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

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."


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." 


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?


10 healthcare buzzwords to ban in 2015

What term in healthcare would you be happy if you never heard again?

We've all been there.

You're sitting in a meeting that's probably gone a little long. When the new guy gets up to present, if you weren't asleep before you might as well be now, because the presentation's lingo sounds identical to everything else you've heard.

Or, you're talking to a colleague, and he says that one thing that makes your skin crawl.

You probably didn't say anything in that meeting or to your colleague. Erring on the side of manners was probably best.

Now, it's your chance to let us know: What healthcare term drives you nuts?

Following a short poll of our editorial team, we've made our own list. The words below have been everywhere we've looked in 2014 and, for one reason or another, really rub us the wrong way. Feel free to let us know what's on your list in the comments below.

1. Disruption. This is the top pick from our editorial staff. If disruption is the new normal, can you disrupt disruption? And what qualifies you as a disruptor, anyway? "Disruption" is descriptive enough that it piques interest but vague enough that it leaves you feeling let down when you realize it could pertain to pretty much anything. Plus, whatever happened to teamwork?

2. Innovation. Disruption's less-vexing cousin, innovation is another word that just can't catch a break. Innovate? Inno-wait! Just because something is new doesn't mean it's worth this much attention. There has got to be another fitting word somewhere to describe that new idea/invention/process, etc.

3. Accountability. We sure hope accountability in healthcare goes without saying. The fact that this term is thrown around so often (We assume everyone is reminding one another?) is slightly nerve-wracking. We would hope accountability, a.k.a. responsibility, is assumed into one's decision to join the healthcare field, enough so that reminders would be unnecessary.

4. Big data. At this point, there's so much data out there that the term seems like a bit of a misnomer. "Cloud" seems like it deserves a mention by proxy, but then it's more specific, and probably more important. After all, it's where the big data lives.


Can you really be a good boss to your friends?

Having positive relationships at work is an important part of making a possibly stressful environment a more enjoyable place. Taking breaks, establishing open communication and even spending time socializing with co-workers outside of the office can lead to better relationships and more positive attitudes in the workplace, according to Forbes.

Establishing friendships at work can make for an overall better work environment, but what happens to these relationships when a former co-worker becomes the new boss?

Friendships that developed between peers can be strained when one is promoted to a position of authority, especially if multiple people in the department competed for the same job. On top of other challenges, new bosses need to learn how to delegate and discipline employees while still maintaining their trust. But can they do this and still hold onto friendships?

Managers have to change their friendships with their former peers into boss-employee relationships to remain professional and establish authority. Adjusting to new social dynamics can be one of the most difficult parts of a managerial promotion, according to The Wall Street Journal.

Often, former co-workers will be reluctant to treat a new boss as such, whether out of jealousy or habit. Or, friends will demonstrate misplaced enthusiasm about a co-worker's promotion and expect special treatment or extra slack, according to WSJ. Even though a newly promoted boss might want to maintain positive relationships, it's important not to give into these pressures; now he or she will have new peers to establish relationships with, and it's important to gain their trust and respect as well.

Most often, it's the employees who create the distance between themselves and their new boss, not the other way around, according to WSJ. Many employees don't feel comfortable initiating conversation unrelated to work or socializing outside of the office with their boss, even if they used to be peers.

The various social and professional challenges associated with promotions to manager roles pose several questions. While an existing employee might make a good candidate for a leadership position, is internal promoting always the best idea? And while general challenges are expected in any work scenario, how do internal promotions specifically affect those in a healthcare work environment?

According to a survey of hospital leaders published by The HealthCare Initiative, an affiliate of MRINetwork, two-thirds of hospital leaders responding to the survey reported they believe promoting employees to leadership roles from within an organization is a bad idea because of the strain it puts on existing relationships and changes in authority. One-third of respondents think internal promotions are a good idea, but only if the promoted employee has access to a strong mentorship program for leadership guidance.


