HealthGrades 2010 Report – America’s 50 Best Hospitals

HealthGrades has released its Fourth Annual America’s 50 Best Hospitals Report. 

The report asserts:

From 2006 through 2008, if all hospitals performed at the level of America’s 50 Best Hospitals:

  • 164,964 Medicare deaths may have been prevented.
  • 18,900 Medicare inhospital complications may have been avoided.

The HealthGrades America’s 50 Best Hospitals Award designation recognizes hospitals that demonstrated superior and sustained clinical quality over a ten-year time period, based upon an analysis of more than 130 million Medicare patient records from 1999 through 2008 (the most recent year available.)

HealthGrades America’s 50 Best Hospitals were selected by identifying those hospitals that have received the HealthGrades Distinguished Hospital Award for Clinical Excellence for the most consecutive years. Hospitals that are recognized with a HealthGrades Distinguished Hospital Award for Clinical Excellence rank among the top 5% nationally for quality. America’s 50 Best Hospitals consistently outperformed all other hospitals across all procedures and diagnoses studied.

Find out whether a hospital in your area is on the list:

Job Interview? Experience May Not Be Your Trump Card

If you’re looking for a new job, are you being smart about it?  And what exactly does being smart involve? 

Have you heard people say that they are “sending out resumes everywhere, for everything,” because they just want to work?  While willingness to take on a job that may not be your passion has its merits, it seems these people are rarely successful in their job search.  That may be because hiring managers are looking for something else.    

If you’re in the market for a job, Career Builder has some advice in 9 things that seal the deal for hiring managers.  While a good resume and cover letter helps get you to the interview, what you reveal while you’re there may well be a game changer.

Woman_office “When I hire, I hire for ‘right fit,’ which doesn’t necessarily have anything to do with experience or training. A ‘right fit’ candidate is someone who is aligned philosophically with the company, has a passion for the products or industry, and believes that the kind of work that they do is their mission, not just their livelihood.

“When interviewing candidates to join our firm, two things can be deal breakers: attitude and core values. You can’t teach attitude, but you can teach skill. A positive attitude, strong work ethic and strong values should trump more experience and skill.

Read the rest from

Physicians At Risk

This is an updated repost of a June, 2005 article.  The information remains important and timely.

Most physicians live each day in a high-stress, goal-oriented, deadline-driven, atmosphere. They live with the realization that one mistake or overlooked detail could cost a patient’s life. Sadly, they also know that admission of weakness of any kind may cause them to be ostracized by peers, patients, and employers.

All of that leads to a deadly, but not unexpected result: For decades doctors have been killing themselves at a far higher rate than other people.

Female doctors kill themselves at a rate 130 percent higher than other adult women, while the rate among male physicians is 40 percent higher than men in general.

This issue was brought to the fore late in 2004 with the suicide of well-known pediatric heart surgeon Dr. Jonathan Drummond-Webb. Press accounts at the time of his death portrayed him as a man tormented by a sense of failure because he could not save every sick child.

WebMD's eHealth reports a sobering reality; physicians who have reported depressive symptoms (even those for which they are receiving effective treatment) to their licensing boards, potential employers, hospitals and other credentialing agencies have experienced a range of negative consequences, including repetitive and intrusive examinations, licensure restrictions, discriminatory employment decisions, practice restrictions, hospital privilege limitations, and increased supervision. Such discrimination can immediately and severely limit physicians' livelihoods as well as the financial stability of their families. For this reason, well-meaning colleagues or family members sometimes discourage physicians from seeking help.

We want our doctors to show respect, understanding, and compassion toward us, and rightly so.  Let’s make sure that we, especially those of us who work closely with physicians every day, return the favor.

Related articles/resources:

Medical community begins to address physician suicide from the Boston Globe

Female Physicians Face Higher Suicide Risk from Women's E-News

Physician Depression and Suicide Prevention  – American Foundation for Suicide Prevention

Film: Struggling in Silence – Physician Depression and Suicide

Social Media – For Those With No Fear of Public Writing

Social_networking Fear of public speaking, but not of public writing?  Social media could be your platform of choice.

