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What you should care about in healthcare today, from the editors of Becker's Hospital Review

Hospitals: Why are you surprised nobody wants to use your patient portal?

It's a familiar routine for many patients: navigate to a hospital website and let the clicking begin. First locate the patient portal. Log in. Want to see X-rays from a past appointment? Log into a different portal. Hoping to pay a bill? Try again. Just looking to confirm an upcoming appointment? Go back to the first login and — oh, the server is down.



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Gun violence in hospitals: How much of a threat is it really?

Within the past few weeks, three shootings in healthcare settings made national headlines.

In late December 2014, a man walked into the critical care unit of Wentworth-Douglass Hospital in Dover, N.H., in the early morning and shot and killed his wife before fatally shooting himself. Days later, a shooting at a Veterans Affairs clinic in El Paso, Texas, left a psychologist and the gunman dead.

And more recently, the cardiovascular surgeon who was shot by the relative of a former hospital patient shortly after 11 a.m. on Jan. 20 at Brigham and Women's Hospital in Boston has died.

The succession of these events in such a short period of time may lead some to wonder why more isn't being done to avoid such tragedies. But these events don't occur as frequently as it may seem right now, and steps to avoid such incidents are so potentially burdensome to hospitals that many aren't realistic.

It may sound harsh, but let's look at the facts.

A study published in the Annals of Emergency Medicine identified roughly 154 hospital-related shootings in the United States between 2000 and 2011, roughly 59 percent of which actually occurred in the hospital as opposed to outside on its grounds.

The most common victim of these shootings? The perpetrator. Nearly half (45 percent) of the victims of hospital-related shootings were the perpetrators. Hospital employees comprised roughly 20 percent of victims, whereas nurse (5 percent) and physician (3 percent) victims were relatively infrequent, according to the study.

Ultimately, researchers found hospital-related shootings are relatively rare when compared with other forms of workplace violence such as assault and disorderly conduct. In fact, the likelihood of getting stuck by lighting is higher than the likelihood of being shot in a hospital.



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When it comes to party politics, some CEOs put on more of a poker face than others

Keeping your political opinions out of the office is plain old common sense to most professionals. But the stakes might be especially high if you're a hospital executive.

Executives exercise discretion about so many aspects of their lives. It's a mix of corporate culture, plain old professionalism and concern that something could alienate them from stakeholders and affect the wider organization.
 
The growing hype and predictions about November 2016 make me all the more curious about moods in the C-suite during a presidential election. How hard must executives work to keep their political views out of a job that takes up so much of their lives? And if they don't, what's at stake?
 
Chris Van Gorder, president and CEO of San Diego-based Scripps Health, leads a tax-exempt organization. This means Scripps cannot engage in political campaigning, but that hardly makes Mr. Van Gorder's job immune from incoming political pressures. He still gets bombarded with political emails, letters and requests for donations to candidates.
 
He helps ensure the system is in compliance with the IRS and maintains a politically neutral position, but as an individual, he takes that impartiality one step further.
 
Even as a citizen — as Chris Van Gorder the California resident and registered U.S. voter, not the CEO — he avoids private endorsements and donations to candidates. A show of support made in private can still be interpreted as a Scripps endorsement, he says, and his actions could indirectly equate Scripps to any one political position. The Federal Election Commission's contribution database shows Mr. Van Gorder has pledged money on his own behalf only to the California Hospital Association, a total of $6,500 since 1997.
 
Some executives go an extra mile and take their party affiliation even further off the table. California residents need not disclose their political party when registering to vote, and many Scripps executives have registered either as Independent voters or refrained from specifying their party altogether. "When we are interfacing with Democrats and Republicans, it's easier for us to not be part of any political party and be neutral so we can focus more on the issues opposed to the politics of the issues," says Mr. Van Gorder.
 
Elephants and donkeys aren't much of a concern when you're sick. It's far-fetched to assume patients in need of care will choose a physician or hospital by combing through the FEC database and learning more about the CEO's side of the aisle.
 
Board members and employers, on the other hand — this piece of information might mean more to them.



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When will terrorism supplant healthcare as the most talked-about national issue?

Over the last few years, a great deal of national attention has been focused on healthcare and Patient Protection and Affordable Care Act. The Democrats originally campaigned to make healthcare — and a national program to cover the uninsured — a key political issue. The Republicans then used the periodic unpopularity of the PPACA and issues related to it as a key point to reclaim the Senate in 2014.

While there is a lot that can be changed in healthcare, of course, and while it impacts a great portion of the economy on a national and individual level, I wonder as follows: Will the great majority of Americans get bored with the issue? Will discussions by Republicans and Democrats resonate less and less with the public?

A recent Gallup poll identified the social issues generating public concern throughout the past year. The results were interesting. Complaints about government leadership — including President Barack Obama, the Republicans in Congress and general political conflict — led the list; 18 percent of Americans identified them as American's most important problem. Ten percent named healthcare, making it fourth on the list.

