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It’s not funny how we don’t talk anymore

A mixed bag of stuff this week (dig, if you will, a picture: sleigh full of regulatory madness), including the Perspectives coverage of the Emergency Management standards. But first, a little musing to usher in the change of the seasons.

The nature of my work/vocation requires me to travel a fair amount—and I am not whining about that—it’s my choice to continue to do so, and I understand that if the travel gods are displeased, there is no point in kvetching, but I digress. One of my favorite travel pastimes is watching fellow travelers as they navigate the various and sundry obstacles that one might encounter as they complete the check-in/TSA gauntlet, etc., after which, they generally “crash” in the gate areas or airline clubs. One of the most fascinating/disturbing trends (and I suspect you’ve probably witnessed this yourselves—perhaps even in your own homes) is groups of people (even families!) staring at their devices…and saying not a word to each other. I can’t help but think that if we can’t (or I guess more appropriately, don’t) converse in our private lives, it’s going to have a not-so-good impact on discourse in the workplace. We are better when we are talking—and even technological isolation is still isolation-y.

Hopping down from the ol’ soapbox, just a quick couple of words on the Emergency Management stuff in Perspectives. Interestingly enough (almost to the point of being strangely enough), it appears that folks responding to emergencies have found that the EM standards facilitate effective response—go figure! While I am certainly glad to hear that, I’m not necessarily surprised, mind you. After all, the basic tenets of small “e” emergency management are what inform the big “E” Joint Commission chapter, so if there’s stuff that doesn’t lend itself to response, recovery, etc., I would hope that it would have been expunged by now. Another area of emphasis in the article is the importance of collaboration with the community and other health providers when you are dealing with a significant emergency (as an aside, the CMS final rule also highlights the importance of that collaboration), which (once again) makes a great deal of sense from a practical standpoint. The article closes out with some links to useful information; I’d encourage you to check them out once the stockings are hung by the chimney with care:

Finally, to close out this epistle, I would encourage you to climb into the wayback machine and revisit those halcyon days of Sentinel Event Alert #37 and the management of emergency power systems, etc. My gut tells me that e-power is going to continue (if not increase) to be a focal point for pretty much any and all regulatory systems and the advice provided in SEA #37 relative to evaluating your e-power capabilities, assessing the reliability of normal power, etc., can only become more timely as our reliance on technology grows at an almost exponential rate. We certainly don’t want to get caught unawares on the e-power front and I’d be willing to bet that there have been some changes in the technology infrastructure in your place that might be significant enough for some analysis. At any rate, some more links to peruse once you’ve laid out the cookie and milk for that right jolly old elf:

Beyond that, I hope that we all get a chance to turn off the technology for a bit over the next couple of weeks (and I mean that in the best possible way—I am no Luddite!) and allow some real-time reflection with our family, friends and, indeed, the world at large.

Here’s hoping that 2017 rings in the return of civil discourse!

Do you want to know a secret?

Apropos of nothing, on the face of it, I wanted to share with you a cautionary tale relative to the importance of accurate (and complete) communications, particularly in those perilous moments when you have a less than satisfied customer. As you might guess, I travel by air a fair amount of the time (and no, this isn’t a beef about delays. I count myself pretty fortunate in that regard. Delays are an inevitable function of any commute, doesn’t matter what mode, but I digress) and, without getting into too much detail, a process that had always worked in the past suddenly did not “go” the way I expected/had experienced literally tens, if not hundreds, of times in the past.

The initial encounter with the airline folks did not yield much in the way of satisfaction; in fact, I don’t think I would be hyperbolic in describing the handling of that interaction as bordering on indifferent. I try to keep an even keel in such matters, but I will tell you that I was a wee bit frustrated. I also knew that there was a process for airing my concerns, so I elected to save it for another day.

At this point (and yes there is a point to all this and I’m almost there), I had a pretty good idea of what was going on (clearly, at least in my mind, it was a systems issue and one part of the system wasn’t communicating very effectively with another part of the system), so I contacted customer service and explained my plight. The person I spoke with was very empathetic and offered a solution that she guaranteed would resolve the issue; I came away with a very positive feeling, but guess what? The solution didn’t work. There were a few more back and forths with a few more ideas/solutions, but nothing that really addressed what I was convinced was the issue.  The customer service folks promised to investigate and let me know.

Well, it turns out that it was a systems issue and at least some folks at the airline knew of its existence and had been working on it for a couple of weeks. They weren’t sure when the issue would be resolved, but I was okay with that—because I now knew what was going on. The “problem,” as I now see it, is that the folks who knew there was a problem and what the “symptoms” of the problem were, didn’t let everyone in the customer service process know what was going on. There is nothing more effective in answering someone’s questions than being able to speak directly to the issue—even if the resolution is not immediate.

