My new practice opened on October 5, 2009. In response to many, we offer many
aspects of primary and complementary care. Most of all, we offer time. Time to invest in one's health. The value proposition is quite simple: value your time and invest in your health equals a better quality of life with more productivity and functionality. The Center for Health Change (www.dalejblock.com) is ready to change health care delivery and turn it on its ear.
Dr. Dale
Monday, October 26, 2009
Tuesday, September 15, 2009
A New Beginning
It has been awhile since my last entry.
There has been a lot happening in my professional career with a new beginning on October 5,2009.
On Monday, October 5,I am starting The Center for Health Change, a direct medical practice (aka concierge medicine). This is my response to health care reform. I believe that what patients want is their personal doctor back in their corner. A focus on holistic wellness couseling, nutrition and exercise is needed for all patients to bring about cost reductions so desparate in todays health care delvery system.
I have created a new practice website: www.dalejblock.com. I encourage you to visit the website and learn more about our Center.
I am back, rested and even more dedicated to healthcare stewardship.
Dr. Dale
There has been a lot happening in my professional career with a new beginning on October 5,2009.
On Monday, October 5,I am starting The Center for Health Change, a direct medical practice (aka concierge medicine). This is my response to health care reform. I believe that what patients want is their personal doctor back in their corner. A focus on holistic wellness couseling, nutrition and exercise is needed for all patients to bring about cost reductions so desparate in todays health care delvery system.
I have created a new practice website: www.dalejblock.com. I encourage you to visit the website and learn more about our Center.
I am back, rested and even more dedicated to healthcare stewardship.
Dr. Dale
Saturday, July 18, 2009
Brand vs. Generic
The debate over healthcare reform rolls on. Here is an easy way to decrease costs. Many brand name prescriptions have a generic alternative. In fact, some prescription drugs are actually made on the same manufacturing line, one is stamped for brand and one is stamped for generic. A brand name drug co-pay can be as high as $50.00 per month. Over a year, that is $600.00 spent on one brand name drug. If there is a safe and effective generic equivalent available, chances are its $4.00 per month in some places or $48.00 per year. Let's do the math for the savings: $600.00 minus $48.00 equals $552.00 per year. The saving goes back to the consumer. Why not invest this savings in your health and well being!
Dr. Dale
Dr. Dale
Wednesday, July 8, 2009
Concierge Medicine
As we watch the healthcare debate roll on, many patients are wondering if they will ever get to see a real doctor again.
Some doctors are turning their practices into concierge medical practices.
For an annual fee (around $1500-$2000 per year), doctors agree to provide direct access to a small number of patients. Focusing on health and wellness,patients actually have the opportunity to invest in their health under the auspices of a physician. Office visits are longer and based on the need of the patient. After hours contact is with their physician.
Both the physician and patient win. This type of practice is growing and it will bring back the doctor - patient relationship that has been missing since the HMO days.
Dr. Dale
Some doctors are turning their practices into concierge medical practices.
For an annual fee (around $1500-$2000 per year), doctors agree to provide direct access to a small number of patients. Focusing on health and wellness,patients actually have the opportunity to invest in their health under the auspices of a physician. Office visits are longer and based on the need of the patient. After hours contact is with their physician.
Both the physician and patient win. This type of practice is growing and it will bring back the doctor - patient relationship that has been missing since the HMO days.
Dr. Dale
Sunday, June 28, 2009
Healthcare Reform isn't coming soon!
Have you been watching the news. Healthcare reform is the biggest topic of the airwaves during the past few weeks. Unfortunately, it is much ado about nothing. It is politics and profitability as usual.
I would not expect anything new on the horizon. Congress is on hold until well after the July 4th holiday. Even then, no one will be able to pull it together.
What is it that we really need to fix healthcare in our country.
That is the $64,000.00 question. We first need to agree what is basic to all Americans when it comes to their health and well-being. We must begin to pay for prevention. We must live prevention. We must make prevention a part of all of our lives 24-7. I have blogged about this before.
We must also adopt a catastrophic insurance plan for all.
many can afford the short doctor visits and generics can cost as low as $4.00 per month for many prescriptions. It is the big hit that wipes people out. The hospital stay or major operation is what is so costly. This is really what all Americans need.
Protection when a catastrophe hits us. So prevention, generic medications and catastrophic care. That pretty much sums it up.
For all of you politicians, take it from me. Check your egos and special interests agendas at the door and solve this crisis before its too late. Or is it already too late?
Dr. Dale
I would not expect anything new on the horizon. Congress is on hold until well after the July 4th holiday. Even then, no one will be able to pull it together.
What is it that we really need to fix healthcare in our country.
That is the $64,000.00 question. We first need to agree what is basic to all Americans when it comes to their health and well-being. We must begin to pay for prevention. We must live prevention. We must make prevention a part of all of our lives 24-7. I have blogged about this before.
We must also adopt a catastrophic insurance plan for all.
many can afford the short doctor visits and generics can cost as low as $4.00 per month for many prescriptions. It is the big hit that wipes people out. The hospital stay or major operation is what is so costly. This is really what all Americans need.
Protection when a catastrophe hits us. So prevention, generic medications and catastrophic care. That pretty much sums it up.
For all of you politicians, take it from me. Check your egos and special interests agendas at the door and solve this crisis before its too late. Or is it already too late?
Dr. Dale
Saturday, June 13, 2009
Safety in the Home.
Why is it that no one really understands the importance of safety and injury prevention? Our emergency rooms are filled to capacity with patients requiring medical care because of an accident at home. I really enjoy listening to the patients tell me how stupid they were and if they had only done this or that it wouldn't have happened.
Another favorite of mine is when patients will tell me they have been doing something the same way, but the wrong way for some time and this is the first time they were injured.
As you already know, the cost of healthcare is skyrocketing. If people would just pay a little attention to safety and injury prevention, I believe that we could reduce our healthcare expenditures by millions. The following is a list of the 22 safety items no home should be without published by the National Safety Council on their website authored by Carla Merolla and Laura Coyne.
1. Smoke Detectors
2. Carbon Monoxide Monitor
3. Radon-Detector Kit
4. Night Lights
5. Sensor Lights
6. Sturdy One-Step Stool
7. Rubber Suction Bath Mats and Slip-Resistant Throw Rugs
8. Grab Bars
9. Handrails
10. Deadbolt Locks
11. Ground-Fault Circuit Breakers
12. Fire Extinguishers
13. First-Aid Kit
14. Flashlights
15. Fire-Safety Window Guards and Safety Glazing
16. Written Family Evacuation Plan
17. Family Disaster Kit
18. NOAA All-Hazard Alert Radio
19. Posted Emergency Phone Numbers
20. Test Appliances
21. Personal Protective Equipment
22. Tagged Shutoffs
This list is not comprehensive and the details of each item can be found at the NSC website. According to the National Safety Council, there were 29,500 deaths associated with the home in the year 2000. Many of these deaths were probably not instantaneous. I am sure several came after emergency medical care, trauma services and a whole host of medical services were provided in order to save the life of the patient. Think just a second about the cost of all of this. Prevention, prevention and prevention is becoming my daily mantra to patients. The cost savings to our healthcare delivery system would be astounding with just a little common sense.
Dr. Dale
Another favorite of mine is when patients will tell me they have been doing something the same way, but the wrong way for some time and this is the first time they were injured.
As you already know, the cost of healthcare is skyrocketing. If people would just pay a little attention to safety and injury prevention, I believe that we could reduce our healthcare expenditures by millions. The following is a list of the 22 safety items no home should be without published by the National Safety Council on their website authored by Carla Merolla and Laura Coyne.
