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Thoughts, comments, news, and reflections about healthcare IT from Microsoft's worldwide health senior director Bill Crounse, MD, on how information technology can improve healthcare delivery and services around the world.

New Audiocast: Collaborative solutions for better patient care and a healthier bottom line

New Audiocast: Collaborative solutions for better patient care and a healthier bottom line

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Back in January, I wrote a piece entitled Big Healthcare Savings from Surprisingly Simple Solutions.  I profiled some excellent work at Childrens Memorial Hospital of Chicago where they are using solutions built with Microsoft SharePoint, Microsoft Office, and InfoPath to absolutely delight clinical staff and add of ton of money to their bottom line.

This story is especially compelling because it didn't take expensive consultants or a lot of IT support to make it happen.  In fact, it originally started with one clinician who thought he could improve some scheduling and work-flow processes in his unit using software the hospital already owned.  He did much of the work himself in his spare time.  Some projects took only a few days to implement.  Now, clinicians and business leaders across the organization are launching their own projects based on the simple premise of using very powerful, intuitive and proven commodity software to tackle some of the big issues in healthcare. 

I wanted to share this story with more of you and decided to feature Children's Memorial Hospital of Chicago in my next House Calls audio-cast.  And, who better to tell the story than the clinicians themselves.  I hope you enjoy the show and I hope you'll share this with colleagues across the nation and the world.

Bill Crounse, MD       Worldwide Health Director       Microsoft Corporation 

Click below to listen to the program:

Collaborative solutions for better patient care and a healthier bottom line
This program is also available in MP3 for download.

Are clinicians and business managers in your organization hindered by poor communication? Do gaps in daily work-flow processes overwhelm your hospital and reduce your bottom line? Despite the IT systems you have in place, do you still rely on paper forms and processes? Simple and cost-effective communication and collaboration solutions can reduce these problems for you, your care teams, managers, and patients. In this audiocast, Dr. Bill Crounse and his guests discuss how Children’s Memorial Hospital of Chicago is using information technology solutions from  Microsoft to transform their business and improve their bottom line.

Panel guests

Dr. Cynthia Rigsby, is chief of Body Imaging at Children’s Memorial Hospital and co-chair of the Department of Medical Imaging.  She also serves as professor of Radiology at Northwestern University.

Dr. Andrew De Freitas, is attending physician in the Cardiology division at Children’s Memorial Hospital, is also a professor of Cardiology at Northwestern University.

Eric Gasber, is a Registered Nurse in Surgical Services with the Nursing Sedation Team at Children’s Memorial Hospital.

 

  • I read with interest the story of improving communication and collaboration at Children's Hospital

    We too have been working with Internet enabled tools to improve collaboration, as described below in a summary of a chapter I wrote in "Collaborate for Success! Breakthrough Strategies for Engaging Physicians, Nurses, and Hospital Executives."

    Please contact me at ken.cohn@collaborateforsuccess.com if you would like further information.

    Summary taken from: Chapter 11.  Building Community and Collaboration with Blogs,

    Kenneth H. Cohn, Glen Mohr, and William Ives, in: Collaborate for Success! Breakthrough Strategies for Engaging Physicians, Nurses, and Hospital Executives. Kenneth H. Cohn. Chicago: Health Administration Press, 2006. http://www.ache.org/pubs/cohn.cfm

    Biographic information

    Dr. Cohn is a practicing general surgeon who divides his time providing surgical coverage in New England and writing, speaking, teaching, and consulting. Dr. Cohn can be reached at ken.cohn@collaborateforsuccess.com or via his website, www.healthcarecollaboration.com.

    You may forward this information at will, provided that you reproduce it in its entirety and notify the author.  Thank you for helping disseminate information about how we can work more interdependently to improve care for our patients.

    The blog proved to be an invaluable tool for our Medical Advisory Panel.  The backbone of the blog was a summary of each meeting in outline form that was posted within a day of each meeting.  The blog facilitated our work by providing a convenient platform for continuation of the discussion.  Members who couldn’t attend a particular meeting could stay informed.  And it was particularly useful when it came time to write the summary report.  Having this organizational tool allowed me to recognize important themes that were relevant to the majority of the medical staff.   (Medical Advisory Panel co-chair)

    Introduction

    Physicians are becoming increasingly disaggregated.  The failure of reimbursement to keep up with rising expenses has forced many practitioners to increase the volume of patients they see and treat, thereby limiting their time for activities other than direct patient contact and hence limiting time with referring physicians.  

