Elevating Patient Transfer Management in Rural Hospitalist Programs

Patient transfers can be pivotal moments in a patient's care journey. In this blog post, we’ll explore the key benefits of optimizing transfer management within rural hospitalist programs, reveal indicators for when (and when not) to initiate an external transfer, and discuss how smaller hospitals can augment their operations to ensure strong transfers and expand local care.

Why Prioritize Compassionate Transfer Management?

Let's focus on the meaningful ways a thoughtful approach to patient transfers benefits smaller, more remote hospitals and the people they serve:

• Expanding Access to the Right Care, Right Here: Rural hospitals, while vital, often face resource limitations. Thoughtful transfer management ensures that when specialized care is truly needed, patients can access it promptly at facilities equipped to handle their specific needs. But it also prompts us to consider: Can we expand our services to meet more of those needs locally?

• Improving Outcomes Through Informed Decisions: Timely transfers are crucial for patients with complex conditions. However, a "transfer-first" mentality can disrupt the patient's support system and sense of security. By carefully evaluating when and if a transfer is necessary, we can ensure patients receive the right level of care without unnecessary disruption.

• Strengthening Resource Allocation with Purpose: Managing patient transfers effectively allows rural hospitals to focus their energy more wisely. Optimizing bed usage, staffing, and equipment ensures the hospital is well-prepared for community needs.

• Preventing Unnecessary Costs, Promoting Value: Efficient transfer management isn't just about clinical outcomes; it's about financial stewardship, too. By avoiding unnecessary transfers and partnering strategically with larger facilities, rural hospitals can ensure patients receive the most cost-effective care possible.

When is an External Transfer the Right Decision? A Human-Centered Approach

Clinical expertise is paramount when determining the need for an external transfer. But beyond the medical considerations, it's crucial to consider the patient's well-being and preferences.

• Predictive Analytics as a Supporting Actor: In complex cases, tools like predictive analytics can offer valuable insights to augment a clinician's judgment. This technology helps analyze historical data and anticipate outcomes, empowering care teams to make more informed decisions.

• The Power of a Detailed Facility Database: A well-maintained database of nearby facilities can be an invaluable resource. This database should include information about each facility's protocols, specialties, capabilities, and key contacts, as well as notes from previous transfer experiences. This allows you to cultivate better relationships and knowledge of how to get your patient the best care possible.

Cultivating a Secure, Streamlined Transfer Process: The CareCulture Way

If an external transfer is necessary, a well-defined process is essential:

• Cultivate Strong Relationships with Open Communication: Effective transfers hinge on collaboration. Clear communication pathways, well-defined transition plans, and mutual evaluation of care continuity are vital. Focus on building trust and understanding with receiving facilities.

• Foster Transparency and Trust with Patients: Throughout the transfer process, prioritize clear, compassionate communication. Explain the reasons behind the transfer, answer questions, and address any concerns. A patient who feels informed and supported is more likely to have positive outcomes.

• Consider All Options, Personalize the Approach: Avoid a one-size-fits-all mentality. Take into account each patient's unique preferences, demographics, financial situation, and support system. For instance, uninsured patients may have less flexibility in choosing facilities.

Expanding the Scope of Your Hospitalist Program: Investing in Your Community

Rural hospitals are increasingly focused on expanding their capabilities to meet the critical needs of patient populations. By strategically augmenting services, hospitals can keep more patients closer to their community support systems.

Where to Begin?

Taking on new initiatives can feel daunting, especially for small and rural facilities. At CareCulture, we understand the pressures you face. By prioritizing a people-first approach, fostering strong leadership, and embracing open communication, you can create a culture of care that transforms patient transfer management and strengthens your community's access to quality healthcare.

The Cost of Rudeness in Healthcare and How to Mitigate It

Physicians, Advanced Practice Providers (APPs), nurses, and hospital staff regularly encounter rude behavior. Sometimes it is an impolite or demeaning comment from a patient or a patient family member. Other times, it is a negative or thoughtless jab from a colleague. The unfortunate truth is that rude behavior pervades many organizations. Rudeness does not just hurt our feelings; it negatively impacts our ability to do our jobs and it puts our patients at risk.

