About two weeks ago all users of the CGH computer system got a “privacy and security” e-mail reminder from Joe Huber (HIPAA[1] Security Officer) of the Information Systems Department. “Is it okay to write down your (computer) password,” he asked, “if you keep it somewhere out of sight, such as under your keyboard?”
The answer is “no,” of course. When you scrolled down to read Joe’s answer, he explained that “your password…must be kept in a secure location such as a wallet or a purse or locked cabinet.”
In his e-mail Joe reminded us that Information Systems had sent the same “privacy and security” message two times before. He said he mailed it a third time because someone found an employee’s username and password posted on a computer monitor last month. In other words, the contents of CGH’s information system that were available to a specific employee were potentially available to anyone who happened to stop by and write down that individual’s username and password. Anyone.
Consider what you would think if an employee of the credit union were as careless with her username and password. Any unauthorized person would be able to look up your financial information simply by copying that employee’s secret access codes.
It’s just as easy to imagine how patients or family members would feel if they knew their information at CGH was potentially available to a snoop – or worse. Actually, we don’t have to imagine. We have only to read the news.
For the past several weeks the nation’s news reporters and editorial writers have been full of outrage and ridicule involving the Veteran’s Administration because a VA employee took home a computer disk that continued identifying information on 26 million military veterans. While in was in the employee’s home, the VA disk was stolen. Where is it now? What could someone do with so much information about individual Americans, including those serving in the active military? “How could such a thing have happened?” complained the news outlets. “What kind of security does the VA have?”
I read those stories – and I read Joe’s e-mail – and I thought, “What if that happened to a hospital instead of the VA?” Is everyone at CGH safety conscious about their computer passwords and about the files they have access to? Obviously not. A username and password were posted in plain sight in violation of CGH policy.
In today’s information age we have to treat computer information as if it were cash. Like cash, if access to computer information is left lying around, someone will steal it. If you saw cash on someone’s desk, you’d understand the risk right away.
It may be harder to recognize the value of computer data or passwords that give access to data, but we should consider computer data access as valuable as cash.
Using computers gives us great power to see and use and move around large amounts of information. This is much more responsibility than we had in past years when we worked only with paper records.
Being careless with a single file is a serious matter. Being careless with computer data can be a thousand – or a hundred thousand or a million – times worse.
[1] The Health Insurance Portability and Accountability Act of 1996 (HIPAA) addresses national standards for electronic health care transactions involving the security and privacy of health data.
Saturday, June 10, 2006
Saturday, May 27, 2006
Dr. Prior helps us remember
For Memorial Day 2006 I would like to pay tribute to those who have died in the service of our country by recalling the experience of Jack Prior, MD, who was for many years CGH’s Chairman of Pathology. Dr. Prior retired from CGH a number of years ago. He may have slowed down a bit since his CGH years, but his mind is keen, and he retains a dry sense of humor and the ability to tell a good story.
During World War II, Dr. Prior was an officer with the Medical Battalion of the US Army’s 10th Armored Division. On December 14, 1944 he was the physician responsible for an aid station that was located in a pub in Noville, Belgium – about four miles from Bastogne, site of the famous battle in what has become known as “the Battle of the Bulge.”
Twenty-eight years after those events, Dr. Prior wrote about them for the Onondaga County Medical Society: [1]
During World War II, Dr. Prior was an officer with the Medical Battalion of the US Army’s 10th Armored Division. On December 14, 1944 he was the physician responsible for an aid station that was located in a pub in Noville, Belgium – about four miles from Bastogne, site of the famous battle in what has become known as “the Battle of the Bulge.”
Twenty-eight years after those events, Dr. Prior wrote about them for the Onondaga County Medical Society: [1]
Within two hours of our arrival the little town [of Noville] had turned into a shooting gallery featuring small arms, machine gun, and tank fire on the main thoroughfare. The large front window of the pub was an early casualty and it was necessary to crawl on the floor to avoid being hit as we treated our increasing number of casualties.Dr. Prior described the evacuation of casualties from Noville. When the half -track in which injured soldiers were riding burst into flames from tank fire, the wounded returned to the pub. Later soldiers removed the pub’s doors, strapped the wounded on the doors, and tied the doors to the US tanks heading for Bastogne. In the late afternoon, the American column was pinned down by enemy fire.
We treated the serious injuries in the ditches as we waited three hours for the column to move again. Lying in the ditch and having sniper fire chip away at a fence post beside me was a terrifying experience….Many of our enlisted men demonstrated great bravery on the road, pulling tankers from their blazing tanks, driving jeeps with the injured on the hood to our Aid Station.Once in Bastogne Dr. Prior used a garage as the aid station, but that proved difficult to heat and too small for the growing casualties. So he relocated the aid station to a three-story home. Bastogne had no electricity, no water, no food, and no medical supplies. There were also no doctors so “the civilian population descended on our Aid Station as soon as the Red Cross flag was hoisted – I even did a delivery!” remembered Dr. Prior.
...[T]he weather was very cold and there was about a foot of snow on the ground. My diary indicates we worked twenty four hours a day in the Aid Station, that the plasma froze and would not run, that we had no medical supplies and that the town was continually shelled....
I was holding over one hundred patients, of whom about thirty were very seriously injured litter patients. The patients who had head, chest, and abdominal wounds could only face certain slow death since there was no chance of surgical procedures – we had no surgical talent among us and there was not so much as a can of ether or a scalpel to be had in the city.
