News release 11/4/11
IOM reports on efforts to develop a ‘learning health system’
The Institute of Medicine recently issued a report on efforts by its Roundtable on Value & Science-Driven Health Care to promote a “learning health system.” Guided by leaders from key stakeholder sectors, the Roundtable has worked since 2006 to accelerate the production and use of needed evidence on what works best in health care; characterize and explore the nature, potential and elements of a “learning health system” that yields continuous improvement in outcomes while reducing the costs of health and health care; and marshal collaborative action. The report summarizes a series of Roundtable publications that present a vision and strategies for a learning health system, and efforts by its Innovation Collaboratives to accelerate progress in five areas: best clinician practices, innovative effectiveness research, digital learning, evidence communication, and value incentives. Roundtable members include AHA Trustee Jonathan Perlin, M.D., president of clinical and physician services for HCA Inc., as well as other hospital leaders. For more on the initiative, visit www.iom.edu/vsrt.
Friday, November 4, 2011
Thursday, September 22, 2011
Are You Talking To Me?
Complete recognition is extended to Matthew Weinstock for his article, published September 22, 2011 in HH&N. Matthew Weinstock is the Senior Editor of Hospitals & Health Networks magazine.
Are You Talking to Me?
By Matthew Weinstock September 22, 2011
Better patient-physician communication is central to improving quality of care.
Since 2004, Bill Lee has had 10 heart attacks. That's not a typo: 10 heart attacks in 7 years.
He has coronary artery disease. Oh, and he's diabetic.
A few years ago, he was lying in a hospital bed after his seventh heart attack and his doctors told him, "There's nothing else we can do for you. You are just going to keep having heart attacks."
"That's not acceptable to me," he said. "I'm not going to accept your diagnosis and your prognosis."
From that moment, Lee took it upon himself to become an informed patient. He researched his conditions. He made a list of questions before every doctor's appointment and, importantly, he asked them. That was a new behavior for Lee. He used to be like so many of us, just accepting what the doctor said and taking his medicine, no questions asked.
Lee's compelling story is featured on a new website, "Questions are the Answer." Developed in partnership between the Agency for Healthcare Research and Quality and the Ad Council, the site is aimed at providers and patients, encouraging them to become more engaged in two-way communication.
"We know that when patients and clinicians communicate well, care is better. But in today's fast-paced health care system, good communication isn't always the norm," AHRQ Director Carolyn Clancy said in a statement. "This campaign reminds us all that effective communication between patients and their health care team is important and that it is possible — even when time is limited."
The AHRQ site, unveiled on Tuesday, contains a host of tools including one that lets patients create and prioritize a list of questions. Hospitals wanting to do a better job of promoting two-way communication can co-brand materials from the site.
Matthew and Carolyn Bucksbaum, meanwhile, are putting up $42 million to ensure that their home hospital, the University of Chicago Medical Center, bolsters doctor-patient communication. Matthew Bucksbaum is CEO of shopping mall behemoth General Growth Properties. The Bucksbaum Institute will "train medical students and faculty who, in turn, can serve as role models in communication and shared decision-making."
Of course, it is one thing to put up millions in the hopes that folks adopt shared decision-making, it's entirely another for that to become a reality. The National Institute for Health Care Reform on Tuesday issued a very insightful report detailing the many barriers to shared decision-making. The report, authored by researchers at the Center for Studying Health System Change and Mathematica Policy Research, also offers an array of policy solutions.
Shared decision making is slightly different from two-way communication. The latter can — should, I would argue — be used in any situation. Shared decision-making is typically used for "common health problems" for which there is more than one "medically acceptable treatment option," according to the NIHCR report. The idea is that an informed patient will work with his or her doctor to choose the best care for their particular case.
The authors note, however, that there are many roadblocks: an arcane payment system, clinicians poorly trained in the art of shared decision-making, malpractice concerns, low health literacy among patients, and, not insignificantly, "political hyperbole" that "can stifle discussion and support for shared decision-making." Think back to the arguments on end-of-life care during the health reform debate.
The report, however, points out that both the health reform and stimulus laws elevate shared decision-making through the promotion of patient-centered medical homes, the creation of the Patient-Centered Outcomes Research Institute and more.
But the authors suggest that we need not wait around for elements of those laws to take hold. No, there are some real solutions that could advance shared decision-making right now:
Reward providers. While providers wait for a shift from fee for service, CPT codes could be revised to pay for shared decision-making activity.
Do a better job of promoting and teaching the concept in medical school and create some continuing medical education programs.
Address liability concerns. In Washington, for instance, there are legal protections for physicians who engage in shared decision-making.
Provide patients with more tools/aids.
Tap into the power of electronic health and personal health records.
The shift to accountable care, the medical home, whatever catch phrase you want to use, hinges on the patient (and family) becoming an active participant in the care process. I know this all too well right now. I have a family member undergoing intense treatment for Stage 3 esophageal cancer. He is not a very good patient advocate, but his daughters are and they accompany him to every doctor's appointment armed with questions. Thankfully, his physicians are welcoming of their input and are fully engaged in a dialogue about his treatment plan. Can you say the same about your doctors?
I welcome your thoughts. Email me at mweinstock@healthforum.com.
Matthew Weinstock is the Senior Editor of Hospitals & Health Networks magazine.
Are You Talking to Me?
By Matthew Weinstock September 22, 2011
Better patient-physician communication is central to improving quality of care.
Since 2004, Bill Lee has had 10 heart attacks. That's not a typo: 10 heart attacks in 7 years.
He has coronary artery disease. Oh, and he's diabetic.
A few years ago, he was lying in a hospital bed after his seventh heart attack and his doctors told him, "There's nothing else we can do for you. You are just going to keep having heart attacks."
"That's not acceptable to me," he said. "I'm not going to accept your diagnosis and your prognosis."
From that moment, Lee took it upon himself to become an informed patient. He researched his conditions. He made a list of questions before every doctor's appointment and, importantly, he asked them. That was a new behavior for Lee. He used to be like so many of us, just accepting what the doctor said and taking his medicine, no questions asked.
Lee's compelling story is featured on a new website, "Questions are the Answer." Developed in partnership between the Agency for Healthcare Research and Quality and the Ad Council, the site is aimed at providers and patients, encouraging them to become more engaged in two-way communication.
"We know that when patients and clinicians communicate well, care is better. But in today's fast-paced health care system, good communication isn't always the norm," AHRQ Director Carolyn Clancy said in a statement. "This campaign reminds us all that effective communication between patients and their health care team is important and that it is possible — even when time is limited."
The AHRQ site, unveiled on Tuesday, contains a host of tools including one that lets patients create and prioritize a list of questions. Hospitals wanting to do a better job of promoting two-way communication can co-brand materials from the site.
Matthew and Carolyn Bucksbaum, meanwhile, are putting up $42 million to ensure that their home hospital, the University of Chicago Medical Center, bolsters doctor-patient communication. Matthew Bucksbaum is CEO of shopping mall behemoth General Growth Properties. The Bucksbaum Institute will "train medical students and faculty who, in turn, can serve as role models in communication and shared decision-making."
Of course, it is one thing to put up millions in the hopes that folks adopt shared decision-making, it's entirely another for that to become a reality. The National Institute for Health Care Reform on Tuesday issued a very insightful report detailing the many barriers to shared decision-making. The report, authored by researchers at the Center for Studying Health System Change and Mathematica Policy Research, also offers an array of policy solutions.
Shared decision making is slightly different from two-way communication. The latter can — should, I would argue — be used in any situation. Shared decision-making is typically used for "common health problems" for which there is more than one "medically acceptable treatment option," according to the NIHCR report. The idea is that an informed patient will work with his or her doctor to choose the best care for their particular case.
The authors note, however, that there are many roadblocks: an arcane payment system, clinicians poorly trained in the art of shared decision-making, malpractice concerns, low health literacy among patients, and, not insignificantly, "political hyperbole" that "can stifle discussion and support for shared decision-making." Think back to the arguments on end-of-life care during the health reform debate.
The report, however, points out that both the health reform and stimulus laws elevate shared decision-making through the promotion of patient-centered medical homes, the creation of the Patient-Centered Outcomes Research Institute and more.
But the authors suggest that we need not wait around for elements of those laws to take hold. No, there are some real solutions that could advance shared decision-making right now:
Reward providers. While providers wait for a shift from fee for service, CPT codes could be revised to pay for shared decision-making activity.
Do a better job of promoting and teaching the concept in medical school and create some continuing medical education programs.
Address liability concerns. In Washington, for instance, there are legal protections for physicians who engage in shared decision-making.
Provide patients with more tools/aids.
Tap into the power of electronic health and personal health records.
The shift to accountable care, the medical home, whatever catch phrase you want to use, hinges on the patient (and family) becoming an active participant in the care process. I know this all too well right now. I have a family member undergoing intense treatment for Stage 3 esophageal cancer. He is not a very good patient advocate, but his daughters are and they accompany him to every doctor's appointment armed with questions. Thankfully, his physicians are welcoming of their input and are fully engaged in a dialogue about his treatment plan. Can you say the same about your doctors?
I welcome your thoughts. Email me at mweinstock@healthforum.com.
Matthew Weinstock is the Senior Editor of Hospitals & Health Networks magazine.
Friday, August 26, 2011
Designing space for the high-tech patient room
With complete credit for authorship to John J. Skreenock, HEM as published in the August, 2011 issue of "HEALTH FACILITIES MANGEMENT"
Designing space for the high-tech patient room
By John J. Skreenock, HEM
When planning for new patient rooms, today's health facility professionals have quite the challenge. They must ensure that the room design will provide effective, state-of-the-art technology when the space is initially occupied and adapt to future technologies.
This is easier said than done. Depending on the size of the project and funding, it may be years before the space is actually constructed and ready for occupancy. Working closely with a knowledgeable medical-equipment planner will increase the probability that the design will last well into the future.
Three types of rooms
Most hospitals have three general types of patient rooms, depending on the acuity level of the patient: intensive care unit (ICU) rooms, step-down or intermediate care rooms, and acute care rooms.
ICU rooms are grouped together in a unit to take advantage of the nursing skills required to care for these patients. These nursing units are called medical ICUs, surgical ICUs, cardiovascular ICUs and cardiac ICUs, to name a few.
Each type of patient room must accommodate an extensive array of specialized medical equipment required to care for the clinical needs of the specific patient population. Consideration also must be given to the safe and efficient use of fixed and movable medical equipment brought in to care for the patient. They also must accommodate nursing staff and the cardiac resuscitation team, if they are needed. Consequently, these rooms need to be designed to allow safe, easy access to all sides of the patient.
Once the types of equipment that could be used in the room and the location and position of the patient are known, the room layout can begin.
Room organization
A major consideration for an ICU room is getting the utilities to all the movable and portable equipment brought in and out of the room during a patient's stay. The ceiling, wall and floor space are usually at a premium in these rooms and the anticipated use of specific medical equipment will dictate the location of both the fixed and mobile medical equipment.
Types of utilities and outlets that typically need to be available in the room range from electrical and emergency power receptacles for equipment (e.g., ventilators, hemodialysis units and physiologic monitors); to low-voltage connections for various devices (e.g., television, information technology data lines for bedside physiologic monitors, electronic medical records and alarm monitoring); and medical gases (e.g., oxygen and medical air and vacuum outlets).
There are several methods of getting the utilities near the patient. Fixed floor-to-ceiling columns and movable ceiling- or wall-mounted booms have been gaining popularity over a standard prefabricated headwall or mounting the utilities directly on the walls adjacent to the patient bed. The columns provide better organization of the devices, better accessibility for staff and reduced wire and tube clutter, and fewer tripping hazards.
The columns and booms also allow for some bed movement to take advantage of window vistas, which have been attributed to patient well-being. However, window views may not always be an option due to existing external obstructions. One innovative hospital solved that dilemma by planning to install windowlike frames to display real-time camera views from several locations on the hospital roof.
If a fixed column or boom is used, space on the ceiling needs to be evaluated for proper layout, ceiling support structure and lighting requirements. Some ICU rooms may be equipped with one or two special procedural lights mounted in the ceiling above the patient for procedures that could be performed in the room in an emergency. Procedure lights sometimes are specified for ICU rooms. One model enables lights to be directed to the specific site using a wand- or wall-mounted panel.
Another consideration competing for ceiling space is the patient lift. Patient lifts can be mounted to the ceiling, installed as freestanding structures, or attached to a boom. The Facility Guidelines Institute's 2010 Guidelines for Design and Construction of Health Care Facilities identifies the need to conduct a patient handling and movement assessment and to address this during the construction process, which could have major implications for room design.
If there is a possibility of installing ceiling-mounted lifts in the future it is prudent to plan for them in the early design stages to prevent clashes with structures above the ceiling or to add structural support while the room is being planned.
Nursing staff need good visibility to the patient from the hallway. This is accomplished by using a significant amount of glass. However, sometimes privacy is needed for the patient and switchable or so-called "smart" glass is used in some units to accommodate the dual needs of privacy and observation.
With the touch of a switch, the glass changes from transparent to opaque, blocking light and providing privacy and security. This high-tech glass eliminates the need for blinds or curtains that may present an infection control risk and pose a cleaning challenge for environmental services. These glass panels are relatively expensive compared with that of standard glass, however.
Equipment needs
This is Modular Services Company's equipment solution for neonatal intensive care operations. The design team must ensure that the room is future-proofed for all of the equipment that may be fixed or wheeled into the room. It needs to consider the possible uses of the room when it is completed as well as how the room may be used in the future.
Ultimately, the type of critical care unit and patient determines which technologies are needed in the room. Most ICU rooms include ventilators; physiologic monitors mounted on a wall, boom or column; IV poles that are movable or mounted to a column or boom that can accommodate multiple IV pumps; and patient-controlled analgesia pumps. All of these may require multiple emergency-power receptacles.
Many of these devices will be integrated with the hospital electronic records through wireless connections. This integration requires that the information technology (IT) group be intimately involved with the planning of the room design and antenna placement.
Some facilities monitor ICU patients from a remote site, often called the electronic ICU or command center. For remote-monitored rooms, a pan-tilt-zoom (PTZ) camera, microphone and speakers — either ceiling- or wall-mounted — are needed to enable the remote site to communicate with the patient or nursing staff and observe patient and vital equipment displays and settings.
There is also a telepresence robot on the market that can be maneuvered into the room to gather the same type of information. This type of device requires a clear floor path through the room without wires, tubes or cables on the floor.
Intelligent patient beds are another new component in high-tech patient rooms. They not only require electrical power, but also a low-voltage data jack to connect to the hospital infrastructure for nurse-call and bed-exit alarms to monitor for fall risks. They also require connections for electronic medical records.
The flow of patient care within the room needs to be planned carefully to accommodate wireless workstations on wheels (WOWs), which typically are used for patient charting and confirmation of medication delivery. While they do not require an electrical receptacle or data jack, they take up space and need to be considered in the room layout. The typical footprint for the WOW is approximately 26 inches wide by 28 inches deep; however, newer tablet devices eventually may supersede WOWs for charting patient care.
As more and more new technology is introduced for patient care, the design team faces new challenges in providing the required utilities and adequate footprint. For example, ICU patients too ill to be moved for imaging studies need space in their rooms to accommodate mobile imaging devices like a mobile C-arm radiography or fluoroscopy unit.
The type of patient receiving care will dictate the equipment and utility requirements for the room. Here are some examples of typical ICU room equipment that have relatively large footprints and their utility requirements:
Hemodialysis equipment using continuous renal replacement therapy requires a hot and cold mixed water supply, drain and emergency power.
Ventilators require emergency electrical power, a medical air connection and a data connection for alarm management.
Hypo/hyperthermia units require electrical power.
Intra-aortic balloon pumps used in the cardiovascular ICU require emergency electrical power.
Video endoscopy carts or bronchoscopy carts require electrical power.
C-arms require electrical power.
Space also is required to ensure quick patient access by the resuscitation team with their resuscitation cart or crash cart.
Other types of ICU rooms may require very different equipment needs. For example, specialized orthopedic beds in a trauma ICU that provides for traction are usually larger and have bars that extend toward the ceiling. These require clear space above the bed to accommodate the bars. Likewise, neurologic intensive care areas may call for specialized monitoring equipment that require data jacks as well as a ceiling- or wall-mounted PTZ camera and microphone and speakers.
Point-of-care technology may have an impact on additional requirements for the design of the room as blood gas monitoring and portable ultrasound are becoming more prevalent. The key is using the medical-equipment planner to provide those glimpses into the technologies of the future of patient care and to raise the awareness of potential implications of the design on future needs.
Decisions must be made about making the investment to provide for the necessary flexibility, or at least addressing the potential impact, and designing the room to be able to add future equipment or technologies.
Beyond the ICU
Critical care areas aren't the only sections of hospitals with high-tech patient rooms. Step-down rooms and acute care rooms have their share of technologies requiring planning and installation considerations.
Step-down rooms are associated with the ICUs and have a reduced complement of equipment needs depending on the type of step-down unit. These rooms may be monitored via a telemetry transmitter that sends a patient's heart trace signals and maybe pulse oximetry to a central monitor that is being watched by a trained monitor technician. A step-down room also has a lesser requirement for both the regular and emergency electrical power systems and the number of oxygen, medical air and vacuum outlets. The design may have to accommodate fixed-ceiling patient lifts.
