Gone are the days when the maxim that ruled the healthcare industry was "Build it and they will come", under the impression that that if people knew where services were located they would find their way to the clinics.
In post liberalisation India the healthcare industry is waking up to the fact that the consumer has to be pursued and enticed into visiting healthcare facilities of a particular brand and to buy healthcare products of a particular brand. With the government permitting 100 per cent foreign direct investment (FDI) in the health care industry, there is a deluge of private players in the Indian Healthcare market today. And this has dramatically changed the facade of healthcare marketing and communications in India.
Taking the case of hospitals, there is a wide variety of services (that are not just medical) on offer for the patient. From in-house multi cuisine restaurants, swimming pools, walking tracks, indoor games facilities, libraries and play areas to travel desks that arrange sightseeing tours and shopping for patients, you name it and they have it, all in a bid to woo more and more patients. Hospital promotions take on the form of Public Relations, VIP and visitor hospital tours and walk in exhibitions, loyalty and outreach programmes, support groups etc.
Similarly the pharmaceutical industry is going overboard in its attempts to appease the two routes that they have to reach out to the end consumers- doctors and pharmacists. For retailers it is boom time as they get free supplies of medicines, expensive gifts, holiday trips and also huge margins for promoting and selling particular brands at their outlets. With doctors the gifts, incentives and schemes are getting wilder by the day. The trend is to customise the gift to the doctor so that the pharmaceutical company actually meets a relevant need of the doctor rather than flooding him with things that he throws away or hands over to others. Taking examples of customised gifts it could be admission of a doctor's child to a reputed school or even the reimbursement of shopping bills. All in an attempt to get a better hold on this indirect consumer. For over the counter drugs there are advertisements in all shapes and sizes visible just anywhere. With sponsoring TV programmes to conducting mass consumer contact programmes to free sampling, pharmaceutical companies are trying innovative marketing ideas to get a share of the consumer's wallet.
One look at the statistics and the reason behind this intense competition gets clear. According to a Confederation of Indian Industry - McKinsey study on India's health industry, the country's spending on health care is expected to increase from Rs 86,000 crore at present to Rs 200,000 crore in the next decade. Health care's contribution to India's GDP will increase from the current 5.2 per cent to 8.5 per cent by 2012. The players in the healthcare industry fully realise that these predictions will come true with harnessing the burgeoning purchasing power of the Indian consumer.
Friday, September 12, 2008
Wednesday, September 10, 2008
When Medical Skills Are Not Everything - Logistics Making Better Doctors
How long do you wait to see a doctor? When an epidemic breaks out, how fast can government health officials assess and decide the next course of action? Most importantly, what can health care personnel do to tackle these questions?
Traditionally, medical school emphasized on medical competency. Because of this, it has resulted in doctors who know their stuff, but it has not touched so much on improving the health care experience as a whole.
It must be noted that to the patient, reporting sick is not just about seeing the doctor. It also encompasses a lot more details such as the ambiance of the clinic, the customer service level provided and so on.
Most doctors do not have much experience in dealing with mass casualties, save for a few exceptions, such as military doctors and those involved in treating infectious diseases. Thus, there is little incentive for doctors in private clinics to further improve the flow of patients, when they are busy with treating them.
When we apply a logistic framework to this context, it is possible to dissect the entire consultation process (from admitting the patient to outpatient care) into smaller steps, and then experts evaluate the efficiency of each step (i.e. what could have been further improved).
Using logistic solutions, all the small steps will then be further improved, and hence wastage of the patient's time will be significantly reduced.
As a result, more patients are treated; they are satisfied with their experience, and medical expertise has not been compromised at all.
Mentioned below are three innovative ideas that have been suggested for adoption.
"Mystery shopper" programme
No patient doubts the competency of their doctor, but not all can claim to be satisfied with the health care experience that they received from the clinics.
From making an appointment to outpatient treatment, the entire process is under heavy scrutiny from the patients themselves. Patients nowadays are not concerned with just seeing the doctor; if the nurse has a bad attitude, it may discourage the patient from seeing the doctor for a second time.
The ethics council of the American Medical Association (AMA) has suggested doctors to adopt the use of undercover patients, to test the level of health care experience that their patients received.
In short, these "mystery shoppers" are paid to fake certain illnesses to evaluate the type of inpatient care and treatment that was provided to them.
This approach is obviously controversial, as fake patients may deny true patients of their consultation time. However, it does serve as an effective way to evaluate customer service level in clinics.
Cell phone tracking
When an infectious disease breaks out in the neighbourhood, tracking down who had been in contact with the patients is extremely difficult, and it could take days before health officials have any results.
Thus, Sir Roy Anderson, rector of Imperial College London, has suggested that in countries which have a high mobile phone penetration rate such as Singapore, it may be more effective to track people down through their call log.
The idea may sound new, but to logistic experts, tracking down their designated warehouses and contacts through Global Positioning System (GPS) and other forms of real-time data collection system in their cell phones is already the norm.
Using of electronic health records
It's an old joke, but everyone knows no one except the nurse and the doctor knows what's the doctor scribbling. In the past, the patient's health records were written by hand on paper. As expected, there were several shortcomings to this method, such as the doctor's style of writing and natural wear and tear of the records.