On December 24, 1944 – Christmas eve – Brigadier General Anthony McAuliffe sent a now-famous Christmas message to the US troops who were surrounded by tanks, under constant fire, and without winter clothing or supplies:
“What’s merry about [this Christmas], you ask? We're fighting - it's cold - we aren't home. All true, but what has the proud Eagle Division accomplished….? Just this: we have stopped cold everything that has been thrown at us….The Germans actually did surround us. Their radios blared our doom. Their Commander demanded our surrender….We continue to hold Bastogne. By holding Bastogne we assure the success of the Allied Armies….We are giving our country and our loved ones at home a worthy Christmas present…[2]
At 8:30 p.m. on Christmas eve, Dr. Prior was in the building next to his make-shift hospital, preparing to write a letter to the wife of a young lieutenant who was dying of a chest wound. A bomb hit the three-story aid station leaving it “a flaming pile of debris about six feet high.”
My men and I raced to the top of the debris and began flinging burning timber aside looking for the wounded, some of whom were shrieking for help. At this juncture, the German bomber, seeing the action, dropped down to strafe us with his machine guns. We slid under some vehicles and he repeated this maneuver several times before leaving the area….A large number of men soon joined us….[A]nd two or three inured were pulled out before the entire building fell into the cellar. I estimated that about twenty injured (solders) were killed in this bombing…
It has been 61 years since the events Dr. Prior described in his reminiscence. His account of the experience of Bastogne gives a vivid picture of sacrifices made by those have died for our country. Monday, May 29, 2006 is Memorial Day, the day we remember – and honor – all of them .
[1] John T. Prior, MD, “The Night Before Christmas – Bastogne, 1944,” The Bulletin of the Onondaga County Medical Society, December, 1972. This article is the source of all Dr. Prior’s quotes, used above. If you would like a copy of the article, please send a request via e-mail.
[2] This Christmas message wasn’t the only famous quote from General McAuliffe during the Battle of Bastogne. His more famous quote came in response to the German commander’s demand that Allied troops surrender. “If this [surrender] proposal should be rejected,” the German commander wrote, “one German Artillery Corps and six heavy…Battalions are ready to annihilate the U. S. A. Troops in and near Bastogne.” General MCAuliffe responded with the one-word reply: "Nuts!"
Saturday, April 29, 2006
The importance of listening
“When [going into] an examining room,” said Dr. David Ruben, Chief of Geriatrics at UCLA, “you’ve got to be ‘out there’ for the patient. It’s very much like going on stage. It’s not that it’s insincere, but you have to be optimistic for patients. You need to engage them completely with your attention and be observant of everything that’s going on with them.”
That comment is from a story broadcast recently by National Public Radio. “On stage” was the phase that struck me because, although we are not “acting,” we in health care certainly are at center stage for patients and family members. Patients and family members study us, as if we were performing at a recital, giving a reading at our place of worship, or making a speech in front of our social group.
They watch closely to discern clues about what’s going on with their care or with their loved ones. Are we excited about something? Are we confident? Distracted? Are we sensitive to the patient’s discomfort or anxiety? This is the way we human beings communicate, by closely watching others to see if actions match words. And the more important something is (such as hospital care), the more closely we observe.
This year the federal government will start observing us – through the eyes of our patients. Surveys will be mailed to the patients of CGH and all other hospitals across the country. This is called the HCAHPS survey (pronounced “h-caps” and meaning “Health Consumer Assessment of Healthcare Providers and Systems”). The results of these surveys will be reported publicly, starting in 2007, by the federal Centers for Medicare and Medicaid Services (CMS). Eventually CMS intends to use the hospital patient satisfaction scores to determine how much they pay us for the care of Medicare patients.
CGH will voluntarily participate in a test run of the new HCAHPS survey this summer. The official survey process begins this fall.
Press Ganey Associates, a professional polling organization that already surveys CGH patients, has worked with the HCAHPS survey to determine what patient values are most correlated with high hospital satisfaction. According to Press Ganey, patients who give hospitals high marks well feel they have been listened to by the nurses and other staff.
“You need to engage them completely with your attention and be observant of everything that’s going on…” is the way Dr. Ruben put it, an excellent definition of effective listening.
The experts say that how we perform our jobs is as valued by patients as what we do in the jobs. “Scoring highly (on patient surveys) does not require [hospital staff] perform any additional tasks or duties but simply conduct their existing activities in ways that build relationships with [patients and families],” according to the experts at Press Ganey. Examples? Greeting the patient by name, and asking for help to pronounce the name correctly. Making eye contact with the patient and family members when speaking with them. Asking about a patient’s comfort and helping make the patient comfortable. Explaining what you are doing – and why. Using those most-important words consistently: “excuse me,” “please,” and “thank you.” Before leaving the room, ask, “Is there anything else I can do for you?”
Health care workers are hardly actors in any theatrical sense, but we are clearly stars to our patients when we listen to their needs, when we show concern for their comfort, and when we demonstrate courtesy in the many things we do every day.
That comment is from a story broadcast recently by National Public Radio. “On stage” was the phase that struck me because, although we are not “acting,” we in health care certainly are at center stage for patients and family members. Patients and family members study us, as if we were performing at a recital, giving a reading at our place of worship, or making a speech in front of our social group.