1. Smoke Detectors
2. Carbon Monoxide Monitor
3. Radon-Detector Kit
4. Night Lights
5. Sensor Lights
6. Sturdy One-Step Stool
7. Rubber Suction Bath Mats and Slip-Resistant Throw Rugs
8. Grab Bars
9. Handrails
10. Deadbolt Locks
11. Ground-Fault Circuit Breakers
12. Fire Extinguishers
13. First-Aid Kit
14. Flashlights
15. Fire-Safety Window Guards and Safety Glazing
16. Written Family Evacuation Plan
17. Family Disaster Kit
18. NOAA All-Hazard Alert Radio
19. Posted Emergency Phone Numbers
20. Test Appliances
21. Personal Protective Equipment
22. Tagged Shutoffs
This list is not comprehensive and the details of each item can be found at the NSC website. According to the National Safety Council, there were 29,500 deaths associated with the home in the year 2000. Many of these deaths were probably not instantaneous. I am sure several came after emergency medical care, trauma services and a whole host of medical services were provided in order to save the life of the patient. Think just a second about the cost of all of this. Prevention, prevention and prevention is becoming my daily mantra to patients. The cost savings to our healthcare delivery system would be astounding with just a little common sense.
Dr. Dale
Monday, June 8, 2009
Health Reform is Coming!
Hold on to your hats. Health reform is right around the corner. Or is it?
President Obama is going to push very hard this week to keep health reform on track before Congress goes on break this August. Kathleen Sebelius, Secretary of U.S. Department Health and Human Services, was quoted late last week, " This budget (I.e., Fiscal budget proposal for 2010) sends a clear message that we can't wait any longer if we want to get healthcare costs under control and improve our fiscal outlook."
The issue for all Americans' health and well-being remains access, cost and quality.
There remains little detail on the Administration's legislative and regulatory proposals for health care reform. There continues to be this cloud of secrecy over what appears to be future significant change. Whatever happened to transparency and accountability? Much of what is talked about has to do with Medicare cuts to providers and healthcare systems. A push for "pay-for-performance" or quality-based care is a high priority item.We may even have a public health insurance program available for all Americans as an alternative to the private programs available now either individually or via group coverage. Again, this begs the question, how are we as taxpayers, going to pay for it? This is all becoming more Darwinian as time goes on,the strong will survive and the weak will perish.
How will this effect the people in smaller communities like Williston, Florida? I suspect that Nature Coast Regional Hospital will have to close its doors on the community. Medicare and Medicaid payments to hospitals will begin to be cut by 2011. Our little hospital already provides around 60% "free care" to the county residents. There is very little margin for operations error in hospitals that only provide primary hospital services. Nature Coast Regional Hospital saves lives. Our Emergency Room is open 24-7 to provide immediate and life-saving care. Without our ED being open, people will have to travel an additional 25-30 minutes, which is certainly the difference between stabilizing care and death.
For everyone reading my blogs, write your Congressmen and Senators now and tell them how much our current health care delivery system means to you as patients. Let them know how much we need to remember the patients in all of this.
I continue to say that when we eliminate politics and profitability from health care delivery in this country, we will solve the healthcare crisis. More to follow.
Dr. Dale
President Obama is going to push very hard this week to keep health reform on track before Congress goes on break this August. Kathleen Sebelius, Secretary of U.S. Department Health and Human Services, was quoted late last week, " This budget (I.e., Fiscal budget proposal for 2010) sends a clear message that we can't wait any longer if we want to get healthcare costs under control and improve our fiscal outlook."
The issue for all Americans' health and well-being remains access, cost and quality.
There remains little detail on the Administration's legislative and regulatory proposals for health care reform. There continues to be this cloud of secrecy over what appears to be future significant change. Whatever happened to transparency and accountability? Much of what is talked about has to do with Medicare cuts to providers and healthcare systems. A push for "pay-for-performance" or quality-based care is a high priority item.We may even have a public health insurance program available for all Americans as an alternative to the private programs available now either individually or via group coverage. Again, this begs the question, how are we as taxpayers, going to pay for it? This is all becoming more Darwinian as time goes on,the strong will survive and the weak will perish.
How will this effect the people in smaller communities like Williston, Florida? I suspect that Nature Coast Regional Hospital will have to close its doors on the community. Medicare and Medicaid payments to hospitals will begin to be cut by 2011. Our little hospital already provides around 60% "free care" to the county residents. There is very little margin for operations error in hospitals that only provide primary hospital services. Nature Coast Regional Hospital saves lives. Our Emergency Room is open 24-7 to provide immediate and life-saving care. Without our ED being open, people will have to travel an additional 25-30 minutes, which is certainly the difference between stabilizing care and death.
For everyone reading my blogs, write your Congressmen and Senators now and tell them how much our current health care delivery system means to you as patients. Let them know how much we need to remember the patients in all of this.
I continue to say that when we eliminate politics and profitability from health care delivery in this country, we will solve the healthcare crisis. More to follow.
Dr. Dale
Friday, June 5, 2009
A Healer and a Physician
Dr. Derrick DeSilva interviewed me yesterday on his radio show, “Ask Dr. DeSilva”. The radio show is on the Internet and reaches several thousands of listeners. We talked about the state of health care delivery in our nation today and my 8-point plan for change. The more we talked the more I realized how much Dr. DeSilva and I have in common. We are both clinicians in the trenches slugging it out day after day to provide good care to our patients. We both agree that no one in Washington is listening to us about what it takes to practice medicine today. We are both fed up with the politics and profitability of health care.
On a more positive note, we are both healers as well as physicians. We try to get in to the souls of our patients and help them to heal and be well, not just healthy. Wellness is the ultimate goal for all of us. It requires an active participation by patients to get their mind, body and spirit to connect creating something greater than the individual parts.
Dr. DeSilva has a wonderful Chinese proverb on his website:
The inferior physician treats the disease once it occurs.
The mediocre physician prevents the disease from coming back.
The superior physician prevents the disease from ever occurring.
Success in healthcare should be measured on the state of wellness for the patient, not on whether the illness is cured or the injury is healed. We have become a sick care society. Enough! We all need to become our own healers of the mind, body and spirit. That is the cornerstone of being a good healthcare steward.
Dr. Dale
On a more positive note, we are both healers as well as physicians. We try to get in to the souls of our patients and help them to heal and be well, not just healthy. Wellness is the ultimate goal for all of us. It requires an active participation by patients to get their mind, body and spirit to connect creating something greater than the individual parts.
Dr. DeSilva has a wonderful Chinese proverb on his website:
The inferior physician treats the disease once it occurs.
The mediocre physician prevents the disease from coming back.
The superior physician prevents the disease from ever occurring.
Success in healthcare should be measured on the state of wellness for the patient, not on whether the illness is cured or the injury is healed. We have become a sick care society. Enough! We all need to become our own healers of the mind, body and spirit. That is the cornerstone of being a good healthcare steward.
Dr. Dale
Sunday, May 31, 2009
The Patient-Centered Medical Home
A recent article (May 20, 2009) by Dr. Diane Rittenhouse and Dr. Stephen Shortell published in the Journal of the American Medical Association was an excellent commentary on a new model of healthcare delivery called the patient-centered medical home. According to these authors, "the fundamental challenge in the United States is to expand access to all U.S. residents, while rapidly reengineering the delivery system to provide consistently high-quality care at lower overall cost. Current reform discussions recognize that success will require a shift in emphasis from fragmentation to coordination and from highly specialized care to primary care and prevention." This is where the the patient centered medical home model comes in to being.
