a c hange of s eason code blue health science edition four c hapter 3

A CHANGE OF A CHANGE OF SEASONSEASON

Code BlueCode BlueHealth Science Edition FourHealth Science Edition Four

CHAPTER 3CHAPTER 3

New CharactersNew Characters

Let’s briefly review each new Let’s briefly review each new character:character: Wes DouglasWes Douglas Dr. Emil FlaggDr. Emil Flagg Helen IngersolHelen Ingersol Birdie BankheadBirdie Bankhead David BrannanDavid Brannan Roger SelmanRoger Selman

Wes Douglas’ First Wes Douglas’ First InterviewInterview

Before being offered the job as Before being offered the job as interim administrator, Wes was interim administrator, Wes was offered a job as a hospital offered a job as a hospital consultant.consultant.

Before the interview, Wes reflects on Before the interview, Wes reflects on the brief experience he had with the brief experience he had with Hap Castleton prior to his death. Hap Castleton prior to his death. What was his opinion of Hap?What was his opinion of Hap?

Wes Douglas’ First Wes Douglas’ First InterviewInterview

During his interview for the job of During his interview for the job of hospital consultant, Wes was hospital consultant, Wes was interviewed by Edward Wycoff, interviewed by Edward Wycoff, chairman of the finance committee, and chairman of the finance committee, and by Dr. Lindsey Reese, who Wycoff had by Dr. Lindsey Reese, who Wycoff had invited to the dinner.invited to the dinner. Let’s review some of the areas of hospital Let’s review some of the areas of hospital

weakness that Reese wanted Wes to work weakness that Reese wanted Wes to work on. (These areas dramatically impact the on. (These areas dramatically impact the way nurses and doctors perform their jobs.) way nurses and doctors perform their jobs.)

Areas of WeaknessAreas of Weakness

Quality AssuranceQuality Assurance Quality assurance begins with the Quality assurance begins with the

establishment of standards.establishment of standards. Standards include . . .Standards include . . .

________________________________________ ________________________________________ ________________________________________ ________________________________________


Continuous Quality ImprovementContinuous Quality Improvement

Continuous Quality Continuous Quality Improvement (CQI)Improvement (CQI)

A BIG topic in healthcare delivery.A BIG topic in healthcare delivery. Every healthcare professional should Every healthcare professional should

understand the elements of CQI to understand the elements of CQI to succeed in their jobs.succeed in their jobs.

In most hospitals, healthcare In most hospitals, healthcare professionals are required to know professionals are required to know the philosophy and terminology of the philosophy and terminology of this important program.this important program.

Features of Features of Continuous Quality Continuous Quality

ImprovementImprovement Designed to improve the quality of Designed to improve the quality of

products and servicesproducts and services Used in both manufacturing and in Used in both manufacturing and in

hospitalshospitals Based on the philosophy that quality Based on the philosophy that quality

can can continuallycontinually be improved – it does be improved – it does not subscribe to the philosophy that not subscribe to the philosophy that “if something isn’t broke don't fix it”“if something isn’t broke don't fix it”


ImprovementImprovement The emphasis is on future resultsThe emphasis is on future results The philosophy believes that most The philosophy believes that most

problems are caused by processes problems are caused by processes and not by peopleand not by people

Quality is defined by exceeding the Quality is defined by exceeding the expectations of physicians and expectations of physicians and patientspatients


ImprovementImprovement Uses statistical tools to uncover Uses statistical tools to uncover

problemsproblems When a problem is uncovered, the When a problem is uncovered, the

hospital administrator selects a team hospital administrator selects a team to identify each step in the processto identify each step in the process

The team then designs steps toThe team then designs steps tocorrect the problemscorrect the problems


ImprovementImprovement Standards are established so that Standards are established so that

future problems do not occurfuture problems do not occur A program to measure performance A program to measure performance

to determine the standards are to determine the standards are being met is establishedbeing met is established

The steps are: plan, act, do and The steps are: plan, act, do and checkcheck

History of History of Continuous Quality Continuous Quality

ImprovementImprovement Continuous Quality Improvement Continuous Quality Improvement

(CQI) was first developed by an (CQI) was first developed by an individual named individual named W. Edwards Demming. W. Edwards Demming.

His objective was to improve quality His objective was to improve quality while making work more fun.while making work more fun.


