Shane Elmore, RN

If you missed my previous blog post about my recent hospitalization, then I encourage you to go back and give it a read. This post serves as part two of  my up-close-and-personal experience with communication failures in the hospital. Luckily, the situations described in these two posts don’t involve time-sensitive emergencies (TSEs). When communication failures occur in TSEs, the impact can be devastating. Rather, these examples provide evidence that miscommunication is part of the everyday routine in healthcare. This communication crisis is real, and it impacts real people every day.

In case you missed my previous post, let me recap: I was out of town on a business trip and ended up being hospitalized for a day. Luckily, it was just one day; every additional day a patient stays in the hospital, the odds of a full and speedy recovery decrease. But the experience that would follow was so bad, I was half surprised a lady with crazy hair didn't walk up to me on admission and say "may the odds be forever in your favor!" (That's funny if you've seen the Hunger Games. If not, you seriously need to go to the movies now and then ... but hey, no judgment).

If you've been following our blog for any amount of time now, you've heard us refer to the "communication crisis" in healthcare. Occasionally, those of us who work for Pulsara have the opportunity to experience first-hand how the crisis impacts care teams and their patients. This is part one of two posts on an up-close-and-personal encounter I had just last week. I hope you enjoy!

On a recent business trip, I was hospitalized and had to have surgery. I chose the hospital on the suggestion of my Uber driver, since neither hospital in town was a customer of ours, and I really knew nothing about either.  The experience that followed gave a perfect example of how miscommunication mixed with a lack of accountability can have a negative impact on patients.

Listen to this post on the go with Pulsara's new Podcast!

"The first rule of any technology used in a business is that automation applied to an efficient operation will magnify the efficiency. The second is that automation applied to an inefficient operation will magnify the inefficiency." -- Bill Gates

I love this quote from Bill Gates. But just recently, I changed my mind about what this quote means to me and what we, as tech companies, do with that information. When I first heard this quote, I took it to mean that if you have an inefficient process then technology won't help you. If you have an efficient process, then apply technology, and it will only make it better. Makes enough sense, right? 

We make decisions all day, every day. Most of them are taken care of in our sub-conscience, and we don't even have to think about them. But others decisions are more complicated: If you were to have an emergency for example, where would you go for your care? Why would you choose that hospital? What about when you're choosing for your critical patient? Several factors play into this decision, but too often people use the wrong information to make that choice. As a matter of fact, according to a recent New York Times article, going to the wrong hospital could cost patients their lives! That's right. Choose the wrong hospital for your patient's condition, and they're three times more likely to die. 

Happy Heart Month!

As common as heart attacks are, there are some misperceptions around who is vulnerable. I suppose we've asked for it through over-dramatization in the movies. We've all watched the scene where the middle-aged man suddenly clutches his chest, breaks out in a sweat, and then keels over. And he usually has some stereotypical characteristics: beer belly, sedentary lifestyle, a love for all things greasy ... but I can't think of a single movie scene where a woman is the one clutching her chest. I believe that this is concerning given the fact that heart disease is the number one killer of women in America. And these misconceptions are reinforced outside of Hollywood too. In fact, if you Google just the words "heart month" the number one result -- from the CDC -- is all about men. 

Here at Pulsara, our entire focus is on communication. When things break down in healthcare, the root cause is almost always a breakdown in communication. This communication breakdown is what drove our clinician founders to invent a solution so that our patients don't have to suffer for our mistakes. We believe that there is a communication crisis in healthcare that's costing hundreds of thousands of lives every year.

But communication alone cannot make teams fully effective -- no matter the advances in technology  -- if those teams are lacking engagement. From being in the field helping struggling teams, we've found that many confuse communication and engagement, and they are not the same. Whereas communication is defined as the imparting or exchanging of information or news, engagement is emotional involvement or commitment to a cause.

I love my job, and I have the privilege of working with some amazing people around the US. But naturally, we are sometimes met with challenges from teams who haven't yet made upgrading their technology a priority. 

Who's on First is an original comedy skit that was made famous by Abbot and Costello back in the early 1940's. It's a classic illustration of two people talking, but it's as if they are speaking different languages. The longer the skit goes on, the funnier it gets. It's not that their understanding changes — quite the opposite in fact. They continue the conversation, but neither of them ever realizes where the breakdown in communication is happening.

