A new advocacy client of mine is a MD. His stress levels have been off the chart, and his self-care skills negligible. As a RN Patient Advocate, I helped navigate his 1.5 week hospitalization, and was present for his discharge to home. I’ve suggested an anti-inflammatory diet, acupuncture, and guided imagery. He’s agreed to everything, and is researching other complementary modalities. Keep an open mind, and recognize that “other” licensed providers have ethical modalities that aid in our whole-person well-being. Connect and collaborate for our collective health!
What it feels like to be a patient from a doctor’s point-of-view
Anonymous | Conditions | November 3, 2016
For the first couple of years of medical school, the constant stream of exams and the anxiety that came along with each one seemed never-ending. I told myself that it was worth sacrificing my personal health to better the lives of others.
I put off addressing my own mental health needs to keep advancing to the next level of education. I let stress manifest itself in new ways that my body wasn’t used to. I compulsively ate away my feelings with total disregard to both my physical and mental health. I was diagnosed with polycystic ovarian syndrome (PCOS) and became pre-diabetic by the end of my first year. I thought to myself “everyone goes through things like this during medical training. I’ll lose the weight next year”.
Another year went by and along with it came a new diagnosis. I started having terrible headaches that were different from the migraines I had become used to. I became preoccupied with my headaches. If I wasn’t in overwhelming pain, I was having anxiety about when my next headache would occur. After going through months of diagnostic imaging studies and to various physicians, I finally found a cause to my pain. By the end of my second year, I developed a medical condition known as idiopathic intracranial hypertension or pseudotumor cerebri.
My neurologist said that if my headaches weren’t well controlled, I could lose my vision. The pressure in my head could even get so bad that it could cause my brain to herniate if severe enough. It was a huge wake-up call. It’s hard to say how much medical school played a role in the development of my condition, but my headaches and instances of increased intracranial pressure have correlated highly with my stress level.
Making steps towards leading a healthier life by implementing exercise into my daily routine and identifying stressors has improved my symptoms greatly. The process of being a patient has taught me empathy for the patients that so often feel dismissed in our health care system.
A physician recently took the time to research the effects of the anti-inflammatory diet to augment the medications for my condition. The fact that he went above and beyond to provide me with an alternative to the medications that have been failing me for the past few months made me feel cared for. I invite health care professionals to take the extra 5 minutes to examine the current research and alternative modalities to medicine being used to treat your patient’s condition. It can make a huge difference in their quality of life.
My call to action to other graduate students struggling with chronic diseases and mental illnesses during their training processes is this: take care of yourself. You can’t take care of anyone if you’re dead. Your health is worth saving. Ask for help when you need to and advocate for what you believe in.
The author is an anonymous medical student who blogs at Naked Medicine.
Too often I’ve seen executives not engaging in the “soft skills” of leadership, and missing the importance of leading by example. They expect company managers to “know” how to do what they’re being directed to do. How is your company helping to build leadership?
3 must-do strategies for executive leaders to permanently improve employee engagement
Vicki Hess
Every executive leader in healthcare has a vested interest in improving employee engagement – whether he or she acknowledges it or not.
Unfortunately, many senior leaders think HR should manage engagement or they are looking for a magic formula when it comes to sustained improvement. Of course one doesn’t exist.
First, the problem. Here’s what I typically hear in my conversations with hospitals and health systems across the country. Employee engagement survey results come in and senior leaders talk about how important engagement is with their manager group. They share their desire for front line leaders to create department level action plans to transform engagement.
The action plans are created and quite often recorded in online monitoring systems for “accountability”. Most leaders – at all levels – understand that engagement is a key lever for productivity, creativity, safety and patient satisfaction so these actions make sense. Too often, the actions center around what the organization and leader need to do to impact engagement and they leave off the personal responsibility of the employees – but that’s another article.
For a month or two, there’s a focus on improving engagement. Then a new priority comes along and the front line leader’s attention is drawn to a new concern. The front line leader’s “one-up” manager stops asking about engagement. It moves to the back burner and all of the sudden it’s 9 months later and time for a new survey and whole cycle starts again.
If you want to stop this vicious cycle, try these 3 strategies.
