What Not to Wear.........in Hospitals

This blog isn't about what Clinton and Stacey of the show "What Not To Wear" would suggest as to business attire vs. business casual while at work in the hospital.  It's about the recommendations from the Society for Healthcare Epidemiology of America (SHEA).  I read an article this AM as to SHEA's focus, which is the spread of infection by health care workers, clinicians, advanced practice professionals, RNs and physicians and pretty much anyone who comes in contact with the patient through their clothes, jewelry, shoes and accessories.  

SHEA's recommendations would include:

• Bare Below the Elbows: wearing short sleeves, no wristbands, no wristwatches, no rings and no jewelry of any kind.  No long sleeves in the clinical setting to minimize the transfer of bacteria.
• White Lab Coats: Although the lab coat denotes professionalism and is a patient satisfier, if you don't have several and have them laundered frequently, they can also be a source of bacteria.  Clinicians are also encouraged to place them on a hook before they enter the patient's room and not wear them around the patient.
• Neckties:  They too denote professionalism and can be worn but need to be secured by a tie tack or tie bar or preferably tucked in the shirt between buttons to keep them from being in contact with the patient.
• Shoes:  They should be clean, closed toe, low heel and non skid.  Soiled shoes should not be worn in patient care areas at anytime.
• Stethoscopes:  They should be cleaned and disinfected between patients as they are a great source of bacteria if not cared for properly.
• Accessories:  ID badges, ASCOM phones and smart phones can be brought into the patient care area but must be disinfected with great frequency.  

I thought that this article was interesting and worth sharing; I hope that it helps.

A Humbling Account of WWII

Over the weekend, my aunt shared with my cousin who in turn shared with me an account of WWII that was recently declassified which had a direct impact of my existence.  You see, my father, along with his twin brother, was in the Pacific on the USS Fall River, a heavy class cruiser.  He would speak very little of the war.  I knew that he manned the guns on the ship and that his ship never saw any real action.  At least that's what he told me whenever I asked.  

When the war broke out, he left high school and enlisted in the Navy.  He actually came back after the war and graduated from high school.  What I learned this weekend was that if Truman hadn't authorized the use of the atomic bomb on Japan, an elaborate all out attack on Japan had been planned.  The Army, the Army Air Force, the Navy and the Marines would attack Japan in two separate but coordinated invasions.  The casualties were estimated to be over 250,000 Americans and close to a million when you included the Japanese.  

It was later learned that Japan, in addition to planes, ships and submarines, had planned to use thousands of suicide bombers, suicide divers and suicide swimmers to attack ships in waves throughout the Pacific.  But because of Japan's unconditional surrender after the bombings of Hiroshima and Nagasaki, the invasions and attacks weren't necessary.  

We talk of the dropping of the atomic bomb as ending the war in the Pacific theater sooner, but we don't think of the lives that were spared as a result.  I know that many question to use the atomic bomb to this day, but I wonder if knowing that millions upon millions of us Baby Boomers, as well as Generation Xers and Millennials wouldn't be here today, would change some minds?  

Armed Law Enforcement in the ED

Beginning this weekend, there will be an armed law enforcement presence in the ED.  When I moved here 25 years ago, the hospital that I left was just beginning to have armed security in their ED.  A gang presence begin to evolve in the neighborhoods around the hospital and there was an attempted murder in the ED that was gang-related which prompted the change.  I thought at the time that it was nice to get out of that environment. 

Well, here we are 25 years later and we will now have armed deputy sheriffs in our ED.  Times have changed to the point where we need to protect our staff and our patients, especially during weekends.  EDs across the country are experiencing such challenges in protecting their staff as assaults on ED staff continue to rise.  The issues in our ED are primarily drug and alcohol related but nonetheless can still put our staff in a vulnerable position.  

We identified the prime coverage hours and we will have law enforcement on duty along with our security officers.  I am grateful to Sheriff Craig Robertson for his willingness to assist and his coordination of such a effort in a relatively short period of time.  I also appreciate the work of Jo Wilson, VP Operations, and Glenn Emerick, Director of Safety and Security, in making this happen.

Continuing to Build a Culture of Health in Allegany County

The numbers are in for the State of Maryland on the overall health status for Allegany County for 2013.  In the eight individual categories, we improved in two (health behaviors and physical environments); dropped one place in clinical care; and stayed the same in health outcomes, length of life, quality of life and health factors.  We saw improvement in low birth weight babies, poor mental health days, adult smoking, adult obesity, physical inactivity, sexually transmitted infections, number of uninsured, the number of primary care physicians and dentists, preventable hospital stays, more attending college, less unemployment and less children in single-parent households.  We declined in six areas and only slightly in each: excessive drinking is up by a percent, diabetic screenings have declined by 1%, mammography screening by 1%, children in poverty by 1%, a slight increase in air pollution and a very slight increase in violent crime that still falls far short of the state average.  Obviously, a lot of work is needed to continue to improve our overall health status for Allegany County, but we continue to head in the right direction year after year.