Numerous studies across a variety of industries find that rudeness negatively impacts creativity, performance, and team morale. Not to mention, it increases employee turnover and drives customers away. Apply those consequences to the high-risk, high-stress environment of healthcare delivery (where we face a shortage of doctors and high competition for patients), and the implications are concerning. If we want to lead successful hospitals and hospital teams and provide excellent patient care, we cannot afford to tolerate rudeness. 

A study focused specifically on the impact of rudeness on medical teams found that a rude comment by a physician decreases the performance among other doctors and nurses by more than 50%. Not only that, it also negatively impacts patient care quality and safety.

The reality is, when humans are consumed by an emotion (perhaps anger, fear, frustration, or shame), they lose the ability to focus on details and they lose perspective. An example cited in Rhona Flin’s editorial, Rudeness at Work: A Threat to Patient Safety and Quality of Care , showcases the concerning impact rudeness can have in a high-stakes industry. The example comes from the aviation industry, not healthcare.

In her example, two pilots flying a commercial flight carrying 147 passengers from San Diego to Minneapolis became so involved in a “heated discussion over airline policy” that they “lost situational awareness” and passed the airport they were meant to land at by 150 miles before a member of their cabin crew called them and they realized their mistake. This example shows how emotionally charged interactions like arguing can impact our concentration and ability to do our jobs well and care for our customers (in our case, our patients). 

Keeping the immense implications of a practice culture that tolerates rudeness in mind, it is clear that it is worthwhile to take action to prevent it. Implementing strategies to reduce instances of rudeness not only improve provider satisfaction and morale, they also reduce medical errors and patient mortality rates and increate patient satisfaction and patient safety. We recommend these strategies to reduce rudeness in your practice:

Determine the most common sources of conflict in your practice: In order to prevent something, you need to understand its root cause. Common causes in healthcare include siloed communication or lack of any thoughtful communication, feeling put down by superiors, misaligned goals/rules, and a sense that there are unreasonable expectations. As a leader you can identify issues by having conversations with everyone on your staff and provider team to understand the issues they face. In turn, you can begin to take action to put strategies in place that respond to the issues they voiced, confirming that you heard your team and that they have a true voice in the operation of the practice.

 Educate your team on the importance of emotional intelligence: Hospitals are full of people with extremely high IQs. Physicians, APPs, and nurses are commonly hard-driving, type A people with high IQs. However, sometimes emotional and interpersonal skills such as self-awareness, management of emotions, and empathy do not come as naturally. As a leader, you can help your team cultivate their emotional intelligence by providing communication training and creating opportunities to talk to their colleagues, get to know them (perhaps even outside of work), and to truly listen to one another in order to learn what makes them “tick” and what motivates them. The best way to engender emotional intelligence in your team is to practice what you preach. Show your team that you do not take them for granted by expressing your appreciation and truly listening to them. Show that you are self-aware by openly taking responsibility for your own errors. Above all, be kind. Kindness begets kindness.

Create a process for real-time resolution: When it comes to high-intensity conflict, it is almost-always better to address it immediately. Letting conflict simmer can turn anger into rage and frustration into apathy. Therefore, it is best to address it as soon as appropriate with the team member(s) involved. It is always best to address it calmly, avoiding direct accusation, listening, and asking questions about what happened. When addressing a tense situation, always focus on behavior, not personality and express empathy for the situation. In particularly severe situations, it is also important to calmly, clearly, and directly explain the consequences of further rude behavior.

Set ground rules for escalation and follow-up: When a team member knows how disruptive behavior will be handled, how it will be escalated, and what the eventual consequences will be, it can help deter the rude behavior from happening in the first place. It also takes personality out of the equation if discipline becomes necessary. This requires establishing a professional code of conduct. When incidents do happen, it is also important to have candid conversations with the team to learn from the experience and prevent it from happening in the future.

By taking the time to determine the most common sources of rudeness, educating our teams on the impact of rudeness, giving our team training and tools to communicate in a positive manner, and setting ground rules to resolve conflict, we can prevent incidents of rudeness and create a better work environment for our teams to deliver safer, higher quality care.