The acute care room has an even smaller complement of medical equipment and, consequently, less infrastructure. Some health care facilities are designing step-down and acute care rooms to be more like hotel rooms, conveying a less clinical and more comforting experience for both patients and their visiting family and friends.
Many hospitals also treat critically ill infants and children. Neonatal and pediatric ICUs have highly specialized equipment and unique room design requirements.
More of these rooms are being designed as private rooms to provide better control over the sensory environment for the neonate. Alarm management from the equipment in the room requires data jacks. Lines of site that are lost due to privacy and communication challenges need to be addressed with technology because of hard walls. Equipment to care for the neonate can be mounted on the wall or suspended from the ceiling on a boom. Utilities like regular and emergency electrical power are needed in sufficient quantity. Additionally, medical air, oxygen and vacuum are required, as are data jacks for connection to the central monitoring and the hospital information systems.
Planning for future
While considering the equipment now used in each type of room, hospital designers and facility managers must work in conjunction with clinicians to consider the potential use of the room in the future.
It is generally easier and less expensive to include additional space, electrical and data outlets, and utilities while in the design and construction phase of a project, rather than waiting until the spaces are occupied with patients and then deciding an upgrade is needed.
John J. Skreenock, HEM, is senior associate for the Applied Solutions Group at ECRI Institute, Plymouth Meeting, Pa. He can be reached at jskreenock@ecri.org.
Sidebar - Flexible rooms provide savings
A medium-sized hospital planned to renovate a couple of its acute- care nursing floors and convert all of the semiprivate rooms to private rooms, creating a new intensive care unit (ICU) step-down space.
While initial plans called for the rooms to be used for step-down patients, the longer range plan was to convert these spaces to ICU rooms when needed. For a step-down room, telemetry monitoring is sufficient. However, for future use as an ICU setting, centrally monitored, wall-mounted physiologic monitors or other high-technology equipment would be required.
With that in mind, the design had to be modified. The hospital decided to plan the rooms with increased infrastructure to handle the future conversion. Increased gas and vacuum capacity for additional outlets and additional electrical power and data jacks allowed for future upgrades.
These design changes now allow the high-technology equipment that is routinely deployed in the ICU to be used in these rooms in the future. The cost for such infrastructure at such an early stage is a fraction of the cost required in the future to convert the rooms.
However, cost is only one factor that would be considered for future conversion. If the hospital had not increased the infrastructure during the original renovation, a future conversion would have faced major complications, including the potential loss of revenue while the rooms were being renovated extensively, disruption to patient care and department operations, complex infection-control issues and a longer time to complete the conversion.
With all of these considerations, the conversion for ICU patients may never have happened.
Sidebar - Prepping for mass patient surges
When hospitals need extra space for unplanned patients in mass numbers, such as during or after a flu epidemic or a disaster with mass casualties, some facilities provide a flexible solution for allowing the census in a particular nursing department to flex up in times of need and then flex back down when the need subsides.
A portion of the acute care private rooms are designed with the ability to accommodate two patients in the same room, essentially creating a semiprivate room. This flexibility is provided by having the room designed with built-in infrastructure, such as utilities to accommodate two beds.
The design requires two headwall arrangements, each with enough gas and vacuum outlets; regular and emergency power; data jacks for plugging in equipment that communicates with the hospital's information systems; and separate lighting controls for each bed. Movable equipment required for patient care, like beds and IV pumps on poles, can be wheeled in when needed.
The second bed can be set up similar to the first but may not need all the amenities, because it only would be used for a short duration. Flexibility designed into the rooms allows for an unexpected short uptick in the hospital census.
The surge plan then will call for fixed medical equipment as well as additional mobile medical equipment to provide patient care. The mobile equipment may be relocated from another area of the facility, from storage or requisitioned from local rental firms.
This article first appeared in the August 2011 issue of HFM magazine.
Designing space for the high-tech patient room
By John J. Skreenock, HEM
When planning for new patient rooms, today's health facility professionals have quite the challenge. They must ensure that the room design will provide effective, state-of-the-art technology when the space is initially occupied and adapt to future technologies.
This is easier said than done. Depending on the size of the project and funding, it may be years before the space is actually constructed and ready for occupancy. Working closely with a knowledgeable medical-equipment planner will increase the probability that the design will last well into the future.
Three types of rooms
Most hospitals have three general types of patient rooms, depending on the acuity level of the patient: intensive care unit (ICU) rooms, step-down or intermediate care rooms, and acute care rooms.
ICU rooms are grouped together in a unit to take advantage of the nursing skills required to care for these patients. These nursing units are called medical ICUs, surgical ICUs, cardiovascular ICUs and cardiac ICUs, to name a few.
Each type of patient room must accommodate an extensive array of specialized medical equipment required to care for the clinical needs of the specific patient population. Consideration also must be given to the safe and efficient use of fixed and movable medical equipment brought in to care for the patient. They also must accommodate nursing staff and the cardiac resuscitation team, if they are needed. Consequently, these rooms need to be designed to allow safe, easy access to all sides of the patient.
Once the types of equipment that could be used in the room and the location and position of the patient are known, the room layout can begin.
Room organization
A major consideration for an ICU room is getting the utilities to all the movable and portable equipment brought in and out of the room during a patient's stay. The ceiling, wall and floor space are usually at a premium in these rooms and the anticipated use of specific medical equipment will dictate the location of both the fixed and mobile medical equipment.
Types of utilities and outlets that typically need to be available in the room range from electrical and emergency power receptacles for equipment (e.g., ventilators, hemodialysis units and physiologic monitors); to low-voltage connections for various devices (e.g., television, information technology data lines for bedside physiologic monitors, electronic medical records and alarm monitoring); and medical gases (e.g., oxygen and medical air and vacuum outlets).
There are several methods of getting the utilities near the patient. Fixed floor-to-ceiling columns and movable ceiling- or wall-mounted booms have been gaining popularity over a standard prefabricated headwall or mounting the utilities directly on the walls adjacent to the patient bed. The columns provide better organization of the devices, better accessibility for staff and reduced wire and tube clutter, and fewer tripping hazards.
The columns and booms also allow for some bed movement to take advantage of window vistas, which have been attributed to patient well-being. However, window views may not always be an option due to existing external obstructions. One innovative hospital solved that dilemma by planning to install windowlike frames to display real-time camera views from several locations on the hospital roof.
If a fixed column or boom is used, space on the ceiling needs to be evaluated for proper layout, ceiling support structure and lighting requirements. Some ICU rooms may be equipped with one or two special procedural lights mounted in the ceiling above the patient for procedures that could be performed in the room in an emergency. Procedure lights sometimes are specified for ICU rooms. One model enables lights to be directed to the specific site using a wand- or wall-mounted panel.
Another consideration competing for ceiling space is the patient lift. Patient lifts can be mounted to the ceiling, installed as freestanding structures, or attached to a boom. The Facility Guidelines Institute's 2010 Guidelines for Design and Construction of Health Care Facilities identifies the need to conduct a patient handling and movement assessment and to address this during the construction process, which could have major implications for room design.
If there is a possibility of installing ceiling-mounted lifts in the future it is prudent to plan for them in the early design stages to prevent clashes with structures above the ceiling or to add structural support while the room is being planned.
Nursing staff need good visibility to the patient from the hallway. This is accomplished by using a significant amount of glass. However, sometimes privacy is needed for the patient and switchable or so-called "smart" glass is used in some units to accommodate the dual needs of privacy and observation.
With the touch of a switch, the glass changes from transparent to opaque, blocking light and providing privacy and security. This high-tech glass eliminates the need for blinds or curtains that may present an infection control risk and pose a cleaning challenge for environmental services. These glass panels are relatively expensive compared with that of standard glass, however.
Equipment needs
This is Modular Services Company's equipment solution for neonatal intensive care operations. The design team must ensure that the room is future-proofed for all of the equipment that may be fixed or wheeled into the room. It needs to consider the possible uses of the room when it is completed as well as how the room may be used in the future.
Ultimately, the type of critical care unit and patient determines which technologies are needed in the room. Most ICU rooms include ventilators; physiologic monitors mounted on a wall, boom or column; IV poles that are movable or mounted to a column or boom that can accommodate multiple IV pumps; and patient-controlled analgesia pumps. All of these may require multiple emergency-power receptacles.
Many of these devices will be integrated with the hospital electronic records through wireless connections. This integration requires that the information technology (IT) group be intimately involved with the planning of the room design and antenna placement.
Some facilities monitor ICU patients from a remote site, often called the electronic ICU or command center. For remote-monitored rooms, a pan-tilt-zoom (PTZ) camera, microphone and speakers — either ceiling- or wall-mounted — are needed to enable the remote site to communicate with the patient or nursing staff and observe patient and vital equipment displays and settings.
There is also a telepresence robot on the market that can be maneuvered into the room to gather the same type of information. This type of device requires a clear floor path through the room without wires, tubes or cables on the floor.
Intelligent patient beds are another new component in high-tech patient rooms. They not only require electrical power, but also a low-voltage data jack to connect to the hospital infrastructure for nurse-call and bed-exit alarms to monitor for fall risks. They also require connections for electronic medical records.
The flow of patient care within the room needs to be planned carefully to accommodate wireless workstations on wheels (WOWs), which typically are used for patient charting and confirmation of medication delivery. While they do not require an electrical receptacle or data jack, they take up space and need to be considered in the room layout. The typical footprint for the WOW is approximately 26 inches wide by 28 inches deep; however, newer tablet devices eventually may supersede WOWs for charting patient care.
As more and more new technology is introduced for patient care, the design team faces new challenges in providing the required utilities and adequate footprint. For example, ICU patients too ill to be moved for imaging studies need space in their rooms to accommodate mobile imaging devices like a mobile C-arm radiography or fluoroscopy unit.
The type of patient receiving care will dictate the equipment and utility requirements for the room. Here are some examples of typical ICU room equipment that have relatively large footprints and their utility requirements:
Hemodialysis equipment using continuous renal replacement therapy requires a hot and cold mixed water supply, drain and emergency power.
Ventilators require emergency electrical power, a medical air connection and a data connection for alarm management.
Hypo/hyperthermia units require electrical power.
Intra-aortic balloon pumps used in the cardiovascular ICU require emergency electrical power.
Video endoscopy carts or bronchoscopy carts require electrical power.
C-arms require electrical power.
Space also is required to ensure quick patient access by the resuscitation team with their resuscitation cart or crash cart.
Other types of ICU rooms may require very different equipment needs. For example, specialized orthopedic beds in a trauma ICU that provides for traction are usually larger and have bars that extend toward the ceiling. These require clear space above the bed to accommodate the bars. Likewise, neurologic intensive care areas may call for specialized monitoring equipment that require data jacks as well as a ceiling- or wall-mounted PTZ camera and microphone and speakers.
Point-of-care technology may have an impact on additional requirements for the design of the room as blood gas monitoring and portable ultrasound are becoming more prevalent. The key is using the medical-equipment planner to provide those glimpses into the technologies of the future of patient care and to raise the awareness of potential implications of the design on future needs.
Decisions must be made about making the investment to provide for the necessary flexibility, or at least addressing the potential impact, and designing the room to be able to add future equipment or technologies.
Beyond the ICU
Critical care areas aren't the only sections of hospitals with high-tech patient rooms. Step-down rooms and acute care rooms have their share of technologies requiring planning and installation considerations.
Step-down rooms are associated with the ICUs and have a reduced complement of equipment needs depending on the type of step-down unit. These rooms may be monitored via a telemetry transmitter that sends a patient's heart trace signals and maybe pulse oximetry to a central monitor that is being watched by a trained monitor technician. A step-down room also has a lesser requirement for both the regular and emergency electrical power systems and the number of oxygen, medical air and vacuum outlets. The design may have to accommodate fixed-ceiling patient lifts.
The acute care room has an even smaller complement of medical equipment and, consequently, less infrastructure. Some health care facilities are designing step-down and acute care rooms to be more like hotel rooms, conveying a less clinical and more comforting experience for both patients and their visiting family and friends.
Many hospitals also treat critically ill infants and children. Neonatal and pediatric ICUs have highly specialized equipment and unique room design requirements.
More of these rooms are being designed as private rooms to provide better control over the sensory environment for the neonate. Alarm management from the equipment in the room requires data jacks. Lines of site that are lost due to privacy and communication challenges need to be addressed with technology because of hard walls. Equipment to care for the neonate can be mounted on the wall or suspended from the ceiling on a boom. Utilities like regular and emergency electrical power are needed in sufficient quantity. Additionally, medical air, oxygen and vacuum are required, as are data jacks for connection to the central monitoring and the hospital information systems.
Planning for future
While considering the equipment now used in each type of room, hospital designers and facility managers must work in conjunction with clinicians to consider the potential use of the room in the future.
It is generally easier and less expensive to include additional space, electrical and data outlets, and utilities while in the design and construction phase of a project, rather than waiting until the spaces are occupied with patients and then deciding an upgrade is needed.
John J. Skreenock, HEM, is senior associate for the Applied Solutions Group at ECRI Institute, Plymouth Meeting, Pa. He can be reached at jskreenock@ecri.org.
Sidebar - Flexible rooms provide savings
A medium-sized hospital planned to renovate a couple of its acute- care nursing floors and convert all of the semiprivate rooms to private rooms, creating a new intensive care unit (ICU) step-down space.
While initial plans called for the rooms to be used for step-down patients, the longer range plan was to convert these spaces to ICU rooms when needed. For a step-down room, telemetry monitoring is sufficient. However, for future use as an ICU setting, centrally monitored, wall-mounted physiologic monitors or other high-technology equipment would be required.
With that in mind, the design had to be modified. The hospital decided to plan the rooms with increased infrastructure to handle the future conversion. Increased gas and vacuum capacity for additional outlets and additional electrical power and data jacks allowed for future upgrades.
These design changes now allow the high-technology equipment that is routinely deployed in the ICU to be used in these rooms in the future. The cost for such infrastructure at such an early stage is a fraction of the cost required in the future to convert the rooms.
However, cost is only one factor that would be considered for future conversion. If the hospital had not increased the infrastructure during the original renovation, a future conversion would have faced major complications, including the potential loss of revenue while the rooms were being renovated extensively, disruption to patient care and department operations, complex infection-control issues and a longer time to complete the conversion.
With all of these considerations, the conversion for ICU patients may never have happened.
Sidebar - Prepping for mass patient surges
When hospitals need extra space for unplanned patients in mass numbers, such as during or after a flu epidemic or a disaster with mass casualties, some facilities provide a flexible solution for allowing the census in a particular nursing department to flex up in times of need and then flex back down when the need subsides.
A portion of the acute care private rooms are designed with the ability to accommodate two patients in the same room, essentially creating a semiprivate room. This flexibility is provided by having the room designed with built-in infrastructure, such as utilities to accommodate two beds.
The design requires two headwall arrangements, each with enough gas and vacuum outlets; regular and emergency power; data jacks for plugging in equipment that communicates with the hospital's information systems; and separate lighting controls for each bed. Movable equipment required for patient care, like beds and IV pumps on poles, can be wheeled in when needed.
The second bed can be set up similar to the first but may not need all the amenities, because it only would be used for a short duration. Flexibility designed into the rooms allows for an unexpected short uptick in the hospital census.
The surge plan then will call for fixed medical equipment as well as additional mobile medical equipment to provide patient care. The mobile equipment may be relocated from another area of the facility, from storage or requisitioned from local rental firms.
This article first appeared in the August 2011 issue of HFM magazine.
Sunday, August 14, 2011
Friday, June 24, 2011
Violence In Hospitals
With complete credit to author Whitney L.J. Howell
This article first appeared in the January 2011 issue of H&HN magazine.
Security issues
Violence in Hospitals
By Whitney L.J. Howell
With attacks against staff and patients on the rise, administrators rethink security policies
Shortly after 12:30 a.m. on Sept. 3, Darrell Garner walked into Baton Rouge (La.) General Medical Center with a gun. He entered the room where his teenage stepson was a patient and argued with his estranged wife, allegedly shooting her in the arm and shooting her boyfriend in the arm and head. Local police responded quickly, but Garner apparently left while doctors and nurses treated the victims. (Ten days later, the suspect turned himself in to local police where he remains in custody.) Authorities put the facility on lockdown, and for hours, most employees got either erroneous information or none at all.
"At that time, we had no way to alert people to what had really occurred," says Edgardo Tenreiro, Baton Rouge General's executive vice president and chief operating officer. "We also hadn't yet thought about having a command center outside the hospital, so when I arrived at 1 a.m., I spent valuable time driving around our campus, trying to find the center location."
After a three-hour sweep of the facility, the SWAT team gave the all-clear and the medical center returned to normal operations.
Hospital administrators recognized that their security policies needed an upgrade. For one thing, Code White—the emergency code Baton Rouge General uses to announce violent patients—was not only inaccurate, but in this case, with a gunman involved, it also could have put at risk employees who responded to assist colleagues. The following Monday, leaders instituted Code Silver to alert staff to the presence of an active shooter.