A friend recently asked me about the uses of social media.  The request made me think about how rapidly the interactive capabilities of the web are changing, and what that means for us.  So if you’re wondering just what all the “buzz” is about, here is a summary of my response to her question.

Social networking, i.e., the ability for individual users to connect with one another and contribute publicly-available content, has become a powerful force on the web.
First a word of caution; in general, social networking content does not have the benefit of being peer-reviewed or vetted by editors.  For example, CNN posts what they refer to as iReports; videos, messages, etc. from people around the world. The first time you open an iReport you get this message: So you know: iReport is the way people like you report the news. The stories in this section are not edited, fact-checked or screened before they post. Only ones marked ‘CNN iReport’ have been vetted by CNN.
Although blogs, tweets, Facebook, etc. may not display the same disclaimer, the fact is, readers should view social media content with a healthy dose of skepticism.  After a bit of fact checking they can usually begin to determine who offers truthful, trustworthy information.
Blogs for example, can be influential, not just because of frequently updated, worthwhile content, but because bloggers form on line communities by connecting with, and referencing, one another. Those writers in turn gain more credibility, more authority, and more followers, in the blogosphere.   
News reporters are expected to be neutral and not take sides on issues; not so with bloggers and other social media contributors.  Our venue encourages writers to share more of our own personality and opinions.  For most of us, that makes for more interesting reading, as long as we remember that we’re reading someone’s opinion of the facts, which may of course “shift during transit.”  
Twitter, and now Google Buzz, a new entry into the social media foray, are micro-blogging sites.  I suppose they are growing in popularity because of our ever-decreasing attention spans. (Congratulations for making it to this point in this post – 376 words so far!) 
Twitter allows a maximum post size of 140 characters, and both celebrities and ordinary folks jump on Twitter and post little messages about what they’re doing, what they’ve read or seen, or links to sites they find interesting.  Twitter posts are called tweets, and if someone likes what you’ve posted they can re-tweet it, (kind of like forwarding an email, the original author gets credit.) 
Google Buzz just opened about a week ago – it’s Google’s answer to Twitter and attaches to user’s Gmail accounts.  The concept is similar to Twitter, but Google Buzz allows longer posts, and readers/writers get to see their information as a topic thread with other commenters joining in, so there’s a bit more continuity to the messages.

As for Facebook and LinkedIn, Facebook tends to be more social – a way to keep in touch with friends around the world, LinkedIn aims for a more professional interface and encourages connections among professional colleagues, business contacts, professional associations, etc. 
Wikis, like Wikipedia, allow various users to contribute content to a single topic, essentially a user-created encyclopedia. For example, someone can go to Wikipedia and search on NAMSS and get a brief article that a member wrote about the association.  Other writers can jump in and add or change content, or link to the article.  Volunteer editors keep an eye on content updates.
There’s more out there, and more on the horizon.  Users love being able to participate in the interactive world of social media.  It provides an opportunity for even the socially shy to express themselves on topics that matter to them.
Speaking for myself, I sometimes have to step back from all of it because it gets to be a bit overwhelming.

Many of these social media sites track your “friends, followers, or fans,” which can create a desire to constantly participate so you gather a bigger “fan” base.  Again a caution for users, keep it in perspective, don’t get too wrapped up in the numbers, which can go up and down on a whim. Participating in social media can take a great deal of time, so users need to make sure they’re getting a worthwhile return on their investment of that most valuable of resources.  

The Criminal Trial of Anne Mitchell, R.N.

When nurses Anne Mitchell and Vicki Galle wrote an anonymous letter to the Texas Medical Board last year expressing concerns about the care being delivered by Dr. Rolando Arafiles Jr. to Winkler County Memorial Hospital patients, little could they have imagined what would happen next

It is a case that has brought national attention to the 19 bed critical access hospital in Kermit, Texas.

CBS7 News in West Texas reports on day three of the criminal trial of Anne Mitchell, R.N. 

Among those being questioned was hospital administrator Stan Wiley.  “Mr. Wiley “faced a long line of questions in cross-examination. He explained that the only reprimand handed to Dr. Arafiles from the hospital was telling him “not to do it again”. This includes improper surgeries, wounding a patient, sending a patient with appendicitis home without care, and sticking a needle into a patient’s bone.”