This may sound like a surprise, but fewer than one in five of US doctors have started to record their patient's information digitally. The reason is because doctors in small practices feel unmotivated to change their records to digital platforms due to the financial costs. However, it has been proven that electronic records are able to reduce operating cost and improve patient care for clinics.
Fortunately, the US government recently announced a US$150 million Medicare project that will offer doctors to invest in electronic records. Hopefully, this will result in better storage of patient's data other than writing it on paper.
Conclusion
This report is not to say that medical competency is no longer important; it must still be main priority for trainee doctors. However, they must realise that being a doctor is not just about giving the best treatment to patients. It should also be about making sure that the patient feels happy on seeing the doctor, and not having his feelings being dampened by unnecessary paperwork and wasting of the patient's time.
Traditionally, medical school emphasized on medical competency. Because of this, it has resulted in doctors who know their stuff, but it has not touched so much on improving the health care experience as a whole.
It must be noted that to the patient, reporting sick is not just about seeing the doctor. It also encompasses a lot more details such as the ambiance of the clinic, the customer service level provided and so on.
Most doctors do not have much experience in dealing with mass casualties, save for a few exceptions, such as military doctors and those involved in treating infectious diseases. Thus, there is little incentive for doctors in private clinics to further improve the flow of patients, when they are busy with treating them.
When we apply a logistic framework to this context, it is possible to dissect the entire consultation process (from admitting the patient to outpatient care) into smaller steps, and then experts evaluate the efficiency of each step (i.e. what could have been further improved).
Using logistic solutions, all the small steps will then be further improved, and hence wastage of the patient's time will be significantly reduced.
As a result, more patients are treated; they are satisfied with their experience, and medical expertise has not been compromised at all.
Mentioned below are three innovative ideas that have been suggested for adoption.
"Mystery shopper" programme
No patient doubts the competency of their doctor, but not all can claim to be satisfied with the health care experience that they received from the clinics.
From making an appointment to outpatient treatment, the entire process is under heavy scrutiny from the patients themselves. Patients nowadays are not concerned with just seeing the doctor; if the nurse has a bad attitude, it may discourage the patient from seeing the doctor for a second time.
The ethics council of the American Medical Association (AMA) has suggested doctors to adopt the use of undercover patients, to test the level of health care experience that their patients received.
In short, these "mystery shoppers" are paid to fake certain illnesses to evaluate the type of inpatient care and treatment that was provided to them.
This approach is obviously controversial, as fake patients may deny true patients of their consultation time. However, it does serve as an effective way to evaluate customer service level in clinics.
Cell phone tracking
When an infectious disease breaks out in the neighbourhood, tracking down who had been in contact with the patients is extremely difficult, and it could take days before health officials have any results.
Thus, Sir Roy Anderson, rector of Imperial College London, has suggested that in countries which have a high mobile phone penetration rate such as Singapore, it may be more effective to track people down through their call log.
The idea may sound new, but to logistic experts, tracking down their designated warehouses and contacts through Global Positioning System (GPS) and other forms of real-time data collection system in their cell phones is already the norm.
Using of electronic health records
It's an old joke, but everyone knows no one except the nurse and the doctor knows what's the doctor scribbling. In the past, the patient's health records were written by hand on paper. As expected, there were several shortcomings to this method, such as the doctor's style of writing and natural wear and tear of the records.
This may sound like a surprise, but fewer than one in five of US doctors have started to record their patient's information digitally. The reason is because doctors in small practices feel unmotivated to change their records to digital platforms due to the financial costs. However, it has been proven that electronic records are able to reduce operating cost and improve patient care for clinics.
Fortunately, the US government recently announced a US$150 million Medicare project that will offer doctors to invest in electronic records. Hopefully, this will result in better storage of patient's data other than writing it on paper.
Conclusion
This report is not to say that medical competency is no longer important; it must still be main priority for trainee doctors. However, they must realise that being a doctor is not just about giving the best treatment to patients. It should also be about making sure that the patient feels happy on seeing the doctor, and not having his feelings being dampened by unnecessary paperwork and wasting of the patient's time.
How to Overcome Rising Healthcare Costs?
Over the past few years there has been an increase in the chronic diseases. In addition to this, the cost of medical treatment has also gone up. Whatever the conditions might be, at the end, it is the people who has to suffer.
A few days ago, one of my friend's father was suffering from health problems; he was fed up of going for routine checkup's to hospitals and doctors due to the expensive treatment. He shared this problem with his family doctor and asked him for a suggestion to reduce his health care expenses. The doctor, in turn, suggested him that opting for discount health plans would be a good idea to reduce the costs. When asked about the best discount plan available in the market, he gave a spontaneous answer 'Ameriplan'. He also said that keeping the skyrocketing costs and 43 million individuals without health insurance into consideration, Ameriplan has started the discount health plans.
On hearing the doctor say about Ameriplan health insurance, he raised his doubt about the coverage of the plan to his family members. To his surprise, he got an answer 'Ameriplan health plan covers the entire family'. He got to know many interesting things about Ameriplan such as the affordable premiums that start at $19.95 a month, no waiting periods, no paper work, no limits on usage and more. Satisfied with Ameriplan, he joined Ameriplan health plan that is suitable for his requirements. Now, he stopped worrying about all the issues pertaining to health care. When he came to know that Ameriplan also offers its members to work from home that can fetch them unlimited income depending on the time they spend on the business expansion, he became an Ameriplan Independent Business Owner (IBO) that gave him an opportunity to earn unlimited income working from home.
