All Entries in the "competency" Category
Keys to improving physician competency and professional development
These days, everyone is talking about how helpful reducing stress, having a positive mental attitude, and being mindful can be for people with health challenges. But when was the last time you heard anyone say that reducing stress, having a positive mental attitude, and being mindful of personal actions can actually increase a physician’s effectiveness while promoting health, healing and well being? It can and it does.
I don’t have to tell you that physicians and all medical professionals working in hospitals or other medical settings are under a great deal of job-related stress. What you might not be aware of is that left unchecked, negative stress is a workplace contaminant that can have a deleterious effect on your health, well-being and effectiveness. Imagine that you are being assisted by a person who is agitated, stressed out, preoccupied or in a bad mood. Now imagine that that person is you. How do you think your attitude and mood will impede your effectiveness and work experience as well as all you are in contact with? Remember that when physicians are stressed out, their patients and colleagues are more likely to be stressed out too.
A positive attitude and focused attention set the tone for how you work (and also how you play, which is important for a good work-life balance). This can be accomplished through simple mental exercises. Briefly, the key to transforming negative stress into positive stress is found within one’s “internal connections;” the way one perceives, experiences, and relates to the internal and external stressors of daily life. Instead of unrelenting pressure, you can sense productive excitement. Instead of helplessness and hopelessness, you and your patients can sense practical action and confidence. Instead of fatigue, you, your staff/employees can find mutual satisfaction. Once these mental re-connections are in place and operating automatically, you can feel robustly challenged by stressful situations rather than incapacitated, drained or debilitated by them.
Learning how to de-stress and focus your attention can help you put the zest back into your life and your practice and diminish the destructive impact of negative stress. It is enlightening to realize that reducing stress, having a positive mental attitude and being mindful will improve patient care along with your competency and professional development. And keep in mind, that these same techniques can help your patients take the suffering out of pain.
Michael Ellner, CHT, is a certified medical hypnotist in private practice in New York City. He teaches advanced courses in medical hypnosis at schools throughout North America and South Africa and is a featured instructor of Hypnotic Pain Relief, Effective Medical Communication and Stress Management at the annual PAINWeek conference. Ellner is the lead author of a peer-reviewed paper “Hypnosis in Disability Settings,” IAIABC Journal, Vol. 46 No. 2; the co-author of “HOPE is Realistic – A Guide to Helping Patients Take Suffering Out of Pain,” co-written with Kelley T. Woods; and he is the author of “BEDSIDE MANNERS – The Pain Clinicians’ Guide to Effective Medical Communication” To contact Ellner, visit his website: www.nycanxietyhypnosis.com or email michaelellner@verizon.net.
Difference of opinion in Texas
Public Citizen, a nonprofit organization that advocates for individual rights, says the Texas Medical Board needs to step up its game. The organization asserts that the state medical board has failed to punish many physicians in the state who have received sanctions from healthcare organizations. The Texas Medical Board disagrees, citing Federation of State Medical Boards data that often ranks Texas at the top for disciplining physicians.
According to an article from HealthLeaders Media, Public Citizen analyzed 21 years of NPDB data.The group found that almost 450 Texas physicians who had been sanctioned by a healthcare entity had yet to be disciplined by the Texas Medical Board. Public Citizen sent a letter to Texas Governor Rick Perry urging him to take “immediate action to improve the performance of the Texas Medical Board and thereby protect patients in Texas from physicians who should have been, but were not, disciplined.”
Public Citizen does not blame the medical board; it instead puts the blame on a lack of funding and staffing. In Texas, the money that is collected through physician appointments, reappointments, and fines is placed in the state’s general fund. The medical board than submits a request for funding to perform its functions.
Lee Hopper, spokeswoman for the Texas Medical Board, says the agency is not underfunded or understaffed. “Like anybody, of course we would always like more money. But we haven’t been dealing with a budget crisis so the agency is healthy and it’s effective,” she tells HealthLeaders Media.