"With the Code Silver, we're able to tell everyone to get out of harm's way—close patient doors, close doors to the unit, and barricade themselves behind desks," Tenreiro says. "In these situations, we don't want any hospital employee trying to control the individual, and we want to keep others from walking into affected areas."
Traditionally, the public perceives hospitals as places of healing—environments that are antithetical to violence. But recent data reveal a different reality. Shootings at Baton Rouge General, Danbury (Conn.) Hospital, and Johns Hopkins Hospital in Baltimore this year have prompted the health care community to re-examine security policies and procedures.
According to the Joint Commission Sentinel Event Database, 256 assaults, homicides and rapes have occurred in hospitals since 1995. The June Sentinel Event Alert showed a marked spike in activity in the last three years—since 2007, 110 violent incidents have occurred. Joint Commission officials, however, believe hospital violence is significantly underreported.
"Hospital administration makes the decision whether to report incidents, and people don't like to report violence more than they have to," says Russell Colling, a health care security consultant who serves as an adviser to the Sentinel Event Alert. "Many incidents go unreported because they don't fall into the hospital's definition of 'violence,' but others are omitted because officials don't want them to reflect negatively on the hospital's image."
The 2010 International Association for Healthcare Security and Safety crime and safety survey of 212 hospitals found that hospital crime of all kinds is rising. There were 660 aggravated assaults and 2,720 simple assaults in 2009.
Changes in the ways patients and police use hospitals place the facilities at greater risk for violent activity. A 2004 Occupational Safety & Health Administration report for health care providers on preventing workplace violence identified three substantial risks to patient and employee safety: an increased number of mental health patients using hospitals for follow-up care because so many psychiatric facilities have closed or lost beds; a rise in police use of hospitals to hold aggressive and intoxicated individuals; and 24-hour public access to hospitals.
However, neither The Joint Commission nor the OSHA guidelines include a mandate to enact any changes in security.
Not all hospital units or employees are at equal risk, however. Heavy traffic, high stress levels and the types of cases that come in make emergency departments most susceptible to violence. Intensive care units are also vulnerable, Colling says, because of elevated stress levels among patients and their loved ones.
Nurses Bear Brunt
Overall, nurses are the most frequent targets of violence because they have the most direct patient contact. A 2009 study from The Journal of Nursing Administration found that in the past three years, 50 percent of ED nurses experienced some type of physical violence, from shoving, hitting, kicking to being spit upon, and 70 percent experienced verbal abuse. In addition to patient volume and stress levels, the study points to long wait times, a lack of privacy, and anger from patients and family members as contributing factors.
Nurses are not automatically inclined to report abuse, says Diane Gurney, R.N., president of the Emergency Nurses Association. "As nurses, we feel a responsibility to assist patients who need our help, and being involved in these violent incidents has generally been accepted as part of the job," Gurney says. "But this part of the health care and nursing culture must change."
The first step to reduce hospital violence is conducting a risk assessment, says Donna Gates, a nursing professor at the University of Cincinnati. Gates works with the federal government to identify strategies for reducing the number of violent acts in health care environments. As part of an assessment, The Joint Commission recommends hospitals review crime rate records and statistics for the area around the facility and survey employees about their perceptions of risk. All disciplines must be included to identify all areas that need more security.
"Nurses and doctors tell us they want to know what to do when, they want to know what the specific guidelines are, and they want to know when to call security," Gates says. "We have to use their input to move toward a culture of safety."
This type of plan is important because it gathers top-down support throughout the hospital, says Joe Bellino, IAHSS president. By bringing together security personnel, chief nursing officers, ED managers, chief operating officers and local police, hospitals can draft and implement zero-tolerance policies that encourage all staff to report actual and perceived threats.
Data from the Emergency Nurses Association shows that hospitals with zero-tolerance policies are 50 percent less likely than hospitals without one to experience a violent incident.
Hospitals can train their employees based on the results of the risk assessment, Bellino says. Depending on the facility's experience with violent events, employees may require extensive training or they may simply need a refresher course on recognizing initial violent signs or on physical techniques to restrain patients safely. Bellino also suggests allocating funds to have an ED nurse or security officer trained to be a certified safety instructor. He or she then can customize the security information for a specific hospital.
Training employees to de-escalate a potentially violent situation is a hospital's first line of defense, Colling says. Active listening and giving patients and their visitors space can help hospitals sidestep many problems. He suggests all staff uniformly enforce such policies as the number of visitors allowed per patient at any given time to avoid prompting anger or frustration. Hospitals also should reduce the number of access points through which the public can enter.
From Police to Panic Buttons
Bellino says local law enforcement agencies should be involved in planning. "I recommend that all hospitals sit down with their local police to discuss protocols and determine the processes to respond to violence in the hospital, as well as what works best for all involved," he says. "It's optimal to invite law enforcement to the training opportunities for your employees so they know how you respond to these situations, and they learn the layout of your facility."
Sandra Schneider, M.D., president of the American College of Emergency Physicians, says doctors and nurses should become comfortable with requesting a security presence with threatening patients before violence occurs. "It's proactive, if you have a violent patient, to arrive with security and to have the officer with you the entire time," says Schneider. "But make sure the officer knows where his or her resources are and that he or she is adequately trained to quickly subdue a dangerous person."
Hospitals also can use discreet tactics to identify volatile patients and alert staff to take precautions, she says, such as color-coding charts or supplying potentially violent patients with different colored socks. ACEP supports installing panic buttons in case of emergencies.
Technology is an effective tool to prevent violence or counteract an event should it occur. Jane Lipscomb, R.N., a professor at the University of Maryland School of Nursing and an expert in workplace violence prevention, says an architect with safety experience can analyze which hospital units need additional security. The IAHSS also recommended closed-circuit television monitoring of high-risk units, metal detectors at ED entrances and electronic access controls.
The OSHA guidelines endorsed giving staff who work with volatile patients hand-held alarms that can be activated in an emergency and installing shatterproof glass in reception, triage and admitting areas.
The confusion associated with having an active shooter on hospital grounds taught Baton Rouge General two valuable lessons, COO Tenreiro says. Hospitals should establish the location for a command center outside the hospital and ensure all personnel involved in managing a crisis know the location. In addition, hospital officials need a listing of all pertinent land line and cell phone numbers, and the command center should offer Internet access to allow administrators to use such social media sites as Facebook and Twitter to communicate messages to staff inside the facility.
"Most importantly, in a situation like ours where we had an armed person in the building, you must accept that you aren't in control. The cops take over immediately," Tenreiro says. "We served as support resources only."
After a patient shot a nurse at Danbury Hospital, now Western Connecticut Healthcare, in March, OSHA cited the hospital for violence-prevention deficiencies. The hospital has implemented new strategies to better protect staff and patients, says John Lucas, director of security, including a policy posted on the hospital's Intranet home page that outlines responsibilities for the CEO on down. The hospital hired six additional security officers, bringing the total to 34, and placed some of them in the ED that serves both medical and psychiatric patients. Visitors must register at the information desk when entering the hospital and must wear visitor passes.
If a patient begins to exhibit unruly behavior, providers at the bedside may request a security consultation to determine whether the patient poses a threat. If officers identify danger, a patient will undergo a safety assessment—a detailed search of personal effects for any weapons or dangerous items. For patient behavior beyond what hospital security can control, the ED attending physician can request a call to the police by asking for a consultation with "Dr. Blueman."
"In the three months after we implemented the new safety protocols, we've seen a 75 percent drop in reported incidents," Lucas says. "Nine out of 10 conflicts are resolved at the bedside through discussion."
Whitney L.J. Howell is a freelance writer in Durham, N.C.
Facts About Violence
A nationwide survey of emergency nurses between May 2009 and February 2010 found that in hospitals:
97.1% of physical violence was perpetrated by patients and their relatives.
80.6% of physical violence occurred in patients' rooms; 23.2% in corridors, hallways, stairs and elevators; and 14.7% at nurses' stations.
38.2% of physical violence against emergency nurses occurred while they were triaging patients, 33.8% while restraining or subduing patients, and 30.9% while they were performing invasive procedures.
15% of male nurses reported having been victims of physical violence compared with 10.3% of female nurses.
13.4% of violent acts occurred in large urban areas compared with 8.3% in rural areas.
Source: The Emergency Nurses Association's Emergency Department Violence Surveillance Study, 2010
This article first appeared in the January 2011 issue of H&HN magazine.
This article first appeared in the January 2011 issue of H&HN magazine.
Security issues
Violence in Hospitals
By Whitney L.J. Howell
With attacks against staff and patients on the rise, administrators rethink security policies
Shortly after 12:30 a.m. on Sept. 3, Darrell Garner walked into Baton Rouge (La.) General Medical Center with a gun. He entered the room where his teenage stepson was a patient and argued with his estranged wife, allegedly shooting her in the arm and shooting her boyfriend in the arm and head. Local police responded quickly, but Garner apparently left while doctors and nurses treated the victims. (Ten days later, the suspect turned himself in to local police where he remains in custody.) Authorities put the facility on lockdown, and for hours, most employees got either erroneous information or none at all.
"At that time, we had no way to alert people to what had really occurred," says Edgardo Tenreiro, Baton Rouge General's executive vice president and chief operating officer. "We also hadn't yet thought about having a command center outside the hospital, so when I arrived at 1 a.m., I spent valuable time driving around our campus, trying to find the center location."
After a three-hour sweep of the facility, the SWAT team gave the all-clear and the medical center returned to normal operations.
Hospital administrators recognized that their security policies needed an upgrade. For one thing, Code White—the emergency code Baton Rouge General uses to announce violent patients—was not only inaccurate, but in this case, with a gunman involved, it also could have put at risk employees who responded to assist colleagues. The following Monday, leaders instituted Code Silver to alert staff to the presence of an active shooter.
"With the Code Silver, we're able to tell everyone to get out of harm's way—close patient doors, close doors to the unit, and barricade themselves behind desks," Tenreiro says. "In these situations, we don't want any hospital employee trying to control the individual, and we want to keep others from walking into affected areas."
Traditionally, the public perceives hospitals as places of healing—environments that are antithetical to violence. But recent data reveal a different reality. Shootings at Baton Rouge General, Danbury (Conn.) Hospital, and Johns Hopkins Hospital in Baltimore this year have prompted the health care community to re-examine security policies and procedures.
According to the Joint Commission Sentinel Event Database, 256 assaults, homicides and rapes have occurred in hospitals since 1995. The June Sentinel Event Alert showed a marked spike in activity in the last three years—since 2007, 110 violent incidents have occurred. Joint Commission officials, however, believe hospital violence is significantly underreported.
"Hospital administration makes the decision whether to report incidents, and people don't like to report violence more than they have to," says Russell Colling, a health care security consultant who serves as an adviser to the Sentinel Event Alert. "Many incidents go unreported because they don't fall into the hospital's definition of 'violence,' but others are omitted because officials don't want them to reflect negatively on the hospital's image."
The 2010 International Association for Healthcare Security and Safety crime and safety survey of 212 hospitals found that hospital crime of all kinds is rising. There were 660 aggravated assaults and 2,720 simple assaults in 2009.
Changes in the ways patients and police use hospitals place the facilities at greater risk for violent activity. A 2004 Occupational Safety & Health Administration report for health care providers on preventing workplace violence identified three substantial risks to patient and employee safety: an increased number of mental health patients using hospitals for follow-up care because so many psychiatric facilities have closed or lost beds; a rise in police use of hospitals to hold aggressive and intoxicated individuals; and 24-hour public access to hospitals.
However, neither The Joint Commission nor the OSHA guidelines include a mandate to enact any changes in security.
Not all hospital units or employees are at equal risk, however. Heavy traffic, high stress levels and the types of cases that come in make emergency departments most susceptible to violence. Intensive care units are also vulnerable, Colling says, because of elevated stress levels among patients and their loved ones.
Nurses Bear Brunt
Overall, nurses are the most frequent targets of violence because they have the most direct patient contact. A 2009 study from The Journal of Nursing Administration found that in the past three years, 50 percent of ED nurses experienced some type of physical violence, from shoving, hitting, kicking to being spit upon, and 70 percent experienced verbal abuse. In addition to patient volume and stress levels, the study points to long wait times, a lack of privacy, and anger from patients and family members as contributing factors.
Nurses are not automatically inclined to report abuse, says Diane Gurney, R.N., president of the Emergency Nurses Association. "As nurses, we feel a responsibility to assist patients who need our help, and being involved in these violent incidents has generally been accepted as part of the job," Gurney says. "But this part of the health care and nursing culture must change."
The first step to reduce hospital violence is conducting a risk assessment, says Donna Gates, a nursing professor at the University of Cincinnati. Gates works with the federal government to identify strategies for reducing the number of violent acts in health care environments. As part of an assessment, The Joint Commission recommends hospitals review crime rate records and statistics for the area around the facility and survey employees about their perceptions of risk. All disciplines must be included to identify all areas that need more security.
"Nurses and doctors tell us they want to know what to do when, they want to know what the specific guidelines are, and they want to know when to call security," Gates says. "We have to use their input to move toward a culture of safety."
This type of plan is important because it gathers top-down support throughout the hospital, says Joe Bellino, IAHSS president. By bringing together security personnel, chief nursing officers, ED managers, chief operating officers and local police, hospitals can draft and implement zero-tolerance policies that encourage all staff to report actual and perceived threats.
Data from the Emergency Nurses Association shows that hospitals with zero-tolerance policies are 50 percent less likely than hospitals without one to experience a violent incident.
Hospitals can train their employees based on the results of the risk assessment, Bellino says. Depending on the facility's experience with violent events, employees may require extensive training or they may simply need a refresher course on recognizing initial violent signs or on physical techniques to restrain patients safely. Bellino also suggests allocating funds to have an ED nurse or security officer trained to be a certified safety instructor. He or she then can customize the security information for a specific hospital.
Training employees to de-escalate a potentially violent situation is a hospital's first line of defense, Colling says. Active listening and giving patients and their visitors space can help hospitals sidestep many problems. He suggests all staff uniformly enforce such policies as the number of visitors allowed per patient at any given time to avoid prompting anger or frustration. Hospitals also should reduce the number of access points through which the public can enter.
From Police to Panic Buttons
Bellino says local law enforcement agencies should be involved in planning. "I recommend that all hospitals sit down with their local police to discuss protocols and determine the processes to respond to violence in the hospital, as well as what works best for all involved," he says. "It's optimal to invite law enforcement to the training opportunities for your employees so they know how you respond to these situations, and they learn the layout of your facility."
Sandra Schneider, M.D., president of the American College of Emergency Physicians, says doctors and nurses should become comfortable with requesting a security presence with threatening patients before violence occurs. "It's proactive, if you have a violent patient, to arrive with security and to have the officer with you the entire time," says Schneider. "But make sure the officer knows where his or her resources are and that he or she is adequately trained to quickly subdue a dangerous person."
Hospitals also can use discreet tactics to identify volatile patients and alert staff to take precautions, she says, such as color-coding charts or supplying potentially violent patients with different colored socks. ACEP supports installing panic buttons in case of emergencies.
Technology is an effective tool to prevent violence or counteract an event should it occur. Jane Lipscomb, R.N., a professor at the University of Maryland School of Nursing and an expert in workplace violence prevention, says an architect with safety experience can analyze which hospital units need additional security. The IAHSS also recommended closed-circuit television monitoring of high-risk units, metal detectors at ED entrances and electronic access controls.
The OSHA guidelines endorsed giving staff who work with volatile patients hand-held alarms that can be activated in an emergency and installing shatterproof glass in reception, triage and admitting areas.
The confusion associated with having an active shooter on hospital grounds taught Baton Rouge General two valuable lessons, COO Tenreiro says. Hospitals should establish the location for a command center outside the hospital and ensure all personnel involved in managing a crisis know the location. In addition, hospital officials need a listing of all pertinent land line and cell phone numbers, and the command center should offer Internet access to allow administrators to use such social media sites as Facebook and Twitter to communicate messages to staff inside the facility.
"Most importantly, in a situation like ours where we had an armed person in the building, you must accept that you aren't in control. The cops take over immediately," Tenreiro says. "We served as support resources only."
After a patient shot a nurse at Danbury Hospital, now Western Connecticut Healthcare, in March, OSHA cited the hospital for violence-prevention deficiencies. The hospital has implemented new strategies to better protect staff and patients, says John Lucas, director of security, including a policy posted on the hospital's Intranet home page that outlines responsibilities for the CEO on down. The hospital hired six additional security officers, bringing the total to 34, and placed some of them in the ED that serves both medical and psychiatric patients. Visitors must register at the information desk when entering the hospital and must wear visitor passes.
If a patient begins to exhibit unruly behavior, providers at the bedside may request a security consultation to determine whether the patient poses a threat. If officers identify danger, a patient will undergo a safety assessment—a detailed search of personal effects for any weapons or dangerous items. For patient behavior beyond what hospital security can control, the ED attending physician can request a call to the police by asking for a consultation with "Dr. Blueman."
"In the three months after we implemented the new safety protocols, we've seen a 75 percent drop in reported incidents," Lucas says. "Nine out of 10 conflicts are resolved at the bedside through discussion."