And yet terrorism was third-to-last.

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Healthcare: Where some of the most skilled professionals don't wash their hands

Institutional change is undoubtedly hard, but in an industry where people's lives are at risk every second of every day, there is no excuse for not prioritizing and tackling patient safety head on. How quickly is healthcare changing if attention to harm and improvement of patient safety remains so feeble?

A story I wrote in December on the top 10 patient safety issues for healthcare organizations to focus on in 2015 attracted some attention. In his blog "Running a Hospital," Paul Levy, former president and CEO of Beth Israel Deaconess Medical Center in Boston, highlighted the list in his post called "The worst of the top ten lists."

Items on the list included healthcare-associated infections, hand hygiene and medication errors — topics that are hardly novel to any healthcare professional, but nonetheless remain clinical quality issues in today's hospitals. Mr. Levy said the list "prompts discouragement" because it "documents the failure of leadership by all too many boards of trustees, senior administrators and chiefs of clinical service in America's hospitals."

The 10 issues I included in the list were recommended by or confirmed by industry professionals. Taking a step back, the list does appear discouraging, especially since a number of items seem so elementary.

Hand hygiene?

Appropriate use of antibiotics?

If you work in healthcare, you've likely seen the numbers: In 2013, the Journal of Patient Safety reported up to 440,000 patients die each year from preventable medical errors, making it the third leading cause of death in the United States.

To be fair, HHS released new figures in December showing a 17 percent decline in hospital-acquired conditions from 2010 to 2013, resulting in 50,000 fewer patient deaths and 800,000 fewer incidents of harm. Any progress is good progress, but the rate of this particular progress — 50,000 fewer patient deaths of the 1.32 million deaths estimated to occur in that time — seems fractional.

Now, I've never worked in a clinical setting. I'm aware of the pressures and strain of day-to-day operations in healthcare, but I don't have the first-hand experience of working in a trauma bay where I'm sure scrubbing under my nail beds is not my main priority. That said, as a healthcare reporter, I continuously research the industry, speak with healthcare professionals weekly and write about the issues daily, all of which objectively informs my perception.

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How athenahealth's CEO is redefining disruption

Jonathan Bush's no-holds-barred approach applies to all elements of his company athenahealth. Gatherings hosted by the company, of which Mr. Bush is co-founder and CEO, allow professionals and VIPs to bond over drinking games, share taboo stories and take rides on all-terrain vehicles.

However, athenahealth's More Disruption Please event does more than push the envelope on traditional, stuffy conference affair.

If it's not clear by its name, the conference centers around disruption in healthcare. While  many in healthcare are sick of hearing and talking about disruption (you can find it on Becker's Hospital Review's list of words we want banned in 2015), athenahealth takes the idea of healthcare disruption one step further: disrupting disruption.

Let's start from the top.

Disruption in healthcare aims to redefine the status quo by a change, small or drastic, that essentially alters the care delivery system. Companies like Apple and Walgreens are constantly referred to as disruptors in healthcare, due to their respective mobile health and retail health offerings.

But in the eyes of Mr. Bush, simply changing the healthcare delivery system isn't enough. At athenahealth's More Disruption Please conferences, Mr. Bush gathers investors with startups "that might someday make his own company obsolete," according to a Fortune article. It continues, "Bush's rallying cry, as always, is the need to reform the U.S. healthcare system through innovation — and by whatever means necessary."

By whatever means necessary is a big declaration, but athenahealth is up to the challenge, even if it means taking a couple of hits before seeing an upswing. According to the article, athenahealth's annual growth for 2014 is expected to be approximately 16 percentage points lower than growth in 2013.

Eventually, Mr. Bush predicts, and accepts, customers may stop using athenahealth's software products, but the company aims to remain a viable player in the health IT industry.



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The most admired man and woman in healthcare?

Hillary Clinton and President Barack Obama are once again the most admired people in the world, according to Gallup's annual poll.

Each year for nearly seven decades, Gallup asks Americans an open-ended question: What woman/man that you have heard or read about, living today in any part of the world, do you admire most?

Ms. Clinton has earned the title 19 times total, cinching the top spot in 17 of the last 18 years. (She sat out in 2001 when the public mentioned first lady Laura Bush most.) President Obama has been named the most admired man in each of the last seven years, starting in 2008, when he was elected president.

The Gallup poll results are a blend of political, religious, humanitarian and scientific figures. Top female contenders include Oprah Winfrey, Nobel Prize winner Malala Yousafzai and former Secretary of State Condoleezza Rice. Male runners-up include Pope Francis, President Bill Clinton and Rev. Billy Graham.

It all goes back to healthcare here at Becker's. Who would top the list as the most admired man and woman in healthcare? Who did you most warmly respect in 2014?



