Category: Patient Advocacy

“What We’ve Got Here Is A Failure To Communicate“

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“The more elaborate our means of communication, the less we communicate.”

J B Priestley
Image Credit: Cool Hand Luke, Warner Brothers, Seven Arts

One of the most critical aspects of providing quality patient care is effective communication between caregivers and patients. Unfortunately, poor communication can often lead to adverse outcomes for patients. There are many ways that poor communication can affect patient care. First, if caregivers and patients cannot communicate effectively, it can lead to misdiagnoses or delays in treatment. Additionally, poor communication can also lead to medication errors, as well as a breakdown in the doctor-patient relationship. Ultimately, poor communication can seriously impact the quality of care that patients receive.

It is disturbing to me that we are here in 2023 and have access to some of the most sophisticated technology available, and yet there has been a steady increase in the number of “Cool Hand Luke” moments in healthcare over the past year. I’ve written earlier about the recent number of MRI accidents that have occurred. Most communication problems at organizations are caused by ineffective policies and procedures, language issues, poor communication skills, high workloads, EHR issues, and ineffective communication systems.

Medical safety experts at CRICO Strategies investigated 23,000 medical malpractice lawsuits and found more than 7,000 of those lawsuits could be attributed to communication failures. Those communication failures resulted in $1.7 billion in malpractice costs and almost 2,000 preventable deaths. A study conducted by the Joint Commission found 80% of serious medical errors were the result of miscommunication between caregivers during patient handovers. According to the Journal of Healthcare Management, U.S. hospitals lose an average of $12 billion annually because of inefficient communication among healthcare providers.

Let me illustrate an example of the current situation through a personal experience from a family member’s inpatient care journey. The section headings that follow are my characterizations, but the information in each section is what occurred. The patient, in this case, was under the care of an oncologist for an advanced cancer diagnosis with metastasis to the bone and their primary care physician.

The “Drive-By” Medical Specialist Consult – where a specialist is called in to evaluate additional symptoms or conditions requiring treatment. In this case, each comprised a five-minute or less visit to the patient’s bedside, a chart review, and a follow on medication or other procedure order. Here’s the list for this case over two weeks:

  • GI consult for inability to swallow and maintain nourishment following chemotherapy and radiation treatment resulting in an order for tube placement.
  • Neurologist consult for swallowing and speech difficulty resulting in a CT scan order and a medication order for high-dose corticosteroids.
  • Cardiologist consult to evaluate cardiac rhythm problems resulting in orders for ECG and subsequent pacemaker insertion.
  • Urology Consult to evaluate a urinary tract infection resulting in orders for antibiotics and IV fluids.

“Who’s On First” – No clear responsibility for the overall review of these orders and interventions to monitor effectiveness and make changes if required. In this instance, and only after repeated requests by the family did the patient’s primary care physician intervene and demand a full case review with all disciplines present – which took nearly one month.

“If you don’t know the secret password, we can’t talk with you” – Beginning with the original diagnosis, the family understood that this would require complex, multi-disciplinary care with many moving parts. To make things easier for the immediate family members, we contracted with an organization (that I’ve covered before in a previous post) to handle those tasks and coordinate activities for us. Despite having the necessary signed paperwork authorizing all healthcare providers to communicate with them, take their calls, and act on their requests, we encountered continued roadblocks to allow that to happen under the excuse of HIPAA concerns.

We’re not alone in experiencing these information-blocking issues. Here’s patient advocate Grace Cordovado’s LinkedIn video on her recent problems. (Thank you, Grace, for all you do) And here’s an image of Jan Oldenburg’s reply to Grace’s post about her difficulties in helping patient Casey Quinlan (aka Mighty Casey) to transition to hospice care. (Thank you, Jan, for your tremendous efforts)

Image Credit: Jan Oldenburg, LinkedIn
Image Credit: Jan Oldenburg Twitter Timeline, 3/38/23

“I was only following orders” – Patient developed a GI infection because the tube was not being flushed regularly. When questioned by the family, the charge nurse said there were “no standing orders” in the patient’s chart to maintain the patency of the tube. Really?

Image credit: Giphy

We need to fix this NOW. So here’s my plea:

As a first step, I suggest that hospitals, health plans, and physicians stop blaming patients and/or their designated representatives for everything that’s wrong with health care today. Maybe then we can make some progress at collaboratively building on all that’s right with health care. If hospitals, health plans, and physicians expect patients to change their behavior, they must change how they think about, communicate and relate to patients (aka people). They have to become genuinely patient-centered and more engaging to patients…from the patient’s perspective.

“We’ve always done things this way” is not an excuse for continuing these policies.

We need stronger Interoperability regulations with teeth in them. Over $38 Billion in HITECH funding was spent, and what have we got? Nothing worth talking about – just frustration on all sides.

Sign up for The Society of Participatory Medicine and ask your physicians to sign the manifesto. The Society seeks to bring together all healthcare stakeholders (patients, caregivers, healthcare professionals, payers, and others) to encourage collaboration, communication, and cooperation to foster provider/patient engagement, patient empowerment, and education.

Image Credit: Society for Participatory Medicine

The healthcare industry, over the last 100 years, has done a great job of socializing people to assume the passive sick role when we seek care. In that role, we are not expected to challenge physicians or question their decisions…in fact, many patients fear being labeled as difficult when they take on such behaviors.