Whitney L.J. Howell is a freelance writer in Durham, N.C.
Facts About Violence
A nationwide survey of emergency nurses between May 2009 and February 2010 found that in hospitals:
97.1% of physical violence was perpetrated by patients and their relatives.
80.6% of physical violence occurred in patients' rooms; 23.2% in corridors, hallways, stairs and elevators; and 14.7% at nurses' stations.
38.2% of physical violence against emergency nurses occurred while they were triaging patients, 33.8% while restraining or subduing patients, and 30.9% while they were performing invasive procedures.
15% of male nurses reported having been victims of physical violence compared with 10.3% of female nurses.
13.4% of violent acts occurred in large urban areas compared with 8.3% in rural areas.
Source: The Emergency Nurses Association's Emergency Department Violence Surveillance Study, 2010
This article first appeared in the January 2011 issue of H&HN magazine.
Wednesday, June 22, 2011
U. of Illinois at Springfield Offers New ‘Massive Open Online Course’
U. of Illinois at Springfield Offers New ‘Massive Open Online Course’
June 21, 2011, 6:52 pm from: CHRONICLE OF HIGHER EDUCATION
By Marc Parry
What happens when you invite the whole world to join an online class?
As The Chronicle reported last year, a growing number of educators are giving that idea a try by offering free “massive open online courses,” or MOOC’s, to anyone who wants to learn. Today, that experimental idea gained some more traction in mainstream higher education. The University of Illinois at Springfield announced a new not-for-credit MOOC devoted to examining the state of online education and where e-learning is heading. Nearly 500 people from two dozen countries have registered so far, with 1,000 expected to sign up by the time the course begins next Monday.
These courses are part of a small but expanding push toward “open teaching.” Universities such as the Massachusetts Institute of Technology have offered free educational materials online for years, but the new breed of open teachers—at the University of Florida, Brigham Young University, and the University of Regina, among other places—is now giving away the learning experience, too.
The idea for the Springfield course grew out of a presentation called “The Open Future of Higher Education” delivered at a conference this spring by Ray Schroeder, director of Springfield’s Center for Online Learning, Research, and Service.
“The discussions there led me to more deeply consider the path of online learning in this era of a ‘higher education bubble,’” Mr. Schroeder said, referring to PayPal co-founder Peter Thiel’s recent claim that college is comparable to previously overvalued markets in technology and housing. Another influence was the concept of an “Open Educational Resources University,” which, as Mr. Schroeder explains it, involves students learning from freely available materials and then seeking certification of their knowledge from traditional universities.
“I found that many others also were taking stock and questioning where we are headed,” Mr. Schroeder added.
Various online-learning leaders are participating in Mr. Schroeder’s course, which runs through August 19. Not enough MOOC for you? Stay tuned. Starting in September, another group will organize what the MOOC pioneer George Siemens calls the “Mother of all MOOCs.”
In a blog post Monday, Mr. Siemens welcomed the growing interest from traditional universities. And he countered the more skeptical take offered by another open-education leader, David Wiley, who wrote recently that “MOOCs and their like are not the answer to higher-education’s problems.”
“I don’t think I’m overstating it when I say that we are at a similar point to open online learning that we experienced with the growth of the LMS (learning-management system) in the late 90s,” Mr. Siemens wrote. “While some have argued that MOOCs are limited in their appeal—mainly for professional development and highly prepared individuals—I believe MOOCs will continue to be easier to develop and deliver as the growing number of institutions develop pedagogies … and new technologies to run the events.”
This entry was posted in Distance Education. Bookmark the permalink.
E-mail
June 21, 2011, 6:52 pm from: CHRONICLE OF HIGHER EDUCATION
By Marc Parry
What happens when you invite the whole world to join an online class?
As The Chronicle reported last year, a growing number of educators are giving that idea a try by offering free “massive open online courses,” or MOOC’s, to anyone who wants to learn. Today, that experimental idea gained some more traction in mainstream higher education. The University of Illinois at Springfield announced a new not-for-credit MOOC devoted to examining the state of online education and where e-learning is heading. Nearly 500 people from two dozen countries have registered so far, with 1,000 expected to sign up by the time the course begins next Monday.
These courses are part of a small but expanding push toward “open teaching.” Universities such as the Massachusetts Institute of Technology have offered free educational materials online for years, but the new breed of open teachers—at the University of Florida, Brigham Young University, and the University of Regina, among other places—is now giving away the learning experience, too.
The idea for the Springfield course grew out of a presentation called “The Open Future of Higher Education” delivered at a conference this spring by Ray Schroeder, director of Springfield’s Center for Online Learning, Research, and Service.
“The discussions there led me to more deeply consider the path of online learning in this era of a ‘higher education bubble,’” Mr. Schroeder said, referring to PayPal co-founder Peter Thiel’s recent claim that college is comparable to previously overvalued markets in technology and housing. Another influence was the concept of an “Open Educational Resources University,” which, as Mr. Schroeder explains it, involves students learning from freely available materials and then seeking certification of their knowledge from traditional universities.
“I found that many others also were taking stock and questioning where we are headed,” Mr. Schroeder added.
Various online-learning leaders are participating in Mr. Schroeder’s course, which runs through August 19. Not enough MOOC for you? Stay tuned. Starting in September, another group will organize what the MOOC pioneer George Siemens calls the “Mother of all MOOCs.”
In a blog post Monday, Mr. Siemens welcomed the growing interest from traditional universities. And he countered the more skeptical take offered by another open-education leader, David Wiley, who wrote recently that “MOOCs and their like are not the answer to higher-education’s problems.”
“I don’t think I’m overstating it when I say that we are at a similar point to open online learning that we experienced with the growth of the LMS (learning-management system) in the late 90s,” Mr. Siemens wrote. “While some have argued that MOOCs are limited in their appeal—mainly for professional development and highly prepared individuals—I believe MOOCs will continue to be easier to develop and deliver as the growing number of institutions develop pedagogies … and new technologies to run the events.”
This entry was posted in Distance Education. Bookmark the permalink.
Saturday, June 11, 2011
Disaster Warnings
HHS releases toolkit of public health emergency text messages
The Department of Health and Human Services yesterday released atoolkit of prepared cell phone text messages that state and local emergency managers can distribute through their emergency notification systems in a disaster. Many communities have text alert systems for emergency notification. The toolkit currently features text messages relevant to hurricanes, floods and earthquakes, which emergency responders can use as is or tailor based on specific local needs. The messages complement public service announcements for radio and television available through the Centers for Disease Control and Prevention. State and local agencies register to use the toolkit by providing contact information to HHS, so they can receive alerts and updates as the content expands to include health tips for additional types of disasters. Agencies can register by e-mailing publichealthemergency@hhs.gov. Community residents should contact their local emergency management agency to learn whether text message alerts are available in their community and to register if available.
The Department of Health and Human Services yesterday released a
Friday, June 10, 2011
"THE POST-AMERICAN WORLD" by Fareed Zakaria NEW BOOK ANNOUNCEMENT
The Post-American World
Fareed Zakaria (Author)
The New York Times bestseller, revised and expanded with a new afterword: the essential update of Fareed Zakaria's international bestseller about America and its shifting position in world affairs.
Fareed Zakaria's international bestseller The Post-American World pointed to the "rise of the rest"-the growth of countries like China, India, Brazil, and others-as the great story of our time, the story that will undoubtedly shape the future of global power. Since its publication, the trends he identified have proceeded faster than anyone could have anticipated. The 2008 financial crisis turned the world upside down, stalling the United States and other advanced economies. Meanwhile emerging markets have surged ahead, coupling their economic growth with pride, nationalism, and a determination to shape their own future.
In this new edition, Zakaria makes sense of this rapidly changing landscape. With his customary lucidity, insight, and imagination, he draws on lessons from the two great power shifts of the past 500 years-the rise of the Western world and the rise of the United States-to tell us what we can expect from the third shift, the "rise of the rest." The great challenge for Britain was economic decline. The challenge for America now is political decline, for as others have grown in importance, the central role of the United States, especially in the ascendant emerging markets, has already begun to shrink. As Zakaria eloquently argues, Washington needs to begin a serious transformation of its global strategy, moving from its traditional role of dominating hegemon to that of a more pragmatic, honest broker. It must seek to share power, create coalitions, build legitimacy, and define the global agenda-all formidable tasks.
None of this will be easy for the greatest power the world has ever known-the only power that for so long has really mattered. America stands at a crossroads: In a new global era where the United States no longer dominates the worldwide economy, orchestrates geopolitics, or overwhelms cultures, can the nation continue to thrive?
Book Details
Norton Books
* Hardcover
* May 2011
* ISBN 978-0-393-08180-0
* 6.5 × 9.6 in / 336 pages
*
* Territory Rights: Worldwide including Canada, but excluding the British Commonwealth.
Endorsements & Reviews
“Starred Review. Zakaria updates his best-selling earlier vision of world economics and politics, which foresaw the decline of American dominance but reassured us that with that decline came the rise of the rest of the world.” — Booklist
“This is a relentlessly intelligent book that eschews simple-minded projections from crisis to collapse.” — Joseph Joffe, The New York Times Book Review
“Zakaria . . . may have more intellectual range and insights than any other public thinker in the West.” — Boston Sunday Globe
“A provocative and often shrewd take that opens a big picture window on the closing of the first American century and the advent of a new world.” — Michiko Kakutani, The New York Times
“Fareed Zakaria is one of the most thoughtful foreign policy analysts of our day and his new book . . . is a must read for anyone interested in globalization—or the Presidential election.” — Bruce Nussbaum, BusinessWeek
“A far-reaching analysis.” — Slate
“Compelling.” — Thomas Friedman, author of The World is Flat
Fareed Zakaria (Author)
The New York Times bestseller, revised and expanded with a new afterword: the essential update of Fareed Zakaria's international bestseller about America and its shifting position in world affairs.
Fareed Zakaria's international bestseller The Post-American World pointed to the "rise of the rest"-the growth of countries like China, India, Brazil, and others-as the great story of our time, the story that will undoubtedly shape the future of global power. Since its publication, the trends he identified have proceeded faster than anyone could have anticipated. The 2008 financial crisis turned the world upside down, stalling the United States and other advanced economies. Meanwhile emerging markets have surged ahead, coupling their economic growth with pride, nationalism, and a determination to shape their own future.
In this new edition, Zakaria makes sense of this rapidly changing landscape. With his customary lucidity, insight, and imagination, he draws on lessons from the two great power shifts of the past 500 years-the rise of the Western world and the rise of the United States-to tell us what we can expect from the third shift, the "rise of the rest." The great challenge for Britain was economic decline. The challenge for America now is political decline, for as others have grown in importance, the central role of the United States, especially in the ascendant emerging markets, has already begun to shrink. As Zakaria eloquently argues, Washington needs to begin a serious transformation of its global strategy, moving from its traditional role of dominating hegemon to that of a more pragmatic, honest broker. It must seek to share power, create coalitions, build legitimacy, and define the global agenda-all formidable tasks.
None of this will be easy for the greatest power the world has ever known-the only power that for so long has really mattered. America stands at a crossroads: In a new global era where the United States no longer dominates the worldwide economy, orchestrates geopolitics, or overwhelms cultures, can the nation continue to thrive?
Book Details
Norton Books
* Hardcover
* May 2011
* ISBN 978-0-393-08180-0
* 6.5 × 9.6 in / 336 pages
*
* Territory Rights: Worldwide including Canada, but excluding the British Commonwealth.
Endorsements & Reviews
“Starred Review. Zakaria updates his best-selling earlier vision of world economics and politics, which foresaw the decline of American dominance but reassured us that with that decline came the rise of the rest of the world.” — Booklist
“This is a relentlessly intelligent book that eschews simple-minded projections from crisis to collapse.” — Joseph Joffe, The New York Times Book Review
“Zakaria . . . may have more intellectual range and insights than any other public thinker in the West.” — Boston Sunday Globe
“A provocative and often shrewd take that opens a big picture window on the closing of the first American century and the advent of a new world.” — Michiko Kakutani, The New York Times
“Fareed Zakaria is one of the most thoughtful foreign policy analysts of our day and his new book . . . is a must read for anyone interested in globalization—or the Presidential election.” — Bruce Nussbaum, BusinessWeek
“A far-reaching analysis.” — Slate
“Compelling.” — Thomas Friedman, author of The World is Flat
Thursday, June 2, 2011
Multicultural Differences in Healthcare Delivery ... A Quality Issue!
Several of my doctoral students have indicated an interest in focusing research on multicultural differences in health care delivery. I would like to bring to their attention the following article with complete credit to authors; H. Awo Osei=Anto and Cynthia Hedges Greising. The article appeared in the online H&HN magazine, May 2011. hhnonline@healthforum.com
R. E. Hoye
Quality
Using Patient Data to Provide Equitable Care
By H. Awo Osei-Anto and Cynthia Hedges Greising
Most hospitals and health care systems collect patient race, ethnicity and primary language data, but using the data to provide equitable patient-centered care is a challenge for many. Providing equitable care—one of the six Institute of Medicine's Six Aims—is a priority as racial and socioeconomic inequity persists in health care. Leading hospitals are moving beyond data collection to analyzing and using the data to develop targeted interventions for improving care for underserved populations.
According to the 2010 National Healthcare Disparities Report released by the Agency for Healthcare Research and Quality, racial and ethnic minorities continue to receive a lower quality of care, as measured by performance on core quality measures. The 2009 NHDR notes three major implementation strategies to accelerate reduction of health care disparities:
Train health care personnel to deliver culturally and linguistically competent care for diverse populations
Raise awareness of disparities using research and data
Form partnerships to identify and test solutions
Heywood Hospital, a 134-bed, nonprofit facility in Gardner, Mass., is one example of a hospital that has focused on training staff to deliver culturally and linguistically competent care, using data to raise awareness of diversity and potential disparities in care, and using a multidisciplinary team to lead improvement.
Though its geographic area seems to lack diversity, Heywood actively collects and uses racial, ethnic, linquistic and religious data and preferences of its patients. This process has revealed pockets of socioeconomic and minority groups who can benefit from specialized services. In 1999, the hospital established a multicultural task force with representation from executive management, information services, telecommunications, nutrition, plumbing services, mental health, social work and food service. Before 1999, Heywood only provided interpreter services for American Sign Language. In 2002, the hospital developed a program that offers video relay for deaf and hard-of-hearing populations, a phone interpreter and in-house interpretation.
Providing multicultural services has had a tremendous impact, including increasing the number of minority patients and attracting diverse staff and volunteers. Before establishing its in-house interpreter program, Heywood had 56 hospital encounters with deaf or hard-of-hearing patients. Last year, the hospital serviced 1,422 encounters with patients having limited English proficiency, including deaf and hard-of-hearing patients. Once Heywood started providing Spanish interpretation, it received more demand for the service. The hospital now provides interpreter services for Vietnamese, the third most frequently used language by its patients.
Heywood mandates cultural competency training for new hires, and trains staff annually on cultural competency issues. April is diversity month at Heywood, and the hospital educates staff on specific topics impacting various patient populations. The local community respects the hospital and looks to Heywood as a resource for cultural competency issues.
Challenges and opportunities remain at Heywood, including the need for more resources to fund equity efforts and to train staff to provide optimal customer service to all patients. Moving to the next step after identifying trends in patient race, ethnicity and primary language data will involve translating materials into patients' preferred languages, providing specific services for patients, and going out into the community to connect with community leaders and provide education.
For other case studies about hospitals working to provide equitable, patient-centered care, visit the Hospitals in Pursuit of Excellence website at www.hpoe.org and download the report Improving Health Equity Through Data Collection AND Use: A Guide for Hospital Leaders.
H. Awo Osei-Anto is a researcher and Cynthia Hedges Greising is a communications specialist, both at the Health Research & Educational Trust. Visit Hospitals in Pursuit of Excellence at www.hpoe.org to explore these and other topics.
This article first appeared in the May 2011 issue of H&HN magazine.
R. E. Hoye
Quality
Using Patient Data to Provide Equitable Care
By H. Awo Osei-Anto and Cynthia Hedges Greising
Most hospitals and health care systems collect patient race, ethnicity and primary language data, but using the data to provide equitable patient-centered care is a challenge for many. Providing equitable care—one of the six Institute of Medicine's Six Aims—is a priority as racial and socioeconomic inequity persists in health care. Leading hospitals are moving beyond data collection to analyzing and using the data to develop targeted interventions for improving care for underserved populations.
According to the 2010 National Healthcare Disparities Report released by the Agency for Healthcare Research and Quality, racial and ethnic minorities continue to receive a lower quality of care, as measured by performance on core quality measures. The 2009 NHDR notes three major implementation strategies to accelerate reduction of health care disparities:
Train health care personnel to deliver culturally and linguistically competent care for diverse populations
Raise awareness of disparities using research and data
Form partnerships to identify and test solutions
Heywood Hospital, a 134-bed, nonprofit facility in Gardner, Mass., is one example of a hospital that has focused on training staff to deliver culturally and linguistically competent care, using data to raise awareness of diversity and potential disparities in care, and using a multidisciplinary team to lead improvement.