Just like him, there are many more people in America suffering from rising health care costs and insurance premiums. The only solution would be to opt for Ameriplan health plans, which allows one to save a lot of money spent on health care. It is learnt that, once you join Ameriplan health plans, a clear change is visible in your life which can also influence other's lives.
A few days ago, one of my friend's father was suffering from health problems; he was fed up of going for routine checkup's to hospitals and doctors due to the expensive treatment. He shared this problem with his family doctor and asked him for a suggestion to reduce his health care expenses. The doctor, in turn, suggested him that opting for discount health plans would be a good idea to reduce the costs. When asked about the best discount plan available in the market, he gave a spontaneous answer 'Ameriplan'. He also said that keeping the skyrocketing costs and 43 million individuals without health insurance into consideration, Ameriplan has started the discount health plans.
On hearing the doctor say about Ameriplan health insurance, he raised his doubt about the coverage of the plan to his family members. To his surprise, he got an answer 'Ameriplan health plan covers the entire family'. He got to know many interesting things about Ameriplan such as the affordable premiums that start at $19.95 a month, no waiting periods, no paper work, no limits on usage and more. Satisfied with Ameriplan, he joined Ameriplan health plan that is suitable for his requirements. Now, he stopped worrying about all the issues pertaining to health care. When he came to know that Ameriplan also offers its members to work from home that can fetch them unlimited income depending on the time they spend on the business expansion, he became an Ameriplan Independent Business Owner (IBO) that gave him an opportunity to earn unlimited income working from home.
Just like him, there are many more people in America suffering from rising health care costs and insurance premiums. The only solution would be to opt for Ameriplan health plans, which allows one to save a lot of money spent on health care. It is learnt that, once you join Ameriplan health plans, a clear change is visible in your life which can also influence other's lives.
How Does Health Care Issues Play a Prominent Role in Life?
Healthcare is one of the contemporary issues that has brought a great attention in America. Statistics show the prevailing pathetic conditions of health care in America. It has been estimated that over 47 million adults, 8.5 million children are uninsured, 18,000 adults die and a lot many underinsured can't afford to meet the health care expenses. Government's efforts to provide affordable coverage for all turned futile because of the complex convoluted system. It has been unable to come up with a policy to provide affordable healthcare at the grass root level. Recent presidential candidate's focus on providing quality coverage for all shows the complexity of the problem. Efforts by many individuals with regard to this showed no development in the healthcare condition of people.
Companies who have taken it as a part of its corporate social responsibility also failed to make any impact. Interestingly, healthcare providers like Ameriplan have played a very good role in making it possible to a great extent. Ameriplan USA, with over fourteen years of experience in providing discount health services, has contributed a lot in making health care affordable to everyone. Ameriplan has changed the structure of the healthcare industry to a large extent. As a part of this initiative, Ameriplan started discount plans that provide discounts up to 80% which ultimately makes the healthcare bills affordable. Moreover, these Ameriplan discount plans offered by Ameriplan are multipurpose plans. Ameriplan discount plans cover all the services such as dental, vision, prescription and chiropractic care. With a wide network of over 400,000 medical practitioners, 30,000 dental providers, 50,000 pharmacies, 12,000 vision care providers and 7000 chiropractors, Ameriplan offers complete healthcare solutions starting at $19.95 per month for one and all. With a high customer growth ratio, Ameriplan serves as an ultimate example of solving critical problems. More information on Ameriplan discount plans can be had by visiting http://www.health-dental-discount-plans.com.
Companies who have taken it as a part of its corporate social responsibility also failed to make any impact. Interestingly, healthcare providers like Ameriplan have played a very good role in making it possible to a great extent. Ameriplan USA, with over fourteen years of experience in providing discount health services, has contributed a lot in making health care affordable to everyone. Ameriplan has changed the structure of the healthcare industry to a large extent. As a part of this initiative, Ameriplan started discount plans that provide discounts up to 80% which ultimately makes the healthcare bills affordable. Moreover, these Ameriplan discount plans offered by Ameriplan are multipurpose plans. Ameriplan discount plans cover all the services such as dental, vision, prescription and chiropractic care. With a wide network of over 400,000 medical practitioners, 30,000 dental providers, 50,000 pharmacies, 12,000 vision care providers and 7000 chiropractors, Ameriplan offers complete healthcare solutions starting at $19.95 per month for one and all. With a high customer growth ratio, Ameriplan serves as an ultimate example of solving critical problems. More information on Ameriplan discount plans can be had by visiting http://www.health-dental-discount-plans.com.
Nursing Homes Prison 101 - Part Four in a Serious Series About Rehab & Care Centers & Nursing Homes
One day, while visiting in a bad rehab and care center, I saw a woman in a wheelchair. She was complaining to someone (Staff) that she was missing clothing. As usual, staff said that she had to wait (because they were busy), and then they would have to go downstairs to see where her clothing was.
The man waited, in fact, the woman stated that her clothing had been missing for more than one week, so figure that must be enough waiting, correct? Anyway, time passed and passed and the woman again came back to staff and complained about her clothing but bottom line is that no one went downstairs to find her clothing. And my guess was that even if someone went downstairs, they probably would not find the clothing anyway. After all, isn't this the place where all the residents are wearing everyone else's clothing? How can you find clothing in a basement, when the clothing is on someone else's body on the fifth floor?