Sources:

https://www.ncbi.nlm.nih.gov/pubmed/15659998

https://www.sciencedaily.com/releases/2013/01/130130184048.htm

https://pediatrics.aappublications.org/content/136/3/487.short

https://www.ncbi.nlm.nih.gov/pubmed/18714748

https://www.nytimes.com/2017/04/10/well/family/rude-doctors-rude-nurses-rude-patients.html

https://www.bmj.com/content/340/bmj.c2480.full

4 Common Emergency Department Culture Issues and How to Fix Them

Emergency Department culture impacts everything from provider retention and patient experience to efficiency metrics and care quality. No matter the performance issue an emergency department faces, the solution to that issue is invariably culture change. When an emergency department leader focuses on culture first and aligns the team around a culture of service, performance improves.  

So, what exactly is “culture of service” and how can you influence it?  

A culture of service prioritizes the needs of team members and customers over individual needs. It depends upon a servant leader leadership style, which is also defined by making sure that other people’s highest-priority needs are being met.

The Robert K. Greenleaf Center for Servant Leadership defines a servant leader as a leader who “focuses primarily on the growth and well-being of people and the communities to which they belong. While traditional leadership generally involves the accumulation and exercise of power by one at the “top of the pyramid,” servant leadership is different. The servant-leader shares power, puts the needs of others first and helps people develop and perform as highly as possible.”

The culture of your emergency department is shaped by your medical director’s leadership and communication style, daily interactions between team members, team attitudes, and your leader’s and team members’ level of engagement in their practice. A healthy culture is evidenced by reduced provider burnout, improved communication, improved patient satisfaction and care quality, and boosted efficiency metrics.

Here is an overview of the five most common emergency department culture issues I have run across and their antidotes:

1.    Hierarchal Leadership

When leaders let their ego get in the way of putting their team member’s needs first, the team has a tendency to feel unempowered and disengaged. Top-down leadership fuels a lack of engagement and trust amongst the team. When leaders consider it their responsibility to serve their team rather than the team serving them, engagement and trust builds. Engendering a culture of servant leadership at your facility requires that you develop an engaged medical director who encourages staff involvement, leads by example, puts team-member needs first, and truly listens to team needs.

 A few tactical ways to replace hierarchal leadership with servant leadership include:

·      Encouraging leaders and team members to ask themselves, “How can I serve this person?” at every interaction.

·      Asking all staff, “What is one thing I can do to make your life easier?” and then truly listening to their feedback and taking action to put processes in place that consider their feedback.

·      Performing anonymous surveys to seek feedback on what you can do to improve the way you serve the team.

2.    Siloed Thinking/Misaligned Goals

If team members are not clear on departmental goals or how their actions impact those they interface with, tension and inefficiency is inevitable. A team that is not aligned around shared values and goals lacks accountability and motivation. An aligned team has defined core values and metric goals, is locally invested, and prioritizes communication with all they interface with.

A few ways to replace siloed thinking with aligned thinking include:

·      Instating regular interdisciplinary meetings

·      Clearly documenting and communicating shared goals

·      Establishing shared incentives  

3.    Incivility

Studies have shown that when people experience incivility at work their performance declines, they are less committed to the organization they work for, and in some cases, they take their frustrations out on customers. In the healthcare sector, incivility is common in the form of bureaucratic culture, extremely siloed processes, and uncivil communication. This results in a decrease in quality of care, higher provider turnover, loss of productivity, lack of provider engagement, and poor patient experience.

We have found that when we encourage respect at every interaction, positive communication, and simple gestures like a smile or a hello when you pass team members in the hall, productivity, patient experience, and engagement all improve.  

A few simple ways to promote civility include:

·      Setting a new standard by defining civility as important as metric success

·      Modeling the standard through your own behavior

·      Asking team members to hold you and each other accountable

4.    Burnout and Turnover

It is no secret that burnout and turnover is a concern in healthcare, especially in emergency medicine. It has a toxic ripple effect, resulting in unstable teams (mostly staffed with temporary providers who are not invested in community), high recruiting costs, lost revenue during recruitment, inefficiencies due to lack of engagement, and poor patient experience. We have found that engagement is the antidote to burnout and turnover.

