bleeding unexpectedly and, while he was alright in the end, Maggie was frustrated.

Doing some research, McLaughlin found that there is no accepted, effective way to keep IVs hooked to an infant's body. And that's when she started prototyping her own.

McLaughlin ended up developing an IV connection that lies flatter on a baby's skin and so holds more effectively than alternatives. She has partnered with a former nurse to create and market the device under the name IV Safe T. 

That a nurse may become an entrepreneur may sound unusual to some, but as the Boston Globe reports, "research has shown that nurses spend a significant portion of each shift using workarounds and making impromptu fixes to ineffective processes or equipment... Such adaptations take up time that could otherwise be devoted to patient care, but they also demonstrate creativity that can be channeled into developing new tools and procedures to improve the delivery of medicine."

This finding certainly resonates with our experience with ClickCare. From the very beginnings of the company, we've found that nurses have been the most courageous, principled, spirited, persistent collaborators of them all. From our beginnings in school-based healthcare programs, to today, nurses are a core part of what we do at ClickCare.

In fact, these nurses' entrepreneurship puts a spotlight on three things we think are crucial in healthcare:

  • Take matters into your own hands. These nurses found a problem... and instead of waiting for "someone else" to create a solution, they created their own solution. Whether it's pioneering a telemedicine program at your hospital or doing medical collaboration with colleagues, this is key.
  • Use your own experience as a guide. McLaughlin used her own experience with infants to identify the problem that she would solve with her product. We believe that whether it's with patient care or with entrepreneurship, your experience is your best guide.
  • Don't be constrained by hierarchy. Many people think doctors would be more likely to create healthcare innovations than nurses, because of their place in the medical hierarchy. In fact, we've found that providers across the continuum of care are indispensable for both innovation and healthcare collaboration. 

We hope you find these nurses' stories as inspiring as we do -- and that you find ways to take their approach into your own day. 

 

For more stories of innovation and collaboration, download our free medical collaboration quick guide:

ClickCare Quick Guide to Medical Collaboration

 

Tags: good medicine, healthcare collaboration, nurse collaboration

Education: Influencing Which Providers do Medical Collaboration Best

Posted by Lawrence Kerr on Mon, Jan 23, 2017 @ 06:30 AM

writingorders.jpgWe work with a lot of colleagues on medical collaboration -- so we see the good, the bad, and the ugly. We help individual providers get set up with iClickCare; help hospitals learn to do medical collaboration; and guide practices in incorporating telemedicine.

And we've noticed extreme variation in which providers tend to do medical collaboration easily and effectively. Of course, our propensity for collaboration varies widely from one individual to another, very much not constrained by job title. But some provider types tend to embrace collaboration more than others.

So, a question for you: which type of provider do you think does medical collaboration best: the nurse, the aide, the patient, the family, the generalist, the specialist, the dentist, the allied health (PT, OT, counselor)?
You can consider the question from a personality standpoint, but don't forget that there are other influences, beyond the individual, which affect our ability to work together. The range of structural influences impact our ability to collaborate at a fundamental level: the insurance company, the managed care providers, the megalith healthcare system, the smaller hospital, the critical access hospital, the health department, the federal government, the VA, the legal system.

All of that said, we've noticed a very consistent answer to the "best" and the "worst" of how providers do medical collaboration: doctors tend to collaborate the worst and nurses tend to collaborate the best.

So why do nurses tend to embrace collaboration and physicians tend not to, at least at the beginning?

Well, nurses are often more collaborative by nature. Many nurses chose the profession because their personalities are supportive and nurturing. By day to day, minute to minute work, they get orders, execute orders and communicate orders. They are the people who get things done. They see collaboration as benefiting them because they can coordinate the many people involved in getting done what the patient needs done. They are salaried and held to production metrics, but less so than similarly salaried physicians. They are constricted by the same forces as physicians such as HIPAA, but by and large are free of contracts with insurance companies, managed care, and productivity reports. Their education reflects these factors.

I also reflect on the dynamic of differing medical education, in terms of the messages we receive around medical collaboration. Since doctors write orders, they are told that they “are captain of the ship” and therefore fully responsible for outcomes even if they are not directly involved in an action. With deeper pockets than nurses, and with this identification as “captain”, it is they who are the targets of the legal system.

The education of physician reinforces the mantle of responsibility. Most likely, the individual physician was taught on the first day of medical school, “Pay attention, learn everything, because the life of the patient is fully and solely in your hands. If the patient dies, it is your fault.”

That is a different role than advocacy that is often taught to nurses. “You are the keeper of the patient. You must advocate for the patient.”