The point that I am trying to make is this--that clothing is a very important issue when it comes to living in or to temporarily staying in a nursing home and a rehabilitation and care center. Practically none of these residents want to live here or stay here. Out of everyone that I saw there, from the ones that were able to express their opinion, NONE of them liked it there, none of them enjoyed their stay and none of them wanted to stay there, yet they are forced to be there because no one is helping them get out of there. And even those who have family members who are there to get them out of there, are met with red tape, long waiting periods, and total non-attention. Everything works against those who want to leave the place. Why? The reason is that most times the only way a resident gets to leave there is if they are fortunate enough to be brought to a hospital emergency room.
Under ordinary circumstances, residents of any other place in the world, would not want to be sent to the emergency room. However there is a rehab and care center in Staten Island, that is so bad, so uncomfortable and so horrible that residents would probably jump for joy if they had to go to the emergency room. Why? Because in this case, in this horrible case, the emergency room is their only ticket out of the place --while they are still alive. Emergency rooms--for these prisoner residents of this rehab and care center --are seen as a blessing, as a God-send, to those individuals who were previously destined to stay there in that place forever.
Can you even imagine hoping that you had to go to the emergency room? Probably not. Most normal individuals would not want to be in a position of going to the emergency room. However, in a certain rehab and care center in Staten Island, NY, many residents hope and wait for that day that they get their dishcharge from this place--even, yes even if it is to go to the emergency room. Practically any place other than this place is considered a blessing from God.
Please, politicians if you are reading this, please have mercy on those inside of those nursing homes that are abusing their powers and that are neglecting their residents and patients. Please, politicians, please hear this plea, that we need your help to change things for the better inside of these locked nursing homes and rehab and care centers.
The man waited, in fact, the woman stated that her clothing had been missing for more than one week, so figure that must be enough waiting, correct? Anyway, time passed and passed and the woman again came back to staff and complained about her clothing but bottom line is that no one went downstairs to find her clothing. And my guess was that even if someone went downstairs, they probably would not find the clothing anyway. After all, isn't this the place where all the residents are wearing everyone else's clothing? How can you find clothing in a basement, when the clothing is on someone else's body on the fifth floor?
The point that I am trying to make is this--that clothing is a very important issue when it comes to living in or to temporarily staying in a nursing home and a rehabilitation and care center. Practically none of these residents want to live here or stay here. Out of everyone that I saw there, from the ones that were able to express their opinion, NONE of them liked it there, none of them enjoyed their stay and none of them wanted to stay there, yet they are forced to be there because no one is helping them get out of there. And even those who have family members who are there to get them out of there, are met with red tape, long waiting periods, and total non-attention. Everything works against those who want to leave the place. Why? The reason is that most times the only way a resident gets to leave there is if they are fortunate enough to be brought to a hospital emergency room.
Under ordinary circumstances, residents of any other place in the world, would not want to be sent to the emergency room. However there is a rehab and care center in Staten Island, that is so bad, so uncomfortable and so horrible that residents would probably jump for joy if they had to go to the emergency room. Why? Because in this case, in this horrible case, the emergency room is their only ticket out of the place --while they are still alive. Emergency rooms--for these prisoner residents of this rehab and care center --are seen as a blessing, as a God-send, to those individuals who were previously destined to stay there in that place forever.
Can you even imagine hoping that you had to go to the emergency room? Probably not. Most normal individuals would not want to be in a position of going to the emergency room. However, in a certain rehab and care center in Staten Island, NY, many residents hope and wait for that day that they get their dishcharge from this place--even, yes even if it is to go to the emergency room. Practically any place other than this place is considered a blessing from God.
Please, politicians if you are reading this, please have mercy on those inside of those nursing homes that are abusing their powers and that are neglecting their residents and patients. Please, politicians, please hear this plea, that we need your help to change things for the better inside of these locked nursing homes and rehab and care centers.
Monday, September 8, 2008
Why Healthcare Marketing is Essential
Healthcare can be defined as the field dealing with the maintenance and restoration of the health of our physical or psychological state. It is offered in two ways - from the healthcare organizations like hospitals and private nursing homes to the patients who are in distress and from the pharmaceutical companies to the doctors and other healthcare professional to sell their products.
For a healthcare center run by the government, much publicity is not needed. Patients are well concerned these days and they do choose their healthcare provider from the government service. They have trust upon them as their true guide to well-being. Still marketing is needed in the terms of incorporation of modern technologies, newly appointed skilled doctors and paramedics. In the healthcare organizations, trust is the main basis for choosing any healthcare provider. And it spreads from a person to his family members, relatives and friends. Even any illiterate person will consult somebody before visiting a doctor or going to a hospital. They will enquire about the facilities and the cost involved in the treatment. Referral marketing has immense role in any healthcare organization to enhance their credibility.
For the private healthcare provider or any organization, proper marketing is mandatory in terms of services offered, specialist doctor's list, facilities and low cost of service; like for a super specialty hospital, you need to publicize all the information regarding laboratory facility, instruments and equipments available and the competent doctors. Here also trust is the key to success. A word from a person, who has a first-hand experience in a particular healthcare facility, decides the fate of the organization.