Though its geographic area seems to lack diversity, Heywood actively collects and uses racial, ethnic, linquistic and religious data and preferences of its patients. This process has revealed pockets of socioeconomic and minority groups who can benefit from specialized services. In 1999, the hospital established a multicultural task force with representation from executive management, information services, telecommunications, nutrition, plumbing services, mental health, social work and food service. Before 1999, Heywood only provided interpreter services for American Sign Language. In 2002, the hospital developed a program that offers video relay for deaf and hard-of-hearing populations, a phone interpreter and in-house interpretation.
Providing multicultural services has had a tremendous impact, including increasing the number of minority patients and attracting diverse staff and volunteers. Before establishing its in-house interpreter program, Heywood had 56 hospital encounters with deaf or hard-of-hearing patients. Last year, the hospital serviced 1,422 encounters with patients having limited English proficiency, including deaf and hard-of-hearing patients. Once Heywood started providing Spanish interpretation, it received more demand for the service. The hospital now provides interpreter services for Vietnamese, the third most frequently used language by its patients.
Heywood mandates cultural competency training for new hires, and trains staff annually on cultural competency issues. April is diversity month at Heywood, and the hospital educates staff on specific topics impacting various patient populations. The local community respects the hospital and looks to Heywood as a resource for cultural competency issues.
Challenges and opportunities remain at Heywood, including the need for more resources to fund equity efforts and to train staff to provide optimal customer service to all patients. Moving to the next step after identifying trends in patient race, ethnicity and primary language data will involve translating materials into patients' preferred languages, providing specific services for patients, and going out into the community to connect with community leaders and provide education.
For other case studies about hospitals working to provide equitable, patient-centered care, visit the Hospitals in Pursuit of Excellence website at www.hpoe.org and download the report Improving Health Equity Through Data Collection AND Use: A Guide for Hospital Leaders.
H. Awo Osei-Anto is a researcher and Cynthia Hedges Greising is a communications specialist, both at the Health Research & Educational Trust. Visit Hospitals in Pursuit of Excellence at www.hpoe.org to explore these and other topics.
This article first appeared in the May 2011 issue of H&HN magazine.
Friday, April 29, 2011
New Book: 2011 edition of Dissertation and Scholarly Research: Recipes for Success
I am pleased to bring to your attention the announcement of a valuable new book that will assist you in your dissertation and research. Authored by two of my Walden University faculty colleagues, I recommend the 2011 Edition of DISSERTATION And SCHOLARLY RESEARCH: RECIPES For SUCCESS. Read the announcement released this week (4/25/11) for details.
Robert E. Hoye, Ph.D.
ANNOUNCEMENT
We are delighted to announce the publication of the 2011 edition of Dissertation and Scholarly Research: Recipes for Success (Recipes), and the launching of our new website: www.dissertationrecipes.com.
We are dedicated to keeping Recipes for Success current so that students are provided with all the ingredients to put together a gourmet dissertation that the student, the committee and the university will be proud of. The 2011 version includes an update of all sections of the prior version as well as: more quality URLs; more rubrics; more information on the ethics of research; more on abstract writing; more on proposal writing; more on the qualitative paradigm; and more on validity and reliability.
When it comes to a doctoral dissertation, the challenges are immense, especially for adult students returning to school. Students need a place to turn to where their questions can be addressed. Very few busy professionals have much of a sense of how to begin the process of dissertation development, how to do original research of credible academic quality, and how to craft research results into a dissertation. Recipes for Success fills these needs. From the very beginning of the doctoral journey to the ultimate achievement of degree completion, Recipes for Success is a user-friendly guide to the process and content of dissertation and research creation.
Book Excerpt:
Please note: Recipes for Success is presented in three phases. In PHASE 1 you will start your initial preparation, gather ingredients, and prepare the menu for your feast. This includes your mental, physical, and psychological preparation along with the selection of the type of meal (topic and research method) you will serve. In PHASE 2 you will gather your accoutrements and utensils to collect and analyze data to help you solve the problem you pose, answer your research questions, and obtain your purpose. In PHASE 3 you will learn how to put your meal (dissertation) together to ensure a delicious high-quality study to serve at your feast. Included are several presentations and hyperlinks to serve as your maître d' for your banquet.
Our companion website (www.dissertationrecipes.com) supports the book by providing students and faculty a range of supplemental and resource material, including slideshows on major proposal and dissertation elements, methodological resources, writing guides, and a host of other materials. A faculty resource page is also included with materials we have found helpful in mentoring students to successful dissertation completion.
You can order your own freshly baked copy of Recipes for Success directly from our publisher or from Amazon.com. Through June 1 we are offering a $5.00 discount for purchases made directly from our publisher at https://www.createspace.com/3597327. Just enter discount code “LKUSQVZP” when ordering.
Enjoy! And please pass along the news that the 2011 version is out to anyone who might be interested in learning more about putting together a successful dissertation.
Best Regards,
Marilyn K. Simon, Ph.D. marilyn@dissertationrecipes.com
Jim Goes, Ph.D. jim@dissertationrecipes.com
Robert E. Hoye, Ph.D.
ANNOUNCEMENT
We are delighted to announce the publication of the 2011 edition of Dissertation and Scholarly Research: Recipes for Success (Recipes), and the launching of our new website: www.dissertationrecipes.com.
We are dedicated to keeping Recipes for Success current so that students are provided with all the ingredients to put together a gourmet dissertation that the student, the committee and the university will be proud of. The 2011 version includes an update of all sections of the prior version as well as: more quality URLs; more rubrics; more information on the ethics of research; more on abstract writing; more on proposal writing; more on the qualitative paradigm; and more on validity and reliability.
When it comes to a doctoral dissertation, the challenges are immense, especially for adult students returning to school. Students need a place to turn to where their questions can be addressed. Very few busy professionals have much of a sense of how to begin the process of dissertation development, how to do original research of credible academic quality, and how to craft research results into a dissertation. Recipes for Success fills these needs. From the very beginning of the doctoral journey to the ultimate achievement of degree completion, Recipes for Success is a user-friendly guide to the process and content of dissertation and research creation.
Book Excerpt:
Please note: Recipes for Success is presented in three phases. In PHASE 1 you will start your initial preparation, gather ingredients, and prepare the menu for your feast. This includes your mental, physical, and psychological preparation along with the selection of the type of meal (topic and research method) you will serve. In PHASE 2 you will gather your accoutrements and utensils to collect and analyze data to help you solve the problem you pose, answer your research questions, and obtain your purpose. In PHASE 3 you will learn how to put your meal (dissertation) together to ensure a delicious high-quality study to serve at your feast. Included are several presentations and hyperlinks to serve as your maître d' for your banquet.
Our companion website (www.dissertationrecipes.com) supports the book by providing students and faculty a range of supplemental and resource material, including slideshows on major proposal and dissertation elements, methodological resources, writing guides, and a host of other materials. A faculty resource page is also included with materials we have found helpful in mentoring students to successful dissertation completion.
You can order your own freshly baked copy of Recipes for Success directly from our publisher or from Amazon.com. Through June 1 we are offering a $5.00 discount for purchases made directly from our publisher at https://www.createspace.com/3597327. Just enter discount code “LKUSQVZP” when ordering.
Enjoy! And please pass along the news that the 2011 version is out to anyone who might be interested in learning more about putting together a successful dissertation.
Best Regards,
Marilyn K. Simon, Ph.D. marilyn@dissertationrecipes.com
Jim Goes, Ph.D. jim@dissertationrecipes.com
Saturday, March 19, 2011
Corporate Social Responsibility: An Ethics-Based Concept in Healthcare
Article published with permissions of the American Academy of Medical Administrators in AAMA EXECUTIVE. an online refereed journal, March 2011. Full credit for this insightful article goes to Dr. Sandra K. Collins, address below.
Corporate Social Responsibility: An Ethics-Based Concept in Healthcare
Sandra K. Collins, MBA, PhD
Associate Professor
Southern Illinois University Carbondale
College of Applied Sciences and Arts
School of Allied Health
Health Care Management
Carbondale, IL
Abstract
The topic of ethics is always one that can spur intense debate. This is true in virtually every business industry and the healthcare industry in no exception. An exploration of foundational ethics theories brings forth the Corporate Social Responsibility (CSR) concept. A notable concept, CSR, has been studied for decades and has been linked to many business disciplines. However, it is a largely misunderstood concept surrounded by key business consideration such as societal need and profit maximization. An extensive literature review reveals the underpinnings of the CSR concept originate from the ethics discipline. Sharing this research will perhaps allow healthcare professionals to more closely examine the public’s perceptions and expectations in terms of who healthcare professionals serve. Furthermore, exploring CSR concepts may act as a catalyst to increasing the awareness that acting for the good of society often requires profit maximization.
Introduction
When organizational strategies are created and decisions are made, a conflict can occur in terms of to whom the healthcare professionals within a facility are chiefly responsible. Are they accountable to the stockholders to maximize earnings, or are they accountable to the needs of society? Healthcare professionals must decide which group takes priority. This decision is grounded as an intense ethics debate and a foundational issue surrounding the concept of Corporate Social Responsibility (CSR).
It seems that business leaders in most industries are seeking ways to resolve social issues. Even healthcare organizations are attempting to identify themselves as ethical players in the patient-care arena. This seemingly has created an increased interest emphasis on CSR since there is perception that organizations practicing CSR philosophies are potentially more ethical than those that do not (1). Therefore, an understanding of the theoretical concepts associated with CSR and ethics doctrine is necessary for astute healthcare professionals. Exploring the evolution of these time-honored concepts will provide healthcare professionals with the foundation by which to examine their organizational goals in terms of societal need and profit maximization. As the research will clearly identify, too much focus on either can be devastating to a healthcare organization. A true balance is necessary.
CSR: An Evolving Concept
Many healthcare professionals have a natural propensity to want to help others. This is often why they entered the field in the first place. However, the healthcare industry, as a whole, must operate differently than it has in the past. Excellent patient care is always a lofty goal and should remain a key factor in any healthcare organization. However, it is often difficult for many healthcare professionals to see that excellent patient care can be hindered without profit maximization initiatives. This is even more difficult for the public to see. A healthcare organization believed to be profit focused would almost certainly meet severe public scrutiny.
Who healthcare professionals are accountable to, society or organizational stakeholders, has caused theories to surface which address how businesses, and those within, impact society. The outcome of this is an amplified concern for ethical expectations regarding social issues and philanthropic activities across all business industries. Catastrophes such as Hurricane Katrina have led to the establishment of an assortment of social expectations pertaining to how businesses ought to react to the needs of society (1,2). For example, Shell Oil saw fewer applications for employment after they purportedly refused to adequately focus on human rights in another country where it operated. Perhaps the public viewed the actions of Shell Oil as unethical and attempted to equalize the atrocity by inflicting harm back on the organization to send a strong message to organizational leaders (2,3).
CSR has been studies for years by researchers in a number of academic disciplines (2,4). There are three eras which define the progression of CSR.
• The first phase began in the 19th and 20th centuries when the organizational focus was chiefly on making the most money possible.
• Phase two ran between the 1920s and the 1930s. Profit maximization was still important but it no longer was the primary goal of organizations. This phase defined the expectation that organizational leaders should operate with concern beyond the organization’s stakeholders, but also be concerned with how business decisions impacted shareholders such as employees and community members.
• Phase three started in the 1960s and ran until the 1970s. The focus of this phase was on augmenting the quality of life of both organizational stakeholders and shareholders. During this phase, business leaders were expected to focus on their commitment to society and how their organizations could participate in solving social problems. Profit maximization was acceptable if those profits were gained ethically and if a portion of them were to be dedicated to social good (2,5).
Although widely accepted across multiple educational disciplines, CSR has also been vastly criticized. CSR is often labeled as being too vague with too many subjective and varied meanings (2,6). Furthermore, CSR has been criticized for being surrounded by value-laden judgments making it a highly subjective subject which may be impossible to apply universally (2,7).
Despite the numerous criticisms surrounding CSR, the social agreement between business and society has been progressively reorganized over many decades. Even political figure Franklin D. Roosevelt (FDR) discussed the relationship between business and society in his New Deal platform by creating a new philosophy which attested that the government was responsible for assuring businesses were doing more than merely creating conditions by which individuals could pursue happiness. FDR was adamant that organizations were responsible for guaranteeing the well-being of all community members. He believed the government was responsible for the level of happiness felt by everyone in the community. FDR’s efforts seemingly raised the level of social consciousness. (2,8).
The interest in how organizations, and the professionals within, impact society continues to develop (2,9). This has largely been driven by what society determines to be important. Topics such as global warming, environmental deterioration, discrimination, respect for human rights, safety in the workplace, and doing the right thing have become key issues for society (2,10).
Viewpoints of Corporate Social Responsibility
CSR is often defined as the procedure by which organizations try to meet their economic, legal, ethical, and discretionary responsibilities to society. It revolves around two contrasting viewpoints. These viewpoints are known as the Classical and the Socioeconomic (2,11). The Classical viewpoint indicates that the only responsibility an employee has is to the stockholders of the company. Therefore, the primary role of individuals within the organization is only to maximize profits (2,11,12).
Some theorists believe that the Classical viewpoint is appropriate since paying too much attention to the social good of the community may undermine the market mechanism. This potentially results in a loss to employees and consumers because someone must pay for the redistribution of organizational assets. Businesses typically do not absorb the financial losses but they pass them on to others in the form of increasing prices or decreasing wages (2,11). Theorists in support of the Classical viewpoint indicate that the principal social responsibility of all businesses is financial expansion (2,13).
The other predominant viewpoint is the Socioeconomic viewpoint. It indicates that the financial gains sought by organizations must be altruistic or essentially considered as the right thing to do. Profits must be achieved by following the laws, regulations, and social expectations (2,11,14). The responsibility of an organization’s employees goes beyond making money. It includes protecting the best interest of the communities, the environment, and the whole society in which the organization serves. Incidents such as withholding information from community members concerning life-threatening agents which were knowingly being emitted into the environment from factories has publically emphasized the importance of this CSR viewpoint (2,11). Even issues such as asbestos contamination demonstrate the Socioeconomic viewpoint. Organizations may find it difficult to maintain a healthy profit margin five years from now if what they are doing kills a great number of their employees within two years (2,11). Social legislation emerged from situations such as this and initiated the inception of groups such as the Environmental Protection Agency (EPA), the Equal Employment Opportunity Commission (EEOC), the Occupational Health and Safety Administration (OSHA), and the Consumer Product Safety Commission (CPSC) (2,14).
The Socioeconomic viewpoint agreed that maximizing profits is important, but only as a means to offer ethical and honorable services to all shareholders (2,14). The Socioeconomic viewpoint suggested that the Classical viewpoint does not serve the interest of the public (2,15).
Corporate Social Responsibility Orientations
Theories of CSR are linked to the evolving nature of societal expectations. The original CSR viewpoints have served as the foundational studies from which CSR theory has emerged. Theorists have determined that CSR is a personality construct and that ethical propensity will vary from individual to individual. The most widely accepted CSR model has been created by Archie Carroll and includes a range of obligations that businesses have to society including:
• Economic - organizations have an obligation to be both profitable and productive in order to meet the needs of society in terms of consumption. Activities which result in ineffective business operations, such as inappropriate allocation of resources or unwarranted risk taking, would be considered socially irresponsible.
• Legal - each organization must act within the limits of the law. Therefore, any attempts to meet the economic responsibilities of an organization must be legally acceptable. There is much controversy in terms of this orientation because of the conundrum which supposes that the real reason organizations act ethically is to avoid legal ramifications. Skeptics of ethical behavior in organizations have indicated that acting ethically to avoid unfavorable legal consequences is not the same as acting ethically for the good of society.
• Ethical - responsibility of an organization revolves around a variety of unwritten codes and social norms which are commonly held in society. These codes and behaviors are believed to be germane to the ongoing success and socially responsible behavior of organizations. Organizations which operate predominantly in the Ethical orientation of CSR theory will not need written laws to guide them toward ethical decisions and behavior.
• Discretionary - correlates with philanthropic activities (2,16). These activities can be perplexing to business leaders because they are largely ill defined. In other words, society expects organizations to volunteer and to have a humanitarian philosophy (2,15).
Individuals who have an economic CSR orientation will be innately driven to maximize profits for organizational stockholders. Individuals who fall within the legal, ethical, or discretional categories will be naturally driven by their concern for society and the organizational stakeholders such as employees, patients or customers, and those in the community (1,2,11).
The Connection to Ethics Doctrine
Studied for several decades, CSR originated from the theoretical assumptions that organizations are responsible to society and the community they serve. It originates from the supposition that organizations owe something to societal stakeholders rather than merely to the organization’s stockholders (2,17).
The theory of CSR has been widely accepted across numerous educational disciplines but it has been heavily criticized as well. Some theorists believe the theory is too elusively defined, while others have identified it as a measurable personality construct (2,6,7,18). As previously discussed, CSR has been linked with a variety of performance issues. It has also been linked to a number of theoretical concepts stemming from the realm of the ethics doctrine.
Nonmaleficence and Beneficence
CSR is a concept that has evolved from the theories surrounding the field of ethics. Two of the main ethical theories which correlate with CSR are nonmaleficence and beneficence. These two concepts are considered to be societal expectations.