So with doctors and nurses coming from such different starting points, think about the complexity that compounds as we add dozens of different types of providers to the mix -- and we expect them to collaborate on behalf of the patient. I look forward to hearing your stories and experiences of collaboration in the comments below -- every person, case, patient, and provider is certainly different.

As we work together, we need to remember that “none of us is as smart as all of us.” 

What if that were the first sentence we learned in medical school, or nursing school, or any professional school? What if it were then reinforced as we learn and work? We would all be happier - and healthier - for it. 

 

Read our Quick Guide to Medical Collaboration here, with stories of medical collaboration from around the world:

ClickCare Quick Guide to Medical Collaboration

Tags: telemedicine, medical collaboration, nurse collaboration, medical education

The Key People in Health Care Collaboration? They're Not Always Doctors.

Posted by Lawrence Kerr on Mon, Aug 17, 2015 @ 07:30 AM

Medical collaboration across the continuum of care

 

One thing people have a hard time understanding about iClickCare is that it enables fairly open-ended communication and collaboration among multiple people on a patient's case. Everyone from aides to caregivers to parents to specialists to nurses teachers have been known to collaborate -- even on a single case. 

  • No, we explain, it's not just the transmission of orders through a medical system.
  • Yes, we assure, it's different from one-to-one text messaging, both because multiple parties share opinions in one place and because you can use multimedia. 

Not every medical provider appreciates just how important this is. But the ones who have collaborated with different kinds professionals throughout their career "get it" immediately:

  • "So, a teacher can collaborate on a patient's case and share how the surgery is affecting the patient at school? THANK GOODNESS."
  • "Finally! I can include technicians and aides in the conversation, who often have more up-to-date knowledge of the patient's status!"
  • "The fact that everyone on the case can 'ring in' on their timeframe, and that we can review all those comments later-- well, it changes everything." 

The sense of relief and excitement that many providers feel when they learn they can use a telemedicine tool to do medical collaboration across the continuum of care is palpable.

This sentiment was echoed recently in a couple of pieces from doctors in the New York Times. Dr. Klitzman shared his discomfort in trying to connect patients to the religious and spiritual help they may need -- and feeling like there was no mechanism to communicate with people outside of the patient's medical team who could help with their medical care. He says, "I occasionally noticed priests in white collars and rabbis wearing yarmulkes or black hats riding the elevators and walking the halls, but was surprised to find that other doctors and I simply ignored them, never speaking to them." There are simply not good protocols for including "providers" that aren't necessarily the traditional core team in the care of our patients. (In this case, religious leaders and caregivers.) That's a big reason iClickCare is intentionally "open-ended" (even as it is HIPAA-secure) so that providers can loop in the people most crucial to the patient's holistic care -- whether those people are doctors or not.

A related episode was described by Dr. Zuger. She shared a humbling moment when a patient was given an X-ray on the wrong foot because she'd accidentally made the order that way -- and the technician insisted that the X-ray be done consistent with the order, despite the patient's repeated protests. How much simpler would it be if the tech could have sent the prescribing physician a quick message to confirm the order? That way, all the providers, across the spectrum of care, are providing value -- not just following orders in a chain of command.

We're big proponents of the use of telemedicine for this kind of medical collaboration, but it can happen in real life (and real time), too. It just takes the bravery to ask the questions, the humility to collaborate with whoever is the most appropriate, and the creativity to find and make the protocols yourself.

 

You can try iClickCare for free, if you want to experiment with this kind of medical collaboration. Click here to find out more: 

Try the iClickCare 14-day evaluation

Tags: telemedicine, medical collaboration, nurse practitioners, good medicine, healthcare collaboration, nurse collaboration

How Medical Collaboration Can Make Us Feel Human Again

Posted by Lawrence Kerr on Fri, Aug 22, 2014 @ 11:44 AM

a warm gaze blunts provider burnout

Some people may think medical providers join the profession for the pay, status, or job stability. My experience, however, has been that the work is challenging, the pay is dropping, and every provider I know is doing it because they care about people.

As the Dennis Rosen, MD, writing in the New York Times recently quoted the mother of a son with a genetic abnormality, "I like the people in health care. People in health care, they don’t stare at my son like he’s some kind of freak, you know? They see him for who he is." And the child's doctor affirmed the connection, saying, "I have yet to meet a child who fails to kindle my compassion or to bring out in me the most basic desire to try to help."

Caring about people in medicine becomes more difficult every day.

This basic desire to connect and help can easily be thwarted by the realities of the job, however. Nearly half of medical providers experience burnout and when they do, they can lose their sense of empathy for others and feel deeply isolated and emotionally exhausted.

