The End

The first post on this blog was added on November 12, 2004 – it’s hard to believe I’ve been writing online about various aspects of healthcare for almost ten years.

When I started this site, originally named MSSPNexus, (Medical Staff Service Professionals) the focus of my writing was current news and standards pertaining to hospital medical staff administration.  Later, as my career took a different path, I added risk management and over the past few years patient blood management into the mix.

In 2004 being a healthcare blogger was a heady experience; there weren’t that many of us and we formed a sort of online friendship, especially through Nick Gene’s Medical Grand Rounds.  We were sometimes interviewed, either by one another or by traditional news media.  KevinMD came along in 2005, and his blog remains one of the best and most active medical sites on the web.  Nurse Kim’s Emergiblog was always a fascinating read.  Of note, she recently posted that she is shutting down her blog.  Dr. Mike Sevilla soon found that it is difficult to remain anonymous on the web, and he continues to write under his real name.  There were a host of others, many of whom contributed to the first grand rounds hosted on this site.

sunset_valleyOver the past couple of years Supporting Safer Healthcare has been sadly neglected.  There are many concerns about protected health information and social media, some justified, and some over-the-top paranoid.   We who write weigh every word and image carefully before posting.  There are also security issues, this blog was hacked by spammers a couple of years ago and had to be rebuilt from the ground up.

My current hospital position in bloodless medicine/patient blood management is fascinating and contributes to patient safety and good quality healthcare, although from a different perspective than medical staff administration and risk management.  I have learned more about the clinical aspects of healthcare, and my interactions with patients are often the most rewarding part of the job.  The down side is that the time and focus it requires can be a bit daunting.  I’ve been left with little creative energy for writing.

If I may offer one parting word of advice to everyone, find out of you are anemic and if you are, get treatment.  It’s often as simple as building up your body’s iron stores through changes in nutrition or iron supplements.  In many cases not being anemic (in other words, having a good blood hemoglobin count) is the single biggest protection against needing a blood transfusion during a hospital stay.  Research continues to mount showing that patients who do not need transfusions recover more quickly and with fewer complications.

Progressive hospitals everywhere are developing patient blood management programs that are designed to conserve a patient’s own blood supply and avoid the need for transfusion whenever possible.  In the hospital where I work the program is growing out of the body of knowledge acquired over the past 15 years of being a center of excellence for bloodless medicine patients, i.e., those who decline blood under all circumstances. Historically, that has been primarily Jehovah’s Witnesses, but others are now requesting our services in increasing numbers. If your hospital doesn’t have such a program encourage leadership to contact one that does.  There is also a professional society devoted to PBM, the Society for the Advancement of Blood Management, which offers professional education and resources.

It’s time to close this chapter of my professional career.  For those of you who have been readers of this blog for all or part of the past ten years, thank you. The older posts will remain online for now.  It has been my pleasure to be of some small service in sharing news and insights that affect both the delivery and safety of healthcare.  Many of you are gatekeepers for patient safety – a worthwhile role to be sure.  Keep up your good work. Patients, and at some point isn’t that all of us, need you.

Rita Schwab
MSSPNexus / Supporting Safer Healthcare


Angry Physicians Impact Care

Kaiser Health Plan reports on a long-festering problem that many hospitals have been reluctant to address: disruptive and often angry behavior by doctors. Experts estimate that 3 to 5 percent of physicians engage in such behavior, berating nurses who call them in the middle of the night about a patient, flinging scalpels at trainees who aren’t moving fast enough, demeaning co-workers they consider incompetent or cutting off patients who ask a lot of questions.

Experts say that doctors’ bad behavior is not merely unpleasant; it also has a corrosive effect on morale and poses a significant threat to patient safety.

To be fair to physicians, bad behavior is not limited to them.  Administrators, nurses, and others can also subject co-workers and subordinates to what could only be termed as work-place bullying.  Physicians, however, impact patient care in ways that others do not.  When those caring for a patient hesitate to call a physician about care concerns for fear of being subjected to a wrathful outburst, hospital and medical staff leadership must act.

Read:  Hospitals Crack Down on Tirades by Angry Doctors


What Your Boss May Not Be Telling You

Is your boss happy with your work?  If you think he or she must be because “no news is good news” you may be so wrong.  As Alison Green reveals in 10 Things Your Boss Isn’t Telling You, bosses are human and some of them avoid conflict, even when having a difficult conversation is called for. 