They watch closely to discern clues about what’s going on with their care or with their loved ones. Are we excited about something? Are we confident? Distracted? Are we sensitive to the patient’s discomfort or anxiety? This is the way we human beings communicate, by closely watching others to see if actions match words. And the more important something is (such as hospital care), the more closely we observe.
This year the federal government will start observing us – through the eyes of our patients. Surveys will be mailed to the patients of CGH and all other hospitals across the country. This is called the HCAHPS survey (pronounced “h-caps” and meaning “Health Consumer Assessment of Healthcare Providers and Systems”). The results of these surveys will be reported publicly, starting in 2007, by the federal Centers for Medicare and Medicaid Services (CMS). Eventually CMS intends to use the hospital patient satisfaction scores to determine how much they pay us for the care of Medicare patients.
CGH will voluntarily participate in a test run of the new HCAHPS survey this summer. The official survey process begins this fall.
Press Ganey Associates, a professional polling organization that already surveys CGH patients, has worked with the HCAHPS survey to determine what patient values are most correlated with high hospital satisfaction. According to Press Ganey, patients who give hospitals high marks well feel they have been listened to by the nurses and other staff.
“You need to engage them completely with your attention and be observant of everything that’s going on…” is the way Dr. Ruben put it, an excellent definition of effective listening.
The experts say that how we perform our jobs is as valued by patients as what we do in the jobs. “Scoring highly (on patient surveys) does not require [hospital staff] perform any additional tasks or duties but simply conduct their existing activities in ways that build relationships with [patients and families],” according to the experts at Press Ganey. Examples? Greeting the patient by name, and asking for help to pronounce the name correctly. Making eye contact with the patient and family members when speaking with them. Asking about a patient’s comfort and helping make the patient comfortable. Explaining what you are doing – and why. Using those most-important words consistently: “excuse me,” “please,” and “thank you.” Before leaving the room, ask, “Is there anything else I can do for you?”
Health care workers are hardly actors in any theatrical sense, but we are clearly stars to our patients when we listen to their needs, when we show concern for their comfort, and when we demonstrate courtesy in the many things we do every day.
Saturday, April 22, 2006
I had no idea
Two months ago we heard shocking reports about several individuals who were arrested for illegally harvesting body tissue in New Jersey funeral homes. [1] The tissues were provided to a legitimate medical supply company where they were properly processed and distributed to hospitals around the country – including to Community General Hospital.[2] The investigation into these matters is continuing, most recently with a probe of a Philadelphia funeral home.
We saw an entirely different kind of story in our local paper recently. For the 26th consecutive year, students from SUNY Upstate Medical University gathered at Weiskotten Hall for a memorial service to honor individuals who donated their bodies to science.
All of us benefit directly or indirectly from the gifts of bodies and body parts from voluntary donors. For many years the New York State driver’s license has included a short form allowing each of us to “make an anatomical gift to be effective upon my death.” This prompts a story about anatomical harvesting at CGH several years ago.
A young adult died in our Emergency Department as the result of a neurological event, and the spouse agreed to organ harvesting. The couple had been married only a few years, and they had discussed with each other their willingness to donate their bodies “to help others if something should happen.” When the patient was pronounced dead, the spouse readily gave consent, and the deceased patient went to the OR for harvesting.
Six months later the surviving spouse called me one morning and asked to meet with members of the Emergency Department and OR teams who cared for the patient who had died. “I want to thank them,” the spouse said, “and I have some unanswered questions, some things I am wondering about that I would like to ask.”
I did not know what to make of this request. The spouse was certainly heartfelt, but what were the “unanswered questions?”
Working with the Nursing Division, I arranged for a small reception in the Personnel Lounge for the spouse at mid-morning one day. I invited those who had cared for the patient to stop and introduce themselves to the spouse. It was voluntary, and I told the spouse that CGH people were busy, and I could not be sure how many would be able to attend.
Many did. Employees shook hands with the spouse and introduced themselves. They said, “I cared for your [spouse] in the ED,” and “I was with [the patient] in the OR.” They said, “I am sorry for your loss.” The spouse said, “Thank you so much for all you did,” and “Thank you for coming this morning.”
One nurse from the OR had done homework. She arrived with a small piece of paper that had numbers written on it. “Let me tell you about some of the people who benefited from [the patient’s] gift,” she began. “There was a 15 year-old girl in [a Southern state] with bone cancer. She received your [spouse’s] long bones. There was a middle-aged man in St. Louis who received the heart. I was there when the harvest team arrived from St. Louis. A few hours later, as we continued to work on your [spouse], there was a phone call that was put over the OR speaker. The caller said, ‘The heart is in the patient, and it is beating.’ And we all cheered.”
The nurse continued, “I tried to count the number of patients who were helped by [the patient’s] gift – the eyes, the kidneys, the skin, the bones, the heart. There were more than 150 individuals who were helped by some part of your [spouse]. The harvesting took many hours, and at the end we were all exhausted. We all said a prayer for your [spouse] in the OR.”
I don’t think there was a dry eye in the room. “I had no idea,” the spouse said. “I had no idea that so many people were helped. Thank you for telling me this. You have no idea how much this means to me.”
This story has stayed with me all these years as a reminder of the good that we do – and how powerful it is when we explain what we do so others may share its meaning.