The intent behind nonmaleficence is to do no harm. This philosophy is foundational and widely prevalent in the healthcare industry. It is most famously associated with the Hippocratic Oath which is taken by physicians. However, it can be useful in considering the impact of the decisions and actions of all healthcare professionals, as well as those in other business industries. Ethics theory indicated that organizational decisions and actions should be grounded in nonmaleficence. The do no harm philosophy should be extended to employees, patients or customers, vendors, communities, and anyone with whom the institution interacts. The goal of nonmaleficence is to protect all stakeholders from any type of harm.
Beneficence is another key ethical concept. It demands that individuals should relate to all organizational stakeholders with kindness and compassion. Both beneficence and CSR focus on how organizational decisions and actions impact stakeholders. This concept can be as simple as telling staff that they are appreciated and valued to as complex as addressing a distraught patient who cannot afford a necessary medical procedure (2,19).
The ethical theories of nonmaleficence and beneficence may seem relatively simple and easily achieved in the business industry. One particular industry which is heavily linked to these principles is the healthcare industry. Although nonmaleficience and beneficence are seemingly simplistic, the healthcare industry is wrought with complexities surrounding these foundational concepts. If the industry could operate how it was originally intended the complexity would be largely alleviated. In the beginning, this people-focused industry was based solely on the service of caring for the public rather than maximizing organizational profits. This philosophy is appreciated by CSR advocates. However, with today’s complex regulatory and reimbursement pressures, the healthcare industry has been forced to function more like a business. The focus has shifted from primarily being about helping the sick to covertly emphasizing making a profit (2,19).
Addressing Corporate Social Responsibility in Healthcare
The shift from serving the ill to profit maximization is duly noted in the healthcare field. In some respect, this shift has occurred out of necessity. For example, like other industries, healthcare organizations must attempt to recruit the most talented and skilled professionals. This is difficult to do if there are insufficient financial resources available to offer competitive salaries and benefit packages. Therefore, healthcare organizations have been forced to use business principles which allow them to make a profit so they will have the financial resources available to be competitive in the labor market. Without a skilled workforce, it is difficult if not impossible to offer quality patient care. This is essentially true in both for-profit and non-profit entities (2, 20).
However, being focused on profits creates a conflict in this particular industry considering that healthcare is perceived differently than virtually any other industry in terms of origination and mission (2,19). This is essentially true in both for-profit and non-profit entities because a social contract exists regardless of the profit status of the organization. A social contract exists between those who created the institution, those that seek care and trust in the facility, the providers of care who expend their talents and efforts to deliver care, the regulatory bodies that regulate the field, the taxpayers that largely finance the facility, the executives that create and implement policy, and a multitude of intermediary agencies such as professional associations, supplies, communities, and financial institutions.
Individuals within the organization which innately focus only on profits may make decisions or act in ways that cause public resentment. The public does not expect a healthcare organization to act like a business. They expect healthcare facilities, and the employees within, to care about their illnesses more than reimbursement schedules or managed care contracts. A large degree of trust is placed on the healthcare facility from the patients’ perspective. Therefore, the industry is held to a higher standard than typically any other business industry. This is perhaps why CSR has been widely accepted by the healthcare industry (2,19).
Conclusion
A close inspection of organizational goals comes from the exploration and study of CSR initiatives, historical evolution, and connection with ethics related expectations. The goals of CSR are defined by reflecting upon what responsibilities an organization and the professionals within should attempt to fulfill which guide and permeate throughout the organizational structure. Understanding the need for quality of care centered healthcare facilities is often more obvious; however, the need to function in a financially prosperous way often is less obscure (2, 21). The healthcare industry as a whole is in a place where profits are vital in the delivery of quality patient care. Not only are CSR activities and philosophies the expectation, but they are the ethical underpinnings of the organizational structure.
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13. Drucker, P. F. (1953). The employee society. The American Journal of
Sociology, 58(4), 358-363.
14. Carroll, A. B. (1991). The pyramid of corporate social responsibility: Toward the moral management of organizational stakeholders. Business Horizons, 34(4), 39-48.
15. Bell, D. (1973). The coming of the postindustrial society. Business and
Society Review and Innovation, 5(2), 5-23.
16. Carroll, A.B. (1979). A three dimensional conceptual model of corporate social performance. Academy of Management Review, 4(4), 497-505.
17. Rowley, T., & Berman, S. (2000). A brand new brand of corporate social
performance. Business & Society, 39(4), 397-418.
18. Lee, L. (1987). Social responsibility and economic performance: An empirical examination of corporate profiles. San Diego, CA: United States International University.
19. Morrison, E. E. (2006). Ethics in health administration: A practical approach for decision makers. Sudbury, MA: Jones and Bartlett.
20. Bouckaert, L., & Vandenhove, J. (1998). Business ethics and the
management of non-profit institutions. Journal of Business Ethics,
17(10), 1073.
21. Fuentes-Garcı´a, F., Nu´n˜ez-Tabales, J., & Veroz-Herrado´n, V. (2008).
Applicability of corporate social responsibility to human resources
management: Perspective from Spain. Journal of Business Ethics, 82(1), 27-44.
© 2011 American Academy of Medical Administrators - All Rights Reserved.
Corporate Social Responsibility: An Ethics-Based Concept in Healthcare
Sandra K. Collins, MBA, PhD
Associate Professor
Southern Illinois University Carbondale
College of Applied Sciences and Arts
School of Allied Health
Health Care Management
Carbondale, IL
Abstract
The topic of ethics is always one that can spur intense debate. This is true in virtually every business industry and the healthcare industry in no exception. An exploration of foundational ethics theories brings forth the Corporate Social Responsibility (CSR) concept. A notable concept, CSR, has been studied for decades and has been linked to many business disciplines. However, it is a largely misunderstood concept surrounded by key business consideration such as societal need and profit maximization. An extensive literature review reveals the underpinnings of the CSR concept originate from the ethics discipline. Sharing this research will perhaps allow healthcare professionals to more closely examine the public’s perceptions and expectations in terms of who healthcare professionals serve. Furthermore, exploring CSR concepts may act as a catalyst to increasing the awareness that acting for the good of society often requires profit maximization.
Introduction
When organizational strategies are created and decisions are made, a conflict can occur in terms of to whom the healthcare professionals within a facility are chiefly responsible. Are they accountable to the stockholders to maximize earnings, or are they accountable to the needs of society? Healthcare professionals must decide which group takes priority. This decision is grounded as an intense ethics debate and a foundational issue surrounding the concept of Corporate Social Responsibility (CSR).
It seems that business leaders in most industries are seeking ways to resolve social issues. Even healthcare organizations are attempting to identify themselves as ethical players in the patient-care arena. This seemingly has created an increased interest emphasis on CSR since there is perception that organizations practicing CSR philosophies are potentially more ethical than those that do not (1). Therefore, an understanding of the theoretical concepts associated with CSR and ethics doctrine is necessary for astute healthcare professionals. Exploring the evolution of these time-honored concepts will provide healthcare professionals with the foundation by which to examine their organizational goals in terms of societal need and profit maximization. As the research will clearly identify, too much focus on either can be devastating to a healthcare organization. A true balance is necessary.
CSR: An Evolving Concept
Many healthcare professionals have a natural propensity to want to help others. This is often why they entered the field in the first place. However, the healthcare industry, as a whole, must operate differently than it has in the past. Excellent patient care is always a lofty goal and should remain a key factor in any healthcare organization. However, it is often difficult for many healthcare professionals to see that excellent patient care can be hindered without profit maximization initiatives. This is even more difficult for the public to see. A healthcare organization believed to be profit focused would almost certainly meet severe public scrutiny.
Who healthcare professionals are accountable to, society or organizational stakeholders, has caused theories to surface which address how businesses, and those within, impact society. The outcome of this is an amplified concern for ethical expectations regarding social issues and philanthropic activities across all business industries. Catastrophes such as Hurricane Katrina have led to the establishment of an assortment of social expectations pertaining to how businesses ought to react to the needs of society (1,2). For example, Shell Oil saw fewer applications for employment after they purportedly refused to adequately focus on human rights in another country where it operated. Perhaps the public viewed the actions of Shell Oil as unethical and attempted to equalize the atrocity by inflicting harm back on the organization to send a strong message to organizational leaders (2,3).
CSR has been studies for years by researchers in a number of academic disciplines (2,4). There are three eras which define the progression of CSR.
• The first phase began in the 19th and 20th centuries when the organizational focus was chiefly on making the most money possible.
• Phase two ran between the 1920s and the 1930s. Profit maximization was still important but it no longer was the primary goal of organizations. This phase defined the expectation that organizational leaders should operate with concern beyond the organization’s stakeholders, but also be concerned with how business decisions impacted shareholders such as employees and community members.
• Phase three started in the 1960s and ran until the 1970s. The focus of this phase was on augmenting the quality of life of both organizational stakeholders and shareholders. During this phase, business leaders were expected to focus on their commitment to society and how their organizations could participate in solving social problems. Profit maximization was acceptable if those profits were gained ethically and if a portion of them were to be dedicated to social good (2,5).
Although widely accepted across multiple educational disciplines, CSR has also been vastly criticized. CSR is often labeled as being too vague with too many subjective and varied meanings (2,6). Furthermore, CSR has been criticized for being surrounded by value-laden judgments making it a highly subjective subject which may be impossible to apply universally (2,7).
Despite the numerous criticisms surrounding CSR, the social agreement between business and society has been progressively reorganized over many decades. Even political figure Franklin D. Roosevelt (FDR) discussed the relationship between business and society in his New Deal platform by creating a new philosophy which attested that the government was responsible for assuring businesses were doing more than merely creating conditions by which individuals could pursue happiness. FDR was adamant that organizations were responsible for guaranteeing the well-being of all community members. He believed the government was responsible for the level of happiness felt by everyone in the community. FDR’s efforts seemingly raised the level of social consciousness. (2,8).
The interest in how organizations, and the professionals within, impact society continues to develop (2,9). This has largely been driven by what society determines to be important. Topics such as global warming, environmental deterioration, discrimination, respect for human rights, safety in the workplace, and doing the right thing have become key issues for society (2,10).
Viewpoints of Corporate Social Responsibility
CSR is often defined as the procedure by which organizations try to meet their economic, legal, ethical, and discretionary responsibilities to society. It revolves around two contrasting viewpoints. These viewpoints are known as the Classical and the Socioeconomic (2,11). The Classical viewpoint indicates that the only responsibility an employee has is to the stockholders of the company. Therefore, the primary role of individuals within the organization is only to maximize profits (2,11,12).
Some theorists believe that the Classical viewpoint is appropriate since paying too much attention to the social good of the community may undermine the market mechanism. This potentially results in a loss to employees and consumers because someone must pay for the redistribution of organizational assets. Businesses typically do not absorb the financial losses but they pass them on to others in the form of increasing prices or decreasing wages (2,11). Theorists in support of the Classical viewpoint indicate that the principal social responsibility of all businesses is financial expansion (2,13).
The other predominant viewpoint is the Socioeconomic viewpoint. It indicates that the financial gains sought by organizations must be altruistic or essentially considered as the right thing to do. Profits must be achieved by following the laws, regulations, and social expectations (2,11,14). The responsibility of an organization’s employees goes beyond making money. It includes protecting the best interest of the communities, the environment, and the whole society in which the organization serves. Incidents such as withholding information from community members concerning life-threatening agents which were knowingly being emitted into the environment from factories has publically emphasized the importance of this CSR viewpoint (2,11). Even issues such as asbestos contamination demonstrate the Socioeconomic viewpoint. Organizations may find it difficult to maintain a healthy profit margin five years from now if what they are doing kills a great number of their employees within two years (2,11). Social legislation emerged from situations such as this and initiated the inception of groups such as the Environmental Protection Agency (EPA), the Equal Employment Opportunity Commission (EEOC), the Occupational Health and Safety Administration (OSHA), and the Consumer Product Safety Commission (CPSC) (2,14).
The Socioeconomic viewpoint agreed that maximizing profits is important, but only as a means to offer ethical and honorable services to all shareholders (2,14). The Socioeconomic viewpoint suggested that the Classical viewpoint does not serve the interest of the public (2,15).
Corporate Social Responsibility Orientations
Theories of CSR are linked to the evolving nature of societal expectations. The original CSR viewpoints have served as the foundational studies from which CSR theory has emerged. Theorists have determined that CSR is a personality construct and that ethical propensity will vary from individual to individual. The most widely accepted CSR model has been created by Archie Carroll and includes a range of obligations that businesses have to society including:
• Economic - organizations have an obligation to be both profitable and productive in order to meet the needs of society in terms of consumption. Activities which result in ineffective business operations, such as inappropriate allocation of resources or unwarranted risk taking, would be considered socially irresponsible.
• Legal - each organization must act within the limits of the law. Therefore, any attempts to meet the economic responsibilities of an organization must be legally acceptable. There is much controversy in terms of this orientation because of the conundrum which supposes that the real reason organizations act ethically is to avoid legal ramifications. Skeptics of ethical behavior in organizations have indicated that acting ethically to avoid unfavorable legal consequences is not the same as acting ethically for the good of society.
• Ethical - responsibility of an organization revolves around a variety of unwritten codes and social norms which are commonly held in society. These codes and behaviors are believed to be germane to the ongoing success and socially responsible behavior of organizations. Organizations which operate predominantly in the Ethical orientation of CSR theory will not need written laws to guide them toward ethical decisions and behavior.
• Discretionary - correlates with philanthropic activities (2,16). These activities can be perplexing to business leaders because they are largely ill defined. In other words, society expects organizations to volunteer and to have a humanitarian philosophy (2,15).
Individuals who have an economic CSR orientation will be innately driven to maximize profits for organizational stockholders. Individuals who fall within the legal, ethical, or discretional categories will be naturally driven by their concern for society and the organizational stakeholders such as employees, patients or customers, and those in the community (1,2,11).
The Connection to Ethics Doctrine
Studied for several decades, CSR originated from the theoretical assumptions that organizations are responsible to society and the community they serve. It originates from the supposition that organizations owe something to societal stakeholders rather than merely to the organization’s stockholders (2,17).
The theory of CSR has been widely accepted across numerous educational disciplines but it has been heavily criticized as well. Some theorists believe the theory is too elusively defined, while others have identified it as a measurable personality construct (2,6,7,18). As previously discussed, CSR has been linked with a variety of performance issues. It has also been linked to a number of theoretical concepts stemming from the realm of the ethics doctrine.
Nonmaleficence and Beneficence
CSR is a concept that has evolved from the theories surrounding the field of ethics. Two of the main ethical theories which correlate with CSR are nonmaleficence and beneficence. These two concepts are considered to be societal expectations.
The intent behind nonmaleficence is to do no harm. This philosophy is foundational and widely prevalent in the healthcare industry. It is most famously associated with the Hippocratic Oath which is taken by physicians. However, it can be useful in considering the impact of the decisions and actions of all healthcare professionals, as well as those in other business industries. Ethics theory indicated that organizational decisions and actions should be grounded in nonmaleficence. The do no harm philosophy should be extended to employees, patients or customers, vendors, communities, and anyone with whom the institution interacts. The goal of nonmaleficence is to protect all stakeholders from any type of harm.
Beneficence is another key ethical concept. It demands that individuals should relate to all organizational stakeholders with kindness and compassion. Both beneficence and CSR focus on how organizational decisions and actions impact stakeholders. This concept can be as simple as telling staff that they are appreciated and valued to as complex as addressing a distraught patient who cannot afford a necessary medical procedure (2,19).
The ethical theories of nonmaleficence and beneficence may seem relatively simple and easily achieved in the business industry. One particular industry which is heavily linked to these principles is the healthcare industry. Although nonmaleficience and beneficence are seemingly simplistic, the healthcare industry is wrought with complexities surrounding these foundational concepts. If the industry could operate how it was originally intended the complexity would be largely alleviated. In the beginning, this people-focused industry was based solely on the service of caring for the public rather than maximizing organizational profits. This philosophy is appreciated by CSR advocates. However, with today’s complex regulatory and reimbursement pressures, the healthcare industry has been forced to function more like a business. The focus has shifted from primarily being about helping the sick to covertly emphasizing making a profit (2,19).
Addressing Corporate Social Responsibility in Healthcare
The shift from serving the ill to profit maximization is duly noted in the healthcare field. In some respect, this shift has occurred out of necessity. For example, like other industries, healthcare organizations must attempt to recruit the most talented and skilled professionals. This is difficult to do if there are insufficient financial resources available to offer competitive salaries and benefit packages. Therefore, healthcare organizations have been forced to use business principles which allow them to make a profit so they will have the financial resources available to be competitive in the labor market. Without a skilled workforce, it is difficult if not impossible to offer quality patient care. This is essentially true in both for-profit and non-profit entities (2, 20).