This case is terrible and fascinating on so many levels.  If Ms. Mitchell is found guilty of the felony of “misuse of official information,” what nurse will ever again be willing to report questionable medical care?  It also serves as a serious reminder of the need for hospital administration, including medical staff leadership, to act appropriately and document well  when faced with medical staff disciplinary issues.

Ms. Mitchell’s trial is expected to conclude today.

Update 2/11/10 –

Anne Mitchell Reacts to Not Guilty Verdict

NYT – Whistle-Blowing Nurse is Acquitted in Texas

Related Articles:

Two Nurses Fired

Who Will Become “Homeland Security” in Your Hospital?

It took years before the truth was uncovered; the charming doctor was a cold-blooded killer.

Puzzle Add a bit of information here, an element or two of data there, and slowly the complete picture appears – if someone has access to all the pieces and understands how they connect. 

A secure central repository for collection and review of sensitive threat data was the subject of much discussion in the US in early 2010. The failed attempt to bring down a US airliner on December 25, 2009 brought the issue into the spotlight when it became apparent that various intelligence agencies held pieces of the puzzle, but no one agency held them all.  As each piece was revealed and added to the others, many government leaders called for improvements to data sharing and collaboration with the Department of Homeland Security.  

The DHS web site states that the agency “seeks to develop a complementary system connecting all levels of government without duplicating effort.”  The agency’s intended role is to collect, analyze, and report data gathered by various individuals and organizations. 

The Department of Homeland Security focuses primarily on keeping people safe from those who deliberately intend to cause harm.  Healthcare focuses on keeping people safe as well, although rarely must we contend with those whose intention to harm is deliberate.  The parallel, however, is obvious.  Who in healthcare stands in the role of “homeland security?”  What group or service is responsible for collecting and analyzing multi-source data related to potential threats to patient safety? 

I have written previously on the need to develop central data repositories in the hospital setting.  Assuming that an organization boasts highly qualified and well-supported medical staff service professionals, I believe the data related to credentialed and privileged practitioners, (physicians, mid-level providers, etc.) whether generated internally or externally, is best funneled through medical staff services administration.  No one else in the organization is better positioned to “see” the whole picture related to those we entrust with the greatest authority and responsibility for patient safety. 

Managing such vital data is a serious undertaking; as with the work of Homeland Security, lives may literally hang in the balance.  Collecting and analyzing the information, while important, is only the beginning; those reporting findings must be supported and heard.  Senior leadership, both medical and administrative, must be willing to respond appropriately as the “picture” unfolds.  

Patient safety is highly complex, and there is certainly more to it than overseeing the role of credentialed providers.  “Homeland Security” in your hospital may spring from a high-level patient safety committee, a subcommittee of the Governing Board, or elsewhere.  Whatever group takes on the challenge, it is imperative that the work of medical staff services administration is included.  

Your patients simply can’t be safe without it.

Protecting Attorney Client Privilege

"You can't have that document, it's protected under attorney-client privilege." 

Ever heard that?  Ever said that?  If you work in healthcare administration, including risk or medical staff management, the answer is probably yes.

Perhaps you've wondered whether the information in the disputed document was legitimately protected under attorney client privilege, or whether that statement was simply being used as a convenient "blanket" response when the real answer was, "I don't know if I can share this information with you, so I'm erring on the side of caution and saying no," or "I don't want you to have that information, so I'm saying no."

Well, who better to shed some light on that sometimes thorny issue than an attorney?  In this case, Shannon DeBra of Bricker & Eckler in Columbus, OH.  The case under consideration is Fry v. Health Alliance of Greater CincinnatiThe Hospital argued that some of the documents, including meeting minutes and handwritten notes that Dr. Fry requested, were protected under attorney client privilege.  Attorney_client

Did the court agree? 

Yes, and no.

Ms. DeBra explains the issues in a summary article that provides insight into what the courts look for when determining whether or not a particular document is indeed protected under attorney client privilege.  A bit of well-placed documentation can make all the difference.

Read Protecting the Attorney Client Privilege: Lessons Learned from The Christ Hospital Whistleblower Case

Related Article from The NAMSS Blog:
Whistleblower Case Provides Lessons on Attorney Client Privilege Protections