If you manage employees, you know that it is a challenging task. Even if your team is great, keeping them educated, motivated and focused requires energy and effort. If you have one or more problem employees, the effort required increases exponentially.

Dr. Frank Benest reminds employees that they must work to understand their supervisor’s communication style in Communicating With Your Boss

“To enhance communications, you need to figure out how your boss prefers to communicate. Is your manager informal or formal? Does your boss like for staff to simply pop into her office with a new idea or make an appointment? Does your manager like to talk about an idea first, or does she prefer to get a memo or email first, read it, and then talk about the issue? …”

Good communication is a key component of all successful relationships, both personal and professional.

Medical Staff Services – Knowledge Required

I spoke at a conference of medical staff service professionals Friday.  My time slot was towad the end of the two day program, and the topic, professional communication skills, was a little lighter fare than that of most of the other speakers. 

It’s a topic I like to present because I get to tell stories, some of them wonderful examples of people who said or did just the right thing, at just the right time, like the father who knew what to say to his tired daughter.  Some of the stories focus on the fact that the way we dress influcences how people think about us.  Some are shared in the hopes of bolstering people up who handle an often difficult, sometimes thankless, job with grace and courage.

Some of the other presenters at the two-day conference spoke about electronic medical record implementation and meaningful use, accountable care organizations, risk management, healthcare law, and Joint Commission standards.  It reminded me again that medical staff service professionals need a broad understanding of healthcare trends in order to be effective in their jobs.

It’s not a career for the faint of heart.

The Heart of Healthcare

Our days. or in some cases our nights, are spent with co-workers.  The desire to collaborate with compassionate, intelligent people led me to a career in healthcare, and over the past 25+ years, I’ve had the pleasure of working with some phenomenal individuals.

Some have been physicians; both those who have cared for family and for me, as well as those with whom I’ve toiled on projects, committees and boards.  I’ve been impressed time and again with the dedication and courage these men and women display in the face of daunting obstacles.  My expectations are high when it comes to leaders of the healthcare team, and rarely am I disappointed. 

Some have been nurses, physician assistants, and therapists; front line warriors in the battle against illness and disability.  Those who excel refuse to allow their souls to be crushed by the unceasing demands of their high-tech, high-touch roles.

There are pharmacists, risk and quality managers, social workers, and paramedics who remain fixed in my memory although years have passed since we traveled the same hallways. 

Many have held one of the multitude of ancillary jobs necessary to keep healthcare organizations functioning.  There’s no one I want to see more than a skilled maintenace employee when the power goes out or water suddenly begins pouring from the ceiling,  and bless the information technology staffer who responds promptly and knowledgeably when the the computer program I desperately need locks up my system.  At one hospital I stopped by the coffee shop nearly every morning, more for the smile and friendly greeting I knew I’d get from the dietary staff than for the coffee.  

“Anyone can hold the helm when the sea is calm,” said Publilius Syrus more than 2,000 years ago; but today’s sea of healthcare is anything but calm. Administrators, Directors, Chief Executive Officers, Healthcare Attorneys, and others who set our course and work to keep the ship from running aground in stormy seas, bear a heavy responsibility.  Those I have most admired are the leaders who remain slightly awed by the magnificent work that flows around them every day. 

Thanks to all of you, the heart of healthcare, I’ve never wished I had chosen another field.

How To Tell Your Boss You’re Overworked

Does just walking into your office in the morning cause anxiety?  

Paperwork Despite your best efforts, are you greeted by stacks of paper, an over-flowing in-box, dozens of unread emails, a blinking phone message light, and reminder sticky-notes plastered everywhere?  Did you carry work home last night in an over-stuffed briefcase, or respond to emails and phone calls on your ever-present Blackberry?   

Do you feel overwhelmed by constantly increasing job demands?  

If so you’re not alone; there are some very capable, hard-working people facing that challenge right along with you.  

First, let’s talk about what not to do.  


1.  Blame your supervisor for not rescuing you.  

  • Decide that you really shouldn’t have to explain the obvious to your boss, he knows you need help and just doesn’t care.
  • Complain at every opportunity about having too much to do, and wonder why you are apparently the only person in the place who cares at all about doing a good job.