    New web technologies offer simple and convenient ways for clinicians to share information, to find others who have the information they need, and to keep in contact with one another.  The purpose of this summary is to discuss the use of blogs to create virtual medical communities. What is a blog?

    A blog (short for web log) is an easily maintained web site that allows a group of geographically disconnected people to form a virtual community. A blog makes communicating simple and convenient by making it easy to add new information, by archiving everything in a permanent, searchable database and by automatically notifying subscribers when new information is added. Blogs simplify communication.

    Blogs create a searchable and instantly accessible archive. Everything published on a blog can be readily accessed through a full-text search. For example, once someone answers a question on a blog, the answer becomes part of a permanent searchable knowledge base.

    Blogs encourage transparency. By making the interaction of the group more transparent, blogs invite participation and break down silos and hierarchies. For example, new members can get up to speed quickly and begin receiving the information they need by searching the archive and subscribing.

    Blogs enable secure centralized management. While blogs encourage transparency, they still offer control.

    Case study

    The utility of blogs in facilitating a clinical priority-setting process is outlined in the following case study.

    A 750-bed West-Coast hospital system began a structured dialogue process to engage physicians in setting clinical priorities for the next three to five years as it planned the construction of a new hospital that would consolidate two campuses.  A Medical Advisory Panel (MAP) was formed of sixteen clinically active physicians who committed to attending weekly meetings in return for a commitment from hospital leaders to give serious consideration to implementing the MAP recommendations, as described in Chapter 1. The MAP heard presentations from physicians in all major clinical areas on their recommendations to improve care for the community and foster better physician-physician and physician-administrator communication and collaboration.  The MAP collated the recommendations into a consensus report, which highlighted the need for major improvement initiatives involving information technology, radiology, the operating room, and the intensive care unit.

    A password-protected blog was created to support the structured dialogue process. To make it user-friendly, the blog design included pre-set content categories for Presenter Reports, Meeting Minutes, and Implementation Status. It also included prominent links to such common tasks as adding content and downloading materials. A blog administrator was trained and charged with regularly updating the blog, maintaining the flow of discussion, and ensuring that the blog discussion was integrated with the weekly face-to-face meetings. The administrator was also provided with an aggregator to facilitate seeking outside sources of information and bringing them into the structured dialogue process. Throughout the process, a physician-facilitator monitored use of the blog, customized the functionality to serve the panelists’ needs, and coached the administrator.

    In the first month of the structured dialogue process, panelists learned how to use the blog during a 20-minute presentation that explained:

    1) Its purpose in supporting the structured dialogue process and saving physicians’ time;

    2) Examples of ways blogs are used elsewhere in healthcare organizations;

    3) The login procedure, likely tasks, and how to obtain technical support.

    The blog facilitated the structured dialogue process at every step, as explained below.

    The blog provided a convenient distribution point for material relevant to physician presenters and their reports.  Panelists could download material that explained the structured dialogue process and criteria that reports were expected to address, which they gave to physician presenters in their department.  When presenters submitted their reports, they were uploaded to the blog, which generated an automatic e-mail linking to the report on the blog and reminding panelists to read the reports prior to the weekly MAP meeting.

    Within two days after each MAP meeting, minutes were posted to the blog, which helped panelists keep track of what they had done.  A calendar maintained on the blog kept important details from being overlooked.

    As the presentations drew to a close, the blog’s search engine facilitated report writing.  A large amount of data accumulated in the course of the MAP meeting weekly for eight months and hearing an average of two presentations each week. Panelists could search the archive to find recurring themes and specific comments and examples that otherwise might have faded in memory or have been too time-consuming to locate in the minutes and reports.

    The blog also served as the location to post drafts of the MAP report to allow panelists to provide important feedback at convenient times for them.

    Building solidarity and community The blog permitted panelists to interact outside the confines of weekly meetings, as new ideas surfaced and new issues appeared and the secure, password-protected site allowed panelists to discuss what was on their minds without fear of outsiders reading their comments.