ImprovementImprovement Demming took CQI to the American Demming took CQI to the American

automobile industry, who rejected it.automobile industry, who rejected it. At that time American automobile At that time American automobile

makers dominated the world and makers dominated the world and were not interested in improving were not interested in improving quality.quality.


ImprovementImprovement Demming then took it to Japan Demming then took it to Japan

where Japanese automakers where Japanese automakers implemented it. implemented it.

In the following years, the Japanese In the following years, the Japanese automobile industry almost put the automobile industry almost put the American automobile industry out of American automobile industry out of business, based on the quality of business, based on the quality of their products.their products.


ImprovementImprovement Finally, American manufacturers saw Finally, American manufacturers saw

that unless they improved the quality that unless they improved the quality of their products, they would no of their products, they would no longer be able to compete in global longer be able to compete in global markets, and so they too adopted markets, and so they too adopted continuous quality improvement.continuous quality improvement.

The healthcare industry subsequently The healthcare industry subsequently adopted continuous quality adopted continuous quality improvement.improvement.


One way of measuring the quality of One way of measuring the quality of care offered by a hospital is to look care offered by a hospital is to look at morbidity and mortality.at morbidity and mortality.

Other Areas of Weakness Other Areas of Weakness Identified During First Identified During First

InterviewInterview HIPAAHIPAA EMTALAEMTALA Risk ManagementRisk Management

HIPPAHIPPAHealth Insurance Health Insurance

Portability and Portability and Accountability Act of Accountability Act of

19961996 When was it passed?When was it passed? What was its objective?What was its objective? What does it do?What does it do? What information is protected?What information is protected?

HIPPAHIPPAHealth Insurance Health Insurance

Portability and Portability and Accountability Act of Accountability Act of

19961996 Who is covered under the act?Who is covered under the act? What are the penalties?What are the penalties?

EMTALAEMTALA

Stands for The Emergency Medical Stands for The Emergency Medical Treatment and Active Labor ActTreatment and Active Labor Act

The act is designed to prevent what is The act is designed to prevent what is known as “patient dumping.”known as “patient dumping.”

Under the act, hospital emergency rooms Under the act, hospital emergency rooms must provide (without regard for the must provide (without regard for the ability of the patient to pay) stabilization ability of the patient to pay) stabilization and emergency treatment when a patient and emergency treatment when a patient presents themselves at an emergency presents themselves at an emergency room for emergency care.room for emergency care.

Risk ManagementRisk Management

Risk management involves: Risk management involves: Identifying potential risks (such as falls, Identifying potential risks (such as falls,

infections, and so on).infections, and so on). Analyzing those risksAnalyzing those risks Establishing priorities for addressing Establishing priorities for addressing

those risksthose risks Bringing resources to bear in reducing Bringing resources to bear in reducing

or eliminating those risksor eliminating those risks

Why do organizations Why do organizations like hospitals do the like hospitals do the

things they do?things they do? When working in a hospital, it is useful to When working in a hospital, it is useful to

understand why the board or management understand why the board or management takes the actions they do.takes the actions they do.

Without a doubt the doctors, nurses, and Without a doubt the doctors, nurses, and other employees are concerned about who other employees are concerned about who will be their new administrator.will be their new administrator.

Put yourself in the place of the employees of Put yourself in the place of the employees of Brannan Community Hospital. What Brannan Community Hospital. What difference does it make to you who is chosen difference does it make to you who is chosen to be the new hospital administrator?to be the new hospital administrator?

Employability SkillsEmployability Skills

Employability SkillsEmployability Skills Although he doesn’t Although he doesn’t

know it, Wes Douglas know it, Wes Douglas is about to be is about to be interviewed for a job.interviewed for a job.

If you haven’t If you haven’t already, all of you already, all of you will eventually face will eventually face the employment the employment interview.interview.

What do you think all What do you think all employers look for in employers look for in a new employee?a new employee?

What Do Employers Look What Do Employers Look For?For?

Ability to do the jobAbility to do the job Ability to get along Ability to get along

with peoplewith people Willingness to fit the Willingness to fit the

corporate culturecorporate culture Integrity and loyaltyIntegrity and loyalty Adaptability to Adaptability to

changechange

Let’s discuss each of these in a little more detail.