25 comments from readers: The good, the bad and the ugly

Here at Becker's Hospital Review, the reporters value the opportunity to open an insightful dialogue with our readers through comments posted at the end of articles. Support, criticism, questions and discussion are all present, and we appreciate our readers for their engagement!

Based on readers' comments, the following 25 articles include some of the most well-received or disputed content, or incited the most interesting conversations. See the list below for the good, the bad and the ugly — and keep commenting.

1. House Republicans sue Obama administration over PPACA: 5 things to know
Ava: What a bunch of fools. Congress wanted President Obama to postpone the employer mandate. This Congress is so ineffective and spends America's money on stupid lawsuits instead of getting the work of the people done....How about if they work on immigration, jobs, infrastructure, or heck, practically anything else instead of wasting our time and hard earned money on ignorant political stunts?

2. Is executive compensation aligned with health system strategy? 10 findings
Dr. No: Anyone who thinks compensation for healthcare execs should be higher must be FIRED. We should go back to the old system of having nuns run hospitals. The privilege of serving patients is the compensation. Overpaid C-suites are the main problem in health care; along with consolidation, acquisition, overbuilding, overtreating, overinvestment in useless technologies - LOOK AT OUTCOMES. Cut the fat right off from the top! What was I just saying about barring men from running anything for 100 years?

3. Union accuses Prime of overbilling Medicare by $93M
Todd: These unions should not be in Healthcare. Hospitals are not sweat shops. This particular union is known for its unscrupulous activities. Our tax dollars are being pilfered by the SEIU.

4. The problem to be solved
Bonnie: As always, David Pate has hit the nail on the head! Whether you call it health maintenance (1990s) or population health (2014), the focus in health 'care' needs to shift from 'sick' care to 'health'. Until we figure this out we're only putting bandages on a very sick system.

Clinicians take accountability: These "buckets" are not new, clinicians have been slow or reluctant to react to the changing conditions of healthcare. The business model has always known that "cost control" was not handled very well by senior leaders. I would disagree with Dr. Pate, it is the healthcare model that needs to adjust to the the business model of healthcare. No one wants to say this out loud, but has been the clinical side of healthcare that has created this out of control spending, not the business side.

Lynn: I agree with all 3 buckets, but the naked emperor wants to know "What is our proposed business model for 'health'"? I've heard this question asked in many forums. Apparently, the answer is "there is none". When we are healthy, healthcare costs drastically reduce/disappear. So how do we motivate the healthcare industry to put themselves out of business?

Dr. David Pate: Bonnie- Thanks for your kind comment. Totally agree. "Clinicians take accountability" - I understand your disagreement (I think), but the "clinical side" is reacting rationally to the business model and incentives that exist. I don't know of any healthcare economist or policy expert that does not agree that ability to pay (including insurance) + unequal decision-making and lack of transparency in favor of the clinician + fees paid for every service rendered drives increased healthcare spending. It is not the sole cause, as my article suggests, but I don't know anyone else that thinks the business model has not contributed to excess healthcare spending.

Dr. David Pate: Hi Lynn: I think that there is a model that will work. In my opinion, a successful model would have to evolve to providers having access to the insurance premium, whether they become the insurer or simply turn the current insurance company-provider relationship on its head. Then, all of our services become cost centers, providers will right-size their operations, providers will be relentless in the pursuit of waste and in reducing cost and in eliminating low value/no value services, the incentive will be on promoting, maintaining, and restoring health, we will engage in more meaningful discussions about end-of-life care, we will shift people into new roles (health coaches, care coordinators, etc.), we will use team-based care to deliver services and thereby relieve the pressure on certain shortages of healthcare professionals, and we will finally be rewarded, instead of penalized, for our investments in health, fitness, wellness, prevention, and early detection. There is so much disease in the pipeline due to childhood obesity, personal health behaviors, and current disease burdens, that there won't be any overnight reduction in the need for acute and chronic healthcare services, and so as we begin to improve health, there will be plenty of time over an extended period of time for the healthcare professional markets to right-size without the need for more drastic measures.