To sustain in the top, branding is very much needed. And to become a brand name in healthcare facility, you need to build trust among not only in the patients, but to the relatives also, which is equally important. The more individuals are satisfied about your healthcare; more are the chances to get the brand equity. To become the leader in the healthcare sector, you need to spread the message to your catchment area that you are the best and of course the reasons behind it. All the branches of your organization should speak the same language. Proper communication in between the staffs and the patients is very much essential.
Now let us discuss why marketing is essential in the filed of pharmaceutical companies.
There are millions of pharmaceutical companies and all of them have one motto - selling and increase the amount of selling of their product. In any country, there must be hundreds of companies making the same merchandise. The best one in accordance with the quality and marketing will thrive.
To achieve your goal, again you need to build trust among the doctors and paramedics. As many medical representatives continuously meet doctors to endorse their product, you have to come out with such thing that other are not providing. You need to brief the doctor about the beneficial aspects of the product. The best way to achieve this is to take help of the audiovisual media. E-detailing is becoming popular these days. But all these need a personal touch.
In the healthcare field, the proverb 'Survival of the fittest' is equally applicable. You have to market the healthcare facility to the right person in right ways to endure.
For a healthcare center run by the government, much publicity is not needed. Patients are well concerned these days and they do choose their healthcare provider from the government service. They have trust upon them as their true guide to well-being. Still marketing is needed in the terms of incorporation of modern technologies, newly appointed skilled doctors and paramedics. In the healthcare organizations, trust is the main basis for choosing any healthcare provider. And it spreads from a person to his family members, relatives and friends. Even any illiterate person will consult somebody before visiting a doctor or going to a hospital. They will enquire about the facilities and the cost involved in the treatment. Referral marketing has immense role in any healthcare organization to enhance their credibility.
For the private healthcare provider or any organization, proper marketing is mandatory in terms of services offered, specialist doctor's list, facilities and low cost of service; like for a super specialty hospital, you need to publicize all the information regarding laboratory facility, instruments and equipments available and the competent doctors. Here also trust is the key to success. A word from a person, who has a first-hand experience in a particular healthcare facility, decides the fate of the organization.
To sustain in the top, branding is very much needed. And to become a brand name in healthcare facility, you need to build trust among not only in the patients, but to the relatives also, which is equally important. The more individuals are satisfied about your healthcare; more are the chances to get the brand equity. To become the leader in the healthcare sector, you need to spread the message to your catchment area that you are the best and of course the reasons behind it. All the branches of your organization should speak the same language. Proper communication in between the staffs and the patients is very much essential.
Now let us discuss why marketing is essential in the filed of pharmaceutical companies.
There are millions of pharmaceutical companies and all of them have one motto - selling and increase the amount of selling of their product. In any country, there must be hundreds of companies making the same merchandise. The best one in accordance with the quality and marketing will thrive.
To achieve your goal, again you need to build trust among the doctors and paramedics. As many medical representatives continuously meet doctors to endorse their product, you have to come out with such thing that other are not providing. You need to brief the doctor about the beneficial aspects of the product. The best way to achieve this is to take help of the audiovisual media. E-detailing is becoming popular these days. But all these need a personal touch.
In the healthcare field, the proverb 'Survival of the fittest' is equally applicable. You have to market the healthcare facility to the right person in right ways to endure.
What Would They Say Today?
Eighteen months after the terrorist attacks of 9/11, America's healthcare leadership announced that while they had not been ready on September 11, 2001, now they were. On March 13, 2003, in a much ballyhooed statement, still sited to this day, the American College of Healthcare Executives announced:
"HOSPITAL CEOs SAY BIOTERRORISM PLANS ARE IN PLACE CHICAGO
Since September 11, 2001, hospitals have faced new challenges protecting and caring for their communities, especially the threat of bioterrorism. According to a new survey conducted by the American College of Healthcare Executives (ACHE), 84 percent of hospital CEOs agree that since 9/11, their hospitals have worked more closely with public agencies (e.g. fire, police, and public health departments). Further, 95 percent of the respondents said their hospitals already have, or within six months will have, a bioterrorism disaster plan in place, developed in coordination with local emergency or health agencies."
Little did they know the sense of false security and the cooling of momentum this assertion would cause from that day forward.
The Clear View of Reality
Since 2003, multiple independent evaluations of hospital preparedness and hospital disaster planning have found the reality in each successive year to be far below that purported in 2003. A brief survey three reports by the Institutes of Medicine in June, 2006 serve as proof that any hint of hospital preparedness is false and that momentum towards preparedness has been lost. These reports, Hospital-Based Emergency Care: At the Breaking Point, Emergency Care for Children: Growing Pains, and Emergency Medical Services at the Crossroads found a disparity between self reported preparedness on multiple association and government surveys compared to actual preparedness measured across the five core indicators of hospital preparedness.
"Evaluations of ED disaster preparedness consistently yield the same finding: EDs are better prepared than they used to be, but still fall short of where they should be"
At first blush, this seems to confirm the ACHE assertions, but the report goes on to point out that hospitals lack patient surge capacity due to cost related downsizing, nursing shortages, loss of specialists, physical space constrains and overcrowding. Failures of planning and coordination were also identified and linked to erroneous planning assumptions.
"When a disaster occurs, the normal operating assumptions about patients, responses, and treatments often must be jettisoned. Depending on the type of event, some of the nonroutine things that can happen include the following:
· Victims who are less injured and mobile will often self-transport to the nearest hospitals, quickly overwhelming those facilities.
