Thursday, April 25, 2024

Putting fun in the practice: Hire for attitude, train for skills

“Fun is taken seriously at Southwest Airlines. Life is too short and too hard and too serious not to be humorous about it,” Herb Kelleher, founder of Southwest Airlines


Healthcare is a stressful profession. Most doctors and healthcare employees must work smarter, harder, and faster than ever. It is not surprising that burnout exceeds 50% of healthcare workers. As the pace and intensity of healthcare have increased, we have often lost touch with the lighter side of life and even questioned why we went into the profession in the first place. Many medical practices have become very serious and bottom-line focused. We are asked to leave our personal and emotional baggage at the door before entering the office. We have been told that humor in the workplace is unprofessional and that silliness is for play and not for medical practices.

I think we can learn from Southwest Airlines, which believes that failure to nourish and encourage a sense of humor in the workplace not only undermines productivity, creativity, adaptability and morale can also impact employee retention, resulting in costly turnover.

Southwest Airlines hires employees, from baggage handlers to pilots, who can do their jobs well with laughter and grace. A passenger on a Southwest Airlines plane wants to engage with empathetic employees who inherently believe that serving passengers includes a healthy sense of humor, which makes the lives of the employees and the passengers more fun. Healthcare can be challenging - simply by the type of service we provide - but healthcare professionals have an opportunity and a responsibility to move out of the serious, stiff, humorless atmosphere and add appropriate levity when providing care for our patients. We need to find ways to make working in healthcare fun despite the intensity and seriousness of our profession.

How do you find those with a funny bone and as well as a crazy bone? We need to follow the example of the Southwest Airlines hiring process: “hire for attitude and train for skills.” Their hiring department looks for employees who don’t take themselves too seriously and then commits to training them on what they need to do to make the flight enjoyable for the passengers. They focus on hiring employees with the right spirit, those who are willing to work hard and have fun at the same time.

Perhaps when you are interviewing a potential employee for the first time, you might ask, “Tell me how you used your sense of humor in a work environment or tell me how you have used humor to diffuse a difficult situation.”

When posting a job opening, you might include something along the lines of, “We are looking for someone who doesn’t take themselves too seriously while taking their patient care very seriously.” You could share, “Consider Acme Healthcare if you want a future that encourages coloring outside the lines, without boundaries, the opportunity to be original, and a chance to work your tail off!” This kind of post emphasizes that your practice is committed to providing a medical practice that is serious about providing outstanding patient care while committing to having fun, building connections, and creating a culture filled with down-to-earth, charismatic people. I am not suggesting that you are looking for standup comedians or those who can dole out one-liners. The message must be clear that behind all the fun, there’s hard work.


Bottom Line:

Consider looking for future employees with a sense of humor. You should hire for spirit, grit, work ethic, and enthusiasm. You can follow up and train for skills, which is easy. Treat such an employee as a family member or best friend when you have such an employee. Don’t ever take them for granted. Finally, treat everyone with kindness and respect. They will appreciate the kindness and pass it on to your patients. As a result, you will have an enjoyable, productive, efficient, and fun practice.

Let’s end this blog with another quote by Herb Kelleher, “We will hire someone with less experience, less education, and less expertise than someone who has more of those things and has a rotten attitude. Because we can train people. We can teach people how to fly and how to be kind to passengers, but we can't change their DNA.”


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Wednesday, April 24, 2024

Improve patient outcomes by speaking their language

Patients with limited English proficiency (LEP) face poorer health outcomes due to low health literacy and language barriers.

In a recent systematic review, 75% of studies showed that LEP patients experienced better outcomes when they spoke the same language as their providers.Written translation also supports connection. In a recent study 91% of Spanish-speaking parents preferred to receive translated copies of their children’s written discharge instructions to improve comprehension.

How can health care professionals build the trust they need to successfully treat culturally and linguistically diverse patients? A language access plan offers a roadmap to help practitioners build cultural competence to connect with patients. Planning ahead allows for efficient use of resources and effective communication.

Here's how to create an effective, patient-centered language access plan for your practice.


Assess community needs


The first step is to understand the population you serve. To determine which languages are spoken in your community, refer to the U.S. Census Bureau’s language tables. For greater precision, artificial intelligence tools can fill in missing data based on the known demographics in your practice area. Once you understand your patients’ needs and preferences, you can begin to meet those with communications that connect.

Keep in mind which points of contact these patients are likely to have with your practice team. Whether they’re telephoning, using an online portal, or visiting the office for an appointment, ensure that your team is offering meaningful language access at each touchpoint.


Create your connection toolkit


Next, create a comprehensive language services toolkit. Consider the following questions when creating your plan:

Which types of interpreting will you offer? A review by the Wellesley Institute found that providing trained interpreters improved health outcomes and increased preventative care.

There are several ways to provide this service, and your practice will probably want to offer a mix of options. On-site interpreting and video remote interpreting (VRI) both offer face-to-face interaction for improved communication, allowing both the patient and interpreter to respond to important non-verbal cues like facial expressions and body language. VRI may provide a quicker, more cost-effective way to provide access to an interpreter in a patient’s preferred language, allowing you to provide service to more communities.

Over-the-phone interpreting is the best fit for follow-ups or non-emergency situations when there isn't enough time to arrange for an on-site interpreter.

Remote simultaneous interpreting (RSI) is rapidly gaining popularity due to the recent increase in remote care. RSI is concurrent, which means the interpreter interprets while the other patient speaks, so there's no delay.