This CGH story – along with the annual memorial service at SUNY – are antidotes to the revulsion we feel at learning of the tissue scandal in New Jersey.
Please take out your driver’s license. Have you signed permission to be an anatomical donor “to help others if something should happen?”
[1] Two CNY patients got tissue linked to indicted supplier ,” Post-Standard, February 23, 2006
[2] “CGH opens info line on body tissue scare,” CGH Family Letter, February 25, 2006
We saw an entirely different kind of story in our local paper recently. For the 26th consecutive year, students from SUNY Upstate Medical University gathered at Weiskotten Hall for a memorial service to honor individuals who donated their bodies to science.
All of us benefit directly or indirectly from the gifts of bodies and body parts from voluntary donors. For many years the New York State driver’s license has included a short form allowing each of us to “make an anatomical gift to be effective upon my death.” This prompts a story about anatomical harvesting at CGH several years ago.
A young adult died in our Emergency Department as the result of a neurological event, and the spouse agreed to organ harvesting. The couple had been married only a few years, and they had discussed with each other their willingness to donate their bodies “to help others if something should happen.” When the patient was pronounced dead, the spouse readily gave consent, and the deceased patient went to the OR for harvesting.
Six months later the surviving spouse called me one morning and asked to meet with members of the Emergency Department and OR teams who cared for the patient who had died. “I want to thank them,” the spouse said, “and I have some unanswered questions, some things I am wondering about that I would like to ask.”
I did not know what to make of this request. The spouse was certainly heartfelt, but what were the “unanswered questions?”
Working with the Nursing Division, I arranged for a small reception in the Personnel Lounge for the spouse at mid-morning one day. I invited those who had cared for the patient to stop and introduce themselves to the spouse. It was voluntary, and I told the spouse that CGH people were busy, and I could not be sure how many would be able to attend.
Many did. Employees shook hands with the spouse and introduced themselves. They said, “I cared for your [spouse] in the ED,” and “I was with [the patient] in the OR.” They said, “I am sorry for your loss.” The spouse said, “Thank you so much for all you did,” and “Thank you for coming this morning.”
One nurse from the OR had done homework. She arrived with a small piece of paper that had numbers written on it. “Let me tell you about some of the people who benefited from [the patient’s] gift,” she began. “There was a 15 year-old girl in [a Southern state] with bone cancer. She received your [spouse’s] long bones. There was a middle-aged man in St. Louis who received the heart. I was there when the harvest team arrived from St. Louis. A few hours later, as we continued to work on your [spouse], there was a phone call that was put over the OR speaker. The caller said, ‘The heart is in the patient, and it is beating.’ And we all cheered.”
The nurse continued, “I tried to count the number of patients who were helped by [the patient’s] gift – the eyes, the kidneys, the skin, the bones, the heart. There were more than 150 individuals who were helped by some part of your [spouse]. The harvesting took many hours, and at the end we were all exhausted. We all said a prayer for your [spouse] in the OR.”
I don’t think there was a dry eye in the room. “I had no idea,” the spouse said. “I had no idea that so many people were helped. Thank you for telling me this. You have no idea how much this means to me.”
This story has stayed with me all these years as a reminder of the good that we do – and how powerful it is when we explain what we do so others may share its meaning.
This CGH story – along with the annual memorial service at SUNY – are antidotes to the revulsion we feel at learning of the tissue scandal in New Jersey.
Please take out your driver’s license. Have you signed permission to be an anatomical donor “to help others if something should happen?”
[1] Two CNY patients got tissue linked to indicted supplier ,” Post-Standard, February 23, 2006
[2] “CGH opens info line on body tissue scare,” CGH Family Letter, February 25, 2006
Saturday, April 8, 2006
Thank you, 95%
Community General Hospital has seen an increase in the percentage of hospital people (that includes doctors and employees) who comply with proper hand hygiene. In the first three months this year, we are averaging 95% compliance, compared with a 90% average in the past two years.
Three weeks ago I quoted a newspaper obituary for David Williamson Milne, a man who died in Kingston, Ontario on October 30, 2005. “The surgery was successful,” read the obituary.
According to the Hand Hygiene Resource Center, “two million people become ill each year as a result of a hospital-acquired infection,” at a cost of some $4.5 billion. This week the Wall Street Journal reported “the rising alarm” that 90,000 hospitals deaths occur each year from these infections.[2] That translates to about 250 patient deaths each day! To put that number in perspective, last year CGH had an average daily census of 192 patients.
A review of 34 studies shows that “hand washing adherence among health care workers…varied from 5% to 81%” – with the average “only 40%.” Yesterday Sue Chamberlain, CGH’s Infection Control Program Director, told me there is a 1999 study by the Centers for Disease Control (CDC) that shows an average 54% of health care workers wash their hands as required. From this I conclude that the average hospital’s compliance is in the 40-50% range.
“‘It is no longer tolerable to accept noncompliance rates of more than 50% when we are dealing with critically ill patients,’” according to Dr. Don Goldman of the Institute of Healthcare Improvement (IHI) who was quoted in the Journal article. Dr. Goldman noted that computer-chip makers have better hand-cleaning performance than some hospitals.
At CGH nothing we do is more important than keeping safe the patients entrusted to our care. So I thank you for the increased vigilance that has boosted our hand hygiene compliance to 95%. We are at the very top of nationwide performance, ]something we should be proud of – and something very important for patients.