The patient-centered medical home is grounded on four major supporting structures:
1. Primary Care
2. Patient-centered Care
3. New-model Practice
4. Payment Reform.
The importance of primary care is based on years of research demonstrating the role of primary care in producing more positive outcomes at lower costs. Primary care is comprehensive, first-contact, longitudinal and coordinated medical and preventive care delivered by a team of providers spearheaded by the physician.
Patient-centeredness is the tailoring of medical care to meet the needs and preferences of patients. Active participation by the healthcare consumer leads to shared decision-making regarding treatment strategies. Traditional and nontraditional communication (i.e. Internet or virtual office visits) is critical to promoting patient-centeredness.
New-model practice builds on innovations in healthcare delivery: continuous quality improvement, patient safety, transparency and accountability. Evidence-based medicine, population-based healthcare systems, performance measurement and improvement, point-of-care decision support and information technology (i.e., the electronic medical record) are additional areas of concentration promoting the new-model practice.
Payment reform requires, in addition to traditional fee-for-service, additional payment mechanisms to reimburse clinicians for jobs well done. Pay-for-performance and care management are two additional structures being considered to help primary care practitioners in establishing and delivering on the patient-centered medical home.
In reality, what this all means is that when patients have easy access to high quality care that is provided at a lower cost, everybody wins. The U.S. healthcare delivery system is on the brink of a major collapse. It is a distinct possibility that if we continue as we are, our nation will have a national healthcare delivery system much like our neighbors in Canada. This would certainly save money. But would it promote the kind of healthcare that U.S. healthcare consumers have become accustomed to?
According to Rittenhouse and Shortell, marketplace and political realities will necessitate action on healthcare delivery system reform in the U.S. the widely endorsed patient-centered medical home has the potential to increase access and quality and to decrease the rate of growth in costs over time. As healthcare reform gains momentum, this model of healthcare delivery is sure to be tested. The results of this experiment will undoubtedly shape the future of healthcare delivery in our nation for decades to come.
Dr. Dale
The patient-centered medical home is grounded on four major supporting structures:
1. Primary Care
2. Patient-centered Care
3. New-model Practice
4. Payment Reform.
The importance of primary care is based on years of research demonstrating the role of primary care in producing more positive outcomes at lower costs. Primary care is comprehensive, first-contact, longitudinal and coordinated medical and preventive care delivered by a team of providers spearheaded by the physician.
Patient-centeredness is the tailoring of medical care to meet the needs and preferences of patients. Active participation by the healthcare consumer leads to shared decision-making regarding treatment strategies. Traditional and nontraditional communication (i.e. Internet or virtual office visits) is critical to promoting patient-centeredness.
New-model practice builds on innovations in healthcare delivery: continuous quality improvement, patient safety, transparency and accountability. Evidence-based medicine, population-based healthcare systems, performance measurement and improvement, point-of-care decision support and information technology (i.e., the electronic medical record) are additional areas of concentration promoting the new-model practice.
Payment reform requires, in addition to traditional fee-for-service, additional payment mechanisms to reimburse clinicians for jobs well done. Pay-for-performance and care management are two additional structures being considered to help primary care practitioners in establishing and delivering on the patient-centered medical home.
In reality, what this all means is that when patients have easy access to high quality care that is provided at a lower cost, everybody wins. The U.S. healthcare delivery system is on the brink of a major collapse. It is a distinct possibility that if we continue as we are, our nation will have a national healthcare delivery system much like our neighbors in Canada. This would certainly save money. But would it promote the kind of healthcare that U.S. healthcare consumers have become accustomed to?
According to Rittenhouse and Shortell, marketplace and political realities will necessitate action on healthcare delivery system reform in the U.S. the widely endorsed patient-centered medical home has the potential to increase access and quality and to decrease the rate of growth in costs over time. As healthcare reform gains momentum, this model of healthcare delivery is sure to be tested. The results of this experiment will undoubtedly shape the future of healthcare delivery in our nation for decades to come.
Dr. Dale
Thursday, May 28, 2009
Sprucing Up the Office
Shortly after arriving in Williston, I had a new patient make an interesting observation about her experience in our office. She said that everything went well from a clinical perspective but she had a real problem with the waiting area. She told me that when she was getting ready to take a seat prior to be called back into the examination area, she looked down at the chairs in the waiting area and noted how dirty they were. Because of this critical observation on her part,she decided to stand until she was called back in order to be seen.
About a month later, another patient who had been to the office made a similar observation. He commented that the medical care he received was excellent but that if we were going to rebuild the family health center, we needed to "spruce up the office".
You might think that people would not necessarily make comments about the decor. They may even look past the aging vinyl chairs and graying tile floor if they received high quality medical care. Apparently not.
Right before our open house in April, our CEO agreed to a makeover for the reception area of the family health center. Painting and patching, pictures and a flat screen television were some of the new changes. The open house was a success but the real comments were about how nice the reception area looked. We just laid the new floor this week and the positive comments about the decor continue.
Our patients really do notice the physical plant. Just the right, soothing colors and no opulence transform an "OK" visit to the office into a more satisfying experience. I have seen this before. In other practices, new waiting room chairs or new carpet and paint show that you really care about the patient experience. It does not go unnoticed. It is actually very much appreciated. We are sprucing up the hospital now. I cannot wait to hear the comments about the new hospital lobby.
Dr. Dale
About a month later, another patient who had been to the office made a similar observation. He commented that the medical care he received was excellent but that if we were going to rebuild the family health center, we needed to "spruce up the office".
You might think that people would not necessarily make comments about the decor. They may even look past the aging vinyl chairs and graying tile floor if they received high quality medical care. Apparently not.
Right before our open house in April, our CEO agreed to a makeover for the reception area of the family health center. Painting and patching, pictures and a flat screen television were some of the new changes. The open house was a success but the real comments were about how nice the reception area looked. We just laid the new floor this week and the positive comments about the decor continue.
Our patients really do notice the physical plant. Just the right, soothing colors and no opulence transform an "OK" visit to the office into a more satisfying experience. I have seen this before. In other practices, new waiting room chairs or new carpet and paint show that you really care about the patient experience. It does not go unnoticed. It is actually very much appreciated. We are sprucing up the hospital now. I cannot wait to hear the comments about the new hospital lobby.
Dr. Dale
Monday, May 25, 2009
Timeliness is next to Godliness
Delays have become the norm within health care delivery today.
Everybody is complaining about waiting.
Delays for an appointment.
Delays in the reception area or in the examination room waiting to see the doctor.
Delays on test results.
Delays for referrals to specialists or diagnostic testing.
Many patients tell me wait times can be as long as 10 hours or more in some local emergency rooms in Gainesville.
Same day appointments in the office are becoming more of a reality. Customer demand is fueling this change.
Why is it that we have become so inpatient when it comes to getting our healthcare?
Unrealistic expectations on the part of patients have created many logjams.
Ask yourself the last time you really needed to be seen in an emergency room. Was it truly an urgent problem? Was it life or death? Could it have been handled in an office setting?
What is an acceptable wait time for receiving medical care? It depends on the acuity of the patient's problem. Even with this identified, no one really has the right answer. It is all about supply and demand. Supply of providers and demands of patients.
It appears that may change as the healthcare industry begins to implement the patient-centered medical home. If healthcare delivery is really about the patient, then getting the patient to the right venue to receive their care is a critical success factor for achieving positive outcomes.
Timeliness is next to godliness in healthcare. Of course, it depends on whether you are on the giving or receiving end of healthcare services. Caveat emptor!
Dr. Dale
Everybody is complaining about waiting.
Delays for an appointment.
Delays in the reception area or in the examination room waiting to see the doctor.
Delays on test results.
Delays for referrals to specialists or diagnostic testing.
Many patients tell me wait times can be as long as 10 hours or more in some local emergency rooms in Gainesville.