With RSI, the interpreter is in another location, so communication is handled through video and headsets. Although the interpreter is not in the room, patients often find the immediacy of RSI reassuring. Children’s hospitals have used It to assess children in a global clinical trial. There’s also evidence that RSI is the most effective interpreting method for reducing the rate of clinically significant medical errors.

How will you translate documents? Providing professionally translated documents helps ensure that patients fully understand their health care, insurance, and billing options. This is not only practical but also a matter of compliance: regulations like Section 1557 of the Affordable Care Act require specific documents to be available in the patient's preferred language.

But truly meaningful access requires not only making translated material available but going beyond minimum compliance mandates. A culturally competent approach to communication promotes equity and patient satisfaction by ensuring your patients understand their health status and treatment plan.

Machine translation technology can speed up the process, but only in tandem with specialist translators who understand the medical field and thus avoid translation errors that could harm patients or lead to frustration.

Some patients may have difficulty with written information, even when it's written in their home language or at or below the recommended fifth-grade reading level. A medical interpreter may be required to read the written documents to the patient and assist you with any follow-up questions.


Provide training


Train your staff so that everyone understands their specific role in implementing the plan. This includes training in both cultural competence and the technology used to provide language access to patients.

Cultural competence in health care goes beyond language to include skills such as fostering health literacy for diverse patient populations and navigating social and cultural differences in communication. To promote consistency in training and procedures, appoint one person on your team to the role of language access coordinator.

When everyone in your office can confidently handle requests for language access, patients will feel more confident in the care you provide.


Build community awareness


Now it’s time to let your community know that language isn't a barrier to getting care at your practice through an awareness campaign that includes the major marketing channels your patients use.

With growing diverse populations, your practice needs a plan that supports equal access to care. A language services provider has the expertise to assist with translation, language asset management and navigating regulations. This partnership increases accuracy, compliance and overall efficiencies.

The good news is that more language access tools than ever are at your team’s disposal. Using these tools to connect with patients can ensure everyone in your diverse community gets the care they need to improve their health in a culturally relevant way.


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Tuesday, April 23, 2024

EHR upgrades and patient care

Each time my EHR is upgraded, I am informed on the new functionality and the wonderful tools it will encompass to make charting more efficient and patient care better. Improvement features with interoffice staff communication, improved coding features, and data sharing all seem to be a necessity with upgrades but why don’t I see improved efficiency and less screen time as a result?

Unfortunately, to the contrary, often with upgrades functionality changes, colors and format differ, and I find myself having to relearn EHR processes all over again. I usually don’t find the upgrade to be that much different than the version from the year prior, and personally I haven’t been mesmerized by the improved aspects of patient care as a result. What changes, however, is the logistical flow. As clinicians, we are taught on structure. Medicine uses tradition such as how we obtain a history starting with the chief complaint. There is a flow to medical notes, from taking a history to presenting a case. We are trained this way and medical school basic doctoring courses still teach the cadence of performing an exam with this style of flow. We organize our thoughts and communicate our presentations both orally and written in this manner. However, the EHR organizational structure is seemingly constructed with countless variations. The construct seems to ignore the legacy of how we are trained. We try to be flexible with the EHR flows and constant inflow of changes to colors, icons, functionality placement, etc.Why does it always have to change with every upgrade? Most recently, an upgrade to the EHR included emojis. Really?

Why EHR companies change color formats, icons, and sometimes location of functions is beyond me. The changes do make the upgrade readily apparent, but do the changes aid in patient care and safety? Is my job more efficient as a result? Functionality may indeed improve, but my overall arching question is why must all the icons, the colors, the locations of such tabs change as well? The Greek philosopher Heraclitus is credited with the idea that the only constant in life is change but with the frequency of “needed” upgrades, it is nearly mandatory we are forced to change every few months. Acclimatizing to our EHRs seems to be in competition with keeping up with newest medical advances in disease management -- a statement which I never thought I would have to make.

Respectfully, I do understand that EHRs may help to improve accuracy, help with clinical decision-making, have tools for medication interaction review, and search features to retrieve needed information in a sea of medical records hidden in specific tabs within the EHR, and in some instances help with medical legal defense. Conversely, I find efficiency of the patient examination, and the satisfaction of delivering care less so because of the complexity and task-oriented functions of the EHR. In many instances, I find myself feeling like a data entry clerk rather than a clinician.

Clinicians, now more than ever, have many data entry duties. The clinical encounter’s efficiency is dictated by the ease of the EHR. I would suspect that most clinicians do not feel that their efficiency and clinical duties ease because of such upgrades. The National Academy of Medicine stated that nurses and doctors spend 50% of their workday looking at a computer screen, not the patient, and the increased EHR demands contribute to provider burnout.

The “upgrades” seem like a barrage of changes like a video game that my kids play. The marketing of new features, colors, and graphics make computer games fun. I wish I had the same positive outlook as my kids do when I hear an upgrade is coming to my EHR. The EHR often seems like a video game in and of itself. It has many nuances and features that often seem hidden and depending on the training and skill of the user, can then be unlocked for clinical use. Developing such skill and adaptability takes work, time, effort, and practice -- but then may quickly fade once the newest upgrade is placed into motion.

If I had a wish, I would ask computer informaticists who assist with such upgrades to ask me if I even need an upgrade and at a bare minimum, keep the same icons, colors, and fundamental basics without significant change. The hours spent on meetings, emails, and videos about the impending new and improved upgrade could potentially be better spent on patient care. Until then, I will have to continue to get used to EHR upgrades and learning the new format and inefficiencies of such.

I wonder when Madden 2025 comes out…


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