Ability To Do The JobAbility To Do The Job AptitudeAptitude

Defined as the natural Defined as the natural talent or ability to learn talent or ability to learn easily and quickly; a set easily and quickly; a set of factors which can be of factors which can be assessed and which assessed and which show what occupation show what occupation a person is best suited a person is best suited for.for.

Education and Education and TrainingTraining

ExperienceExperience

AptitudeAptitude

Different people have different skills. Different people have different skills. Individuals with strengths in one area Individuals with strengths in one area often have weaknesses in another. often have weaknesses in another.

A person who is good with mechanical A person who is good with mechanical concepts may not be a good writer. concepts may not be a good writer.

An individual who is excellent in math An individual who is excellent in math may not have good people skills. may not have good people skills.

A person who is good with people may A person who is good with people may not be good in science.not be good in science.

AptitudeAptitude

Some people spend Some people spend a great deal of a great deal of time qualifying for time qualifying for a specific a specific occupation, only to occupation, only to find they don’t find they don’t enjoy the work. enjoy the work.

They lack the They lack the aptitude for that aptitude for that particular job!particular job!

AptitudeAptitude

How does one avoid making a How does one avoid making a mistake when selecting a career?mistake when selecting a career?

I spent all these years going to

school, but now that I’m here,

I hate my job!

Education and TrainingEducation and Training

Most professional healthcare jobs Most professional healthcare jobs require some form of licensure and require some form of licensure and certification. certification.

Professional associations such as the Professional associations such as the American Medical Association, the American Medical Association, the American Nursing Association, and American Nursing Association, and the American Hospital Association the American Hospital Association can help students identify the can help students identify the requirements for a specific profession. requirements for a specific profession.

Education and TrainingEducation and Training

Knowledge is Knowledge is expanding at an expanding at an ever-increasing ever-increasing rate. rate.

Much of what one Much of what one learns in school learns in school will be obsolete will be obsolete within fifteen within fifteen years of years of graduation. graduation.

ObsoleteObsolete

Education and TrainingEducation and Training What, then, should What, then, should

a student take a student take away from formal away from formal education? education?

ExperienceExperience

Depending upon Depending upon the job, some the job, some employers will employers will require real world require real world work experience work experience before they hire an before they hire an individual.individual. Internships can Internships can

often satisfy this often satisfy this requirement.requirement.

Ability To Get Along With Ability To Get Along With PeoplePeople

Do you know that Do you know that the main reason the main reason people are fired is people are fired is not their lack of not their lack of technical skills, but technical skills, but their inability to their inability to get along with get along with people?people?

Willingness to Fit into the Willingness to Fit into the Corporate CultureCorporate Culture

What is What is “corporate “corporate culture?”culture?” It is It is “the way we do “the way we do

things around here.”things around here.” The corporate The corporate

culture of IBM is culture of IBM is different from the different from the corporate culture corporate culture of Microsoft.of Microsoft. How?How?

Integrity and LoyaltyIntegrity and Loyalty

What special characteristics of the What special characteristics of the healthcare industry make it healthcare industry make it important that physicians, nurses, important that physicians, nurses, and other healthcare employees be and other healthcare employees be individuals of integrity and loyalty?individuals of integrity and loyalty?

AdaptabilityAdaptability

What special What special challenges does challenges does the healthcare the healthcare field face that field face that mandate mandate employees be able employees be able to adapt to new to adapt to new conditions?conditions?

Adaptability to ChangeAdaptability to Change New technology, global New technology, global

competition and competition and changing national and changing national and world economies world economies continually alter the continually alter the way things are done. way things are done.

Employees must have a Employees must have a commitment to lifetime commitment to lifetime learning and must be learning and must be willing to adapt to an willing to adapt to an environment that is environment that is continually changing.continually changing.

Adaptability to ChangeAdaptability to Change

The only The only constant in the constant in the modern world of modern world of work is work is changechange..

Medical TerminologyMedical Terminology Did you know that Did you know that

many medical many medical terms have Greek terms have Greek or Latin roots?or Latin roots?

Students can Students can increase their increase their understanding of understanding of terminology by terminology by memorizing a few memorizing a few basic root words.basic root words.