I do have a nagging question about the remaining 5%. Who would fail to wash hands and raise the risk of a potentially life-threatening infection for a patient in the next room, a colleague in the cafeteria …or for that matter, a loved one at home?
[1] “A Tipping Point,” CGH Family Letter, March 18, 2006.
[2] “Hospitals Get Aggressive About Hand Washing,” Wall Street Journal, April 5, 2006
Three weeks ago I quoted a newspaper obituary for David Williamson Milne, a man who died in Kingston, Ontario on October 30, 2005. “The surgery was successful,” read the obituary.
Dave’s recovery was preceding well, thanks to the care of the [hospital] staff. Unfortunately, a series of hospital-acquired infections set back his progress and ultimately caused his premature passing.[1]
According to the Hand Hygiene Resource Center, “two million people become ill each year as a result of a hospital-acquired infection,” at a cost of some $4.5 billion. This week the Wall Street Journal reported “the rising alarm” that 90,000 hospitals deaths occur each year from these infections.[2] That translates to about 250 patient deaths each day! To put that number in perspective, last year CGH had an average daily census of 192 patients.
A review of 34 studies shows that “hand washing adherence among health care workers…varied from 5% to 81%” – with the average “only 40%.” Yesterday Sue Chamberlain, CGH’s Infection Control Program Director, told me there is a 1999 study by the Centers for Disease Control (CDC) that shows an average 54% of health care workers wash their hands as required. From this I conclude that the average hospital’s compliance is in the 40-50% range.
“‘It is no longer tolerable to accept noncompliance rates of more than 50% when we are dealing with critically ill patients,’” according to Dr. Don Goldman of the Institute of Healthcare Improvement (IHI) who was quoted in the Journal article. Dr. Goldman noted that computer-chip makers have better hand-cleaning performance than some hospitals.
At CGH nothing we do is more important than keeping safe the patients entrusted to our care. So I thank you for the increased vigilance that has boosted our hand hygiene compliance to 95%. We are at the very top of nationwide performance, ]something we should be proud of – and something very important for patients.
I do have a nagging question about the remaining 5%. Who would fail to wash hands and raise the risk of a potentially life-threatening infection for a patient in the next room, a colleague in the cafeteria …or for that matter, a loved one at home?
[1] “A Tipping Point,” CGH Family Letter, March 18, 2006.
[2] “Hospitals Get Aggressive About Hand Washing,” Wall Street Journal, April 5, 2006
Saturday, March 18, 2006
A tipping point
“Some day, we may look back at this and say it represented a tipping point in public consciousness.”
That is a message I received yesterday from my colleague Peter McGinn, PhD, who is the President and CEO of United Health Services in Binghamton, NY. Peter copied me on an e-mail that he sent to his staff about an obituary that appeared in a Canadian newspaper five months ago.
In reprinting the obituary, I repeat Peter’s words to his staff: “Please read this very carefully – all the way through.”
That is a message I received yesterday from my colleague Peter McGinn, PhD, who is the President and CEO of United Health Services in Binghamton, NY. Peter copied me on an e-mail that he sent to his staff about an obituary that appeared in a Canadian newspaper five months ago.
In reprinting the obituary, I repeat Peter’s words to his staff: “Please read this very carefully – all the way through.”
On October 30, 2005, David Williamson Milne passed away at Kingston General Hospital after a battle with hospital-acquired infections. He was loved and is deeply missed by many.
David Milne was the kind of person that you got to know, and like, quickly. His friends were among society’s small and society’s great, and he treated each with equal respect and appreciation. His Scottish humor and laugh were infectious. Even in his last days he could make us laugh.
His family was the joy of his life and sustained him throughout. As the youngest of a large Manitoba farm family, he was his mother’s joy and primary recipient of her loving largess. He wedded his first love and childhood sweetheart, Catherine, who followed him from posting to posting, with one and then two children, Catherine Jr. and Jacqueline.
As a long-service pilot in the Canadian Armed Forces David Milne’s life was not without risk, but risk balanced in an equation with skill. His heart surgery was a risk, but it was balanced against the outstanding skill of Dr. Hamilton at Kingston General Hospital. The surgery was successful and Dave’s recovery was preceding well, thanks to the care of the KGH staff. Unfortunately, a series of hospital-acquired infections set back his progress and ultimately caused his premature passing.
Every year hospital-acquired infections cause or contribute to the death of more people than breast cancer, heart disease, and car accidents combined. Most of these infections are initiated by otherwise caring healthcare workers who forget or neglect to clean their hands.And for each of those who, like our friend David, succumb to one of these unnecessary infections, there are many more who ache for their loss. These are not numbers on month-end reports. These are our fathers, our mothers, our children, and our dear friends, who are dying prematurely because of unclean hands. The little bit of extra time that it takes for healthcare workers to wash or to use an alcohol sanitizer is pittance compared to the waste of so many productive, loved and loving lives.
In honour and memory of David Williamson Milne a donation will be made in his name to the Community and Hospital Infection Control Association of Canada. His family and his extended group of friends openly urge those at Kingston General Hospital as well as healthcare workers everywhere to clean their hands before and after every patient contact. It is absolutely a matter of life and death.
Farewell to a dear husband, father and friend.
Saturday, January 28, 2006
Whatever became of bedside manner?