3 thoughts on U.S. healthcare (Sons of Anarchy), foreign policy (Homeland) and the interest rate policy (not what Ben Franklin envisioned)

This year has been incredibly interesting on many fronts. This article features observations on three of the key dynamics we see, all maddening.
1. Healthcare, akin to "Sons of Anarchy," is riddled with unintended consequences and intrigue. The healthcare system increasingly looks like some kind of version of the fascinating but violent TV show "Sons of Anarchy." There is suspense, there is anger and there are double-crosses. If you have not seen the show, please excuse the reference.

The list of problems in healthcare is long. The healthcare exchange sign-ups last year were heavily inflated, and subsidies were provided to millions who arguably are not eligible for subsidies to encourage sign-ups. The taxes borne by insurances companies will be handed off to enrollees, the savings from healthcare reform are nonexistent, and there is very little evidence of improved care quality. Also, there is greater consolidation, which some would say means higher healthcare prices.
The only great certainty is one that has been said again and again for more than 100 years: Taxes will rise or have risen.

Perhaps the single point of good news is a shift toward consumers being more oriented to the cost of their care. The growth of high-deductible health plans and the transfer of healthcare costs to patients has led to more concern, even though consumers still have a very hard time being cost savvy for non-routine treatments. Nonetheless, we see healthcare taking up a bigger and bigger part of middle class budgets. Ultimately, consumer awareness may be the best hope for actually reigning in healthcare costs.


Giving thanks for these 9 medical pioneers

Happy Thanksgiving! Here at Becker’s Healthcare, we’d like to give thanks to a few of the many men and women whose pioneering work underpins modern medicine. Medicine is one of the most collaborative disciplines, and without the contributions of these individuals medical care today would be very different.

The following individuals are a selection of those responsible for some important firsts in medicine, from the discovery of “germs” to the foundation of molecular biology.

1. Edward Jenner (1749-1823): Vaccines
British surgeon and naturalist Edward Jenner developed the first vaccine, the smallpox vaccine, in 1796. Jenner was inspired to develop the practice of vaccination after noticing that milkmaids who caught the disease cowpox never developed smallpox. Jenner inoculated the son of his gardener with cowpox, and the boy failed to develop smallpox after being exposed repeatedly to infected smallpox material. This first vaccine laid the foundations for the field of immunology.

2. Elizabeth Blackwell (1821-1910): First female physician in the U.S. and U.K.
This British native was the first woman to receive a medical degree in the United States and the first woman on the UK Medical Register, a list of all practicing physicians in that country. After watching a friend die of what was probably uterine cancer around 1845, Blackwell decided to obtain her medical degree. She earned it from Hobart College in Geneva, N.Y., in 1849 and subsequently opened a practice in New York City. She was heavily involved in social change as well as medicine throughout her life and had such famous friends and correspondents as Florence Nightingale, Elizabeth Cady Stanton and Lady Anna Byron, wife of the poet Lord Byron.

3. Louis Pasteur (1822-1895): Germ theory of disease
Among his many claims to fame, French chemist and microbiologist Louis Pasteur was the first scientist to support the germ theory of disease, the idea that diseases are caused by microorganisms, with his research. Pasteur expended a lot of effort investigating what agents caused beverages like milk and wine to spoil, inventing his eponymic process “pasteurization” in the process. After discovering that microbes were responsible for sour wine and spoiled milk, Pasteur hypothesized that microbes also caused disease in the body. He later supported this theory in the mid-1860s by showing that a malady attacking silkworms in Alais, France, was caused by microbes attacking silkworm eggs.