Same day appointments in the office are becoming more of a reality. Customer demand is fueling this change.
Why is it that we have become so inpatient when it comes to getting our healthcare?
Unrealistic expectations on the part of patients have created many logjams.
Ask yourself the last time you really needed to be seen in an emergency room. Was it truly an urgent problem? Was it life or death? Could it have been handled in an office setting?
What is an acceptable wait time for receiving medical care? It depends on the acuity of the patient's problem. Even with this identified, no one really has the right answer. It is all about supply and demand. Supply of providers and demands of patients.
It appears that may change as the healthcare industry begins to implement the patient-centered medical home. If healthcare delivery is really about the patient, then getting the patient to the right venue to receive their care is a critical success factor for achieving positive outcomes.
Timeliness is next to godliness in healthcare. Of course, it depends on whether you are on the giving or receiving end of healthcare services. Caveat emptor!
Dr. Dale
Sunday, May 24, 2009
Patient Centeredness
On the American Hospital Association's Quality web page, the real business of health care is about:
1. preventing ill-health
2. caring for people who are sick
3. meeting the needs of people with chronic disease or disability
4. making people in communities healthier.
The Institute of Medicine's Crossing the Quality Chasm report defined patient centeredness as focusing "on the patient's experience of illness and health care and on the systems that work or fail to work to meet individual patients' needs".
Several characteristics of patient-centered care have been identified based on work done by The Picker Institute:
1. respect for patients' values, preference and expressed needs;
2. coordination and integration of care;
3. information, communication and education;
4. physical comfort;
5. emotional support;
6. involvement of family and friends;
7. access.
Patients vary on their desire to be involved in their health care. Patients today are made to feel excluded as partners in the discussion and decisions that affect them and the health care they receive. As a consequence, patients and their families find the health care they receive to be impersonal and incomplete.
At our family health center and in the hospital at Nature Coast, we strive to be all inclusive with patients and family members concerning decisions about choices related to health care needs. It does not take any longer to have a meaningful discussion with a patient and with their family about what to do. I am a big believer in having an open dialogue about the risks and benefits of treatments. I see myself as a coach who guides my patients through the maze of what has become one of the largest bureaucracies in the world, the U.S. healthcare delivery system.
What do I believe is the critical success factor for patient-centeredness? The clinician must develop the skills of being a good listener. When an open-ended question is posed to the patient at the beginning of the encounter, "What can I help you with today?" or "What brings you in to see me today?", when left alone the patient will talk about their issues for around 2 minutes and stop. It is this uninterrupted time that makes the patient feel as though they have had the opportunity to become a partner in their care. This is the most critical time period that begins the cascade of patient-centered decisions and activities.
The number one reason that malpractice suits are brought against most physicians is the perception that there was a significant failure to communicate with the patient.
Making the patient the center of the healthcare universe should be our number one priority as our nation attempts to rebuild the healthcare delivery system.
The patient is the center of our universe at Nature Coast. In just a short while, patient care surveys will be done to check my perception.
Dr. Dale
1. preventing ill-health
2. caring for people who are sick
3. meeting the needs of people with chronic disease or disability
4. making people in communities healthier.
The Institute of Medicine's Crossing the Quality Chasm report defined patient centeredness as focusing "on the patient's experience of illness and health care and on the systems that work or fail to work to meet individual patients' needs".
Several characteristics of patient-centered care have been identified based on work done by The Picker Institute:
1. respect for patients' values, preference and expressed needs;
2. coordination and integration of care;
3. information, communication and education;
4. physical comfort;
5. emotional support;
6. involvement of family and friends;
7. access.
Patients vary on their desire to be involved in their health care. Patients today are made to feel excluded as partners in the discussion and decisions that affect them and the health care they receive. As a consequence, patients and their families find the health care they receive to be impersonal and incomplete.
At our family health center and in the hospital at Nature Coast, we strive to be all inclusive with patients and family members concerning decisions about choices related to health care needs. It does not take any longer to have a meaningful discussion with a patient and with their family about what to do. I am a big believer in having an open dialogue about the risks and benefits of treatments. I see myself as a coach who guides my patients through the maze of what has become one of the largest bureaucracies in the world, the U.S. healthcare delivery system.
What do I believe is the critical success factor for patient-centeredness? The clinician must develop the skills of being a good listener. When an open-ended question is posed to the patient at the beginning of the encounter, "What can I help you with today?" or "What brings you in to see me today?", when left alone the patient will talk about their issues for around 2 minutes and stop. It is this uninterrupted time that makes the patient feel as though they have had the opportunity to become a partner in their care. This is the most critical time period that begins the cascade of patient-centered decisions and activities.
The number one reason that malpractice suits are brought against most physicians is the perception that there was a significant failure to communicate with the patient.
Making the patient the center of the healthcare universe should be our number one priority as our nation attempts to rebuild the healthcare delivery system.
The patient is the center of our universe at Nature Coast. In just a short while, patient care surveys will be done to check my perception.
Dr. Dale
Sunday, May 17, 2009
Are You Getting Effective Medical Care?
As a patient, one must always question whether you are receiving effective medical care. But as a lay person, how would you know?
The Institute of Medicine's Crossing the Quality Chasm report defines effectiveness as "care that is based on the use of systematically acquired evidence to determine whether an intervention, such as preventive service, diagnostic test, or therapy, produces better outcomes than alternatives, including the alternative of doing nothing". This definition serves as the foundation for evidence-based medicine.
I refer to evidence-based medicine as one of my 8-points of change for healthcare.It is one of the backbones for healthcare stewardship. What does it mean to receive evidence-based medicine?
Evidence-based medicine is the melding of three critical factors:
1. Best research evidence derived from laboratory experiments, clinical trials, epidemiological research, and outcomes research.
2. Clinical expertise through which the clinician uses his clinical skills and experience to rapidly evaluate each patient's unique health state, to make a diagnosis, and to recommend treatments based on knowledge of the respective risks and benefits.
3. Patient values which refers to each patient's unique preferences, concerns and expectations that are part of each clinical encounter.
The lay person may ask the question: What care is right? The clinician must be able to explain in lay terms the above three criteria in order to ensure that the care the patient is about to receive will be effective.
This is a new concept for many patients. It is new because these types of medical care help patients learn to manage their own health. It forces a dialogue between the patient and clinician in order to come to an agreement on what care is right for the patient. This is healthcare stewardship. This is what I use with my patients.
Is your doctor using it with you?
Dr. Dale
The Institute of Medicine's Crossing the Quality Chasm report defines effectiveness as "care that is based on the use of systematically acquired evidence to determine whether an intervention, such as preventive service, diagnostic test, or therapy, produces better outcomes than alternatives, including the alternative of doing nothing". This definition serves as the foundation for evidence-based medicine.
I refer to evidence-based medicine as one of my 8-points of change for healthcare.It is one of the backbones for healthcare stewardship. What does it mean to receive evidence-based medicine?
Evidence-based medicine is the melding of three critical factors:
1. Best research evidence derived from laboratory experiments, clinical trials, epidemiological research, and outcomes research.
2. Clinical expertise through which the clinician uses his clinical skills and experience to rapidly evaluate each patient's unique health state, to make a diagnosis, and to recommend treatments based on knowledge of the respective risks and benefits.
3. Patient values which refers to each patient's unique preferences, concerns and expectations that are part of each clinical encounter.
The lay person may ask the question: What care is right? The clinician must be able to explain in lay terms the above three criteria in order to ensure that the care the patient is about to receive will be effective.
This is a new concept for many patients. It is new because these types of medical care help patients learn to manage their own health. It forces a dialogue between the patient and clinician in order to come to an agreement on what care is right for the patient. This is healthcare stewardship. This is what I use with my patients.