· Casualties are likely to bypass on-site triage, first aid, and decontamination stations.
· EMS responders will often self-dispatch. Providers from other jurisdictions may appear at the scene and transport patients, sometimes without coordination or communication with local officials.
· In some cases, local facilities are not aware of the event until or just before patients start arriving. Hospitals may receive no advance notice of the extent of the event or the numbers and types of patients they can expect.
· There may be little or no communication among regional hospitals, incident commanders, public safety, and EMS responders to coordinate the response region wide."
The Institute of Medicine reports goes on to call for improved communications and integration across disaster response services including Emergency Medical Services (EMS), community emergency operations and most importantly the implementation of the standardized Incident Command System.
"To respond effectively, hospitals must interface with incident command at multiple levels and be prepared to deal with transitions between levels, for example, when incident command shifts from the local to the state or federal level. Each hospital should be familiar with the local office of emergency preparedness and know how hospitals are represented at the emergency operations center during an event, whether through the hospital association, the health department, the EMS system, or some other mechanism."
They Didn't Think of That Either
Beyond the problems common to all disaster care environments, special needs populations (children, elderly, mentally and physically challenged) have needs and preparedness issues unique to them. Unfortunately, the "one size fits none" approach taken by America's hospitals has ignored issues highlighted by the Institutes of Medicine Emergency Care for Children: Growing Pains report.
"The needs of children have traditionally been overlooked in disaster planning. Historically, the military was considered the only target of potential biological, chemical, and radiological attacks, so the focus for training, equipment, and facilities was on the care of healthy young adults."
"Younger patients require specialized equipment and different approaches to treatment in the event of a disaster. Children cannot be properly decontaminated in adult decontamination units because they require adjustments to the water temperature and pressure (heated, high-volume, low-pressure water). Rescuers also need to have child-size clothing on-hand for use after the decontamination."
The problems are compounded for rural hospitals. Despite the fact that many both inside and outside hospital leadership believe that rural hospitals are at lower risk and thus require less commitment to preparedness, the truth is quite the opposite.
"The focus of emergency preparedness has been on urban areas in part because of the perceived increased risk of terrorism in these areas. However, there is a danger associated with neglecting rural areas. Indeed, one might argue that rural areas may be even more vulnerable to a terrorist attack. Many nuclear power facilities, hydroelectric dams, uranium and plutonium storage facilities, and agricultural chemical facilities, as well as all U.S. Air Force missile launch facilities, are located in rural areas and are potential targets for attack. Additionally, if individuals with infectious diseases, such as smallpox, enter the country through Canadian or Mexican borders, rural providers may be the first to identify the threat."
A Problem of Their Own Making
The greatest indictment of hospitals by the Institute of Medicine Reports however dealt with disaster preparedness training and drills finding great variability in the training of even key healthcare personnel with even less training for non-clinical hospital staff.
"Serious clinical and operational deficiencies, fragmentation, and lack of standardization exist across a broad spectrum of key professional personnel (nurses, physicians, ancillary care providers, administrators, and public health officials) in both individual training and coordination of a team response."
This failure to provide training not only effects patient care, but hospital employee safety. Despite public statements by hospitals that "safety is worth the cost" and "preparedness is priceless" The American College of Emergency Physicians (ACEP) and the Agency for Healthcare Quality and Research (AHQR) separately found a very different financial and leadership commitment to preparedness and training.
"Many hospitals report inadequate funding to cover the attendance costs (e.g., time off, tuition, travel) of training (ACEP, 2001). At the University of Pittsburgh Medical Center, a disaster drill in the Emergency Department costs $3,000 per hour in staff salaries alone (AHRQ, 2004)."
"Additionally, the failure of hospital administrators or Emergency Department personnel to recognize the importance of training can result in a lack of support (ACEP, 2001)."
Multiple agencies, including the Institutes of Medicine have called for an increased coordinated financial commitment to preparedness on the part of individual hospitals, hospital corporations, hospital management / holding companies, as well as local, state and federal governments.
"This lack of coordination is reflected in the haphazard funding of preparedness initiatives. EMS and trauma systems have consistently been underfunded relative to their presence and role in the field."
"States and communities should play an important role in determining how they will prepare for emergencies. To the extent that they are supported in this effort through federal preparedness grants, the critical role and vulnerabilities of hospitals must be more widely acknowledged, and the particular needs of hospitals and hospital personnel must be taken explicitly into account"
Despite this, funding for preparedness has decreased across the board including congressional cuts in healthcare preparedness funding for 2007, 2008 and again for 2009. These cuts have been mirrored in state funding initiatives; meanwhile hospitals continue to believe that they are prepared despite evidence to the contrary.
So What Should They Say Today?
Given these realities leaders in the field of healthcare and hospital management must now confront the fact that self reporting on preparedness is a failed method, no different than asking a 10 year old to grade their own final exam. With the curtain pulled back it is time for healthcare and hospitals to say:
"It is our corporate and personal responsibility to ensure the safety and preparedness of our entire staff, clinical and non-clinical as well as prepare to respond to the needs of the patients we serve every day and the patients we will serve when disaster strikes."
The problem is that healthcare and hospital leaders have done everything in their power to quietly avoid the need to make this statement much less bring this statement into reality. In the two years since the Institutes of Medicine published their reports, hospitals have lobbied first to delay and forestall the deadlines for both Joint Commission preparedness guidelines and National Incident Management System (NIMS) compliance elements. The effect of this has been to make such things as facility beautification a higher financial priority than facility preparedness.