In its letter to Perry, Public Citizen recommends letting the medical board keep more—preferably all—of the funds it collects. This raises some interesting questions to think about.
Should the medical board be entitled to all of the money collected through its processes? Should the medical board learn to do more with less, like many other businesses and citizens are currently forced to do? Would more funding lead to more disciplinary action?
The question that really sticks on my mind is, as a healthcare consumer, how important is it that disruptive physicians be disciplined? I know the short answer is very, but at what cost? Do you want your state’s medical board to use all of the money it collects to fund its needs? Or would you like to see some of this money go into the state’s general fund to be used for other public services?
Free Form Friday: Quality Dashboard
Congratulations to Dianna Jernigan, RN, MSN, director of quality, risk management, and education at Cobre Valley Regional Medical Center in Globe, Ariz. for winning a free seat at the 15th Annual Credentialing Resource Center Symposium. Jernigan submitted a quality dashboard form that the organization uses to get a quick snapshot of how practitioners are doing with certain quality measures, such as Hospital Consumer Assessment of Health Providers and Systems survey results and core measures. Jernigan says the dashboard is a quick and concise way to look at the information, and has led to increased accountability among the medical staff.
“It used to be, we had someone in medical records that reported the core measures and turned them in and the report only went to administration; no one else really ever saw it,” she says. “Now we have someone who gets that information, it comes here to this report, than all of the directors are able to see it and be held responsible for their part in those scores.”
Free Form Friday: FPPE proctor evaluation form
Congratulations to Vicki Tauer, our March winner of the 15th Annual Credentialing Resource Center Symposium free seat contest. Tauer, MSM, CPCS, CPMSM, is the supervisor of medical staff services at Fairfield Medical Center in Lancaster, Ohio. Her medical staff office recently revamped its FPPE proctor evaluation form to make it more user-friendly for proctors.
Here is a copy of the FPPE proctor evaluation form.
For more information on the CRC Symposium, which takes place May 10-11 in Orlando, click here.
Patient Satisfaction Blog Series for CRC 2012
Easier? It can make my job easier?
You are now experts at improving the three physician-specific questions on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey:
- During this hospital stay, how often did doctors treat you with courtesy and respect?
- During this hospital stay, how often did doctors listen carefully to you?
- During this hospital stay, how often did doctors explain things in a way you could understand?
I mentioned last week that this would make your job easier. How can that be? The following are some of the benefits that come from having satisfied patients:
- Fulfills patient priorities and wants
- Improves professional standing
- Improves compliance with recommended treatments and follow up
- Reduces liability risks and costs
- Improves staff retention and satisfaction
- Improves physician satisfaction
- Reduces unnecessary calls, returns to the ED, and professional aggravation
- Improves clinical outcomes and measures
There are other benefits as well. If you think back, you can probably find an example for each of the above from your own journey in the medical profession (as either a patient or provider). Happiness (satisfaction) is contagious!
Hopefully this series has whetted your appetite to do further reading, research, and reflection on improving patient satisfaction. Although “because the government says so” may be adequate motivation for some, the real motivation should come from our desire to provide the best patient care possible. After all, isn’t that what we are all about?
Editor’s note: William Mills, MD, MD, MMM, CPE, FACPE, CMSL, FAAFP, is a featured speaker at the 15th annual Credentialing Resource Center Symposium, May 10-11. He will be speaking on using patient satisfaction scores to drive improvement as well as how to privilege low- and no-volume practitioners. For more information, click here.
Patient Satisfaction Blog Series for CRC 2012
Blah, Blah, Blah?
As I mentioned in my last post, there are three physician-specific questions on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey:
- During this hospital stay, how often did doctors treat you with courtesy and respect?
- During this hospital stay, how often did doctors listen carefully to you?
- During this hospital stay, how often did doctors explain things in a way you could understand?