Is your doctor using it with you?
Dr. Dale
Saturday, May 16, 2009
Prevention, Prevention, Prevention
This was a particularly difficult week for me. It seems that every patient that was seen in the office was focused on sick care and chronic disease.
I often get this statement from my patients, "If I wasn't sick, I wouldn't need to be here (i.e. doctor's office)". My other favorite, "Just fix me up, doc. I got things to do. I don't have time to be sick."
As you may already know, one of my 8-points for healthcare change is to move from a sick care system to a well care system. So lately, I have been contemplating how to get my point across to patients about preventive health and wellness. I know, as do others in the healthcare professions, that Americans do not follow advice very well about disease prevention and being well. Therefore, you have to become a Madison Avenue marketing executive and design slogans to get your patients attention.
My little wellness ditty goes like this:
Eat a healthy diet,
Move your body,
Rest your body,
Find your inner spirit,
No smoking or tobacco use,
Alcoholic beverages in moderation,
No illicit drug use,
Age-related cancer screening,
Look for the positive each day,
Take control of your health today,
Protect the environment.
Now I know it's not fancy with big words and catchful phraseology. It will probably not replace Dr. Oz's messages on Oprah. But, the message about being healthy and well must be simple. The KISS principle, Keep It Simple Stupid, works well for me. My issue is we are not coaching our patients into being healthy and well. The statistics support my opinion. We are a sick society and getting sicker in mind, body and spirit. I hope this week creates opportunities for Jim and I to work on disease prevention and health promotion. Every opportunity with a patient is an opportunity to get the wellness message out there.
Dr. Dale
I often get this statement from my patients, "If I wasn't sick, I wouldn't need to be here (i.e. doctor's office)". My other favorite, "Just fix me up, doc. I got things to do. I don't have time to be sick."
As you may already know, one of my 8-points for healthcare change is to move from a sick care system to a well care system. So lately, I have been contemplating how to get my point across to patients about preventive health and wellness. I know, as do others in the healthcare professions, that Americans do not follow advice very well about disease prevention and being well. Therefore, you have to become a Madison Avenue marketing executive and design slogans to get your patients attention.
My little wellness ditty goes like this:
Eat a healthy diet,
Move your body,
Rest your body,
Find your inner spirit,
No smoking or tobacco use,
Alcoholic beverages in moderation,
No illicit drug use,
Age-related cancer screening,
Look for the positive each day,
Take control of your health today,
Protect the environment.
Now I know it's not fancy with big words and catchful phraseology. It will probably not replace Dr. Oz's messages on Oprah. But, the message about being healthy and well must be simple. The KISS principle, Keep It Simple Stupid, works well for me. My issue is we are not coaching our patients into being healthy and well. The statistics support my opinion. We are a sick society and getting sicker in mind, body and spirit. I hope this week creates opportunities for Jim and I to work on disease prevention and health promotion. Every opportunity with a patient is an opportunity to get the wellness message out there.
Dr. Dale
Thursday, May 14, 2009
A New Approach to Quality Care
The Institute of Medicine's Crossing the Quality Chasm report described new, more beneficial approaches in providing care to patients. This new approach consists of the following:
1. Care is based on continuous healing relationships.
2. Care is customized according to patient needs and values.
3. The patient is the source of control.
4. Knowledge is shared and information flows freely.
5. Decision-making is evidence-based.
6. Safety is a system priority.
7. Transparency is necessary.
8. Needs are anticipated.
9. Waste is continuously decreased.
10. Cooperation among clinicians is a priority.
It is no longer acceptable for the health professional to control care. Doctors can no longer fly by the seat of their pants when treating patients. Secrecy can no longer be tolerated. The health system can no longer react to needs. Cost reduction over patient care is unacceptable. Is this really happening today?
There is so much going on in Washington, D.C. and all of the states' capitols regarding healthcare reform that you almost need a scorecard to keep track of all the players. What is missing from most of the conversation is this new approach to patient care. Ask yourself whether you can see this new approach being implemented the next time you make a visit to the doctor or hospital.
If you visit our health center in Williston, I can guarantee that this new approach is being adopted in our practice. We are also having an impact on health care delivery in our town.
For example, we have always had same day appointments for our patients. Just the other day, Jim mentioned to me that the doctor's practice across the street had a new sign. "What did it say?", I asked. Same day appointments. Who says you cannot lead by example. Needs of patients are being anticipated.
Dr. Dale
1. Care is based on continuous healing relationships.
2. Care is customized according to patient needs and values.
3. The patient is the source of control.
4. Knowledge is shared and information flows freely.
5. Decision-making is evidence-based.
6. Safety is a system priority.
7. Transparency is necessary.
8. Needs are anticipated.
9. Waste is continuously decreased.
10. Cooperation among clinicians is a priority.
It is no longer acceptable for the health professional to control care. Doctors can no longer fly by the seat of their pants when treating patients. Secrecy can no longer be tolerated. The health system can no longer react to needs. Cost reduction over patient care is unacceptable. Is this really happening today?
There is so much going on in Washington, D.C. and all of the states' capitols regarding healthcare reform that you almost need a scorecard to keep track of all the players. What is missing from most of the conversation is this new approach to patient care. Ask yourself whether you can see this new approach being implemented the next time you make a visit to the doctor or hospital.
If you visit our health center in Williston, I can guarantee that this new approach is being adopted in our practice. We are also having an impact on health care delivery in our town.
For example, we have always had same day appointments for our patients. Just the other day, Jim mentioned to me that the doctor's practice across the street had a new sign. "What did it say?", I asked. Same day appointments. Who says you cannot lead by example. Needs of patients are being anticipated.
Dr. Dale
Monday, May 11, 2009
Six Aims for Quality Transformation of Healthcare Delivery
The Institute of Medicine (IOM), established in 1970 under the charter of the National Academy of Sciences, serves as adviser to the nation to improve the health of all Americans. The Institute provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector and the public.
In 2001, the IOM released a landmark report, Crossing the Quality Chasm: A New Health System for the 21st Century.The report expounded on the needed focus related to specific quality issues and accompanying changes in the U.S. healthcare delivery system that are required. Specifically, the report indicated that all "healthcare organizations...should adopt as their explicit purpose to continually reduce the burden of illness, injury and disability and to improve the health and functioning of the people of the United States".
To close the widening quality chasm in the U.S. healthcare delivery system, the IOM report recommended that healthcare should focus on these six aims: patient safety, effectiveness, patient-centeredness, timeliness, efficiency and equitability. The report notes that focusing on these six aims will begin a transformation in our current national healthcare delivery system. This transformation will require a systematic re-design of current healthcare systems and processes of care.
I am in complete agreement with this report. I have written about the report in my books. In fact, you might say that these six aims of transformation have become my guiding force for clinical activity at Nature Coast Regional Health System. What all the stakeholders in our national healthcare system need to realize is that this report is applicable at all levels of patient care; from the individual practitioner to the largest of all the healthcare delivery systems in this country.It transcends all the local, state, regional and national healthcare bureaucracies because it is all about the patient. If I can adopt the recommendations of this report in a small rural health system, others in a similar situation should be able to do the same. It needs to become a grass roots effort at the smallest level to rise up and create the groundswell for national transformation. I am assuming that President Obama's advisers have read this report. If not, it needs to be brought out again into the mainstream media to shock the consciousness of all Americans.
My next blog will describe the report's new, more beneficial approach to providing patient care.
Dr. Dale
In 2001, the IOM released a landmark report, Crossing the Quality Chasm: A New Health System for the 21st Century.The report expounded on the needed focus related to specific quality issues and accompanying changes in the U.S. healthcare delivery system that are required. Specifically, the report indicated that all "healthcare organizations...should adopt as their explicit purpose to continually reduce the burden of illness, injury and disability and to improve the health and functioning of the people of the United States".