Medical TerminologyMedical Terminology

ExampleExample Nephr = kidneyNephr = kidney itis = inflammation ofitis = inflammation of Nephritis = Nephritis =

inflammation of the inflammation of the kidneykidney

Learn root words Learn root words on pages 42-43.on pages 42-43.

Discussion Question 1Discussion Question 1 Edward Wycoff felt that Edward Wycoff felt that

Hap Castleton and Wes Hap Castleton and Wes Douglas would make a Douglas would make a good team, as each good team, as each would complement the would complement the strengths and strengths and weaknesses of the weaknesses of the other.other.

With this in mind, With this in mind, discuss the relative discuss the relative strengths and strengths and weaknesses of Hap and weaknesses of Hap and Wes.Wes.

Discussion Question 2Discussion Question 2 Edward Wycoff Edward Wycoff

related the story of related the story of several vice several vice presidents of a large presidents of a large Fortune 500 company Fortune 500 company who were successful who were successful within the structure of within the structure of that company, but lost that company, but lost their fortunes when their fortunes when they attempted to go they attempted to go into business for into business for themselves.themselves.

[Continued] [Continued]

Discussion Question 2Discussion Question 2

Why did this Why did this happen, and what happen, and what can an can an administrative administrative person learn from person learn from this experience? this experience?


Why would a young CPA entertain an Why would a young CPA entertain an offer to serve as interim administrator offer to serve as interim administrator of the Brannan Community Hospital? of the Brannan Community Hospital?

What does Wes have to win by What does Wes have to win by accepting this offer, and what might he accepting this offer, and what might he have to lose? have to lose?

Place yourself in the role of Wes Place yourself in the role of Wes Douglas. Would you accept the offer?Douglas. Would you accept the offer?


Assuming that Assuming that Roger Selman Roger Selman had to be had to be fired, what do fired, what do you think of you think of Wycoff's Wycoff's timing? timing?


It has often been said, that how someone It has often been said, that how someone does something is as important as what does something is as important as what he or she does.he or she does.

If you were chairman of the board, If you were chairman of the board, would you fire Roger Selman?would you fire Roger Selman?

If not, why not?If not, why not? If so, is there anything you would do If so, is there anything you would do differently? differently?


While Edward Wycoff While Edward Wycoff was willing to blame was willing to blame Roger Selman for the Roger Selman for the hospital’s financial hospital’s financial problems, Roger felt problems, Roger felt that the board shared that the board shared responsibility for the responsibility for the hospital’s poor hospital’s poor financial condition. financial condition.

What might the board What might the board of trustees have done of trustees have done to avoid the crisis to avoid the crisis described in Chapter described in Chapter 3?3?


What was the reaction of the hospital’s What was the reaction of the hospital’s employees to the appointment of Wes employees to the appointment of Wes Douglas as administrator? Douglas as administrator?

What might the board have done to What might the board have done to make the transition easier for their new make the transition easier for their new administrator? administrator?


As long as the As long as the board does the board does the right thing, does it right thing, does it matter what the matter what the employees or the employees or the medical staff medical staff thinks? thinks?


Where does real Where does real authority come authority come from, a title, or from, a title, or credibility? credibility?


What will Wes What will Wes Douglas have to do Douglas have to do to build his to build his credibility with the credibility with the board, the medical board, the medical staff, and the staff, and the employees? employees?


As long as an allied As long as an allied health employee health employee has good technical has good technical skills, is it skills, is it important for him important for him or her to have or her to have good good communication communication skills, and some skills, and some political savvy? political savvy?


Birdie Bankhead, Hap Castleton’s Birdie Bankhead, Hap Castleton’s secretary, believes that Edward secretary, believes that Edward Wycoff may have had ulterior Wycoff may have had ulterior motives in selecting Wes Douglas to motives in selecting Wes Douglas to be the new hospital administrator. be the new hospital administrator.

What might these motives be? What might these motives be? Assuming that Bankhead is correct, Assuming that Bankhead is correct,

what can Wes do to protect himself? what can Wes do to protect himself?

Discussion Question 13Discussion Question 13 What is the difference What is the difference

between a fixed price between a fixed price contract and a cost contract and a cost reimbursement reimbursement contract? contract?

Who loses money if Who loses money if there is a cost overrun there is a cost overrun under a fixed price under a fixed price contract? contract?