The connection between this disconnection and the burdens providers face is clear: "A significant proportion of doctors feel trapped, thwarted by the limited time they are allowed to spend with patients, stymied by the ever-changing rules set by insurers and other payers on what they can prescribe or offer as treatment and frustrated by the fact that any gains in efficiency offered by electronic medical records are so soon offset by numerous, newly devised administrative tasks that must also be completed on the computer." (Article here.)

Of course, we often think technology makes this kind of isolation and burnout worse. We get the sense that if we could return to a world before EMRs, incessant messages, and endless paperwork, we could connect with our patients. But the truth is that technology isn't going anywhere and our only choice is how to use it in our service. 

For instance, we've found that by using Hybrid Store-and-Forward Telemedicine, we're able to deal with consults more quickly, leaving more time and energy for the patient sitting right in front of us. Our colleagues have also found that collaboration and communication with other providers and patients can (1) cut that sense of isolation and (2) decrease the unfinished issues, both of which are so damaging. Finally, we believe that when we take small steps to take ownership over our day and our work, we feel more able to survive, thrive, and connect. 

So it's not that it's impossible to connect in this modern day of medicine. It just takes a return to the collaboration, communication, and empathy that got us into this work in the first place. 

 

For more stories of medical collaboration, click here:

 

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Image courtesy of lencioni on Flickr, used under Creative Commons rights.

Tags: telemedicine, medical collaboration, collaboration, communication with patients, provider burnout, nurse collaboration

5 Surprising Ways Telemedicine Supports Assisted Living

Posted by Lawrence Kerr on Thu, Mar 27, 2014 @ 12:59 PM

assistedliving resized 600

 

Telemedicine is often associated with very remote areas, access to super-specialized providers, or cutting-edge technology. However, some of the most heart-wrenching and interesting uses of telemedicine have been with ordinary people in ordinary circumstances.

In particular, I've seen how telemedicine can make Assisted Living Communities more efficient and more resident or person-centered. 

Assisted Living is often part of a transition from full independence to full support: a person finds a midpoint between living at home and skilled nursing care. Of course, the lines are blurry -- home care, independent living, assisted living, and full support care like memory care or skilled nursing. What all of these care services have in common, though, is the prioritization of excellent care and the maintenance of a patient's lifestyle and independence.

Traditionally telemedicine has served Assisted Living by technological replacement of human visits and by home monitoring. Significant gains in health have been documented by monitoring weight, medication adherence, blood pressure and activity. Medical collaboration tools like iClickCare bring another level of support. Tools like these can have a significant impact on senior care by enabling simple, secure care coordination and collaboration with the family, the resident (often a senior), and their caregivers and providers. HIPAA compliance is a given.

The creativity and commitment of Assisted Living providers is astounding -- and for that reason, they are innovating evermore ways of using telemedicine in their practice.

Here are just a few of the ways that Assisted Living Communities use telemedicine to improve care and decrease costs and hassle:

  • Measuring key patient indicators like weight or blood pressure without the resident having to leave their home
  • Efficient, remote collaboration with team members, specialists or key providers from nearby hospitals or practices
  • Aides and nurses, even family members, for more background history and also private pictures or video clips
  • Decrease in ER and OR visits due to surgeons and other providers evaluating remotely whether a procedure is required
  • Several kinds of provider "touch points" on a single case, since geriatric issues often involve more than one specialty 
What about the assisted living or senior care that you do? How has technology enabled better patient care? We'd love to hear your stories in the comments below...
For a free overview of telemedicine options, pros, and cons, click here:
ClickCare Quick Guide to Telemedicine
Image courtesy of adam_jones on Flickr, used under Creative Commons rights.

Tags: medical collaboration, coordinated care, assisted living facilities, care coordination, healthcare collaboration, nurse collaboration

What "Gravity" Taught me About Avoiding Provider Burnout

Posted by Lawrence Kerr on Tue, Oct 15, 2013 @ 10:43 AM

 

"This is Dr Ryan Stone. Do you copy?
Anyone? Do you copy….
Anyone?
Do you copy? Please! Copy?"

Gravity, Warner Brothers, Director Alfonso Cuarón 2013


 

How often do we wish that we could have someone who we could talk to? Someone to take to  bounce our treatment plan off, someone to help with followup, someone with whom to share the responsibility and relieve the loneliness. Someone to lighten the load. Even if the response is: "That sounds ok."