    The 24x7 access decreased barriers to participation and allowed even reticent panel members to contribute to the structured dialogue process.  Some panelists found it easier to reflect over weekends than during Monday morning meetings.  The blog provided a way to capture their insights. For example, after spending a frustrating weekend on call, a physician panelist posted a detailed log of the time he wasted in Radiology trying to access studies of critically ill patients on whom he was consulted. His comments focused the MAP’s attention on Radiology service issues early in the process and gave others an opportunity to reflect on time they had wasted searching for imaging studies on their patients.  One participant commented, “I thought it was just me.”

    The blog also allowed physicians who missed a meeting because of vacation, illness, or a conference to remain current and as such, facilitated the process moving forward during the summer.

    The blog encouraged members to contribute information that they found relevant without worrying about wasting scarce meeting time. Some physicians used the blog to provide outside reading for fellow panelists, for example, an article on differences in cost of care between the US and Canada.

    Because successive drafts of the final report were posted to the blog, the writing process became transparent and supported the development of a consensus report, in which all panelists could take an ownership role.

    In short, the blog allowed the Medical Advisory Panel to pursue a data-driven  approach to clinical priority setting based on the material in physician presenters’ reports and lowered barriers to participation.  When polled at the end of the report-writing process, panelists unanimously endorsed continuation of the blog into the implementation phase and have asked senior administrators to become part of the weblog community by extending them passwords to the site.

    Lessons learned

    The design and approach employed in the case study ensured that panelists clearly understood the purpose of the blog and how it could facilitate the structured dialogue process.  In addition, it was important to have responsive support that not only handled technical issues but, more important, monitored use of the blog and adjusted the design and functionality to serve the panelists’ evolving needs. For example, initial use of the blog was limited to distributing presenter reports and meeting minutes. Later, new categories were added for implementation notes and links to the final report drafts.

    Blogs allow people who may be geographically disconnected to network and collaborate at times that are mutually convenient.  The user-friendly search characteristics facilitate using a blog as a data repository.  Blogs facilitate project management by allowing team members to know what is happening without wasting their time playing telephone tag and thus help them implement new ideas in a timely fashion.

    The transparent engagement that blogs facilitate encourages healthcare professionals to share their thoughts and feelings and makes it safe for new approaches to emerge by lessening risks of humiliation and failure.  For complex organizations that acknowledge that innovation occurs at the edge of chaos, blogs allow people to try out new ideas and benefit from the collective intelligence of their group.

    Key Concepts

    • A blog is an Internet-based, user-friendly content management system, useful for harried professionals seeking ways to make their time count, improve their practice environment, enhance physician-physician communication, and facilitate physician-hospital collaboration

    • Blogs make it easy for healthcare professionals to collaborate with colleagues at times of mutual convenience

    • Blogs mirror the way practicing physicians work: decentralized, searchable, available 24 x 7

    • A proactive but flexible organizational policy regarding blog use that encourages informal communication and discourages leaks of proprietary information and patient health information is necessary to foster spontaneity and serendipity

  • Trust in a Medical Setting.

    Experience dealing with a host of difficult to impossible situations may help others in their encounters with these difficult and distrusting patients. These individuals may make up a small per cent of patients and family members, probably less than 2 per cent, but take up 90 per cent of energy in coping with day-to-day conflicts that arise from their behavior. Difficulties managing distrustful patients and family members must be dealt with on the spot, and they don’t go away.

    Examples come from office experiences or wards, including situations that keep doctors and nurses and therapists awake at night, aggravate waking hours and poison leisure, that is, empirical, based upon experience and observation alone without science or theory. To survive an outrageous patient or relative requires resourcefulness, patience and imagination. Street wisdom learned the hard way is what I present, and without a guide or mentor to soften the bewilderment and sense of failure and frustration that accompanies these individuals. We seldom talk about these difficult, distrustful and sometimes threatening individuals amongst ourselves; rather we suffer and endure them silently, by ourselves. The problem is timeless as recorded in the world’s literature.

    Out of the wreckage of human behavior comes valued experience leading to maneuvers and tactics of survival that are appropriate to almost all aspects and settings of human interaction including day-to-day medical care.

    Links:

    Trust in a Medical Setting. Hauppauge, NY: Novinka Books, Nova Science Publishers, 2006.

    www.novapublishers.com

    richardsmithmd.com

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