One of the most challenging things about working in a high-stress environment like a hospital is dealing with burnout. If you've been in healthcare for more than a day, you've probably met a nurse, doctor, or ancillary staff member who, for one reason or another, needs an attitude adjustment. If you've been doing it for more than two years, you have probably even been that person at some point. When it comes to burnout, it's usually easier for us to spot it in others long before we can see it in ourselves. Fortunately, there are some strategies you can employ to manage and reverse burnout. 

“Argue like you’re right, and listen like you’re wrong.” It sounds simple, but remembering this advice can go a long way in helping you communicate more effectively with others on your team, whether in healthcare, technology, or any other field.

When I was in school, I always dreaded the time when report cards came out. There was only one part of the report card that ever worked in my favor … the conduct grade. Maybe this is just a Texas thing, but when all else failed, I could point to the “gets along well with others” part of the report card to make a case for how well things were going. Unfortunately that wasn’t enough to keep me from being grounded and losing my rights to my Nintendo. 

When it comes to communication in healthcare, do you ever feel like you're playing a game of "telephone?"

One of the most challenging aspects of living in the technological age is the speed of change. There was once a day when the person armed with the most knowledge and information had the upper hand. That's not the case in today's world. Instead, the person or company that can rapidly learn and adjust to changing trends, information, and technology will now lead the pack. Your ability to adapt to a rapidly changing world will be the one skill that separates you from your competition.

Recently in my travels I heard something that really stuck with me: “When a hospital goes the extra mile, patients will do the same.”

Think about that for a minute. Is your hospital one that truly goes the extra mile? What does that entail?

The best person to ask this question of is a Paramedic who services your hospital. There are several things that determine where a medic takes a patient who has trusted them with their lives:

Whew. Are you feeling the pressures of the fall season already, or is it just me? Maybe it's the after-effects of all the hustle and bustle that comes with summer (road trips, family reunions, a constant stream of company at our house) or maybe it's the beginning of school for the kiddos plus a renewed focus at work that drives my to-do list ever longer. Probably it's a combination of all of that, but I'm sure I'm not the only one who is feeling the strain of an incredibly busy life right now. 

"If you delegate tasks, you are creating followers. If you delegate authority, you are developing leaders." - Andy Stanley

Delegation is one of the best-kept secrets of the world's most productive leaders. There's nothing inherently difficult about delegation -- and it can be applied in any industry -- so why don't you do it more?

I bet I have some idea why. Here's my guess at three reasons you don't delegate:

Just for grins and giggles, I signed in to Netflix recently and watched a few episodes of the medical drama from the 70's, "Emergency!" I'm a little young to remember the show when it was on the air, but when I started in EMS, my paramedic partner insisted that I watch some of it. It was a rite of passage. Of course, there was also Bringing Out the Dead starring Nicholas Cage and Mother, Jugs & Speed with Bill Cosby, but those are for another post.

 What opportunities are hospitals missing out on due to their attitudes about risk? I have worked in the hospital setting since I was 20 years old (which was ... many .... years ago). Sure, I’ve had some frustrations when it comes to the inability to get things done, but I think we’ve all been there at one time or another.  Now that I work with hospitals, rather than in them, it has become clear where the root of some of these challenges lie. Let’s look deeper at one issue I see at almost every hospital I visit.

Last week, I talked about the root of all evil in STEMI care (variability) and then about some sources of variability in STEMI care and how to identify and reduce them in your facility. When it comes to variability, stroke programs have their challenges too. Today I will share with you the top four questions I ask that reveal when the "V word" has snuck into your stroke systems.

How do you solve care management problems at your hospital?

I think that's a fair question. I was talking with a nurse from reputable a STEMI receiving center just a few days ago, and he told me "our times are amazing!" In my role, anytime I hear that it makes me ask lots of questions. I want to learn what the leading hospitals are doing to solve the problems that we all face.

In last week's blog post, I talked about the root of all evil in STEMI care processes: VARIABILITY. 

There are several areas where we commonly see variability in STEMI processes. Here are 3 questions whose answers will give you some insight into whether you might have a variability problem at your facility: 

As Pulsara employees, when we meet with prospective clients we hear a lot of different stories about how well their facilities are already doing. Most of the time they tell us what their mean time for Door-to-Balloon (D2B) is. Many of them sound good on the surface, but there's usually more going on under the hood that they aren't proud of or willing to show you.