Recently, a consultant from MIT visited a frustrated manager at a call center. The manager was experiencing something that many medical providers have experienced at different times. He was struggling to figure out "why some of his teams got excellent results, while other, seemingly similar, teams struggled?" It's that same frustration we wonder about as providers: we feel "flow" and pride in giving excellent care at one place where we work, while everything seems difficult at a different hospital or location.

After months of data analysis, the call center folks found that the teams that performed best were those that communicated best: "we’ve found patterns of communication to be the most important predictor of a team’s success. Not only that, but they are as significant as all the other factors—individual intelligence, personality, skill, and the substance of discussions—combined."

So how can you improve communications? Well, the hospital lounge is evidence that we've known the answer all along. The call center made one simple change to try to improve communication: they adjusted break schedules so everyone could take a break, make a coffee, and have a conversation at the same time. That change had huge consequences. Soon, they were seeing such increases in efficiency that they anticipate a savings of $15 million per year.

And while medical providers tend to measure success more in terms of patient outcomes than in terms of efficiency, we think there are some interesting patterns to inform our providers for medical collaboration. The coffee-break solution helped cultivate good teamwork, but what are the characteristics of what a good team actually looks like?

5 things that turn a good group of people into a great team for medical collaboration, via HBR:

• Everyone on the team talks and listens in roughly equal measure with short communications. That's why the entire continuum of care -- nurses, aides, doctors, and everyone in between -- must be included in the care conversation.
• With conference room encounters, members face each other and have energetic conversations and gestures. With communication technologies this means feedback, prompt responses, and a simple thanks. Video conferences take time and money. But store-and-forward telemedicine tools allow for this kind of energetic exchange of ideas.
• Members connect with each other not just the group leader. The typical "hub and spoke" consultation doesn't allow all team members to collaborate or share information. Face to face conversations and some telemedicine can support these kinds of "horizontal" conversations.
• Members can carry on back-channel and side conversation with the team. We feel everyone, no matter where in the hierarchy, should be talking to each other.
• Members periodically break, explore outside the team and bring information back. While there's a place for efficiency and 100-hour weeks, we certainly think that medical providers benefit from not being excessively overworked and overtaxed. One benefit (among many) is that team members that have a little wiggle room in their schedule can bring back new ideas and information. 

 
There may be specialties that have more fanfare or higher profiles. But Long Term Care is unique, fundamentally important, and complex for two reasons. First, it is the only speciality in medicine that affects every person -- both as a family member and as a care recipient -- at some point in their lives. Second, it invariably involves many collaborators, at all points in the continuum of care, and needs the focused collaboration of the family.

For instance, even in the simplest of long term care cases, all of the following people, and more, will likely need to be involved:

• Physician Assistant
• Nurse
• Home care aide or other caregiver
• Cardiologist
• Physician
• Therapists
• Wound Care Nurse
• Family

Managing, coordinating, and supporting these Interdisciplinary Teams can be time-consuming, risky, and difficult. Communication is great, but the more people that get involved, the more risk there is that something could fall through the cracks. Many teams actually choose to limit the number and type of people that collaborate on a given case. This is not an ideal solution, however.

Effective collaboration among every provider on the continuum of care is really the only way to ensure the best results for the patient.

Increasingly, the Long Term Care community is acknowledging this complexity and emphasizing the use of Interdisciplinary Teams (IDT) as a means to support the best patient centered care. And when it comes to Medicare reimbursement and submitting correct MDS data, an interdisciplinary approach is not just "nice to have" -- it is absolutely essential.

So how does a team providing Long Term Care coordinate and collaborate without letting any balls get dropped? We know it's not easy, so we recommend using tools to help make this kind of medical collaboration effortless. We know, we know -- technology can sometimes make our lives more difficult. But deciphering stacks of handwritten notes and playing phone tag is not effortless. That's why we created iClickCare -- we knew most teams need an effortless, easy-to-use way to collaborate that works with, not against, the flow of their lives and work.

In a long term care setting, using a telemedicine tool for medical collaboration can help you:

• Communicate efficiently and quickly to make better informed decisions
• Create, share, and implement care plans.
• Quickly send notes, photos and video clips to others and get efficient consults.
• Include the family in care decisions in meaningful ways.
• Avoid unnecessary doctor's visits and care delays.