I Don't Like His Message But Could He Be Right?

Dr. Ezekeil Emanuel has a new book that is out, "Reinventing American Healthcare."  I am not a big fan of Dr. Emanuel, although I have never met him.  I have seen him on various talk shows and read some his work.  He gives the appearance that he is the smartest man in the room and it doesn't matter what room he is in.  I am not saying that he isn't a bright guy; but maybe listening once in a while may be beneficial.  

For those of you who don't know him, he is a former or current health policy advisor to the Obama White House (no one is really sure) and brother of Rahm Emanuel, former White House Chief of Staff and current Mayor of Chicago.  Ezekeil was rumored to be appointed the CEO of Obamacare when it was first rolled out and was failing miserably.  The White House was testing the waters that it needed a leader to get it fixed.  I am not quite sure what Kathleen Selibus, Secretary of Health and Human Services, and her many deputies, assistants and under secretaries were doing, but the idea was put out there; fortunately, it never got any traction.  

Getting back to the message in Dr. Emanuel's book: do we really need 5000 hospitals across the US?  He says that smaller hospitals are finding it harder and harder to recruit physicians as well as find funding to support things like IT and the the entire patient care infrastructure.  (By the way, WMHS is considered a medium sized health system, whew!)   

The challenge will be that many of these smaller hospitals are the largest employers in their communities and, in many cases, the engines driving their economies.   There is probably some truth to his message.  When U.S. health care was at its peak of $3 TRILLION in annual spending, there was a lot of money to go around.  That is no longer the case.  Health care is being transformed, as has been the case at WMHS for the last three plus years.  But when it is all said and done, every hospital in the U.S. will be making dramatic changes to how they do business, including getting cost out of their hospitals.  Such a requirement may be especially challenging for smaller hospitals where their margins are already pretty thin.

No More Red Pen Corrections

I saw an article over the weekend that an academy in England is banning the use of the red pen for corrections by teachers.  The reason: it hurts students' self-esteem.  OMG!  How about the fact that it can also make you a better writer?  I can speak on this issue from personal experience.  

I was new in my first supervisory job in health care and I was asked to write my first memo for the Director of Materials Management to sign and send to his counterparts in the organization.  I sat down with pen in hand and wrote the memo.  I gave it to my boss, who gave it to the Director.  Within the hour it was returned to me with a sea of red.  You could barely see the blue ink that I had used to write the original.  I was crushed; after all, I already had three years of college.  I asked myself and my immediate boss if my writing ability was that bad?  My boss was kind and said that his boss was rather particular.  I re-wrote the memo with his many changes and suggestions and it was then signed and sent.  

That process repeated itself many times and over time my writing skills improved dramatically and eventually no more red pen markings.  To this day, I value someone taking the time to assist me in developing my writing skills.  Did I find the red pen intimidating? Sure I did, but I valued what it meant.  What it said to me was "stop and re-think what it is that you are trying to say; learn from someone who certainly knows more than you do."  

To this day, I so very much appreciate George Rasmussen taking his time to make me not only a better writer but seeing the potential in me.  You see, within three years of that first memo written by me as Equipment Supervisor and red inked from top to bottom, I was the Director of Materials Management, replacing my mentor--all because of his guidance, direction and, most importantly, because he cared.  

The red pen certainly gets one's attention and if you understand the intention behind the red ink, your self-esteem should remain well in tact.

The Results are In

I may be jumping the gun, but at yesterday's System Management meeting, we had a presentation on the results of our latest employee engagement/satisfaction survey.  It was conducted about a month ago.  We had over 1440 employees participate in the survey, which is about a 65% completion rate; anything over 28% is statistically significant.  For our engagement mean score, we were very well positioned at 5.13 or almost at the 75 percentile (5.21).  For our previous survey, we were at 4.94.  

Almost 85% of those completing the survey felt either engaged or content, which is up 8% over the previous survey, while 15% feel either ambivalent (12.1%) or disengaged (2.9%) and both are down 8% (a good thing).  The individual department and patient unit results will be shared at the upcoming department directors meeting and have shown marked improvement in many areas.  

As for the strengths derived from the survey, they were employee benefits provided to employees, the ability to balance one's job and personal life through the assistance of their manager and receiving regular feedback on one's performance from their manager.  The two areas where improvement is needed include: job security and being kept informed about future plans.  One area that we were pleased to see such a dramatic improvement was related to patient safety by discussing preventing errors and mistakes.  The previous survey was at 48.2%; this survey was 72% strongly agreeing or agreeing that we are focused on safety .  

All in all, I am thrilled with such positive results and the dramatic improvement in many areas.  We will work to focus our attention in those areas where improvement is needed as well as in those departments where improvement over the previous survey did not occur or the results declined from the previous survey.  More to follow.