The New York Times ran a series of letters to the editor last month under the heading: “What ever became of bedside manner?” [1]
The nine letters were mostly from doctors, who offered their own advice for improving doctor-patient communications. The doctors recommended good manners, such as making eye contact, remaining seated while a patient recounts symptoms, washing hands in the presence of a patient, returning phones calls and accepting appointments promptly for established patients. [2]
Some letters also pointed out a patient’s responsibility for effective communications. “So often patients come to us without organized information or prior records,” one wrote. [3] Another physician noted that patients can waste time by speaking of irrelevant things. He wrote about a recent example where a patient recounted a lengthy medical experience from the Korean War. The physician said,
I have been in the hospital field for over 30 years, and I am still amazed at how much we sometimes talk past each other. We must all have examples of people misunderstanding one another – not because they were not listening, but because they applied different frames of reference to what was being said.
Messages we think we are sending may not be the same messages the other is receiving. We have different training, different experiences. We cannot automatically assume that our own perspective is shared by another. Sometimes our different frame of reference may cause us to make assumptions about another’s motivation. We may not even know we’re making an assumption, but what we think about the other fellow can affect the way we listen to – and accept or dismiss – what is being said.
I can imagine, for example, that the gentleman who rambled on about his Korean War experience (in the example above) may have done so because he was nervous at seeing a doctor – and his nervousness prompted too much talking. Or perhaps his long-winded story was an attempt to establish a relationship with the doctor before he brought up an embarrassing problem or a scary health complaint.
The point is, we may not know what motivates the other party, but our communications can improve if we imagine reasons why the other party might say or do something that is otherwise inexplicable. Keeping an open mind about the other person can help get past distracting or annoying communications. How might the caregiver’s communication with the Korean veteran have changed if he had considered reasons for the patient’s story other than mindless prattle?
When communications prompt an emotional reaction in the caregiver or the patient the focus can move away from what is being done or what has to be learned. If we’re thinking “How rude!” or “Who knows what she meant by that!” we’ve already changed the focus of our attention. When the focus moves away from the communication process, we risk not hearing something, forgetting to say something, not paying attention to something.
Good manners in health care communications are not just the “extra” that we bring to the bedside. They are an important part of the caring that we do, facilitating unambiguous understanding and reducing the chance for a mistake.
[1] “What’s Become of Bedside Manner? (Nine Letters),” New York Times, December 4, 2005.
[2] “Some Simple Guidelines for (seeing) Patients,”, Sharon Lewin, MD, New York Times, December 4, 2005
[3] Allan B. Ettinger, MD & Deborah M. Wesibot, MD, New York Times, December 4, 2005
[4] Mark Melamed, MD, New York Times, December 4, 2005
[5] Judith A. Erlen, New York Times, January 17, 2006
The nine letters were mostly from doctors, who offered their own advice for improving doctor-patient communications. The doctors recommended good manners, such as making eye contact, remaining seated while a patient recounts symptoms, washing hands in the presence of a patient, returning phones calls and accepting appointments promptly for established patients. [2]
Some letters also pointed out a patient’s responsibility for effective communications. “So often patients come to us without organized information or prior records,” one wrote. [3] Another physician noted that patients can waste time by speaking of irrelevant things. He wrote about a recent example where a patient recounted a lengthy medical experience from the Korean War. The physician said,
I listened patiently as the minutes ticked by, wondering what the story had to do with his eye condition or general medical history. It eventually became evident that it was simply an interesting anecdote that the patient felt like sharing…[4]Several weeks after the first set of letters, the Times printed more letters on bedside manners. Several suggested that better communications training is (or should be) available for health care professionals. One writer suggested that health care workers “ask themselves, ‘Is this how I would want my family member to be cared for? Is this how I would want a family member to be addressed?’” [5]
I have been in the hospital field for over 30 years, and I am still amazed at how much we sometimes talk past each other. We must all have examples of people misunderstanding one another – not because they were not listening, but because they applied different frames of reference to what was being said.
Messages we think we are sending may not be the same messages the other is receiving. We have different training, different experiences. We cannot automatically assume that our own perspective is shared by another. Sometimes our different frame of reference may cause us to make assumptions about another’s motivation. We may not even know we’re making an assumption, but what we think about the other fellow can affect the way we listen to – and accept or dismiss – what is being said.
I can imagine, for example, that the gentleman who rambled on about his Korean War experience (in the example above) may have done so because he was nervous at seeing a doctor – and his nervousness prompted too much talking. Or perhaps his long-winded story was an attempt to establish a relationship with the doctor before he brought up an embarrassing problem or a scary health complaint.
The point is, we may not know what motivates the other party, but our communications can improve if we imagine reasons why the other party might say or do something that is otherwise inexplicable. Keeping an open mind about the other person can help get past distracting or annoying communications. How might the caregiver’s communication with the Korean veteran have changed if he had considered reasons for the patient’s story other than mindless prattle?
When communications prompt an emotional reaction in the caregiver or the patient the focus can move away from what is being done or what has to be learned. If we’re thinking “How rude!” or “Who knows what she meant by that!” we’ve already changed the focus of our attention. When the focus moves away from the communication process, we risk not hearing something, forgetting to say something, not paying attention to something.
Good manners in health care communications are not just the “extra” that we bring to the bedside. They are an important part of the caring that we do, facilitating unambiguous understanding and reducing the chance for a mistake.
[1] “What’s Become of Bedside Manner? (Nine Letters),” New York Times, December 4, 2005.