Burnout is, in part, caused by stress and not being able to do anything about it. A long-ago stress model was used to study peptic ulcer in rats. The stressor was nothing more than wrapping the mouse in restraints. We providers have restraints galore. We have hierarchies to deal with as nurses and HIPAA regulations everywhere. Lack of time cascades into documentation demands. There are too many patients. We struggle against our restraints to do what we know is complete and right. Then, we settle for what we can do. It is never enough. Each restrains us from what we need and want to do: take care of patients.

Do you copy? Anyone? 

We went into healthcare because we wanted to help someone. We do, but not in the way we wish, the way we know we could. More stressors dangle in front of us as we struggle against restraints. Quality assurance, documentation, uninformed family, distrustful patients, guilt and incompletion. 

What to do? Get the satisfaction and comfort of working with colleagues. Collaborate with your colleagues, your associates, your coworkers, your floor-mates. Whatever way you choose, find a way to talk to your friends. We prefer hybrid store-and-forward telemedicine because can talk to our colleagues on their own time, not their time or ours. Another schedule is avoided.

Whatever way you want to do it, do it. Collaborate today.

 

Download Quick Guide Medical Collaboration

Tags: hybrid store and forward medical collaboration, provider burnout, store and forward medical collaboration, nurse collaboration

The Shocking (and obvious) Truth About Medical Collaboration

Posted by Lawrence Kerr on Mon, Aug 12, 2013 @ 09:41 AM

This post was originally published on July 24th. Since this piece of our website was not working for all viewers, we're republishing some selected posts this week.  

Working with the doctors and nurses I see every day is one of my favorite things about this work. I also observe a lot of folks working together, and the frustrations and successes I have been seeing made me want to look in the literature for other perspectives on medical collaboration. I found many articles, but two of them really struck me. 

The first was about teamwork on inpatient medical units and the second discussed barriers to nurse-physician collaboration. They made some pretty stark observations about the ways healthcare providers are failing to work together effectively -- and why. 

Sure, we're working in teams and we're trying hard. But working in a team is not the same as working together in a team.

These studies found 4 key barriers to medical collaboration:

  1. People aren't in the same place at the same time. This may sound obvious, but the fact that medical teams are working in different buildings, across organizations, and over different shifts creates a unique communications challenge. Communications systems that ignore this challenge (like video conferencing systems or pages in hospital hallways) ultimately fail. 
  2. Common systems don't work. Healthcare providers report that the communications systems they're expected to use don't facilitate collaboration or coordination of care. Whether it's an EMR, a paging system, or telephone calls, providers are frustrated with the current options. They're old technologies that don't match the pace, aspirations, or reality of healthcare today. 
  3. Coordination of care is basic, and not happening. You would think that the question, "who is taking care of this patient?" would be pretty basic. But providers report that coordination of care is taking up increasing amounts of their time and happening poorly. So poorly, in fact, that knowing who is taking care of a given patient is becoming a daily challenge.
  4. The "cockpit approach" doesn't work. Well, to be more specific, it does work -- 10% of the time. In a few specific situations, like in ERs and NICUs, applying learnings from airplane cockpits works (e.g., using checklists). But as Zwarenstien and Reeves point out, 90% of medicine takes place outside of this type of setting. The rest of medicine involves fluid teams, long-term and complex problems, and takes place in different locations and different times. That means that the cockpit construct doesn't help much, and these teams are left without a solution.

These barriers are familiar to me, both in our own hospital setting, and in the experience of many ClickCare users. The good news is that time and time again, I've seen creative, courageous nurses, aides, and physicians overcome these barriers, creating better patient care and a better provider experience.

What ClickCare's users taught me about breaking through to medical collaboration: 

  1. Accept that this is your problem, even if it's not your fault. We may not have caused these difficulties in collaboration and communication, but we're suffering from them. The good news is that we've noticed ClickCare users getting a lot of satisfaction and stress-relief from collaboration. It wasn't their fault that it wasn't happening in the first place, but it did benefit them to make it happen.  
  2. Experiment. There isn't a one-size-fits-all solution for collaboration, and so we have to experiment with figuring out what can work for us. The thing about experimentation, though, is that new efforts may not work right away. In the words of Seth Godin, "Anyone who says failure is not an option has also ruled out innovation." 
  3. Choose a communications technology that works for you, even if not everyone is using it. As human beings, we have a tendency to wait for permission, to wait for standardization, to wait until we find out what everyone else is doing. But given the slow rate of change in the medical world, we have to take change into our own hands. Even if not everyone has adopted a new technology, it could easily be the right thing for us, for our organization, and for our patients. 
Try the iClickCare 14-day evaluation

Tags: medical collaboration, coordinated care, collaboration, communication with patients, provider burnout, nurse practitioners, good medicine, collaboration leadership, nurse collaboration, clickcare

Can't Keep Up? 5 Ways to Simplify Medical Collaboration

Posted by Lawrence Kerr on Tue, Jun 18, 2013 @ 03:04 PM

It started off as one of those crazy days. Eating my breakfast out of a napkin as I walk, and tying my tie at stoplights on the way to the hospital. 