Poor communication is a failing of the health system, not of patients. A good health system engages fairly and respectfully with everyone who seeks care. It recognizes that its patients and plan enrollees come with a range of previous experiences with the health care system, as well as different literacy levels, language fluency, and cultural norms. It is the responsibility of system managers and front-line providers to ensure that good communication techniques guide everything from examination room interactions to provider training.

It’s About Time – Patient Advocacy: A Personal Story & Some Recommendations

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“What we offer is the opportunity to save you time and eliminate the frustrations of navigating the healthcare system.”

Curus Healthcare Solutions
Image Credit: Shutterstock.com

As I mentioned in my first post of 2022, this year I want to explore how the use of technology in health care can save time for patients, their families, and front-line health care workers. But, in this post, instead of talking about technology, I’m going to focus on people – specifically people helping people.

First, a disclaimer. For the first time since I began writing this blog, I will focus on a specific company, Curus Healthcare Solutions. I have no financial or other business interests in the company. I will discuss my personal experience and that of other family members with them. I’ll also make some recommendations at the end that I believe can help others facing a similar situation.

Introduction – In my advisory capacity with The Center for Innovation Commercialization, I get the chance to meet with and listen to companies who are developing innovative products and services for health care. That was the case with Curus Healthcare Solutions. I was introduced to Mark Schlussel, the CEO, and Jared Mort, the COO, and had an extensive conversation about their work in helping patients and their families navigate the complexities of our so-called health “system” when trying to manage care for themselves or loved one. After 40-plus years in the health care industry, I’ve heard dozens of companies profess to be “patient-centric” or “putting the patient at the center of what we do.” So, you can imagine that I was skeptical at first about what I was about to hear. After the usual formalities and introductions were over, within two minutes, I knew I was experiencing something very different. Listening to what the company had already accomplished and their plans for growth, I was struck by the passion for service I heard from both executives. Digging a bit deeper and researching the company’s claims, I found that people using their services were uniform in their praise.

YouTube Video Credit: Curus Healthcare Solutions

I left that conversation very impressed with the organization, their people, their business model, their growth plans, and the results they were delivering for their members. Little did I know at that time how soon members of my own family would require those services.

Beyond Theory, Becoming Reality – Two months after that initial introduction, I received a call from a family member trying to manage an urgent situation for their spouse who had multiple chronic conditions. They needed to find a skilled nursing facility and get a transfer done within forty-eight hours and were in a panic. I remembered the conversation I had with Curus and reached out to Jared to see if they could do anything to help. Instant response: “put us in touch with your relatives, and we’ll get to work.” Several phone calls followed, and to my amazement, Curus was able to find a suitable SNF close to my relative’s home and facilitate the transfer – all in under forty-eight hours. My relatives signed a chronic care agreement with Curus. They have been managing all the care for this individual through several hospital admissions, rehab work, and a return to the SNF for some ongoing care.

Shortly after that, the spouse received a diagnosis of cancer and faced the double dilemma of “what do I do now that both of us are ill and facing a period requiring intensive care at multiple sites over an extended amount of time.” Another call, a lengthy discussion, and a second chronic care agreement was signed. Since that time, Curus has managed every aspect of their care, from scheduling appointments to dealing with insurance coverage, arranging for assistance with home care, and consolidating all the medical records from multiple specialists into a comprehensive personal health record. Once everything was in place, Curus reviewed the recommended care plan with my family members and answered their questions.

“If I didn’t have Sara and Jared helping me though this, I’d be lost.”

Family member

Am I a fan? Absolutely. Would I recommend them to others? I would, and I have. A congregation member at the church we attend is trying to manage multiple co-morbidities with both in-network and out-of-network physicians. As you might expect, they’re going crazy trying to figure out what’s covered, what isn’t, and how much the out-of-pocket costs are. I’m in the process of trying to connect them with Curus to see whether they can help.

Since it’s too late to offer some suggestions for New Year’s Resolutions, I’ll make a few targeted recommendations based on my personal experiences as described above:

If you are an employer – Consider engaging with a company like Curus to help your employees manage their health care needs, deal with multiple chronic conditions, eliminate unnecessary care, and lower overall annual costs of care for your organization without impacting the quality of care your employees receive. As businesses deal with “the Great Resignation” and Post-COVID neurological, vascular, renal, and gastrointestinal syndromes, this type of care navigation benefit will be well-received by potential and existing employees.

“We at Curus believe that care navigation as well as care orchestration are going to be to critical components within the total healthcare spend.”

Mark Schlussel, CEO, Curus Healthcare Solutions

If you are a health care benefits advisor/manager – Adding the services that Curus provides to your portfolio of services creates differentiation in the market and positions you to grow your client base.

If you are a patient – As you can tell from my family’s experience, having someone you can trust to take over the critical functions of dealing with the complexities of our health system takes away the stress of managing this yourself and provides you with confidence that your needs are being looked after.

If you are a family member trying to manage care for a loved one – Families in the “sandwich generation” who are trying to manage care for elderly parents and children, usually from a distance, can benefit from having a care navigator who is focused on their specific needs instead of cookie-cutter approaches and helps to manage both sides of this very complex situation.

I hope that this information is helpful. As a long-time skeptic of how marketing messages are delivered and of companies that only “talk the talk,” it is encouraging to find a company that genuinely lives its mission and actually “walks the walk.” Thanks, Curus team, for giving my family peace of mind. You have no idea how much that means.