2.  Keep quiet and take on every new task you’re given  

  • Believe that if you say yes to every project someone will eventually realize you’re over-burdened and offer to help.
  • Refuse to admit that you can’t get everything done and accept that you’ll just have to work harder and longer to keep your job.

3.  Hide what’s not getting done in the hope that no one will figure it out.  

  • I once took over a position where my predecessor had left suddenly without giving notice. On my first day I had to call Maintenance to open the locked desk drawers. You guessed it – piles of unfinished work had been carefully locked away. Not a pleasant way to start a new job, or finish an old one for that matter.
  • A colleague once told me that after an employee left her company, Maintenance discovered unfinished work hidden in the ceiling tiles above his desk.  At least he gets points for creative hiding.

Now let’s give some thought to strategies that may actually help.  


1.  Communicate with your supervisor – frequently and respectfully  

  • Even if you have great rapport with your boss, it’s best not to bring up the subject of being overworked and overwhelmed out of the blue.  Respectful discussions need to occur on a regularly scheduled basis regarding priorities, goals, job performance and workload. 
  • Develop a brief reporting tool to share with your supervisor that shows your progress on current assignments, pending work, etc.  If a goal isn’t being met, offer a brief explanation as to why.

2.  Learn to negotiate  

  • Sometimes the best answer isn’t yes or no.
  • Explain how a new request impacts current assignments and suggest strategies for prioritizing your most import goals. 
  • Be prepared to offer suggestions as to what tasks might be eliminated or transferred.
  • Make it a point to bring up, not just problems, but potential solutions as well.

3.  Consider ways that you may be sabotaging your own success    

  • Are you a perfectionist, working and reworking even low-level tasks until they meet a perfect standard?   If so, think return on investment.  Some projects may justify that level of scrutiny, but for those that don’t you’re simply wasting your time, and we’ve already decided that you don’t have enough of that to squander.
  • Are you a socializer?  I’m a believer in the power of networking and connections, but it’s another area where return on investment must be considered. Can you limit the time you spend visiting with co-workers?
  • Do you spend so much time and energy on crisis-management that you never have time to organize and plan?  Break that cycle or you’re doomed to the life of a “headless chicken.”

 4.  Understand that sometimes, it is what it is  

  • As an employee you have certain expectations; your supervisor and organization also have expectations.  You may find yourself in a situation where the two simply don’t mesh. Only you can decide whether it’s one you can (mostly) happily live with every day.
  • As long as you hold the job and accept the pay check, do your best work; but don’t be afraid to look around and see what other opportunities are available. 
  • If you do decide to move on, don’t jump right back into the same situation.  Look for an organization culture that aligns with your own.  We spend way too much time at work to do it in an environment that makes us miserable.


Related reading:


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

The Value of Insightful Leadership

How important is insightful leadership to an organization, department, or team?  And what constitutes good leadership?


When there is no skillful direction, the people fall – Proverbs 11:14

Even bright, hard-working, dedicated people can accomplish little without the guidance of skilled leaders.  Frustration, anxiety, and mistrust result when there is no clear direction, or when goals change like shifting sands. 

What are the most important characteristics of a good leader?  My list includes:

1. Trust

My number one requirement for leaders; can I trust you?  Do you exhibit personal integrity and ethics; do your words and actions align?

2. Competence

Are you knowledgeable about the task at hand, and do you remain open to continued learning?

3. Humanity 

Do you value people?  Not just the work they produce, but their individual value as human beings?

4. Generosity

Do you share knowledge, education opportunities, and credit for a job well done with your team?

5. Humor

Admittedly, I can work for someone without a sense of humor, but collaborating with someone who knows how to enjoy the moment and not view everything as deadly serious certainly makes showing up for work in the morning more appealing.

Those are my top five characteristics for leaders; feel free to add a comment below about yours.

CPMSM CPCS Job Listing Added to Side Bar

I’ve added an interesting little widget to the side bar that posts random jobs around the nation using the search terms CPMSM, CPCS. 

Scroll down and look for the widget on the far right.

Whether or not you’re in the market for a career change, it’s fascinating to keep your eye on current trends in medical staff service positions around the country.


Strong Job Categories Despite Recession

What positions are “mission-critical” in today’s economy?  Career Builder weighs in on that question with a list of six job categories that remain “bright spots in today’s job market.

One of Career Builder’s picks is Administrative Healthcare positions, and, as you’ll see one of the  listed sub-specialties in high demand is credentialing.