4. Joseph Lister (1827-1912): Antiseptic surgery
British surgeon Joseph Lister is best known for applying Louis Pasteur’s work in microbiology to pioneer antiseptic surgery. At the University of Glasgow in the 1860s Dr. Lister experimented with wound treatment with carbolic acid, then used to treat sewage, using Pasteur’s studies of the germ theory of disease to guide his work. After successfully proving that carbolic acid-basedsterilization of wounds reduced gangrene, Dr. Lister went on to promote handwashing and surgical instrument sterilization as a means of reducing infection. His legacy in sterilization is also evident in the naming of a bacteria genus, a slime mold genus and Listerine, all of which are his namesakes.


How email can threaten your career

Do you send work emails from bed at night or while on vacation? Is your smartphone glued to your hand during a teeth cleaning or haircut? If you've answered yes to any of these questions, keep reading.

Two psychology researchers at Northern Illinois University in DeKalb say this behavior may be symptomatic of a new condition they call "telepressure," according to Forbes. Telepressure is the feeling of needing to respond to electronic communication, including emails, texts and voicemails, as quickly as possible to ensure you appear responsive and connected.

Larissa Barber, a psychology professor at NIU and lead author of a new study on telepressure said, "Employees pick up on both subtle and not-so-subtle cues in the work environment that imply that fast response times are needed to be perceived as productive workers. This may leave employees feeling like they technically have the option of not being continuously accessible, but that unplugging — even for short periods of time — may be damaging to their careers."

As it turns out, this attitude can eventually contribute to reduced quality of performance and even serious health issues. According to Forbes, employees and managers alike who feel subject to a lot of telepressure are more likely to burn out, lose focus and even experience health-related absenteeism. Habits that may have initially formed from a strong work ethic may ultimately be what damages careers.

In one survey sited by Forbes, 81 percent of workers have checked work email on a weekend and a third of workers respond to emails at work within 15 minutes. Another survey found 28 percent of employees' days are spent reading and replying to emails. Communication is an essential part of almost any job, but what happens when it becomes too much to handle?

According to a Human Solutions study, 52 percent of people who reported feeling stressed out at work said this stress has caused them physical health problems and 42 percent reported suffering from mental health problems. More than half of employees surveyed in the study, 56 percent, said they thought about quitting their job because of the stress they experience, and 75 percent of employees said the quality of their personal or family life suffered because of stress experienced at work. Notably, 64 percent of respondents reported the quality of their work suffered because of stress experienced at work.


Healthcare's foggy and forgettable names

Last week, a fellow editor couldn't take it any more. She had to get something off her chest.
"You know what system I hate writing about?" She paused her typing, turned to me and named a newly formed health system in the Midwest, which shall remain unspecified. "It has at least four different names. I never know what to call it. And its website is a mess!"
I sympathized with her. So many systems have legacy names, operating names, colloquial hyphenated names — maybe more. How strange it feels to call a health system's public affairs department and say, "Hi, can you tell me the name of the organization I just called?" And yet, desperately seeking accuracy, that's just what we do.
Even stranger is how long this confusion persists. We're only healthcare journalists who write about hundreds of hospitals and health systems every week. I can't imagine being an employee of that system, hearing people refer to my organization four different ways day after day. Or, worse, a patient — one who doesn't know the strategic reasons why the name and familiar face of her hospital changed overnight.
Ambiguity is a bad look in healthcare.
Speaking of bad: Health systems adopt some pretty strange names. I once left an article I was writing open on my computer, halfway done, when my friend borrowed it to check movie times. Before she closed out of the story, the health system's name caught her eye. "Nice name," she said. "It sounds like a piece of Ikea furniture. What does that even mean?"
It was a mumbo-jumbo moniker, the smashing of words that mean nothing together. I wonder why there aren't more hospitals named after historical figures, medical pioneers, influential nurses, hometown points of pride. You know, names that mean something. Names we have a shot at understanding without reading the health system's annual report.
Healthcare system names can be highly disjointed, confusing and downright bad. There's much room for improvement, but there's another strange dynamic at play. Every now and then, a health system fixes a name that is hardly broken compared to the others out there.