As I walked into the Operating Room holding area, it was the usual scene. Doctors and nurses rushing past each other. Everyone waiting for my 7 signatures to prevent a "Never Event." Rushed voices, and a tangle of regulations to navigate. 

Then, something shifted. Maybe my demeanor was different or the sunny weather made everyone take their time,. But suddenly the rush to the OR took on the easy, collaborative, good-humored tone that it used to have, when medical collaboration came naturally and the pace of healthcare was slower. As I walked down the hall, I had conversation (and collaboration) after conversation:

Dr. Gupta: "Thanks for seeing my Dad. What did you think?"
Me: "He's such a nice man. I think we're OK to do the surgery the way we talked about on Monday. Also, could you shed some light on what he said about his abdominal pain?"

Michelle, the OR nurse: "We have this equipment available for this morning, Do you want anything else? We were thinking that this would be a good setup." 
Me: "Looks good. Just so you have an idea, let me show you this photo of the patient, and here is his history, by the way."
Michelle: "Hmm... got it. Oh, then I have another idea. Let me get this other thing ready as well."
Me: "Anything else I can do to stop you from running around?"
Michelle:  "Nope! I'm glad I talked to you! This will be a lot easier."

Dr. Brandt: "So, looks like we're set to do the case together next Friday. Any thoughts on it?"
Me: "Like you said before, this is a risky procedure for Mr. S. The trouble is, he's run out of options. I tried for over two years to treat this problem without surgery because of his multiple medical conditions."
Dr. Brandt: "That makes me feel better. I was really worried... but now at least I know that other options were tried."

Leah, the Recovery Room nurse: "You know the little girl you did surgery on yesterday? What is she talking about? Something about a knob?"
Me (laughing): "Yep! Rachael and I talked about controlling her pain by imagining a knob that can she can control and 'turn down' her discomfort. Have you used self-hypnosis much?" [Then, a brief conversation about self-hypnosis ensues.]
Leah: "That makes so much sense. Focusing on healing instead of pain is exactly why I hate being forced to ask the patient 'How much PAIN do you have, on a scale of 1 to 10?' Do you think we can do anything about it?"

Carol, the nurse on the floor: "This Mom is kind of nervous. Everything is fine, but I think it best if you could come up and just make a quick check."
Me: "Thanks for letting me know. And I'm happy to see you! It's so nice to talk like we used to once in a while."

Looked at one by one, there is nothing special about this collection of conversations. But it's a rare day in this new world of EMRs and regulations that it actually happens. This day was a good day-- a simple day of medical collaboration and happy providers.  

Here's what I noticed about it: 

  1. Doctors and nurses are working together on the patient's behalf
  2. Providers are desparately seeking support, input, and encouragement... and when provider burnout 
  3. Support is there, when providers seek it out
  4. Human, personal patient care happens, despite the systemic barriers, forms, and check-boxes
  5. Providers really care -- on a deep, emotional level -- about their patients.

In the everyday stress of being a provider and the commitment of the medical profession, this pleasure in caring for patients can start to disappear. The day I describe above was a good one, and I hope more of your days can be, too. So, in service to that... 

5 tips to simplify medical collaboration and make every day a good day in the OR: 

  1. Remember the patient. Despite all the regulatory hurtles, always keep in mind that it is the patient, not the record, you are caring for.
  2. Know that you're not the only one who's stressed. The truth is that your colleagues, no matter where in the hierarchy, are as stressed as as you are (or more so.) Remembering that can help you give people the benefit of the doubt and help you feel more like part of a team.
  3. Take a second to encourage someone. It doesn’t take a whole lot of effort to support each other-- and it pays off in so many ways.
  4. Search out and use the tools available to you. Whether it's telemedicine, a great pen, or a new app, experiment with the tools that can help you care for your patients and your colleagues.
  5. Keep trying. Keep looking for better ways to work happily as a healthcare provider. Happy providers mean improved patient satisfaction, so it couldn't be more important. These ways are still there, but we must winnow through more chaff. You care and your colleagues care. So keep trying.
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Tags: medical collaboration, collaboration, care coordination, healthcare collaboration, nurse collaboration

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