Have an Engagement Champion at the executive level
Ideally, everyone on the senior leadership team would feel completely committed to engagement, but I know that’s not always going to happen. To quote Peter Drucker, “Whenever anything is being accomplished, it is being done, I have learned, by a monomaniac with a mission.” This doesn’t mean that some leaders can let engagement slide off their dashboards; it does mean that you need a champion.
Who is yours? Who on your senior leadership team feels most passionately about employee engagement and is willing to lead a consistent, well thought out campaign to keep engagement on the front burner? Without this level of commitment, engagement might improve in some departments but won’t improve overall. Ideally, the president or CEO is driving the conversations and actions over time. Having a senior level person championing engagement makes a strategic difference.
Provide tools for improvement that are distributed on a regular basis
When a system or process improves it’s usually because of a consistent focus with tools to back it up over time…think Lean Daily Management or traditional Performance Improvement practices. Because employee engagement is often seen as a “soft skill” with hard to measure results, it’s easy to fall into the trap of thinking that leaders will just know what to do.
In my work with clients, I have found the opposite of this to be true. Front line leaders are hungry for high impact, easy to implement ideas and tools to use. From one-on-one meeting agendas to rounding questions to team meeting ideas, many leaders struggle to know what to say and do. Having a working process to “drip” tools and strategies over time makes a difference. How are you providing consistent, realistic tools for your front line leaders to positively impact engagement?
Build in an accountability system starting with executive leaders
Traditional engagement action plans place the accountability on the front line leader. In many nursing settings, these leaders have upwards of 50 direct reports and many other priorities. How do you keep the accountability alive for engagement?
One idea goes back to involvement from the executive leadership team. When senior leaders are interested in the engagement level of their direct reports, they show a level of concern that models what directors and managers should offer to the supervisors who report to them, etc. Think about this. If you are a front line manager and your boss never asks about your own level of engagement, how important are you going to think it is?
Having a system with routine reminders including prompted questions for senior leaders helps to keep the focus present over time. Your Engagement Champion can also make sure that engagement shows up on meeting agendas and strategic planning conversations.
What Now?
In our world of healthcare, uncertain times lie ahead. Uncertainty breeds disengagement when unchecked. Disengagement leads to turnover which leads to time and money spent on re-hiring…and the cycle continues. A revolving door of staff leads to patient dissatisfaction which leads to poor financial performance. None of it is what you want.
The only way to deliver on the promises you are making to your customers & stakeholders is to continually provide an environment where employees are engaged. Now is the time for your senior leadership team to adopt these 3 must do strategies so you can improve engagement for good.
Vicki Hess, RN, is your go-to resource for transforming employee engagement at the individual, department or organization-wide level. As the author of four books, creator of the Engagement Excelerator Virtual Coaching Program, Certified Speaking Professional (CSP), trainer and consultant; Vicki inspires healthcare leaders to take action in a real-world, relatable way. Organizations that implement Vicki’s ideas experience increased engagement, productivity, safety, quality, retention, patient satisfaction, creativity and more. Access free tools and resources when you visit www.EngagementExcelerator.com.
As a RN Patient Advocate, I frequently engage in discussions with in home patient-clients and families about “safety vs. independence”. Can the patient accept the risk of staying at home, perhaps falling again, or hurting themselves in some way? We discuss “what if” scenarios. It’s immensely important that everyone be “on the same page” so that the burden of decisions doesn’t lie with any one caregiver.
How To Spend Your Final Months At Home, Sweet Home
There’s no mystery about what older adults want when they become seriously ill near the end of their lives.
They want to be cared for at home. For as long as possible.
It’s easy to understand why. Home represents familiarity, safety and identity — the place where we belong.
Yet health systems aren’t rewarded financially for making “time at home” a priority like they are for reducing the number of patients readmitted to hospitals.
Researchers from the Dartmouth Institute for Health Policy and Harvard Medical School argued that should change recently in the New England Journal of Medicine.
Health systems should focus on “outcomes that matter to patients,” they wrote, citing a new national analysis of terminally ill patients.
Where these patients — most of them older adults — spent their last 180 days varied significantly across the country. People had the most time at home in Mason City (145.82 days) and Waterloo, Iowa (144.61 days), and the least time at home in Idaho Falls, Idaho (118.83), and Shreveport, La. (119.15 days).