What is Needed?
While the Institutes of Medicine and many other organizations have made recommendations to improve hospital disaster preparedness, the sad fact is that the only way to force hospitals to properly and adequately prepare is to enforce the existing guidelines, mandate meaningful external certification of compliance and engage the public in demanding local hospitals "just do it." There is an old adage in healthcare law:
"No change in healthcare has ever come without regulation, legislation or litigation."
Enforcement of existing guidelines will require that the applicable government agencies including the Department of Homeland Security, FEMA, the Department of Justice, the Department of Health and Human Services and the Center for Medicare Services mandate full and complete NIMS compliance by the original September 30, 2008 deadline. Further, these agencies must be willing to use the full force of law to induce hospitals to invest in preparedness rather than pianos and fountains. Federal preparedness legislation carries with it implications of Medicare fraud, Sarbanes-Oxley violations and federal false claims issues. It is an unfortunate reality that government must all too often prosecute to create compliance.
The private sector has a responsibility to enforce preparedness guidelines as well. Joint Commission has repeatedly chosen to "partner with hospitals" rather than "punish" the recalcitrant faculties who repeatedly delay and curtail preparedness efforts. Joint Commission accreditation is a powerful force for change in hospital healthcare. The current tendency of hospitals to do as little as possible as slowly as possible necessitates that Joint Commission enforce the original preparedness compliance deadline in January of 2009 rather than permitting yet another extension.
Perhaps the best thing everyone in healthcare oversight and leadership can say to the American people is:
"We're Sorry and We Will Do Better!
"HOSPITAL CEOs SAY BIOTERRORISM PLANS ARE IN PLACE CHICAGO
Since September 11, 2001, hospitals have faced new challenges protecting and caring for their communities, especially the threat of bioterrorism. According to a new survey conducted by the American College of Healthcare Executives (ACHE), 84 percent of hospital CEOs agree that since 9/11, their hospitals have worked more closely with public agencies (e.g. fire, police, and public health departments). Further, 95 percent of the respondents said their hospitals already have, or within six months will have, a bioterrorism disaster plan in place, developed in coordination with local emergency or health agencies."
Little did they know the sense of false security and the cooling of momentum this assertion would cause from that day forward.
The Clear View of Reality
Since 2003, multiple independent evaluations of hospital preparedness and hospital disaster planning have found the reality in each successive year to be far below that purported in 2003. A brief survey three reports by the Institutes of Medicine in June, 2006 serve as proof that any hint of hospital preparedness is false and that momentum towards preparedness has been lost. These reports, Hospital-Based Emergency Care: At the Breaking Point, Emergency Care for Children: Growing Pains, and Emergency Medical Services at the Crossroads found a disparity between self reported preparedness on multiple association and government surveys compared to actual preparedness measured across the five core indicators of hospital preparedness.
"Evaluations of ED disaster preparedness consistently yield the same finding: EDs are better prepared than they used to be, but still fall short of where they should be"
At first blush, this seems to confirm the ACHE assertions, but the report goes on to point out that hospitals lack patient surge capacity due to cost related downsizing, nursing shortages, loss of specialists, physical space constrains and overcrowding. Failures of planning and coordination were also identified and linked to erroneous planning assumptions.
"When a disaster occurs, the normal operating assumptions about patients, responses, and treatments often must be jettisoned. Depending on the type of event, some of the nonroutine things that can happen include the following:
· Victims who are less injured and mobile will often self-transport to the nearest hospitals, quickly overwhelming those facilities.
· Casualties are likely to bypass on-site triage, first aid, and decontamination stations.
· EMS responders will often self-dispatch. Providers from other jurisdictions may appear at the scene and transport patients, sometimes without coordination or communication with local officials.
· In some cases, local facilities are not aware of the event until or just before patients start arriving. Hospitals may receive no advance notice of the extent of the event or the numbers and types of patients they can expect.
· There may be little or no communication among regional hospitals, incident commanders, public safety, and EMS responders to coordinate the response region wide."
The Institute of Medicine reports goes on to call for improved communications and integration across disaster response services including Emergency Medical Services (EMS), community emergency operations and most importantly the implementation of the standardized Incident Command System.
"To respond effectively, hospitals must interface with incident command at multiple levels and be prepared to deal with transitions between levels, for example, when incident command shifts from the local to the state or federal level. Each hospital should be familiar with the local office of emergency preparedness and know how hospitals are represented at the emergency operations center during an event, whether through the hospital association, the health department, the EMS system, or some other mechanism."
They Didn't Think of That Either
Beyond the problems common to all disaster care environments, special needs populations (children, elderly, mentally and physically challenged) have needs and preparedness issues unique to them. Unfortunately, the "one size fits none" approach taken by America's hospitals has ignored issues highlighted by the Institutes of Medicine Emergency Care for Children: Growing Pains report.
"The needs of children have traditionally been overlooked in disaster planning. Historically, the military was considered the only target of potential biological, chemical, and radiological attacks, so the focus for training, equipment, and facilities was on the care of healthy young adults."
"Younger patients require specialized equipment and different approaches to treatment in the event of a disaster. Children cannot be properly decontaminated in adult decontamination units because they require adjustments to the water temperature and pressure (heated, high-volume, low-pressure water). Rescuers also need to have child-size clothing on-hand for use after the decontamination."