[2] “Some Simple Guidelines for (seeing) Patients,”, Sharon Lewin, MD, New York Times, December 4, 2005
[3] Allan B. Ettinger, MD & Deborah M. Wesibot, MD, New York Times, December 4, 2005
[4] Mark Melamed, MD, New York Times, December 4, 2005
[5] Judith A. Erlen, New York Times, January 17, 2006
Saturday, January 7, 2006
"A classic example”
Earlier this week an employee raised a concern about patient privacy after she saw a provider interviewing a patient about her health history in a way that could be overheard by others.
Yesterday John Conner, our HIPAA[1] Privacy Officer, sent an all-department e-mail to remind us how important it is to use only the minimum necessary information when communicating about patients.
He wrote about a situation involving a department that produces a list of patients to be treated each day. The list is used to check-off names as patients arrive for their appointments. Last week a patient reported being able to see information on the list, such as the diagnoses or treatments associated with other names.
John called the situation “a classic example” of not following the minimum necessary standard.[2] In other words, more information was included on the patient list than was necessary. A second problem was that the list was visible to others. Patient information must be protected from unauthorized access, including casual access by others.
“The event provides a valuable learning opportunity for us,” John wrote, and he asked employees to bring similar situations to the attention of their supervisors right away.
I responded to John with an e-mail, saying that his message reminded me of another situation that dates from pre-HIPAA days. The mother of a patient called me to complain about a lack of information privacy. Her son, who had been a patient the prior week, had left his blue jeans in the room when he was discharged. She called Security, which promptly contacted the nursing unit, and the lost jeans were found.
When the mother stopped at Security to pick up the clothing, she saw that they were stored in a clear plastic bag, marked “patient belongings.” The bag also contained the printed half-sheet with the patient’s name, address, age – and diagnosis.
“Why, Mr. Quinn,” the mother asked me, “did the security officer have to know that my son is HIV positive?” It was a good question, and as a result, CGH changed its then-policy of including the half-sheet to identify patient belongings.
I’d like to thank the employees who showed their interest in (and sensitivity to) patient privacy this week. Confidentiality is a subject we take very seriously, and – as is apparent – one we need to remind ourselves about constantly.[3]
__________________
[1] HIPAA refers to the Health Insurance Portability and Accountability Act of 1996, a federal law that limits how hospitals and other health care providers may use health information that identifies an individual patient. The rule does not restrict the ability of doctors, nurses and other providers to share the information necessary to treat patients.
[2] HIPAA requires providers to use or share only the minimum amount of protected information necessary for a particular purpose. Information on HIPAA is available on this federal website: http://www.hhs.gov/news/facts/privacy.html
[3] For CGH policies on patient confidentiality, go to “Public Folders” on the CGH intranet, find “Manuals” and select “Hospital Policies.” “Hospital Policies” will take you to a number of headings. Select “09 Management of Information” and go to the subsection on “Confidentiality & Security.”
Yesterday John Conner, our HIPAA[1] Privacy Officer, sent an all-department e-mail to remind us how important it is to use only the minimum necessary information when communicating about patients.
He wrote about a situation involving a department that produces a list of patients to be treated each day. The list is used to check-off names as patients arrive for their appointments. Last week a patient reported being able to see information on the list, such as the diagnoses or treatments associated with other names.
John called the situation “a classic example” of not following the minimum necessary standard.[2] In other words, more information was included on the patient list than was necessary. A second problem was that the list was visible to others. Patient information must be protected from unauthorized access, including casual access by others.
“The event provides a valuable learning opportunity for us,” John wrote, and he asked employees to bring similar situations to the attention of their supervisors right away.
I responded to John with an e-mail, saying that his message reminded me of another situation that dates from pre-HIPAA days. The mother of a patient called me to complain about a lack of information privacy. Her son, who had been a patient the prior week, had left his blue jeans in the room when he was discharged. She called Security, which promptly contacted the nursing unit, and the lost jeans were found.
When the mother stopped at Security to pick up the clothing, she saw that they were stored in a clear plastic bag, marked “patient belongings.” The bag also contained the printed half-sheet with the patient’s name, address, age – and diagnosis.
“Why, Mr. Quinn,” the mother asked me, “did the security officer have to know that my son is HIV positive?” It was a good question, and as a result, CGH changed its then-policy of including the half-sheet to identify patient belongings.
I’d like to thank the employees who showed their interest in (and sensitivity to) patient privacy this week. Confidentiality is a subject we take very seriously, and – as is apparent – one we need to remind ourselves about constantly.[3]
__________________
[1] HIPAA refers to the Health Insurance Portability and Accountability Act of 1996, a federal law that limits how hospitals and other health care providers may use health information that identifies an individual patient. The rule does not restrict the ability of doctors, nurses and other providers to share the information necessary to treat patients.
[2] HIPAA requires providers to use or share only the minimum amount of protected information necessary for a particular purpose. Information on HIPAA is available on this federal website: http://www.hhs.gov/news/facts/privacy.html
[3] For CGH policies on patient confidentiality, go to “Public Folders” on the CGH intranet, find “Manuals” and select “Hospital Policies.” “Hospital Policies” will take you to a number of headings. Select “09 Management of Information” and go to the subsection on “Confidentiality & Security.”