This post will deal with tips to improve your scores on the explanation question. By now, I’m sure you would make Emily Post proud of how polite you are. (For those much younger than I, she was the queen of etiquette.) I also expect you have made some brilliant diagnoses as a result of your improved listening skills. Now it is time to focus on how you explain things to patients and increase those scores at the same time. Your patient shouldn’t feel like Charlie Brown talking to his parents and just hear “blah, blah, blah,” when you are explaining important health related issues.
Patients (those are the horizontal people in hospitals) are often not at their intellectual peak while hospitalized. Remember this is our workplace—not theirs—so we need to be a little more diligent when explaining complex, emotionally charged issues. Here are a few pointers that will help you with your ability to explain what’s going on in a way that the patient may understand:
- Provide more information than you believe is necessary
- Provide the option of having another person in the room to hear the information, take notes, and ask questions
- Encourage patients to write down their questions in between visits. This allows them the opportunity to think about the previous interactions and formulate questions that specifically address their fears and concerns
- Ask patients if they need any more information
Remember that we often get caught up in our jargon and patients “appear” to understand as they don’t want to disappoint their physician or appear not so bright. Ask follow-up questions that probe their understanding. You may be surprised by how much your patient did not understand once you start asking them these questions.
So go forth and improve the satisfaction of those we serve, while simultaneously improving quality, publicly reported measures and making your job easier. I couldn’t resist. This will make your job easier. Read next week’s post to see how.
Editor’s note: William Mills, MD, MD, MMM, CPE, FACPE, CMSL, FAAFP, is a featured speaker at the 15th annual Credentialing Resource Center Symposium, May 10-11. He will be speaking on using patient satisfaction scores to drive improvement as well as how to privilege low- and no-volume practitioners. For more information, click here.
Patient Satisfaction Blog Series for CRC 2012
I’m Sorry, What Did You Say?
As I mentioned in my last post, there are three physician-specific questions on the Hospital Consumer Assessment of Healthcare Providers and Systems HCAHPS survey. They are:
- During this hospital stay, how often did doctors treat you with courtesy and respect?
- During this hospital stay, how often did doctors listen carefully to you?
- During this hospital stay, how often did doctors explain things in a way you could understand?
This post will deal with tips to improve your scores on the listening question. Hopefully you have tried to be a little more respectful (as discussed in my last post) and have found it rewarding. So let’s improve your listening skills now.
You have probably figured out this is a perception issue, and you are correct. The following tips have been shown to improve the patient’s perception that you are listening:
- Sit down during the conversation portion of the visit
- Ask open-ended questions and listen with empathy
- Use “reflective” listening (paraphrase, clarify, ask for understanding)
- Offer a physical gesture, such as a handshake, a touch on the shoulder, or a pat on the knee
- Make eye contact with the patient and family
- Pay attention to the patient and not the chart or cell phone
Although these tips improve the perception that you are listening, you actually do need to listen carefully. Remember back to medical school when the wise attending said that the patient will tell you what is wrong with them if you will only listen? My experience is that they were right. How about your experience?
Editor’s note: William Mills, MD, MD, MMM, CPE, FACPE, CMSL, FAAFP, is a featured speaker at the 15th annual Credentialing Resource Center Symposium, May 10-11. He will be speaking on using patient satisfaction scores to drive improvement as well as how to privilege low- and no-volume practitioners. For more information, click here.
Featured webcast: Assessing the competence of low- and no-volume practitioners
Create strategic solutions to privileging low- and no-volume practitioners with advice from two leading medical staff and credentialing experts. In this online program, Yisrael M. Safeek, MD, MBA, CPE, FACPE, an experienced physician leader and former Joint Commission surveyor, and Sally Pelletier CPMSM, CPS, a national credentialing and privileging expert, walk medical staff leaders and medical services professionals through steps to develop a working strategy to establish competency for low- and no-volume practitioners.