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Curiosity killed the cat — and got the hospital employee fired

I'm a fan of the blog PostSecret — if you're not familiar, it's an "ongoing community art project where people mail in their secrets anonymously" and those secrets are then posted online every Sunday.

Secrets range from silly to serious, and checking out the website is one of my favorite Sunday activities. But one secret from this week's batch struck a chord with me and is a scary one for any hospital or health system leader.

It reads as follows:

"I work for a major hospital system in Ohio. When I'm bored, I look through my Facebook friends, my family, and my coworkers [sic] Electronic Medical Records."

This secret-sender is not alone. For instance, two employees at the Nebraska Medical Center in Omaha were fired in September after they accessed the EMR of an Ebola patient being treated there.

"Unfortunately, I think this likely happens close to every day," Matthew Fisher, JD, an associate with Mirick, O'Connell, DeMallie & Lougee, said in an email interview. "Record snooping is coming up as a pervasive issue and one that can go on for years without it necessarily being discovered."



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Can pessimism among healthcare professionals be overcome?

Is the American dream dead? Many Americans believe so. According to a New York Times poll, only 64 percent of respondents said they still believed in the American dream, the lowest rate in nearly two decades.

Pessimism is widespread and is even more potent now than it was during the depths of the financial crisis — in 2009, 72 percent of Americans still believed hard work would lead to big payoffs, according to the NYT.

The timing of the poll's results is interesting because economists say the economy is at its highest point since the recession. Furthermore, the nation added 321,000 jobs last month and average hourly earnings have increased much more than expected. That, combined with lower oil prices, puts more money in the wallets of average Americans, according to the NYT.

So, why the sad face? Is the Gatsbian notion of the American dream — the promise that through hard work, anyone can transcend the boundaries of inequality and get rich — merely a romantic vestige of the past, a fallacy? Is the American dream hopeless? Is the green light simply out of reach?

Perhaps. Or, maybe Americans have shifted their idea of who's to blame for their inability to attain the dream. According to the NYT's poll, the majority of respondents, 54 percent, said they were more concerned that over-regulation in Washington would limit economic growth than they were about inequality.

Sounds familiar. One of the biggest complaints in healthcare is the burdensome, often excessive regulatory demands of the Patient Protection and Affordable Care Act, including the regulations of meaningful use and the two-midnight rule, as well as preparing for the implementation of ICD-10, among others.

The law is further exacerbated by Congress' inability to cooperate across the partisan divide, most recently demonstrated by the lawsuit House Republicans, led by House Speaker John Boehner (R-Ohio), filed against the Obama administration over unilateral actions he took on the healthcare law regarding the employer mandate and subsidy payments to insurance companies.

The belief that politics and regulations play too heavy a hand in healthcare — and more importantly, the seeming inability to effectively adhere to the many demands of these regulations — has led to increased frustration across the industry. According to the biennial "Survey of American Physicians" by Physicians Foundation and Merritt Hawkins, 46 percent of physicians would give the PPACA a failing grade, while only 25 percent would give it an A or a B. One half of respondents believe implementing ICD-10 will cause "severe administrative problems" in their practices, and three-fourths believe it will "unnecessarily complicate coding." 

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The habits that make us and break us — and can determine the fate of your company

A typical day: It's 11 a.m., and I'm most of the way through posting my news for the day on the health IT site. I'm feeling a little tired, so I get up and Keurig myself a cup of coffee. I'm the kind of person who doesn't need more than half a cup of coffee to get going, but my 11 a.m. coffee is sometimes my third cup of the day.

So why do I do it?

Having three cups of coffee makes me jumpy and a little unfocused, but I'm almost never deterred. It seems impossible to be derailed from my coffee once I decide to take a break.

Charles Duhigg's "The Power of Habit: Why We Do What We Do in Life and Business," a New York Times best-seller, explains this habit and more in a simple, three-step cue-behavior-reward system — a "habit loop."

First, there's a cue that sets off the behavior (It's 11 a.m. and I'm writing my news stories for the morning). The behavior occurs (I brew myself a cup of coffee), and the reward is obtained (I feel re-energized to post the news briefs online).

My internal struggle with the Keurig isn't a big deal in the scheme of things. After too much coffee, I'm just a little unfocused. However, habits compound quickly. If everyone at Becker's did what I do every morning, our company would be a jittery mess between 11 and noon every day.

As it turns out, habit loops exist on an organizational level as well. Groups of employees repeating seemingly unrelated actions again and again can create rigid patterns of events, whether failures or successes. This can happen easily without any employee ever realizing he or she is part of a collective contribution to an ingrained organizational outcome. These organization-level habit loops can make the difference between monumental profit and monumental loss of money, reputation and — in healthcare — even lives.

Deconstructing organizational habits is an extremely important exercise — for anyone. If you're struggling, it's a great opportunity to foster success. If you're successful, it's important to understand how and why. So, what should you know about understanding habits in your organization?



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