To close the widening quality chasm in the U.S. healthcare delivery system, the IOM report recommended that healthcare should focus on these six aims: patient safety, effectiveness, patient-centeredness, timeliness, efficiency and equitability. The report notes that focusing on these six aims will begin a transformation in our current national healthcare delivery system. This transformation will require a systematic re-design of current healthcare systems and processes of care.
I am in complete agreement with this report. I have written about the report in my books. In fact, you might say that these six aims of transformation have become my guiding force for clinical activity at Nature Coast Regional Health System. What all the stakeholders in our national healthcare system need to realize is that this report is applicable at all levels of patient care; from the individual practitioner to the largest of all the healthcare delivery systems in this country.It transcends all the local, state, regional and national healthcare bureaucracies because it is all about the patient. If I can adopt the recommendations of this report in a small rural health system, others in a similar situation should be able to do the same. It needs to become a grass roots effort at the smallest level to rise up and create the groundswell for national transformation. I am assuming that President Obama's advisers have read this report. If not, it needs to be brought out again into the mainstream media to shock the consciousness of all Americans.
My next blog will describe the report's new, more beneficial approach to providing patient care.
Dr. Dale
Sunday, May 10, 2009
Quality-Driven Healthcare: Doing the right...
Quality-driven healthcare delivery is and will always be a difficult subject to tackle. Everyone has an opinion. Patients, providers, health insurance, government and other stakeholders debate and write on this topic daily.
All of my patients in Williston have their own ideas on what constitutes quality health care. To many, it is really just sitting down and the doctor taking time to hear about what "ails" them. To others, it is more about making the correct diagnosis, initiating the proper treatment, and getting them better. Better to go back to work, better to back to school, and better to go on with their lives.
I guess, the easiest way to describe what is quality-driven healthcare may be summed up in the following way:
Doing the right thing (need);
In the right amount (cost);
At the right time (when needed);
In the right way (appropriate);
Producing the best possible results for the patient (outcome).
I like this the best to describe quality-driven healthcare. It covers everything. However, it is really too simplistic an approach for everyone to agree on as to using it as the driving force for quality-driven healthcare services. In the next several blogs, I will explore and discuss more in depth what has become the accepted approach to quality-driven healthcare in this country.
I wrote about this approach extensively in Healthcare Stewardship. This accepted approach for quality-driven healthcare is what I believe will save healthcare in this country.
But for now, let's all learn about doing the right...
Dr. Dale
All of my patients in Williston have their own ideas on what constitutes quality health care. To many, it is really just sitting down and the doctor taking time to hear about what "ails" them. To others, it is more about making the correct diagnosis, initiating the proper treatment, and getting them better. Better to go back to work, better to back to school, and better to go on with their lives.
I guess, the easiest way to describe what is quality-driven healthcare may be summed up in the following way:
Doing the right thing (need);
In the right amount (cost);
At the right time (when needed);
In the right way (appropriate);
Producing the best possible results for the patient (outcome).
I like this the best to describe quality-driven healthcare. It covers everything. However, it is really too simplistic an approach for everyone to agree on as to using it as the driving force for quality-driven healthcare services. In the next several blogs, I will explore and discuss more in depth what has become the accepted approach to quality-driven healthcare in this country.
I wrote about this approach extensively in Healthcare Stewardship. This accepted approach for quality-driven healthcare is what I believe will save healthcare in this country.
But for now, let's all learn about doing the right...
Dr. Dale
Wednesday, May 6, 2009
A Story to Guide Us All
From time to time, I have opened a lecture or talk with a story I discovered on the Internet many years ago. It has served as my guiding force and helped me create my tag line for my medical consulting company. The story goes like this:
One evening, a health care executive sat reading his company's annual financial report. His young son was not amused. He was bored and wanted his dad's undivided attention. "I've got nothing to do!" he cried. The health care executive tore out the last page of the financial statements from the report. "Here", he said to his son. "Draw on the back of this for a while". His young,eager son grabbed the paper and off he went.
A few minutes later, the boy returned. Proudly, he showed his father the simple stick figure he had just drawn. The executive smiled, but he had hoped the drawing activity would have occupied more of his son's time. "What may I do next?" his son asked.
The father thought to himself. "A puzzle, my son likes to work on puzzles". He turned over his son's drawing to the complicated financial statement. "If I tear this into little pieces, can you put all the numbers back together for me?" he asked his son. His son was just as eager to please his father and agreed to the task. "This should take him at least an hour", the executive thought.
Soon after, his son returned with the page taped together. The executive was amazed. "How did you put all those numbers together so quickly?" he asked. "Simple", said the son. The young boy turned the page over to show the stick figure on the back."I just put the person back together, and those numbers took care of themselves."
How powerful a statement. If you take care of people, the financials will take care of themselves. This has been my company's tag line for years. This is the full embodiment of healthcare stewardship. We must take politics and profitability out of the equation to fix our broken national healthcare delivery system. It is my belief along with many others that we have to get back to taking care of people. I agree with the following: No measure, no manage; no manage, no margin; no margin, no mission. But at what expense? Have we lost are willingness to do the right thing for our fellow man? Are we that myopic a society to have allowed ourselves to focus on the margin and not on our patients in healthcare delivery? My tag line should become our national healthcare mantra. It isn't too late, or is it?
Dr. Dale
One evening, a health care executive sat reading his company's annual financial report. His young son was not amused. He was bored and wanted his dad's undivided attention. "I've got nothing to do!" he cried. The health care executive tore out the last page of the financial statements from the report. "Here", he said to his son. "Draw on the back of this for a while". His young,eager son grabbed the paper and off he went.
A few minutes later, the boy returned. Proudly, he showed his father the simple stick figure he had just drawn. The executive smiled, but he had hoped the drawing activity would have occupied more of his son's time. "What may I do next?" his son asked.
The father thought to himself. "A puzzle, my son likes to work on puzzles". He turned over his son's drawing to the complicated financial statement. "If I tear this into little pieces, can you put all the numbers back together for me?" he asked his son. His son was just as eager to please his father and agreed to the task. "This should take him at least an hour", the executive thought.
Soon after, his son returned with the page taped together. The executive was amazed. "How did you put all those numbers together so quickly?" he asked. "Simple", said the son. The young boy turned the page over to show the stick figure on the back."I just put the person back together, and those numbers took care of themselves."
How powerful a statement. If you take care of people, the financials will take care of themselves. This has been my company's tag line for years. This is the full embodiment of healthcare stewardship. We must take politics and profitability out of the equation to fix our broken national healthcare delivery system. It is my belief along with many others that we have to get back to taking care of people. I agree with the following: No measure, no manage; no manage, no margin; no margin, no mission. But at what expense? Have we lost are willingness to do the right thing for our fellow man? Are we that myopic a society to have allowed ourselves to focus on the margin and not on our patients in healthcare delivery? My tag line should become our national healthcare mantra. It isn't too late, or is it?
Dr. Dale
Monday, May 4, 2009
Providing Health Care as a Family Physician
Family physicians in small towns have a difficult job. You are often the go to person for everything health care related. Even if you cannot help the patient, you are the first one sought out for advice. Our practice in Williston provides so many different functions.
On the patient level, I provide my patients personal health care used in diagnosing and treating illness. My focus is on the patient rather than the disease requiring me to understand patient's goals for health and balancing my treatment plan's intensity with quality of life issues. I try at all times to focus my treatment decisions with the goals of the patient. From a healthcare stewardship perspective, I only order those tests that will enhance my ability to make a diagnosis or treat the patient more effectively. Trust and understanding allows for the development of a continuous healing relationship. All of this is done within the context of the family and the community.