Sunday, December 25, 2005
We have to take you in
On rounds this morning, I witnessed the life of our hospital as always. Nurses attended their patients. Doctors were at the bedside and at the charts. A technologist pushed a bed toward Radiology. The Emergency Department accepted its next patient. A maternity patient went upstairs for evaluation. The laboratory staff was busy testing fluids. In the kitchen, breakfast trays were being prepared for upstairs. Security was on alert.
It is a holiday, and our patients need us.
There is no elective surgery, and all our patients are those who cannot be anywhere else. As a hospital, we care for the acutely ill every day and all night.
It is a holiday, and our patients need us.
There is no elective surgery, and all our patients are those who cannot be anywhere else. As a hospital, we care for the acutely ill every day and all night.
There is an often quoted line of poetry by Robert Frost:
Home is where, when you go there,/ They have to take you in.[1]
The line applies to hospitals too – “we have to take you in.” What a responsibility we have, and what a privilege!
Saturday, September 3, 2005
A most difficult heroism
In the aftermath of Hurricane Katrina, words fail. The scale of the Gulf Coast disaster is truly massive, and the situation in New Orleans is a natural disaster compounded by a human one.
I have been thinking about those New Orleans hospital workers who left their families last Sunday, fully expecting to ride out the approaching hurricane while caring for the patients who needed them. By week’s end, however, the patients and caregivers of one hospital had become “almost indistinguishable,” according to the Los Angeles Times. [1] The newspaper reported the hospital had become “a chamber of horrors” with sewage backed up in sinks, its basement morgue under water, and a body bag in the ED. One employee was quoted as saying, “Workers are to the point of collapse.”
When the hurricane intensified Sunday night, hospital staff moved patients into hallways to protect them from the shattering windows. When the power failed, the hospital’s generators came on, but the rising water stopped the generators, and the hospital was without the electricity that runs ventilators, CT scanners, computers and air conditioning. Patients used 02 tanks to smash windows for fresh air. An internal evacuation moved patients to an upper floor. By Thursday hospital staff were in the third day of hand-ventilating patients. The National Guard started, then stopped an external evacuation because of sniper fire. Other rescue workers eventually followed, and aluminum boats were packed with patient stretchers and IVs as nurses accompanied patients to the Superdome and to the airport, which served as staging areas for evacuation out of the area. By Thursday 1,800 patients had been evacuated from New Orleans hospitals – with another 3,000 waiting for evacuation.
Hospital staff have families too – were they safe? With so many communications problems, the hospital staff were unable to talk with their loved ones. What must have been the worry, the fatigue, and the demands on doctors and hospital employees as they remained with the sick in those wasted facilities without the ability to provide sanitary or adequate care?
There have been many dramatic photos of the Coast Guard rescuing hundreds of people from rooftops and attic windows. The helicopters worked, allowing such heroic action. But medical equipment did not work. Indeed, the buildings themselves failed. That required a different kind of heroism by the caregivers of New Orleans. They struggled without rest to keep patients as safe as possible without equipment that is basic to proper care.
I have not seen any dramatic photos of life saving within the hospitals, comparable to the photos of Coast Guard rescuers. But the work of hospital people represented a different kind of heroism, one of the most difficult kind.
[1] “Hospital Descends into Misery,” Los Angeles Times, September 2, 2005.
I have been thinking about those New Orleans hospital workers who left their families last Sunday, fully expecting to ride out the approaching hurricane while caring for the patients who needed them. By week’s end, however, the patients and caregivers of one hospital had become “almost indistinguishable,” according to the Los Angeles Times. [1] The newspaper reported the hospital had become “a chamber of horrors” with sewage backed up in sinks, its basement morgue under water, and a body bag in the ED. One employee was quoted as saying, “Workers are to the point of collapse.”
When the hurricane intensified Sunday night, hospital staff moved patients into hallways to protect them from the shattering windows. When the power failed, the hospital’s generators came on, but the rising water stopped the generators, and the hospital was without the electricity that runs ventilators, CT scanners, computers and air conditioning. Patients used 02 tanks to smash windows for fresh air. An internal evacuation moved patients to an upper floor. By Thursday hospital staff were in the third day of hand-ventilating patients. The National Guard started, then stopped an external evacuation because of sniper fire. Other rescue workers eventually followed, and aluminum boats were packed with patient stretchers and IVs as nurses accompanied patients to the Superdome and to the airport, which served as staging areas for evacuation out of the area. By Thursday 1,800 patients had been evacuated from New Orleans hospitals – with another 3,000 waiting for evacuation.
Hospital staff have families too – were they safe? With so many communications problems, the hospital staff were unable to talk with their loved ones. What must have been the worry, the fatigue, and the demands on doctors and hospital employees as they remained with the sick in those wasted facilities without the ability to provide sanitary or adequate care?
There have been many dramatic photos of the Coast Guard rescuing hundreds of people from rooftops and attic windows. The helicopters worked, allowing such heroic action. But medical equipment did not work. Indeed, the buildings themselves failed. That required a different kind of heroism by the caregivers of New Orleans. They struggled without rest to keep patients as safe as possible without equipment that is basic to proper care.
I have not seen any dramatic photos of life saving within the hospitals, comparable to the photos of Coast Guard rescuers. But the work of hospital people represented a different kind of heroism, one of the most difficult kind.
[1] “Hospital Descends into Misery,” Los Angeles Times, September 2, 2005.
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