NAVIGATING AGING
Multiple factors contributed, including the availability of medical and social services and seniors’ financial and caregiving resources.
Do a few more weeks spent at home matter? Yes, if what patients truly value is taken seriously, the researchers asserted.
They describe a patient who had been in the hospital six weeks and finally returned home accompanied by a family member. “Just to see familiar photos on the wall made us feel we could breathe again,” that family member said.
What’s needed to make care at home possible during the last six months of life? We asked several experts:
Reallocating resources. “We have to reallocate resources within the healthcare system to the home setting,” said Dr. Diane Meier, a geriatrician and director of the Center to Advance Palliative Care in New York City.
This is already happening, to some extent. Medicare is testing the feasibility of bringing comprehensive medical services directly to frail, ill seniors through its Independence at Home demonstration project, now in 14 locations.
And house call programs that send physicians into seniors’ homes are beginning to expand across the country. To find a program near you, check this web site sponsored by the American Academy of Home Care Medicine.
Clarifying priorities. If staying at home at the end of life is a priority, this has to be communicated – clearly and frequently — to your family, caregivers, and physicians, said Dr. Thomas Lee, co-author of the New England Journal of Medicine study and chief medical officer at Press Ganey, a firm that tracks patients’ experiences with care.
Tradeoffs have to be part of this discussion.
Lee gives the example of his 89-year-old mother, who lives by herself in a condominium in Boston’s Beacon Hill neighborhood. Though she’s fallen several times, she’s refused to consider moving to assisted living or having a paid caregiver come in to help.
Being safe isn’t his mother’s foremost goal; independence is, Lee said. And that means accepting the risk that she could fall again or hurt herself.
Every time he sees a frail elderly patient, Dr. Thomas Cornwell asks “do you want to go to the hospital if you get sicker or do you want to stay at home?”
“If a crisis occurs, let’s say an exacerbation of congestive heart failure, and your values haven’t been discussed, you’ll generally end up in a hospital and, at least temporarily, in a nursing home,” said Cornwell, who has made over 32,000 house calls and is affiliated with Northwestern Medicine in metropolitan Chicago.
Making medical decisions. Take advantage of services designed for people with serious illnesses who need help at home.
One is home-based palliative care, which addresses worrisome symptoms such as pain or nausea that otherwise could send a vulnerable older adult to a hospital. In this model, a doctor, nurse and social worker join together to address a patient’s needs after a comprehensive assessment.
Home-based palliative care is still relatively new and not widely available. To learn more about programs in your area, go to www.getpalliativecare.org. Contact a few and ask if they offer these services or know of another organization that does.
Hospice care is similar in its approach, but only for people expected to live six months or less. The vast majority receive care in their homes. Unfortunately, most adults wait to sign up for hospice services until the last several weeks of life, missing out on potentially valuable assistance.
Getting needed help. Meier worries that an emphasis on home-based care for people with terminal illness could translate into more work for family caregivers who shoulder the burden of this care, not more support.
Currently, caregivers patch together services as best they can. Medicare doesn’t pay for aides who help frail, ill seniors bathe, dress, toilet, take their medications, keep their house clean, and prepare breakfast, lunch, or dinner. Low-income seniors can qualify for help from Medicaid, but the amount of assistance available is limited and varies by state.
There’s no easy solution to this “how can I get the help I’ll need?” dilemma. Be realistic about the cost of care (about $10 per hour, on average, with wide geographic variation) and the resources you have available. Also, be realistic about other elements of caring for someone at home, including the skills that will be required and whether the environment can support this challenge.
“Are the bedroom, the bathroom, and the kitchen on the same floor?,” asked Cornwell. “If not, you’re going to have a problem.”
Building community. “You’re going to need support” from family, friends or other social contacts if you’re trying to manage a serious illness at home, said Laura Connors, executive director of Beacon Hill Village in Boston.
Her organization sends volunteers into seniors’ homes to help in various ways on an as-needed basis. Older adults pay an annual fee to participate in the community’s social events and qualify for discounted home care services.
As with children, it “takes a community” to care for vulnerable older adults, Connors said, and you need to know “who’s going to be there for you.”
NAVIGATING AGING
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