On the health care system level, I serve as the initial point of entry for my patient's evaluation of medical issues. After the triage is performed, I attempt to match my patient's needs with the available resources without trying to over- or undertreat my patient. Coordinating health care services as required allows me to place my patient appropriately in the hands of a specialist when I believe it is required after careful history, physical examination and appropriate testing suggests I cannot care for my patient within the scope of my training and experience. This is my contribution to health care stewardship as it relates to healthcare resource utilization.
On the population level, I direct my patients to appropriate levels of care beyond primary care for secondary and tertiary services such as cardiac catheterization for unstable angina or chemotherapy for cancer. Providing immunizations for my patients helps to stop the spread of communicable disease and assists the public health functions required of all family physicians.
It is not always easy to follow healthcare stewardship principles and practices. Sometimes you just have to say "no" to the request for the MRI of the back with a minor strain or "no" to the prescribing of the antibiotic for a viral illness. I believe patients for the most part respect your judgment as long as you can justify your decisions based on the evidence. Your patients do not need an entire course on anatomy or pathology but a little detail can go along way in helping patients becomes stewards as well.
I had a great day in the office today. Many of the patients received the medical care they needed, not necessarily the medical care they wanted.
Dr. Dale
On the patient level, I provide my patients personal health care used in diagnosing and treating illness. My focus is on the patient rather than the disease requiring me to understand patient's goals for health and balancing my treatment plan's intensity with quality of life issues. I try at all times to focus my treatment decisions with the goals of the patient. From a healthcare stewardship perspective, I only order those tests that will enhance my ability to make a diagnosis or treat the patient more effectively. Trust and understanding allows for the development of a continuous healing relationship. All of this is done within the context of the family and the community.
On the health care system level, I serve as the initial point of entry for my patient's evaluation of medical issues. After the triage is performed, I attempt to match my patient's needs with the available resources without trying to over- or undertreat my patient. Coordinating health care services as required allows me to place my patient appropriately in the hands of a specialist when I believe it is required after careful history, physical examination and appropriate testing suggests I cannot care for my patient within the scope of my training and experience. This is my contribution to health care stewardship as it relates to healthcare resource utilization.
On the population level, I direct my patients to appropriate levels of care beyond primary care for secondary and tertiary services such as cardiac catheterization for unstable angina or chemotherapy for cancer. Providing immunizations for my patients helps to stop the spread of communicable disease and assists the public health functions required of all family physicians.
It is not always easy to follow healthcare stewardship principles and practices. Sometimes you just have to say "no" to the request for the MRI of the back with a minor strain or "no" to the prescribing of the antibiotic for a viral illness. I believe patients for the most part respect your judgment as long as you can justify your decisions based on the evidence. Your patients do not need an entire course on anatomy or pathology but a little detail can go along way in helping patients becomes stewards as well.
I had a great day in the office today. Many of the patients received the medical care they needed, not necessarily the medical care they wanted.
Dr. Dale
Sunday, May 3, 2009
What does a Family Physician do?
What does a family physician do? I am asked this question regularly today. Much more often than 20 years ago. Everyone knows that specialty medicine has been growing for years. Unfortunately, even family physicians have begun to specialize. Hospitalists, sports medicine, urgent care, and ambulatory medicine are just a few of the areas that family physicians have gravitated to over the years. The family doctor is rapidly moving towards extinction. My partner Jim Long, PA-C and I are trying to stop this trend in Williston.
According to the American Academy of Family Medicine (AAFP), the definition of family medicine was updated in 2005 to the following:
A medical specialty which provides continuing, comprehensive health care for the individual and family. It is a specialty in breadth that integrates the biological, clinical and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity.
In 2008, the AAFP expanded their definition with the following:
Family medicine is a three-dimensional specialty, incorporating (1) knowledge, (2) skill and (3) process. Although knowledge and skill may be shared with other specialties, the family medicine process is unique. At the center of this process is the patient-physician relationship with the patient viewed in the context of the family. It is the extent to which this relationship is valued, developed, nurtured and maintained that distinguishes family medicine from all other specialties.
When I came to Nature Coast Regional Health System, fragmentation of the local healthcare delivery system was evident. Most of the physicians in the area were practicing ambulatory medicine only. Adults were seen in some practices and children went to others. The hospital in Williston had only 1 physician on its medical staff. Admissions to the hospital were far and few between. Patients told me that they were traveling to Gainesville 30 miles away to get their diagnostic studies, labs, and specialty medical care. Williston is a rural community. Where was the family doc?
A great deal is changing at our health system nine months later. Comprehensive, continuous, patient-centered care is becoming the norm. Patients' are happy to get as much of their care by their family doctor (i.e., me and Jim) as can be provided in Williston. Patient admissions to the hospital are up. Patients are getting their labs and diagnostic studies (i.e.,x-ray, ct scan, ultrasound, labs, etc) in our hospital. Specialty medicine has come to Williston (e.g., Orthopedics) to see patients in our family health center. Complementary and alternative medicine is finding its way to Williston, as well, with chiropractic, acupuncture and midwifery setting up shop in our family health center. Unattached patients ( i.e., patients without a family doctor) are joining our practice after admission to the hospital because they understand the value of having "their family doc" attend them regardless of the venue for medical care. This is how following the principles and practices of healthcare stewardship can make a difference with respect to quality, cost and access. Providing evidence-based medicine in a lower cost venue with easy and friendly accessibility to health care services is healthcare stewardship at its best. Healthcare stewardship requires primary care physicians to be able to function at the patient level, health system level and population level. What are the health care functions provided by primary care that will contribute to healthcare stewardship? More on this later in my next blog.
Dr. Dale
According to the American Academy of Family Medicine (AAFP), the definition of family medicine was updated in 2005 to the following:
A medical specialty which provides continuing, comprehensive health care for the individual and family. It is a specialty in breadth that integrates the biological, clinical and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity.
In 2008, the AAFP expanded their definition with the following:
Family medicine is a three-dimensional specialty, incorporating (1) knowledge, (2) skill and (3) process. Although knowledge and skill may be shared with other specialties, the family medicine process is unique. At the center of this process is the patient-physician relationship with the patient viewed in the context of the family. It is the extent to which this relationship is valued, developed, nurtured and maintained that distinguishes family medicine from all other specialties.
When I came to Nature Coast Regional Health System, fragmentation of the local healthcare delivery system was evident. Most of the physicians in the area were practicing ambulatory medicine only. Adults were seen in some practices and children went to others. The hospital in Williston had only 1 physician on its medical staff. Admissions to the hospital were far and few between. Patients told me that they were traveling to Gainesville 30 miles away to get their diagnostic studies, labs, and specialty medical care. Williston is a rural community. Where was the family doc?
A great deal is changing at our health system nine months later. Comprehensive, continuous, patient-centered care is becoming the norm. Patients' are happy to get as much of their care by their family doctor (i.e., me and Jim) as can be provided in Williston. Patient admissions to the hospital are up. Patients are getting their labs and diagnostic studies (i.e.,x-ray, ct scan, ultrasound, labs, etc) in our hospital. Specialty medicine has come to Williston (e.g., Orthopedics) to see patients in our family health center. Complementary and alternative medicine is finding its way to Williston, as well, with chiropractic, acupuncture and midwifery setting up shop in our family health center. Unattached patients ( i.e., patients without a family doctor) are joining our practice after admission to the hospital because they understand the value of having "their family doc" attend them regardless of the venue for medical care. This is how following the principles and practices of healthcare stewardship can make a difference with respect to quality, cost and access. Providing evidence-based medicine in a lower cost venue with easy and friendly accessibility to health care services is healthcare stewardship at its best. Healthcare stewardship requires primary care physicians to be able to function at the patient level, health system level and population level. What are the health care functions provided by primary care that will contribute to healthcare stewardship? More on this later in my next blog.