If you'd like to hear stories of how people across the medical community and beyond are using medical collaboration, get our guide here:

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

When it comes to using technology -- for medical collaboration, communication, meaningful use of medical records, or any other crucial function -- there are a lot of considerations that come into play.

In our relationships with current and prospective iClickCare users, we've seen decision parameters run the gamut from savvy to uninformed. And we were intrigued to see a recent report on key features that home health agencies look for in software, from Software Advice, a company that reviews medical software. In 385 interactions with home health software buyers, they found:

• 97% of buyers prefer a cloud-based system over an on-premise solution.
• Field support (mobile and remote access) was the most requested feature to better track care in the patient’s home.
• First-time buyers want the benefits of going digital, and top reasons for purchasing included improving efficiency (58%) and “going paperless” (35%).

We think that this orientation toward cloud-based, efficient, adaptable systems that allow remote access is right on.

This is a smart way for home health agencies -- any group, really -- to make the most of their technology dollars, comply with regulatory issues, and positively impact patient and provider satisfaction. That's one reason we had concerns about a report that Time Warner Cable and the Cleveland Clinic are collaborating on a pilot project installing video conferencing hardware in patient's homes to lower hospital readmissions. This kind of focus on expensive hardware installations can actually make outcomes for patients worse. By not using simple software, cloud-based systems that can be accessed from anywhere, and leveraging hardware that providers already have (like the smartphone in their pocket), a lot of resources tend to be wasted. For that reason, we recommend keeping the following things in mind in any big health IT investment: 

• Keep hardware investment to a minimum. Always see whether you can use existing hardware -- whether computers, smartphones, or other resources -- and invest your dollars in good software and systems. Hardware can easily go obsolete, while software can be updated.
• Make sure it's easy to use. Medical providers have enough on their plate without having to learn complicated systems or having to operate completely new hardware. Look for something that leverages what people already know... and demand a well-designed, easy-to-use interface.
• Prioritize flexibility and collaboration. Some systems can only be used or shared with providers that are "in the network." Look for a service that allows you to get consults and support from any provider, regardless of their status with your service.
• Invest in systems that can be used from anywhere. As the study above shows, savvy buyers are looking for cloud-based services (SaaS) that can be accessed from anywhere -- that kind of flexibility tends to pay off in the long run.

Student athletes face a challenging set of pressures. Like any young people, they must navigate their own aspirations, work with their family's needs, and juggle academics. But students that are also athletes face the additional pressures to maintain scholarships, perform on the field, adhere to team requirements, and keep up demanding practices and training schedules. In fact, a 2011 NCAA survey showed that football and men’s basketball players identify themselves more strongly as athletes than as students. For that reason -- we discuss the ways in which an athlete's pressures almost match that of a job -- the National Labor Relations Board ruled that Northwestern University’s football team was eligible to unionize.

The pressures that student athletes face, however, don't necessarily imply that the team is in any way exploitative -- or under any less pressure than the athlete herself. Teams face a myriad of pressures as well, and often with insufficient resources to meet them. Despite widespread beliefs that sports teams are money-making machines, only 10% of Division I college sports programs turn a profit. Teams -- and the coaches, athletic trainers, and other staff that make them up -- are under pressure from the university, their own budgets, professors, parents, and the athletes themselves. It's a delicate balance with high stakes. An injured player can present a set of difficult decisions and each stakeholder may have a different opinion on the right course forward.

One example of the recognition of these pressures is Natasha's Law, which requires high school coaches and trainers to make sure that a player with a concussion doesn't experience any further symptoms for a full 30 minutes before putting back her into play. Some coaches, trainers, or players may object to this kind of regulation, arguing that they can make better decisions than the law can. But sometimes this kind of regulation actually makes athletic trainers' lives easier by mitigating demands.

As the New York Times recently wrote: 

"Strong athletic departments do two things well. They afford young athletes the chance to reach their full potential, and they prepare them for life when the cheering stops."

Athletic trainers walk this line every day. First of all, there can sometimes be a contradiction between supporting a young athlete in reaching his full potential today and preparing him for life after sports. Second, the athletic trainer and department must consider the needs of not just "this" athlete -- but of all the athletes on the team, present and future.