How many times in our work lives have we been less than proactive in providing everyone in the process a complete picture of what’s going on? Inevitably, one can look back and figure out exactly when full disclosure fell by the wayside and frequently results in hard feelings, etc. It all kind of dovetails back to the mantra of “if you see something, say something,” though in this case, it’s more along the lines of “if you know something, say something.” While one may not intend to be secretive, sometimes it’s tough to defend “compartmentalization” or whatever euphemism you might adopt.  When it comes to safety, the more everyone knows, the more effectively risk can be managed.

Taking care of business

Earlier today, I was conducting an EC/EM interview session with a very participative group and I was complimenting them on their ability to speak to improvement efforts in areas that are not necessarily in their scope of practice. Now, my experience has been that the folks most familiar/expert with the EC function being discussed tend to dominate the conversation (sometimes in a good way, sometimes not) and I thought it was cool that these folks were so familiar with what others in the group felt was important. To my compliment, the observation was made (and I thought this was absolutely the grandest definition of what a high-performance team can achieve) that they mind each other’s business. In that simple turn of phrase (not an exact quote – sometimes paraphrase is the best I can do), the whole concept of what the EC team can embrace and accomplish was crystallized: It’s not about what may or may not be “somebody else’s job” (or “not my job”); it’s actually using the team concept to make and sustain improvements. In the old days we used to call that type of organizational behavior “silos,” which is OK if you’re storing grains and such, but when the goal is organizational improvement, we want to be more like a snack mix with all sorts of nuts and fibrous bits.

And please keep in mind, it’s not necessarily about never having any issues to correct. As long as there are human beings in the mix, there will be corrections to make – be assured of that. But if you can harness the power of a group of committed individuals who accept responsibility, hold each other accountable, and care enough to “mind each other’s business,” you can accomplish so much. There’ll always be stuff to do, but think about the power of getting stuff done.

Brings a smile to my face – how ‘bout you?

She’s a laughing, giggling whirly bird – oh heli!

Interesting development on the survey front in the last couple of weeks. I’m not at all sure what it means, but I thought I would share it with you all, make of it what you will.

During a recent survey in the Sunshine State, a hospital was cited for not having the “recommended (maximum) rotor circumference signage on the pad nor the other recommended signs that are recommended by the FAA” (signs such as “MRI in use,” etc.). Now we could certainly have a good time parsing the whole “recommended signs that are recommended” phraseology, but I keep coming back to that word “recommended.”   How far do we have to go to ensure that we have somehow accounted for every recommendation for every possible risk that we might encounter?. Yeah, beats me, too, but in the interest of furthering the applicable knowledge base, let’s step to the web for some edification:

First I draw your attention to the Advisory Circular issued by the FAA back in 2004. I can’t seem to lay my mitts on anything more contemporary than this, but if you find something more recent, please share.

Now, as we scan the first page of this most comprehensive document, we see a little statement that I think makes the TJC survey citation a little more squishy than I would prefer: “This AC is not mandatory and does not constitute a regulation except when Federal funds are specifically dedicated for heliport construction. “ To me, “not mandatory” sounds like a really big case of the “we don’t have to’s,”  what do you think?

Turning to Chapter 4, Hospital Heliports (this is on page 95 of the document), I will freely admit that there’s a lot of interesting/cool information. (Did you know that the FAA recommends Portland Cement Concrete for ground level facilities—who knew? Do you have Portland Cement Concrete for your ground level facilities? I certainly hope so). Anyway, the chapter describes a lot of important stuff about hazards and markings, including MRI impact, etc.

I’m going to guess that you’ve been having helicopters fly in and out of your airspace on a regular basis, and in all likelihood, some of you are already up to speed on this.  For those of you for whom this might be virgin territory, my advice would be to consult with the folks actually doing the flying and find out what they want to see with your helicopter setup. This would constitute what I euphemistically refer to as a risk assessment. You may have encountered that term once or twice here in Mac’s Safety Space. I can’t imagine that you’d not have heard by now if the pilots using your pad have issues. (I’ve never found them to be shy about safety—nor should they be.) Still, it’s never a bad idea to reach out periodically to make sure that everything is both hunky and dory; it’s really the least we can do.

You’ve got a new favorite…

Generally speaking, we in Safety Land don’t get too involved with Centers for Medicare & Medicaid Services (CMS) doings until they show up on our doorstep. But sometimes, the Feds weigh in on matters that can have far-ranging implications for safety operations. I think we need go back no further than the turn of 2010 to 2011, when it looked as if CMS was going to turn the whole world into a healthcare occupancy. Fortunately, through the good graces and advocacy of ASHE, that’s a bullet dodged. Bravo.