Who loses under a cost Who loses under a cost reimbursement reimbursement contract? contract?


Identify the root words of each of the Identify the root words of each of the following terms. From the roots, explain following terms. From the roots, explain what you think the term might mean. what you think the term might mean. Using a medical dictionary, write the Using a medical dictionary, write the actual definition.actual definition.

cystitiscystitis hematologyhematology

orthodontistorthodontist liposuctionliposuction

ophthalmoloophthalmologistgist

pathologypathology

tracheoscopitracheoscopicc

gingivitisgingivitis

necrosisnecrosis hypodermichypodermic

necrophobianecrophobia histologyhistology


Assume you are a healthcare practitioner Assume you are a healthcare practitioner talking to the patient of someone with no talking to the patient of someone with no medical training about a loved one. Translate medical training about a loved one. Translate the following into “simple English.”the following into “simple English.”

a. I believe your 100-year-old aunt is a. I believe your 100-year-old aunt is necrophobic.necrophobic.

b. The child was cyanotic at admission.b. The child was cyanotic at admission.

c. Your father was suffering from apnea c. Your father was suffering from apnea when he when he called us.called us.

d. Your son has severe gingivitis.d. Your son has severe gingivitis.


Roger Selman argued that it was Roger Selman argued that it was justifiable to sign a contract with the justifiable to sign a contract with the Mountainlands Insurance Company Mountainlands Insurance Company at a price that was lower than at a price that was lower than hospital cost to maintain its volume hospital cost to maintain its volume of patients. of patients.

Do you believe this was an Do you believe this was an appropriate decision? appropriate decision?


Consider the way Consider the way Edward Wycoff Edward Wycoff leads his board leads his board and staff. and staff.

Does he have the Does he have the attributes of a attributes of a successful long-successful long-term leader? Why term leader? Why or why not? or why not?


What made Wes Douglas successful What made Wes Douglas successful in his communication with Birdie in his communication with Birdie Bankhead in this chapter? Bankhead in this chapter?

Writing Exercise 19Writing Exercise 19 Assume that you are in Assume that you are in

the role of Edward the role of Edward Wycoff as he fires Roger Wycoff as he fires Roger Selman. Using the Selman. Using the reasons given in the reasons given in the chapter, prepare a script chapter, prepare a script of the conversation you of the conversation you would have as you let would have as you let Roger know that he was Roger know that he was being terminated. being terminated. Demonstrate kindness, Demonstrate kindness, understanding and understanding and courtesy in place of the courtesy in place of the tactics Wycoff used. tactics Wycoff used.

Writing Exercise 20Writing Exercise 20 Using the tools taught Using the tools taught

in in Supplementary Supplementary Discussion 1—Discussion 1—Employability Skills,Employability Skills, develop a plan to develop a plan to explore a specific health explore a specific health care career. Consider: care career. Consider: (a) personal aptitudes, (a) personal aptitudes, (b) education and (b) education and training requirements, training requirements, (c) pay and employment (c) pay and employment opportunities, and (d) opportunities, and (d) work environment. work environment.

Role Playing 21Role Playing 21

Select a team of six or more people to Select a team of six or more people to role-play the board of trustees of role-play the board of trustees of Brannan Community Hospital and the Brannan Community Hospital and the administrator before the class. Have administrator before the class. Have the board develop a plan to save the the board develop a plan to save the hospital in the next 30 days. Address hospital in the next 30 days. Address the following problems: the following problems: 1) the hospital is not generating enough 1) the hospital is not generating enough

cash to pay its bills.cash to pay its bills.

2) employee morale is at an all-time low. 2) employee morale is at an all-time low.

Role Playing 21 (cont.)Role Playing 21 (cont.)

3) the newspaper is running unfavorable 3) the newspaper is running unfavorable editorials about the operations of the editorials about the operations of the hospital. hospital.

4) the community is losing confidence in 4) the community is losing confidence in the quality of services provided by the the quality of services provided by the hospital. hospital.

5) there is talk of an initiative to close the 5) there is talk of an initiative to close the hospital down.hospital down.

The End!The End!

a c hange of s eason code blue health science edition four c hapter 3

Documents

patients quality

quality of products

people quality

wes douglas wes douglas

check slide

future problems

areas of hospital weakness

job of hospital consultant