What pressures do you face as medical providers treating athletes? Have you noticed them increasing over time? We look forward to hearing, in the comments below. 

And get our guide on how telemedicine can help deal with the pressures you face as an athletic trainer:

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

Telemedicine practitioners can feel isolated. They are often among a handful of people in their immediate practice or hospital who are using telemedicine to perfect care, improve outcomes, and make their lives easier. 

The truth, however, is that healthcare providers using telemedicine are part of a large, growing, and thriving community. When we started working in this field almost two decades ago, telemedicine was rare. Now, however, the most committed, innovative healthcare providers all use telemedicine in one form or another. 

Telemedicine is actually thriving. Here are 5 reasons why: 

• Politics are catching up. As this article details, parity laws are going into effect in several states. Also, the Telehealth Modernizaion Act -- to establish a clear definition of telehealth -- is on its way to going through. "Telehealth is a major contributing factor to increased health care quality, convenience, and lower costs," said Reps. Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio)
• Telemedicine is reaching critical mass. Research and Markets is predicting 18.5 % growth in global telemedicine in the next 4 years. 
• New providers are more familiar with technology. For some of the same reasons as we highlighted in our discussion of concierge medicine, and as this article discusses, new providers are adopting practices like telemedicine at higher rates.
• Providers are using smartphones in their practice. According to Verizon, "38% of physicians with smartphones use medical apps on a daily basis, and that number is expected to increase to 50% this year. Two-thirds of healthcare providers said that implementing or improving their use of mobile technologies is a high or mid-level priority during the next 12 months."

We're thrilled to know that providers are connecting better, people are collaborating, and patient care is improving as telemedicine becomes more widespread.

If you're looking into the options, get our Quick Guide to Telemedicine here:

Image courtesy of thomaslevinson on flickr.com, used under Creative Commons rights. 

Daniel Diaz was peeling an avocado recently and cut himself. Five stitches later, the hospital billed him $3,355.96.

Daniel's case is far from unique. Hospital charges are skyrocketing -- California Pacific Medical Center’s prices have doubled in the past 8 years. And although recent news has focused on insurance, costs and pricing models are proving to be one area of both concern and opportunity in the medical community.

High hospital costs are symptomatic of a system that isn't aligning care with costs. Finances are evermore opaque, bills don't seem to match the service provided, and patients -- not to mention providers -- seem frustrated and disillusioned. But true costs are not necessarily driving high prices. As the New York Times reports, "The main reason for high hospital costs in the United States, economists say, is fiscal, not medical." And it is hospital costs, not doctors' fees, that are the majority of the costs billed to patients.

So healthcare providers are often stuck in a system that doesn't make sense to patients, and doesn't prove rewarding (financially or medically) to the provider. It is in this context that some providers are exiting the system entirely, cutting ties to insurance and sometimes hospitals, and moving to a "concierge medicine" model. “When I decided to abandon insurance, I didn’t want to lose my patient base and make it unaffordable,” Dr. Stanford Owen, a physician who recently switched to the model, said. “I have everything from waitresses and shrimpers to international businessmen. It’s a concierge model, but it’s also the personal doctor model.” 

Concierge medicine is defined in this article as "a growing subset of medicine where patients pay doctors anywhere from $1,500 to $25,000 a year to receive personalized attention and care." It is a model that lets providers drive care, charges patients a truer cost for the care they receive, and may decrease costs overall. While concierge medicine is often associated with "white glove" treatment for the ultra-rich, the model is most basically a model in which doctors cultivate a direct care and payment relationship with patients, circumnavigating the insurance system.

In many ways, concierge medicine (especially in the humbler family doctor model) solves many of the problems we see in healthcare today. That said, it has its limitations, especially when it comes to specialists. “The vast majority of patients I see have very little money and are very, very sick,” Dr. Lahita, an autoimmune specialist, said. “It would be unconscionable for me to take cash. I’d limit my practice, and it wouldn’t be wise.”

We'll be exploring more about the concierge medicine model this month. It may not be the definitive answer to any of medicine's problems, but we certainly salute the brave physicians that are experimenting with a new model -- failures and successes included.

