Scatter my ashes here...

Scatter my ashes here...
scatter my ashes in the desert...

Tuesday, October 21, 2014

The Fallout Continues...

Tonight I did a radio show on breast cancer awareness month and pinkification of October. It was fun, especially when I was scheduled for a 30 minute show and the host suddenly, a few seconds before we started, saw something that erroneously told her we were on for 60 minutes. I was fine with that, I had plenty of material and I could talk forever about these topics. We slowed everything down to stretch it out, and then suddenly, 5 minutes before the 30 minute mark, someone tapped on the door to tell her the show was only 30 minutes, so she let me get my last words in and I scrambled to say all of the important points in the last 3 minutes or so. Crazy, but fun anyway.

After the show we talked for a little while casually about health care and I mentioned my challenges in getting my business off the ground. One of the biggest assumptions I made at the beginning was about how I'd market my services. I thought doctors would be interested in what I was doing and welcome it. Well, getting to talk to a doctor face to face has only happened enough times to count on one hand, and most of those were by accident when I ran into them in town somewhere by chance, like in the grocery store.

The way I see it is, I have this great service that would be so good for their patients, but I can't even get 5 minutes of their time to talk with them about it. They just don't prioritize that, it's a different way of operating than they are used to, and now with fierce competition in town, everyone is protecting their own turf and profits. They see anything outside of what they do as competition.

The host of the radio show, who works in health care herself, told me that a doctor she knows thinks physicians are slow as snails to adopt anything new, she said on the order of 17 years (about as long as a new drug patent used to last before the generic could be marketed).

We are still being inundated with Ebola everything, and I have read some highly astute observations from people at the direct care levels of health care, physicians, nurses, infection control specialists, and techs on the state of health care in this country. Many of the things I have discussed in past blogposts with regard to patient safety and how nurses are treated in the workplace and when they raise concerns about safety issues in the workplace have surfaced in the Texas Presbyterian flap.

I also read with interest this article about how things are being handled at the Biocontainment Unit at the University of Nebraska medical center, one of the hospitals where Ebola cases are treated and they have a solid and effective plan in place for their workers to prevent transmission of the disease. If you go to page 2 they talk about breaking shifts into four hour blocks when dealing with the extreme conditions of having to work in hazmat gear, and on page four, they discuss how they pay attention to the needs of the caregivers.

Some of the things they do could be applied in general, such as allowing time for breaks, to eat and drink and use the bathroom, having behavioral specialists to help people deal with the stresses of working. If you're not in health care, you might think, what? Of course you need to take breaks and eat, drink, and go to the bathroom. If you are a nurse, you're thinking, what a novel common sense approach, and you're already googling on U of N Medical Center to see if they have any open positions on their employment site. You're thinking, hell yes I'll work with those patients in a space suit if it means I get to pee and eat every four hours!

Just think what we could accomplish if safety was our top priority. We'd have to slow down, and maybe take care of the needs of the employees who are taking care of patients. And then maybe we could have zero hospital acquired infections, and instead of thousands of medical errors they would be as rare as Ebola in the U.S.

Why is it that in health care, when we should be staffed by smart people making good decisions because we are relying on them to take good care of our health when we are sick and dependent on them, that it turns out we are at the mercy of irresponsible, detached, myopic decision-making at the highest levels of the organization which trickle down to the front line workers being abused and working under inhumane conditions?

The other thing I noticed was that under the CDC new guidelines, which they released after a bunch of health care workers (namely nurses) made A LOT OF NOISE about the inadequacy of the first few messes they sent out...the new guidelines clearly state that management and leadership (ha- see my blogpost from a few days ago) are responsible for seeing that the guidelines are implemented and followed. Read: Five Pillars of Safety and I quote:

Five Pillars of Safety

CDC reminds all employers and healthcare workers that PPE is only one aspect of infection control and providing safe care to patients with Ebola. Other aspects include five pillars of safety:
•Facility leadership has responsibility to provide resources and support for implementation of effective prevention precautions. Management should maintain a culture of worker safety in which appropriate PPE is available and correctly maintained, and workers are provided with appropriate training.
•Designated on-site Ebola site manager responsible for oversight of implementing precautions for healthcare personnel and patient safety in the healthcare facility.
•Clear, standardized procedures where facilities choose one of two options and have a back-up plan in case supplies are not available.
•Trained healthcare personnel: facilities need to ensure all healthcare providers practice numerous times to make sure they understand how to appropriately use the equipment.
•Oversight of practices are critical to ensuring that implementation protocols are done accurately, and any error in putting on or taking off PPE is identified in real-time, corrected and addressed, in case potential exposure occurred.

A culture of worker safety. Hmm. And what culture is that? It's the one that is greatly exaggerated by most corporate leadership accounts. If something interferes with the bottom line, there will be a workaround. Somehow...

And somehow...University of Nebraska seems to get it, but that safety culture needs to expand throughout the health care system in this country, and profit-centered models of health care are not going to welcome it.

Certainly that culture was nonexistent at Texas Presbyterian, where they couldn't figure out that their PPE was inadequate or spend the money to transport a patient to where someone knew how to take care of him...yet they had plenty of money to hire an expensive PR firm to tell them how to handle their image after their disastrous mistakes that repelled patients to the point where their hospital is nearly empty now.

The culture at Texas Presbyterian, the same one that has administrators telling nurses not to go to the media or they'll be fired, the same one that resulted in one nurse blowing the whistle and we know she'll never be able to go back to working for that hospital again because of the retaliation she will face. Lawyer or not, the hostility directed at her after speaking the truth will make it impossible for her to carry out her duties, as they'll be watching her every step and finding ways to harass her until they get rid of her.

This is the reality of health care, folks. And it needs to change. If you're not in health care, this is what goes on behind the scenes when you or your family member is being "taken care of". This is what the nurses endure. This is what physicians are forced to work with, administrators who are unresponsive to their needs too.

This is what I've been screaming about so passionately for a long time, and finally we have a crisis that has brought these issues directly to the surface. And a lot of organizations are going to deny that they do business this way, and defend their own practices with lawyers, PR tactics, and doing whatever they feel they can get away with. "We're not like Texas Presbyterian" will be the cry of protest. But right now, every one of these organizations is scrambling to give the impression that they are prepared and trying to minimize their expenses to protect their profit. Some are more prepared than others, but the culture is what needs to change across the board.

This is health care in the U.S. naked.

Do you care yet?

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