A few key ways to improve provider engagement include:

·      Providing leadership development programs and other education and peer review opportunities

·      Recruiting a local provider team who is invested in the community they serve

·      Increasing doctor-nurse engagement and interdisciplinary process improvement efforts

·      Offering providers the opportunity to share in ownership of their practice  

In summary, replacing hierarchal leadership with servant leadership, misalignment with alignment, incivility with civility, and disengagement with is bound to not only remedy your department’s culture issues, but also make a substantial positive impact on your provider team’s quality of life, your ED’s quality and efficiency metrics, and your bottom line.

The Transformative Power of Clinical Mission Work

Just a few years after completing his residency in emergency medicine, CareCulture Health Partners CEO Dr. Eugene Gicheru felt the burnout so many physicians face seeping into his life. The monotonous cycle was ingrained: wake up, work, do it all again. The gap between his daily grind and a feeling of fulfillment and purpose widened. Even though he had accomplished his personal goal of becoming a physician, he felt there had to be more. He resolved to break the cycle. He always knew that it was possible to cultivate fulfilling harmony between work and life. But how?

Dr. Gicheru knew that emergency medicine would be challenging and that burnout was common. But he was determined to find an outlet that would reinvigorate him, anchor him, and give him a deeper sense of purpose. He found his answer when he began participating in non-profit clinical mission work with colleagues.

In 2010, Dr. Gicheru went on his first medical mission trip to Armenia. That trip, and the many that followed, sparked a lasting passion for service through mission work. Dr. Gicheru traveled about twice a year to serve, and for him, each trip was a rededication for his commitment to serving others. It filled the void. It blended a sense of purpose he could apply interchangeably to work and to life. And, it turned out, the renewed fervor and purpose it gave him was contagious. Today, Dr. Gicheru is able to travel with his wife Laura and 2 sons so they can experience this sense of purpose as a family.

After joining other organization’s trips for years, Dr. Gicheru co-founded his own non-profit, Great Commission Outreach (GCO). GCO’s mission is to provide high quality health care to communities in need locally and across the world. GCO evolved from encouraging the spirit of service by going on short term mission trips to a complex organization that supports communities both in the United States and all over the world. GCO’s domestic arm, Clinic for the Cities, is dedicated to partnering with churches to provide free local community clinics in the United States.

Dr. Gicheru believes all humans eventually search for meaning and  purpose in their lives and for him that purpose was found through service. He enjoys seeing the clinical team members who join him on trips return to their clinical teams with the same renewed enthusiasm for the practice of medicine he experiences. The feeling is often contagious, extending to co-workers and patients and drastically improving the overall team dynamic.

To learn more about the transformative power of clinical mission work, we spoke with a colleague Dr. Gicheru inspired, Jessica Hughes Kisicki, MD, FACEP, about the way clinical mission work has transformed her approach to her life and career. 

What do you find most rewarding about service?

Dr. Hughes Kisicki: Since I was a child, I have always been inclined to help people in need. I know my purpose is to serve people in need and my goal is to do that in all facets of my life. If I see an opportunity to serve someone in need, I seize it. I find it rewarding to share my knowledge, strength, and love with communities in need. It’s an incredible feeling to watch these same communities grow to be self-sustaining and thriving.

Why do you recommend that clinicians participate in non-profit clinical work?

Dr. Hughes Kisicki: I would recommend missions because serving others not only benefits the person you are serving, but also benefits the person serving. It is incredibly fulfilling to give your time, energy, and love to others. You receive far more than you give. If the world is full of servants, our world will be a better place.  

How has service impacted your life at home?

Dr. Hughes Kisicki: Mission work has changed my life. I’ve always valued selflessness and mission work has enhanced my intention to live that value every day. This work has helped me see that every person has struggles and there is always an opportunity to help others. As a mom and emergency department medical director, I strive to be a servant leader in every aspect of my life. I am raising my children to be servants who are selfless and loving.

I have also found that by treating people selflessly, others have become inspired to do the same. In fact, the Guatemala trip in June 2018 will be full of people from my hospital who have become inspired to serve by seeing how we treat people and by hearing our stories. I have learned that serving is what truly matters in life, not material things. 

How has service made you stronger clinical leader?

Dr. Hughes Kisicki: Service has made me a much stronger leader. I have learned to slow down and really listen to people. I have learned that it is important to inspire others to serve and grow. Every single person has a need that you can fulfill at some point, and it is very important to lift other people up. Status and material things are not important, people are. Love and strength can build people up and change their life.