Concierge medicine makes medical collaboration crucial.  Get our guide:

 We've all had those moments when it seems our brain has not caught up with our body -- or our schedule. As Dr. Pauline Chen described, "I had walked into the exam room to listen to this patient; but my mind was a few steps behind, as I struggled with thoughts about the colleague who’d just snapped at me over the phone because she was in no mood to get another new consult, my mounting piles of unfinished paperwork, and the young patient with widespread cancer whom I’d seen earlier in the day. " 

This feeling of distraction and stress is the opposite of what is termed mindfulness. It may sounds like a warm-and-fuzzy concept, but new research is showing some pretty concrete results from mindfulness practices that help healthcare providers be present, listen better, and do one thing at a time.

New research on mindfulness and healthcare provider burnout shows:

1. Being distracted burns us out. The experience of feeling like our mind is a million places at once contributes to healthcare provider burnout, making us sick, dissatisfied, and exhausted. 
2. Mindful providers are good providers. The research showed that mindful providers had more satisfied patients, better compliance with treatment, and even higher efficiency. 
3. Mindfulness isn't as tricky as it sounds. As the New York Times reported, "Even after [a very short mindfulness course], the researchers found decreased levels of burnout, anxiety, depression and distress among the doctors. And nearly a year later, those salutary effects persisted."

Our favorite mindfulness tool? Telemedicine.

Telemedicine -- especially hybrid store-and-forward telemedicine -- is a tool to get things out of your head and into a system so you can focus on the NOW. Consult requests, pending questions, past patients, teaching cases, and future questions are all in one spot. So when that older gentleman or small child is slowly describing their symptoms, you're happy to take a breath, be there, and listen. 

Curious if telemedicine could help you be more mindful? Get a guide to the options:

A recent New York Times article highlights hospitals featuring luxury amenities like organic meals, swanky lobbies, and posh rooms. In fact, the article even shows a number of hospital and hotel interiors and dares you to guess which is which. The hospitals featured are part of a larger trend in which the "Disney experience" is a common phrase among hospital adminstrators. 

“We found that patient demand correlates much better to amenities than quality of care,” said Dr. John Romley, a research professor at the Leonard D. Schaeffer Center for Health Policy and Economics of the University of Southern California.

But in an age when 50% of providers are burned out and we know patient satisfaction starts with provider satisfaction, are luxury hospital approaches sustainable? Posh hospitals might improve demand, but do they improve patient satisfaction -- or more importantly -- outcomes?

As we know from sources like this New York Times article, providers need many of the same things that lead to patient satisfaction. Both patients and providers need more time in the exam room, better communication, simpler regulations, less rush, and more authentic interaction. So while Haagen-Dazs in waiting rooms might improve demand, we wonder whether it will ultimately also take away from the very things that make patients -- and providers -- happy and well. 

Just another reason we're grateful for the long-term, win-win thinking of our ClickCare community and customers. 

Could telemedicine without video conferencing simplify your life? Take a look:

Trying hard is something that comes naturally to me. I may not have been the fastest player on the football field, but I was the one that hustled the most.

Practicing medicine has often been about trying hard, as well: long hours; fascinating research; late-night visits to post-surgery babies on the way home from dinner with my family. 

But in recent years, as medicine has become increasingly regulated, I notice a trend toward the legislation of hard work. Patient satisfaction went from a feeling to a metric. Collaboration about serving our patients went from a chat in a hospital hallway to a Powerpoint with "tips" on shaking hands and what to say in the exam room.

Combine this kind of profit-seeking approach with healthcare providers that work hard and care harder… and you've got a recipe for burnout and frustration. Providers suffer, medicine stagnates, and patient satisfaction ends up lost in the shuffle.

So I've started doing the only thing I can in this environment: do the right thing in the moment. I've started thinking of it as Zen and the Art of Patient Satisfaction, in fact. Forget the rules. Forget whether this is your first patient or your fiftieth. Forget whether you need to be more productive or have a higher patient satisfaction rating or whether you've been sued before.

Stop trying so hard. 

As Eugen Herrigel says in the famous book Zen and the Art of Archery, "The man, the art, the work -- it is all one.” That moment when patient, provider, and collaborators are all in the moment and truly being responsive to each other: that is Zen and the Art of Patient Satisfaction. And the satisfaction belongs to every single person involved in the care -- as long as they're present.