However, being focused on profits creates a conflict in this particular industry considering that healthcare is perceived differently than virtually any other industry in terms of origination and mission (2,19). This is essentially true in both for-profit and non-profit entities because a social contract exists regardless of the profit status of the organization. A social contract exists between those who created the institution, those that seek care and trust in the facility, the providers of care who expend their talents and efforts to deliver care, the regulatory bodies that regulate the field, the taxpayers that largely finance the facility, the executives that create and implement policy, and a multitude of intermediary agencies such as professional associations, supplies, communities, and financial institutions.
Individuals within the organization which innately focus only on profits may make decisions or act in ways that cause public resentment. The public does not expect a healthcare organization to act like a business. They expect healthcare facilities, and the employees within, to care about their illnesses more than reimbursement schedules or managed care contracts. A large degree of trust is placed on the healthcare facility from the patients’ perspective. Therefore, the industry is held to a higher standard than typically any other business industry. This is perhaps why CSR has been widely accepted by the healthcare industry (2,19).
Conclusion
A close inspection of organizational goals comes from the exploration and study of CSR initiatives, historical evolution, and connection with ethics related expectations. The goals of CSR are defined by reflecting upon what responsibilities an organization and the professionals within should attempt to fulfill which guide and permeate throughout the organizational structure. Understanding the need for quality of care centered healthcare facilities is often more obvious; however, the need to function in a financially prosperous way often is less obscure (2, 21). The healthcare industry as a whole is in a place where profits are vital in the delivery of quality patient care. Not only are CSR activities and philosophies the expectation, but they are the ethical underpinnings of the organizational structure.
REFERENCES
1. Ray, R. J. (2006). Investigating relationships between corporate social
responsibility orientation and employer attractiveness. Akron, OH:
University of Akron.
2. Collins, S. K. (2010). An exploration of corporate social responsibility and Machiavellianism in future healthcare professionals. Carbondale, IL: Southern Illinois University Carbondale.
3. Holliday, C. O., Schmidheiny, S., & Watts, P. (2002). Walking the talk: The business case for sustainable development. San Francisco: Greenleaf
Publishing.
4. Makower, J. (1994). Beyond the bottom line: Putting social responsibility to work for your business and the world. New York: Simon and Schuster.
5. Hay, R., & Gray, E. (1974). Social responsibility of business managers.
Academy of Management Journal, 17(1), 135-143.
6. Frankental, P. (2001). Corporate social responsibility - A pre-invention.
Corporate Communication International Journal, 6(1), 18-23.
7. Aupperle, K. E. (1982). An empirical inquiry into the social responsibilities as defined by corporations: An examination of various models and relationships. Athens, GA: University of Georgia.
8. Will, G. F. (2009). FDR’s sweater fable. Newsweek, 153(10), 62.
9. Albinger, H. S., & Freeman, S. J. (2000). Corporate social performance and attractiveness as an employer to different job seeking populations.
Journal of Business Ethics, 28(3), 243.
10. Nieto, M., & Ferna'ndez, R. (2004). Responsabilidad social corporativa: La u'ltima innovacio'n en management. Universal Business Review, 1(4),
28-39.
11. Robbins, S., & Coulter, M. (1996). Management (5th ed.). Upper Saddle River, NJ: Prentice Hall.
12. Stump, S. (1999). Attracting social investors, appeasing shareholders.
Investor Relations Business, 4(1), 8.
13. Drucker, P. F. (1953). The employee society. The American Journal of
Sociology, 58(4), 358-363.
14. Carroll, A. B. (1991). The pyramid of corporate social responsibility: Toward the moral management of organizational stakeholders. Business Horizons, 34(4), 39-48.
15. Bell, D. (1973). The coming of the postindustrial society. Business and
Society Review and Innovation, 5(2), 5-23.
16. Carroll, A.B. (1979). A three dimensional conceptual model of corporate social performance. Academy of Management Review, 4(4), 497-505.
17. Rowley, T., & Berman, S. (2000). A brand new brand of corporate social
performance. Business & Society, 39(4), 397-418.
18. Lee, L. (1987). Social responsibility and economic performance: An empirical examination of corporate profiles. San Diego, CA: United States International University.
19. Morrison, E. E. (2006). Ethics in health administration: A practical approach for decision makers. Sudbury, MA: Jones and Bartlett.
20. Bouckaert, L., & Vandenhove, J. (1998). Business ethics and the
management of non-profit institutions. Journal of Business Ethics,
17(10), 1073.
21. Fuentes-Garcı´a, F., Nu´n˜ez-Tabales, J., & Veroz-Herrado´n, V. (2008).
Applicability of corporate social responsibility to human resources
management: Perspective from Spain. Journal of Business Ethics, 82(1), 27-44.
© 2011 American Academy of Medical Administrators - All Rights Reserved.
Wednesday, February 16, 2011
SOME ADVICE ON UTILIZING INFORMATION ABOUT YOU & YOUR NAME
Why You Should Own YourName.com
By Miriam Salpeter
When was the last time you searched for your own name online? Did you like what you saw?
You may be surprised to learn your only Internet claim-to-fame is the track trophy you won in college or a mention of your participation in a charity golf tournament—three years ago. If you have a LinkedIn account and an uncommon name, your LinkedIn profile may show up in a search. But if you have many doppelgangers (people who share your name), it’s more difficult to distinguish yourself online.
Why should job seekers worry about how they appear online? Nearly 80 percent of recruiters, human resources professionals, and hiring managers who responded to a Microsoft survey said they search for candidates’ information online and may use it to disqualify applicants. And what if they disqualify you based on incorrect information? Maybe it’s not really you they found online, but someone with the same name and a similar profile. What if you share your name with an unsavory character or someone with a questionable reputation?
[See How Job Seekers Can Build Their Online Brand.]
These are all reasons why you should be vigilant about monitoring your online reputation. Set up Google alerts for your name to receive notification whenever Google indexes something about you or someone who shares your name. Also consider searching and monitoring your name’s alternate spellings or misspellings.
Finding information is the first step; addressing your digital footprint is the next. The best way to control what employers see is by creating your own online presence, or a website in your name; in other words, YourName.com. For example, Mark Smith would be MarkSmith.com. When you create a website with YourName.com, you help search engines identify the correct information when people look for you, no matter how many people have similar profiles and monikers.
For example, Willie Jackson is a technology processional currently serving as CTO at The Domino Project, a new publishing venture by Seth Godin that’s powered by Amazon. He helps organizations leverage the best tools available so they can focus on their business and not on the technology.
His site is the top search result for a query of "Willie Jackson," even though he has the same name as a professional football player. He attributes this to a combination of website optimization, sound search-engine optimization (SEO), and owning the "exact match" domain for his name.
[For more career advice, visit U.S. News Careers, or find us on Facebook or Twitter.]
Maintaining your own site and creating content you want employers and others to see when they search for you online is one of the best ways to control what people learn about you—and one way to help people conducting cursory searches land on your information instead of someone else’s. It also ensures you present an up-to-date, targeted, professional profile, and helps suppress older information you may not want people to find. (For example, that picture of you carrying a profane sign at a rally in college—complete with your name in the caption. Producing current information relevant to your goals may convince a hiring manager to end his or her search before uncovering information you don’t want public.)
In a digitally driven job market, engaging in the online playground by sharing professional information that’s designed to attract employers to you is key to job-search success.
Miriam Salpeter is a job search and social media consultant, career coach, author, speaker, resume writer and owner of Keppie Careers. She teaches job seekers and entrepreneurs how to incorporate social media tools along with traditional strategies to empower their success. Connect with her via Twitter @Keppie_Careers.
By Miriam Salpeter
When was the last time you searched for your own name online? Did you like what you saw?
You may be surprised to learn your only Internet claim-to-fame is the track trophy you won in college or a mention of your participation in a charity golf tournament—three years ago. If you have a LinkedIn account and an uncommon name, your LinkedIn profile may show up in a search. But if you have many doppelgangers (people who share your name), it’s more difficult to distinguish yourself online.
Why should job seekers worry about how they appear online? Nearly 80 percent of recruiters, human resources professionals, and hiring managers who responded to a Microsoft survey said they search for candidates’ information online and may use it to disqualify applicants. And what if they disqualify you based on incorrect information? Maybe it’s not really you they found online, but someone with the same name and a similar profile. What if you share your name with an unsavory character or someone with a questionable reputation?
[See How Job Seekers Can Build Their Online Brand.]
These are all reasons why you should be vigilant about monitoring your online reputation. Set up Google alerts for your name to receive notification whenever Google indexes something about you or someone who shares your name. Also consider searching and monitoring your name’s alternate spellings or misspellings.
Finding information is the first step; addressing your digital footprint is the next. The best way to control what employers see is by creating your own online presence, or a website in your name; in other words, YourName.com. For example, Mark Smith would be MarkSmith.com. When you create a website with YourName.com, you help search engines identify the correct information when people look for you, no matter how many people have similar profiles and monikers.
For example, Willie Jackson is a technology processional currently serving as CTO at The Domino Project, a new publishing venture by Seth Godin that’s powered by Amazon. He helps organizations leverage the best tools available so they can focus on their business and not on the technology.
His site is the top search result for a query of "Willie Jackson," even though he has the same name as a professional football player. He attributes this to a combination of website optimization, sound search-engine optimization (SEO), and owning the "exact match" domain for his name.
[For more career advice, visit U.S. News Careers, or find us on Facebook or Twitter.]
Maintaining your own site and creating content you want employers and others to see when they search for you online is one of the best ways to control what people learn about you—and one way to help people conducting cursory searches land on your information instead of someone else’s. It also ensures you present an up-to-date, targeted, professional profile, and helps suppress older information you may not want people to find. (For example, that picture of you carrying a profane sign at a rally in college—complete with your name in the caption. Producing current information relevant to your goals may convince a hiring manager to end his or her search before uncovering information you don’t want public.)
In a digitally driven job market, engaging in the online playground by sharing professional information that’s designed to attract employers to you is key to job-search success.
Miriam Salpeter is a job search and social media consultant, career coach, author, speaker, resume writer and owner of Keppie Careers. She teaches job seekers and entrepreneurs how to incorporate social media tools along with traditional strategies to empower their success. Connect with her via Twitter @Keppie_Careers.
Saturday, February 12, 2011
Transitioning from Practical to Registered Nurse: A Phenomenological Inquiry of Graduates of a Competency Based Nursing Program
As Chair of the Ph.D. (Health Services) Dissertation Committee for Ellem Rice, Ph.D., I am pleased to post the ABSTRACT of her Dissertation(February 2011). Questions and comments should be directed to Dr. Rice ellenbentz@msn.com
ABSTRACT
"Transitioning from Practical to Registered Nurse: A Phenomenological Inquiry of Graduates of a Competency Based Nursing Program"
The United States is experiencing a nursing shortage, the result of social, financial, and technological supply and demand factors. This research explored the intersection of nontraditional nursing education, modern nursing practice, and the current nursing shortage through a general system perspective. The study used a qualitative, retrospective, interview design to gain an understanding of the transition experiences of graduates of a nontraditional, competency based program for licensed practical nurses. Research questions focused on role development in the first year of nursing practice. Interview transcripts were analyzed using Van Maanen’s technique for vocational role development analysis. Benner’s theory of nursing development was used to contrast the experiences of the nontraditional graduates with previously published transition research in traditional graduates. Analysis indicated that the nontraditional graduates began nursing practice at an advanced level but expressed limited experience with expert nursing concepts. Results have the potential to contribute to a paradigm shift in nursing clinical education and intentional nursing role development. The implementation of cost-efficient and effective nursing curriculum positively impacts health care by improving patient safety and workplace morale, and by promoting critical thinking and nursing autonomy. Fostering ongoing role development for nurses contributes to a competent workforce and quality outcomes. Evidenced based improvements in nursing education promise social change through reallocation of financial and human resources to the broader social objectives of ensuring quality nursing care, creating networks of care, expanding access to health services, and promoting and supporting population health initiatives.
ABSTRACT
"Transitioning from Practical to Registered Nurse: A Phenomenological Inquiry of Graduates of a Competency Based Nursing Program"
The United States is experiencing a nursing shortage, the result of social, financial, and technological supply and demand factors. This research explored the intersection of nontraditional nursing education, modern nursing practice, and the current nursing shortage through a general system perspective. The study used a qualitative, retrospective, interview design to gain an understanding of the transition experiences of graduates of a nontraditional, competency based program for licensed practical nurses. Research questions focused on role development in the first year of nursing practice. Interview transcripts were analyzed using Van Maanen’s technique for vocational role development analysis. Benner’s theory of nursing development was used to contrast the experiences of the nontraditional graduates with previously published transition research in traditional graduates. Analysis indicated that the nontraditional graduates began nursing practice at an advanced level but expressed limited experience with expert nursing concepts. Results have the potential to contribute to a paradigm shift in nursing clinical education and intentional nursing role development. The implementation of cost-efficient and effective nursing curriculum positively impacts health care by improving patient safety and workplace morale, and by promoting critical thinking and nursing autonomy. Fostering ongoing role development for nurses contributes to a competent workforce and quality outcomes. Evidenced based improvements in nursing education promise social change through reallocation of financial and human resources to the broader social objectives of ensuring quality nursing care, creating networks of care, expanding access to health services, and promoting and supporting population health initiatives.
Wednesday, January 26, 2011
Learning Culture and Other Factors Affecting the Adoption of Electronic Medical Records in a Tertiary-Care Teaching Hospital
I was pleased to serve as a Member of the Ph.D. Doctoral Committee for Dr. Virgina Chavez. I encourage all of my doctoral students to consider publication of their rssearch results in a peer-reviewed, scholarly journal. Her timely research relating to electronic medical records was published in a recent on-line edition of the AAMA EXECUTIVE (American Academy of Medical Administrators).
Robert E. Hoye, Ph.D. FAAMA, FRSH
AAMA State Director for Kentucky
Learning Culture and Other Factors Affecting the Adoption of Electronic Medical Records in a Tertiary-Care Teaching Hospital
Virginia D Chavis, PhD
Senior Project Analyst
Intel Corporation
Chandler, AZ
Florence-Betty C. Roque, RN, BSN, MSN, ND, CPNP
Primary Care Provider
Rio Grande Medical Group
Deming, NM
Katherine Kenny, DNP, RN, ANP-BC, CCRN
Clinical Associate Professor
Arizona State University
Phoenix, AZ
Background
One of the highest priorities in healthcare reform is to change a paper-based culture to one that relies on electronic record keeping. The shift from paper to electronic files offers a different way for health professionals to think about patient needs. Improvements in the exchange of medical information may lead to better patient care and innovative ways to treat diseases and disorders. Using electronic medical records (EMR) in hospitals, medical centers, and private practices requires system implementation managers to diagnose the level of workers’ resistance to technology and then decide how best to motivate them to use it.
Medical record reform research (Margalit et al., 2006; Menachemi et al., 2007; Menachemi, Hikmet, Stutzman, & Brooks, 2006; Nowinski, Becker, Reynolds, Beaumont, Caprini, Hahn, et al., 2007) captures the impact technology acceptance has on various organizational factors. Accounting for these factors, many EMR implementations continue to fail. A leading cause is the information technology-centric approach, one that overlooks how health information technology (HIT) will affect the organization’s structures and processes (Berg, 2001). Other challenges, such as identifying professionals who will embrace the new technology and identifying the system features that become objects of resistance, also contribute to failure. To reduce the risk of product implementation failure, EMR should “be conceived as organizational development” (p. 147) and not a “mere” technical project (p. 148). An organizational development (OD) approach puts the emphasis on core business processes rather than the technology functions. Information and technology usage and barriers to adoption are vital elements addressed in an OD approach. The approach also can help manage organizational learning culture changes and IT capabilities.
Limited literature exists that examines the role of learning mechanisms. In the past five years, the amount of literature that keeps abreast of EMR implementation factors increased (Anderson, 2007; Anderson & Balas, 2006; Baker, Persell, Thompson, Soman, Burgner, Liss, et al., 2007; Croll & Croll, 2007; Christensen & Grimsmo, 2005; Feldstein et al., 2006; Lapointe & Rivard, 2006). Analysis of the literature showed that little formal data were available to understand the impact technology has on organizational learning. It is therefore difficult to understand if an organizational learning model is an adequate approach in healthcare settings. The literature review also showed that most EMR implementations are managed as information technology (IT) projects rather than using relevant and reliable organizational development strategies. The empirical insight also identifies common barriers to HIT adoption and describes common attitudes towards a healthcare learning environment. Unfortunately, innovation deployment often includes implementation strategies not congruent with the complex professional roles and relationships in medical environments. Moreover, a limited number of studies have significantly examined technology adoption among physicians, nurses and other medical specialists who care for patients in a multi-disciplinary medical setting.
Given the gaps in literature, the purpose of this IRB-approved quantitative survey research was to identify and understand technology adoption barriers by examining technology-usage behavior (e.g., use of EMR), technology adoption factors, and employees’ attitudes towards organizational learning. It also aimed to assess if a significant relationship exists between technology adoption and target variables, such as age, tenure with the organization, and overall level of education. We examined the relationship between technology adoption and principles of learning organization by investigating medical professionals’ perceptions of the learning culture of the research site and other barriers to EMR adoption. We were interested in knowing if a correlation difference existed between technology adoption scores for a learning mechanism and the learning organization scores, if a significant difference existed in the technology adoption scores for medical professionals who have prior EMR experience compared to those with no experience, and if a correlation difference existed in demographic characteristics of medical professionals and technology adoption scores. Data on the barriers to EMR use among medical staff was used to examine these correlations. Lastly, We presented data on learning organization score, which may serve as a benchmark for understanding which learning dimensions and human factors best influence the widespread adoption of an EMR.