The problems are compounded for rural hospitals. Despite the fact that many both inside and outside hospital leadership believe that rural hospitals are at lower risk and thus require less commitment to preparedness, the truth is quite the opposite.
"The focus of emergency preparedness has been on urban areas in part because of the perceived increased risk of terrorism in these areas. However, there is a danger associated with neglecting rural areas. Indeed, one might argue that rural areas may be even more vulnerable to a terrorist attack. Many nuclear power facilities, hydroelectric dams, uranium and plutonium storage facilities, and agricultural chemical facilities, as well as all U.S. Air Force missile launch facilities, are located in rural areas and are potential targets for attack. Additionally, if individuals with infectious diseases, such as smallpox, enter the country through Canadian or Mexican borders, rural providers may be the first to identify the threat."
A Problem of Their Own Making
The greatest indictment of hospitals by the Institute of Medicine Reports however dealt with disaster preparedness training and drills finding great variability in the training of even key healthcare personnel with even less training for non-clinical hospital staff.
"Serious clinical and operational deficiencies, fragmentation, and lack of standardization exist across a broad spectrum of key professional personnel (nurses, physicians, ancillary care providers, administrators, and public health officials) in both individual training and coordination of a team response."
This failure to provide training not only effects patient care, but hospital employee safety. Despite public statements by hospitals that "safety is worth the cost" and "preparedness is priceless" The American College of Emergency Physicians (ACEP) and the Agency for Healthcare Quality and Research (AHQR) separately found a very different financial and leadership commitment to preparedness and training.
"Many hospitals report inadequate funding to cover the attendance costs (e.g., time off, tuition, travel) of training (ACEP, 2001). At the University of Pittsburgh Medical Center, a disaster drill in the Emergency Department costs $3,000 per hour in staff salaries alone (AHRQ, 2004)."
"Additionally, the failure of hospital administrators or Emergency Department personnel to recognize the importance of training can result in a lack of support (ACEP, 2001)."
Multiple agencies, including the Institutes of Medicine have called for an increased coordinated financial commitment to preparedness on the part of individual hospitals, hospital corporations, hospital management / holding companies, as well as local, state and federal governments.
"This lack of coordination is reflected in the haphazard funding of preparedness initiatives. EMS and trauma systems have consistently been underfunded relative to their presence and role in the field."
"States and communities should play an important role in determining how they will prepare for emergencies. To the extent that they are supported in this effort through federal preparedness grants, the critical role and vulnerabilities of hospitals must be more widely acknowledged, and the particular needs of hospitals and hospital personnel must be taken explicitly into account"
Despite this, funding for preparedness has decreased across the board including congressional cuts in healthcare preparedness funding for 2007, 2008 and again for 2009. These cuts have been mirrored in state funding initiatives; meanwhile hospitals continue to believe that they are prepared despite evidence to the contrary.
So What Should They Say Today?
Given these realities leaders in the field of healthcare and hospital management must now confront the fact that self reporting on preparedness is a failed method, no different than asking a 10 year old to grade their own final exam. With the curtain pulled back it is time for healthcare and hospitals to say:
"It is our corporate and personal responsibility to ensure the safety and preparedness of our entire staff, clinical and non-clinical as well as prepare to respond to the needs of the patients we serve every day and the patients we will serve when disaster strikes."
The problem is that healthcare and hospital leaders have done everything in their power to quietly avoid the need to make this statement much less bring this statement into reality. In the two years since the Institutes of Medicine published their reports, hospitals have lobbied first to delay and forestall the deadlines for both Joint Commission preparedness guidelines and National Incident Management System (NIMS) compliance elements. The effect of this has been to make such things as facility beautification a higher financial priority than facility preparedness.
What is Needed?
While the Institutes of Medicine and many other organizations have made recommendations to improve hospital disaster preparedness, the sad fact is that the only way to force hospitals to properly and adequately prepare is to enforce the existing guidelines, mandate meaningful external certification of compliance and engage the public in demanding local hospitals "just do it." There is an old adage in healthcare law:
"No change in healthcare has ever come without regulation, legislation or litigation."
Enforcement of existing guidelines will require that the applicable government agencies including the Department of Homeland Security, FEMA, the Department of Justice, the Department of Health and Human Services and the Center for Medicare Services mandate full and complete NIMS compliance by the original September 30, 2008 deadline. Further, these agencies must be willing to use the full force of law to induce hospitals to invest in preparedness rather than pianos and fountains. Federal preparedness legislation carries with it implications of Medicare fraud, Sarbanes-Oxley violations and federal false claims issues. It is an unfortunate reality that government must all too often prosecute to create compliance.
The private sector has a responsibility to enforce preparedness guidelines as well. Joint Commission has repeatedly chosen to "partner with hospitals" rather than "punish" the recalcitrant faculties who repeatedly delay and curtail preparedness efforts. Joint Commission accreditation is a powerful force for change in hospital healthcare. The current tendency of hospitals to do as little as possible as slowly as possible necessitates that Joint Commission enforce the original preparedness compliance deadline in January of 2009 rather than permitting yet another extension.
Perhaps the best thing everyone in healthcare oversight and leadership can say to the American people is:
"We're Sorry and We Will Do Better!
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