At any rate, there is a means of tracking interpretations, utterances, and the like—and it’s web-based (your tax dollars actually at work):

https://www.cms.gov/SurveyCertificationGenInfo/PMSR/list.asp

Basically, this site is a repository of all sort of what we might euphemistically characterize as “CMS Survey and Certification memoranda, guidance, clarifications and instructions to State Survey Agencies and CMS Regional Offices.” (Okay, not my characterization; it’s what CMS calls this stuff.) Certainly not everything found here is germane to safety and the environment, but it is searchable. (I couldn’t offer an opinion yet on how efficient the search capacity might be; to be determined.) The information could be considered a—if not the—final word on what’s happening at the ol’ Centers for Medicare & Medicaid Services. I don’t know that you would need to check it every day (and I can’t quite find a means of signing up for e-mail notifications of new postings), but probably worthy of a drop in from time to time.

I need to know

Another challenge that’s been rearing it’s ugly little head is the requirement for staff and licensed independent practitioners (LIP) to describe or demonstrate actions to be taken in the event of an environment of care incident, as well as knowing how to report an environment of care risk. I will freely admit that this one can be most tricky to pull off).

The tricky piece, at least in my estimation, is that any data that would be gathered during survey would be the result of direct interaction with staff in the care environment. For staff, one strategy would be for them to contact their immediate supervisor to report a risk, or to be able to articulate the use of a work order system to notify facilities, biomedical, safety, and/or environmental services of conditions needing resolution. Alternatively, some hospitals have a single phone number for reporting unsafe conditions. Presumably, staff can also speak to their specific roles in emergency response activations such as fire, security, disaster, etc.

As to the LIPs, this task can be exponentially more difficult as, strictly speaking, the expectations of this group are pretty much the same as the rest of the house. I’m presuming that you have an emergency phone number to report codes and fire events. An LIP who is able to articulate familiarity with those codes and events would be useful toward a finding of compliance. They really ought to be able to articulate past the point of ignoring something and to at least be able to put in motion some sort of reasonably attainable resolution.

Again, I’ve not seen this come up a great deal with the LIPs, though certainly the rest of the cadre of front line staff would be considered targets during a survey. I think the key approach is to very clearly and very simply define what constitutes appropriate responses of staff and practitioners. When The Joint Commission doesn’t specifically define what they mean in a standard, it behooves us to define how compliance works in our organizations.

A cup of coffee, a sandwich, and…the boss!

If you’ve not yet procured a copy of the November 2011 issue of The Joint Commission Perspectives, I would encourage you to do so. There is a very interesting article that focuses on a strategy for establishing more effective communication between the folks charged with managing the physical environment (that would be you) and hospital leadership.  Now I think this is a pretty cool idea, but I couldn’t say with any degree of certainty how widespread a success it might be as there are a number of variables involved (and that’s not counting personalities). That said, it’s certainly a strategy worth pursuing, if it doesn’t pursue you first.

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You gotta serve somebody… ‘cause you’ve got HOSPITAL-ity!

A few weeks ago,  I was reading “the nation’s newspaper” (USA TODAY, of course,) and I noticed an article on the front page (below the fold, but definitely front page) about a chain of boutique hotels that has invested in body language training for staff in order to more efficiently identify client needs–just by looking for non-verbal cues. Now, those of you who have been following this blog for a while may remember that my formative years in healthcare were firmly planted in the environmental services realm, so I’ve had what you might call a front row seat for the transformation of certain elements of healthcare from a purely service-oriented pursuit to one that embraces the concept of hospitality.

As safety professionals (and in recognition that sometimes our roles go way past safety), we’re always on the lookout for new trends and this article struck me as, maybe, just maybe, an indication of things to come in how are patients’ expectations may evolve (the evil part of me wants to say mutate, but we’ll leave that be for the moment) based on their experiences in other hospitality/service settings (Catch phrase idea: “Putting the hospital into hospitality.” feel free to make any use of it you might). Depending on the size and complexity of your organization, any number of you folks have responsibilities for front-line staff, be it support services folks, security officers, etc., the number of customer encounters can be rather extensive. I know from my own practice that those types of encounters can be very powerful indeed when it comes to managing the overall patient experience.

So, the question I have for you this day, boys and girls, is: How do we work toward a more customer-focused hospitality sensibility without completely negating our focus on regulatory compliance (basically enforcement of the rules)? I suspect, and perhaps you can confirm or debunk, that this is going to become an increasingly delicate balancing act. Can we still hold the ideals of safety while enhancing the patient experience? What say you, good readers?

EM.02.02.07 offers good framework of staff concerns during disaster responses

Every emergency is different from every other emergency, and every moment in every emergency is different from every other moment in an emergency, and each person’s situation is going to be different.

What it comes down to is organizations must strive to provide sufficient comfort for staff members to be able to show up at work and be productive.

It shouldn’t be difficult to figure out [more]

After the Fort Hood shootings, Twitter proves useful for one hospital

For many people, social media sites like Twitter and Facebook are frequently used to quote movie lines or discuss whether they had coffee or hair of the dog with their Corn Flakes. But from a professional standpoint, The Joint Commission is encouraging the use of social sites for emergency management purposes.

Thursday’s shootings at Fort Hood, TX, let one facility rev up its Twitter presence with useful updates and information. [more]