Methods
Survey Sample
We selected all employed medical professionals at SJHMC Hospital and Medical Center (SJHMC), in Phoenix, Arizona. Medical professionals were defined as registered nurses (RNs), physician (including employed residents), and other medical professionals such as pharmacists and physical therapists. Using Sample Size Calculator by Creative Research Systems®, sample size and power calculations were determined. Based upon a medical population size of N = 1576, a confidence interval of 5% and a confidence level of 95%, the minimal sample size needed was 309. We are confident that all members of the population would have answered that learning environment influenced technology adoption.
Survey Design and Administration
Surveys were completely anonymous. It was publicized in the hospital’s newsletter and nursing huddles. The study was conducted during two periods: October 2009 – November 2009 and 2 weeks in January 2010. For the first collection, a survey along with a cover letter was distributed to 376 faculty physicians and residents, as well as 1,200 nurses, including mid-level practitioners. Paper versions of the survey were handed out to nurses and residents, and electronic surveys were emailed to faculty physicians. All participants, regardless of distribution method, had the option to either return the completed survey in interoffice mail or complete the survey online. Nonmedical staff such as janitors, volunteers, and operational staff (e.g., human resources, legal, and information technology), contingent medical staff, and administrative medical staff were excluded.
A follow-up announcement reminding staff of the study was sent two weeks after the initial invitation. We tracked respondents by hospital units. For the second period, nonrespondents were identified using the unit categories. These groups were handed a second survey package, which included the cover letter, survey, and return envelope.
The technology and Learning Organization Questionnaire was a two-part, self-administered questionnaire. Usage permissions were obtained prior to data collection. The first part, the technology assessment, captured general information technology use, EMR use, and barriers to EMR use. The instrument was developed by Menachemi et al. (2006) and was adopted with some minor modifications. For example, the word “practice” was changed to “center or clinic.” The second portion of the questionnaire came from the Dimensions of the Learning Organization Questionnaire® (DLOQ-A) developed by Yang (2003). It is a validated questionnaire composed of seven discipline areas that measure “changes in organizational learning practices and culture as perceived by the employees” (Marsick & Watkins, 2003, as cited in Dymock & McCarthy 2006, p. 528). The organization adoption score was correlated to organizational learning scores and other variables.
Participants completing the questionnaire online were required to give consent. Once the consent was electronically acknowledged, the participant gained access to the questions. Participants that completed the paper version returned the questionnaire through interoffice mail in a preaddressed envelope. All mailed responses were entered into the electronic database, and data was verified and cross-checked by an independent statistician. In addition, SJHMC Hospital and Medical Center Institutional Review Board (IRB approval number - 08BN042) and Walden University (IRB approval number - 09-29-09-0287953) evaluated and approved this study.
Statistical Methods
Analyses included standard descriptive and inferential statistics. Descriptive statistics was used to describe respondents’ characteristics such as age range, gender, years of experience as a nurse or physician, and years of employment at SJHMC. Learning and technology adoption and significances were determined through t test analysis. Inferential statistical correlation analysis was performed to validate whether a correlation or association existed between two the types of scores); two-sample t tests compared the means of the two populations, and ANOVA. JMP® software was used for analysis, and significance was considered at the p < 0.05 level. With survey research, response bias is a possibility. According to Menachemi (2006), surveys are a valuable method for gathering information for a geographically diverse population, especially when face-to-face interviews are not possible because of cost and/or time constraints. Surveys of physicians also typically yield lower response rates than other healthcare professionals. To attempt to correct for nonrespondent bias physician respondents were compared to nurse respondents, and the return rates were the same. The response rate for nurses was 17.4% and for physicians it was 17.3%. From these numbers, the percentage of nurses that responded equaled the percentage of physicians that responded. Surveys were distributed to all clinical units; however, demographic profiles of the clinical units are not known. Therefore, it is not possible to correct for nonrespondent bias within the two groups. The study conducted by Menachemi and Brooks (2006), which used the same technology assessment survey, compared responders and nonresponders with respect to known demographics and found “no significant evidence of bias was detected even after employing common techniques used to identify response bias” (p. 85). Results Demographics Study participants included registered nurses (RNs), physician (including employed residents), and other medical professionals such as pharmacists and physical therapists. Of the 337 surveys returned (a 21.4% participation rate), 7 respondents were excluded, 69 respondents (20.9%) reported themselves as physicians, and 220 (66.7%) reported their position as nurse. The final return rate was 21%. The percentage of physicians that responded was equal to the percentage of nurses that responded. Demographic characteristics of the respondents are shown in Table 1. One nonemployed physician completed the survey, and those responses were removed from analysis. In addition, six administrative support staff members that would not use an EMR were excluded. Missing demographic answers were noted on the specific questions and the total respondents revised for that question. Respondents that did not answer or partially answered questions 10 and 17 were excluded from data analysis. The number of respondents for this analysis was adjusted to reflect missing responses. Table 1 Participants’ Demographic Characteristics Category Physicians Nurses Other or unknown Age range: < 35 36 (12%) 79 (26.3%) 2 (0.7%) 35-50 22 (7.3%) 91 (30.3%) 11 (3.7%) > 50 10 (3.3%) 46 (15.3%) 3 (1.0%)
Gender:
Male 35 (11.7%) 26 (8.7%)
Female 33 (11.0%) 189 (63.2%) 16 (5.4%)
Mean yrs. At SJHMC 4.6 (<1 – 33) 8.7 (<1 - 39) 8.3 (<1 - 26)
Mean yrs. since graduation 10.3 (<1 – 48) 12.8 (<1 - 41) 13.2 (<1 - 27)
Descriptive analysis of the demographic data consisted of frequencies and percentages of each variable. The majority of the participants were female (63.2%). More people reported their age range as between 35 and 50 (30.3%).
Barriers to the Use of EMRs
To compare barriers among SJHMC employed medical respondents, chi-square analysis was used, and significance was considered at the p < 0.05 level. Differences existed among physicians, nurses, and other medical staff (see Table 2). For example, no time to learn how to use such a system barrier was dramatically higher for nurses (53.8%) than physicians (34.7%) and other medical staff (18.2%). Another notable differences between nurses and the other groups were system difficulty (50.6% vs. 30% for physicians and 9.1% for other medical staff). Patient confidentiality ranked at 40% for both non-nurse groups, but nurses ranked it at 62.1%. The rank for patient resistance was 43.8% and was considerably lower by physicians (14%) and other medical staff (11.1%). Nurses, more frequently than the other two medical groups, indicated more barriers to using EMR.
Robert E. Hoye, Ph.D. FAAMA, FRSH
AAMA State Director for Kentucky
Learning Culture and Other Factors Affecting the Adoption of Electronic Medical Records in a Tertiary-Care Teaching Hospital
Virginia D Chavis, PhD
Senior Project Analyst
Intel Corporation
Chandler, AZ
Florence-Betty C. Roque, RN, BSN, MSN, ND, CPNP
Primary Care Provider
Rio Grande Medical Group
Deming, NM
Katherine Kenny, DNP, RN, ANP-BC, CCRN
Clinical Associate Professor
Arizona State University
Phoenix, AZ
Background
One of the highest priorities in healthcare reform is to change a paper-based culture to one that relies on electronic record keeping. The shift from paper to electronic files offers a different way for health professionals to think about patient needs. Improvements in the exchange of medical information may lead to better patient care and innovative ways to treat diseases and disorders. Using electronic medical records (EMR) in hospitals, medical centers, and private practices requires system implementation managers to diagnose the level of workers’ resistance to technology and then decide how best to motivate them to use it.
Medical record reform research (Margalit et al., 2006; Menachemi et al., 2007; Menachemi, Hikmet, Stutzman, & Brooks, 2006; Nowinski, Becker, Reynolds, Beaumont, Caprini, Hahn, et al., 2007) captures the impact technology acceptance has on various organizational factors. Accounting for these factors, many EMR implementations continue to fail. A leading cause is the information technology-centric approach, one that overlooks how health information technology (HIT) will affect the organization’s structures and processes (Berg, 2001). Other challenges, such as identifying professionals who will embrace the new technology and identifying the system features that become objects of resistance, also contribute to failure. To reduce the risk of product implementation failure, EMR should “be conceived as organizational development” (p. 147) and not a “mere” technical project (p. 148). An organizational development (OD) approach puts the emphasis on core business processes rather than the technology functions. Information and technology usage and barriers to adoption are vital elements addressed in an OD approach. The approach also can help manage organizational learning culture changes and IT capabilities.
Limited literature exists that examines the role of learning mechanisms. In the past five years, the amount of literature that keeps abreast of EMR implementation factors increased (Anderson, 2007; Anderson & Balas, 2006; Baker, Persell, Thompson, Soman, Burgner, Liss, et al., 2007; Croll & Croll, 2007; Christensen & Grimsmo, 2005; Feldstein et al., 2006; Lapointe & Rivard, 2006). Analysis of the literature showed that little formal data were available to understand the impact technology has on organizational learning. It is therefore difficult to understand if an organizational learning model is an adequate approach in healthcare settings. The literature review also showed that most EMR implementations are managed as information technology (IT) projects rather than using relevant and reliable organizational development strategies. The empirical insight also identifies common barriers to HIT adoption and describes common attitudes towards a healthcare learning environment. Unfortunately, innovation deployment often includes implementation strategies not congruent with the complex professional roles and relationships in medical environments. Moreover, a limited number of studies have significantly examined technology adoption among physicians, nurses and other medical specialists who care for patients in a multi-disciplinary medical setting.
Given the gaps in literature, the purpose of this IRB-approved quantitative survey research was to identify and understand technology adoption barriers by examining technology-usage behavior (e.g., use of EMR), technology adoption factors, and employees’ attitudes towards organizational learning. It also aimed to assess if a significant relationship exists between technology adoption and target variables, such as age, tenure with the organization, and overall level of education. We examined the relationship between technology adoption and principles of learning organization by investigating medical professionals’ perceptions of the learning culture of the research site and other barriers to EMR adoption. We were interested in knowing if a correlation difference existed between technology adoption scores for a learning mechanism and the learning organization scores, if a significant difference existed in the technology adoption scores for medical professionals who have prior EMR experience compared to those with no experience, and if a correlation difference existed in demographic characteristics of medical professionals and technology adoption scores. Data on the barriers to EMR use among medical staff was used to examine these correlations. Lastly, We presented data on learning organization score, which may serve as a benchmark for understanding which learning dimensions and human factors best influence the widespread adoption of an EMR.
Methods
Survey Sample
We selected all employed medical professionals at SJHMC Hospital and Medical Center (SJHMC), in Phoenix, Arizona. Medical professionals were defined as registered nurses (RNs), physician (including employed residents), and other medical professionals such as pharmacists and physical therapists. Using Sample Size Calculator by Creative Research Systems®, sample size and power calculations were determined. Based upon a medical population size of N = 1576, a confidence interval of 5% and a confidence level of 95%, the minimal sample size needed was 309. We are confident that all members of the population would have answered that learning environment influenced technology adoption.
Survey Design and Administration
Surveys were completely anonymous. It was publicized in the hospital’s newsletter and nursing huddles. The study was conducted during two periods: October 2009 – November 2009 and 2 weeks in January 2010. For the first collection, a survey along with a cover letter was distributed to 376 faculty physicians and residents, as well as 1,200 nurses, including mid-level practitioners. Paper versions of the survey were handed out to nurses and residents, and electronic surveys were emailed to faculty physicians. All participants, regardless of distribution method, had the option to either return the completed survey in interoffice mail or complete the survey online. Nonmedical staff such as janitors, volunteers, and operational staff (e.g., human resources, legal, and information technology), contingent medical staff, and administrative medical staff were excluded.
A follow-up announcement reminding staff of the study was sent two weeks after the initial invitation. We tracked respondents by hospital units. For the second period, nonrespondents were identified using the unit categories. These groups were handed a second survey package, which included the cover letter, survey, and return envelope.
The technology and Learning Organization Questionnaire was a two-part, self-administered questionnaire. Usage permissions were obtained prior to data collection. The first part, the technology assessment, captured general information technology use, EMR use, and barriers to EMR use. The instrument was developed by Menachemi et al. (2006) and was adopted with some minor modifications. For example, the word “practice” was changed to “center or clinic.” The second portion of the questionnaire came from the Dimensions of the Learning Organization Questionnaire® (DLOQ-A) developed by Yang (2003). It is a validated questionnaire composed of seven discipline areas that measure “changes in organizational learning practices and culture as perceived by the employees” (Marsick & Watkins, 2003, as cited in Dymock & McCarthy 2006, p. 528). The organization adoption score was correlated to organizational learning scores and other variables.
Participants completing the questionnaire online were required to give consent. Once the consent was electronically acknowledged, the participant gained access to the questions. Participants that completed the paper version returned the questionnaire through interoffice mail in a preaddressed envelope. All mailed responses were entered into the electronic database, and data was verified and cross-checked by an independent statistician. In addition, SJHMC Hospital and Medical Center Institutional Review Board (IRB approval number - 08BN042) and Walden University (IRB approval number - 09-29-09-0287953) evaluated and approved this study.
Statistical Methods
Analyses included standard descriptive and inferential statistics. Descriptive statistics was used to describe respondents’ characteristics such as age range, gender, years of experience as a nurse or physician, and years of employment at SJHMC. Learning and technology adoption and significances were determined through t test analysis. Inferential statistical correlation analysis was performed to validate whether a correlation or association existed between two the types of scores); two-sample t tests compared the means of the two populations, and ANOVA. JMP® software was used for analysis, and significance was considered at the p < 0.05 level. With survey research, response bias is a possibility. According to Menachemi (2006), surveys are a valuable method for gathering information for a geographically diverse population, especially when face-to-face interviews are not possible because of cost and/or time constraints. Surveys of physicians also typically yield lower response rates than other healthcare professionals. To attempt to correct for nonrespondent bias physician respondents were compared to nurse respondents, and the return rates were the same. The response rate for nurses was 17.4% and for physicians it was 17.3%. From these numbers, the percentage of nurses that responded equaled the percentage of physicians that responded. Surveys were distributed to all clinical units; however, demographic profiles of the clinical units are not known. Therefore, it is not possible to correct for nonrespondent bias within the two groups. The study conducted by Menachemi and Brooks (2006), which used the same technology assessment survey, compared responders and nonresponders with respect to known demographics and found “no significant evidence of bias was detected even after employing common techniques used to identify response bias” (p. 85). Results Demographics Study participants included registered nurses (RNs), physician (including employed residents), and other medical professionals such as pharmacists and physical therapists. Of the 337 surveys returned (a 21.4% participation rate), 7 respondents were excluded, 69 respondents (20.9%) reported themselves as physicians, and 220 (66.7%) reported their position as nurse. The final return rate was 21%. The percentage of physicians that responded was equal to the percentage of nurses that responded. Demographic characteristics of the respondents are shown in Table 1. One nonemployed physician completed the survey, and those responses were removed from analysis. In addition, six administrative support staff members that would not use an EMR were excluded. Missing demographic answers were noted on the specific questions and the total respondents revised for that question. Respondents that did not answer or partially answered questions 10 and 17 were excluded from data analysis. The number of respondents for this analysis was adjusted to reflect missing responses. Table 1 Participants’ Demographic Characteristics Category Physicians Nurses Other or unknown Age range: < 35 36 (12%) 79 (26.3%) 2 (0.7%) 35-50 22 (7.3%) 91 (30.3%) 11 (3.7%) > 50 10 (3.3%) 46 (15.3%) 3 (1.0%)
Gender:
Male 35 (11.7%) 26 (8.7%)
Female 33 (11.0%) 189 (63.2%) 16 (5.4%)
Mean yrs. At SJHMC 4.6 (<1 – 33) 8.7 (<1 - 39) 8.3 (<1 - 26)
Mean yrs. since graduation 10.3 (<1 – 48) 12.8 (<1 - 41) 13.2 (<1 - 27)
Descriptive analysis of the demographic data consisted of frequencies and percentages of each variable. The majority of the participants were female (63.2%). More people reported their age range as between 35 and 50 (30.3%).
Barriers to the Use of EMRs
To compare barriers among SJHMC employed medical respondents, chi-square analysis was used, and significance was considered at the p < 0.05 level. Differences existed among physicians, nurses, and other medical staff (see Table 2). For example, no time to learn how to use such a system barrier was dramatically higher for nurses (53.8%) than physicians (34.7%) and other medical staff (18.2%). Another notable differences between nurses and the other groups were system difficulty (50.6% vs. 30% for physicians and 9.1% for other medical staff). Patient confidentiality ranked at 40% for both non-nurse groups, but nurses ranked it at 62.1%. The rank for patient resistance was 43.8% and was considerably lower by physicians (14%) and other medical staff (11.1%). Nurses, more frequently than the other two medical groups, indicated more barriers to using EMR.
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