Take a peek at the agenda:
- Contributing factors to the increase of low- and no-volume practitioners
- Governance documents that hamper the hospital’s ability to effectively manage low- and no-volume practitioners (i.e. link membership and privileges)
- How does low volume affect competence
- Matching privileges with competence
- Building a strategic approach to low- and no-volume practitioners (e.g. intended practice plan, medical staff development plan)
- Working strategies to address low- and no-volume
- A medical staff culture that feels an obligation to the low- and no-volume practitioners
- Types of data sources
- How to compile and present the data in a meaningful way
This webcast will be presented on Tuesday, February 21 at 1 p.m. To learn more or to register, click here.
Patient Satisfaction Blog Series for CRC 2012
Courtesy and Respect? Don’t have to; I’m the Physician!
As I mentioned in my last post, there are three physician-specific questions on the Hospital Consumer Assessment of Healthcare Providers and Systems HCAHPS survey:
- During this hospital stay, how often did doctors treat you with courtesy and respect?
- During this hospital stay, how often did doctors listen carefully to you?
- During this hospital stay, how often did doctors explain things in a way you could understand?
This post will deal with tips to improve your scores on the courtesy and respect question. Hopefully you have bought into the concept that improving patient satisfaction improves quality. If you haven’t yet, then try these suggestions and see what happens.
Since approximately 85% of communication is non-verbal, pay particular attention to your body language. We have all been in situations where the body language was so loud, that the spoken words could not be “heard.” Clear your mind prior to beginning the encounter.
Brush up on your polite behaviors such as:
- Knocking on the door before entering
- Making eye contact with the patient and visitors
- Introducing yourself and the members of your team
- Addressing the patient by their preferred name
Do not discuss the patient in the third person when they are present. They are not just the “gallbladder in room 203” but actually a person, too.
These are just a few of the proven methods to improve patient satisfaction and your score on this question. Try these out this week; next week I’ll be sharing about listening skills.
Editor’s note: William Mills, MD, MD, MMM, CPE, FACPE, CMSL, FAAFP, is a featured speaker at the 15th annual Credentialing Resource Center Symposium, May 10-11. He will be speaking on using patient satisfaction scores to drive improvement as well as how to privilege low- and no-volume practitioners. For more information, click here.
Holy Moly, He Wants to Come Back!
Okay, here are the questions:
- What do you do when the physician requests his privileges be restored after he returns from rehab for his cocaine and sexual addictions?
- What do you do when the 67-year-old internist, who retired five years ago, has just been hired by administration to be your new hospitalist?
- What do you do when your favorite cardiologist returns from a medical leave of absence after suffering a significant stroke?
Of course, these scenarios cause more questions than answers. You suddenly wish you had declined the invitation to be chief of staff of your medical staff. The fact remains that demographics apply to physicians as well as the general public.
Alcohol and substance abuse is 12-14% in the general population and is the same or somewhat higher in the physician population. (P Hughes, Prevalence of Substance Abuse Among US physicians, JAMA, 1992) Sexual addiction, especially cyber addiction to pornography, is present in 6-8% of the general population and one out of five are women. (Carnes, Am J Prev Psychology Neurology, 1991, 3:16-23) Dementia is present in 13.9% of individuals 71 and older and 9.7% of these have Alzheimer’s disease. (Plassman, et al, Neuroepid, 2007) Stroke recovery is possible, but of course, varies widely depending on age, severity of the injury, rehabilitation efforts, and support to name a few. None of us are immune from these possibilities.
Okay, now a few answers. Patients are more important than physicians. Don’t get caught in the trap of treating physicians as “special people.” First and foremost, you should have a concrete policy for dealing with all of the above possibilities. It must be iron clad, fair and equitable, be consistent with HIPPA and the American Disability Act, should be patient-safety focused but also allow for the physician to return to your medical staff. This begins with a viable and credible Physician Health Committee, an engaged credentials committee, OPPE and FPPE plans on steroids, legal advice, and a “Fitness to Work” evaluation from an objective and independent physician.
Want more from Dr. White? R Dean White DDS, MS, of Dean White Consulting, will be speaking about how to create a physician re-entry process at the 15th Annual Credentialing Resource Center Symposium, May 10-11. For more information, click here.