Dr. Dale
Wednesday, April 29, 2009
Patient loyalty and healthcare stewardship
Practicing in a small rural community is challenging. Word spreads quickly regarding the quality of medical care available in the community.Williston,Florida is no exception.
Teddy Roosevelt is famous for this unforgettable saying,"Speak softly and carry a big stick". I have tried to obey this edict for years but I really trusted it beginning with my very first day at Nature Coast Regional Hospital. It was my hope to come to the hospital with very little fanfare. Many physicians had come and gone before me and the perception in our community of the hospital and family health center (aka, the clinic) was poor regarding the quality of medical care available.
I started out working several shifts each week in our emergency department. I admitted patients to our hospital and followed them on the floor during their stay. I offered to be their family physician upon discharge in our family health center. Most importantly, I did this under the cover of silence. My goal was to allow word of mouth to spread about the new doctor in town and the quality of care being delivered.
Patient loyalty is much different than patient satisfaction. When patients are satisfied, they are happy with their medical care but they really wouldn't go to the ends of the earth to see "the physician". When patients become loyal, the physician becomes "their physician" and they would travel great distances just to have that one-on-one interaction because there is no other.
Dr. Joe Inguanzo in a recent article on customer loyalty in Hospitals and Health Networks , stated that over the last 25 years, an average of 80 percent of consumers have consistently laid claim to a hospital they would call their "own." More than half of the top 10 reasons consumers prefer a certain hospital center on some form of loyalty: they have always gone there; there is a strong perception of personalized care; a doctor recommended the hospital; perceptions of overall reputation are positive; they or a friend or relative works there; patients' experiences with staff are memorable.
Patient loyalty is a critical element for establishing healthcare stewardship. When patients become loyal, there willingness to buy into the process of healthcare stewardship is much easier. They can be molded into more respectful consumers of healthcare goods and services. Preventive care and wellness become the focus of office visits with fewer and fewer visits for sick care. Emergency room visits go down dramatically and are replaced with many more outpatient encounters. The patient-centered medical home becomes a reality for the busy practitioner.
Nine months have passed since I arrived at Nature Coast Regional Health System.
We are starting to act like a health system and not a fragmented hospital with a dysfunctional "clinic". My partner Jim Long, PA-C, and I are constantly amazed at how quickly we have developed patient loyalty. This month, we will have surpassed over 800 encounters in our family health center. Our average daily census grows in the hospital. We see an average of 20 patients at our local nursing home each week. People are no longer driving away from Williston but they are driving to our community to get their health care. Quality, cost and access are being followed closely and Jim and I are winning the war. Hard work, dedicated staff, caring and kindness are becoming the norm in our health system. Healthcare Stewardship is alive and thriving in Williston.
Dr. Dale
Teddy Roosevelt is famous for this unforgettable saying,"Speak softly and carry a big stick". I have tried to obey this edict for years but I really trusted it beginning with my very first day at Nature Coast Regional Hospital. It was my hope to come to the hospital with very little fanfare. Many physicians had come and gone before me and the perception in our community of the hospital and family health center (aka, the clinic) was poor regarding the quality of medical care available.
I started out working several shifts each week in our emergency department. I admitted patients to our hospital and followed them on the floor during their stay. I offered to be their family physician upon discharge in our family health center. Most importantly, I did this under the cover of silence. My goal was to allow word of mouth to spread about the new doctor in town and the quality of care being delivered.
Patient loyalty is much different than patient satisfaction. When patients are satisfied, they are happy with their medical care but they really wouldn't go to the ends of the earth to see "the physician". When patients become loyal, the physician becomes "their physician" and they would travel great distances just to have that one-on-one interaction because there is no other.
Dr. Joe Inguanzo in a recent article on customer loyalty in Hospitals and Health Networks , stated that over the last 25 years, an average of 80 percent of consumers have consistently laid claim to a hospital they would call their "own." More than half of the top 10 reasons consumers prefer a certain hospital center on some form of loyalty: they have always gone there; there is a strong perception of personalized care; a doctor recommended the hospital; perceptions of overall reputation are positive; they or a friend or relative works there; patients' experiences with staff are memorable.
Patient loyalty is a critical element for establishing healthcare stewardship. When patients become loyal, there willingness to buy into the process of healthcare stewardship is much easier. They can be molded into more respectful consumers of healthcare goods and services. Preventive care and wellness become the focus of office visits with fewer and fewer visits for sick care. Emergency room visits go down dramatically and are replaced with many more outpatient encounters. The patient-centered medical home becomes a reality for the busy practitioner.
Nine months have passed since I arrived at Nature Coast Regional Health System.
We are starting to act like a health system and not a fragmented hospital with a dysfunctional "clinic". My partner Jim Long, PA-C, and I are constantly amazed at how quickly we have developed patient loyalty. This month, we will have surpassed over 800 encounters in our family health center. Our average daily census grows in the hospital. We see an average of 20 patients at our local nursing home each week. People are no longer driving away from Williston but they are driving to our community to get their health care. Quality, cost and access are being followed closely and Jim and I are winning the war. Hard work, dedicated staff, caring and kindness are becoming the norm in our health system. Healthcare Stewardship is alive and thriving in Williston.
Dr. Dale
Monday, April 27, 2009
Healthcare Stewardship: An Eight Point Plan for Change
What is stewardship?
The notion of stewardship is an ethically-driven responsibility for protecting and developing one's limited resources. There is no real ownership of the resources by stakeholders, just borrowing. Therefore, stewardship is the careful and responsible management of borrowed resources that promote people's well being.
What is a steward?
A steward must provide the necessary leadership to establish the rules by which all stakeholders behave in ways that reflect the interests of both public and private sectors. Stewards must then ensure corrective action when behavior by stakeholders becomes aberrant and potentially harmful to the population served.
What is the main goal of Stewardship?
Finally, stewardship's main goal is to help the population being served achieve positive outcomes whilst carefully managing the limited resources available.
Applying stewardship to health care delivery systems.
Applying the concepts of stewardship to present-day issues facing health care delivery systems today creates the careful, well-constructed opportunity of managing borrowed and limited health care resources in a transparent, socially responsible manner. It is with this in mind and using the concept of stewardship as my guiding principle , that I have created an 8-point plan for health care change for our U.S. healthcare delivery system.
My 8-point plan consists of the following:
Slide 17 I am aware that these are lofty goals. They are all applicable to the current crisis that confronts all the stakeholders of the U.S. healthcare delivery system. Now is the time for a major paradigm shift in healthcare delivery at all levels. It is not too late. It will be too late if we do not change now. After all, it really is about the patient.
Dr. Dale
Slide 13 Slide 14
The notion of stewardship is an ethically-driven responsibility for protecting and developing one's limited resources. There is no real ownership of the resources by stakeholders, just borrowing. Therefore, stewardship is the careful and responsible management of borrowed resources that promote people's well being.
What is a steward?
A steward must provide the necessary leadership to establish the rules by which all stakeholders behave in ways that reflect the interests of both public and private sectors. Stewards must then ensure corrective action when behavior by stakeholders becomes aberrant and potentially harmful to the population served.
What is the main goal of Stewardship?
Finally, stewardship's main goal is to help the population being served achieve positive outcomes whilst carefully managing the limited resources available.
Applying stewardship to health care delivery systems.
Applying the concepts of stewardship to present-day issues facing health care delivery systems today creates the careful, well-constructed opportunity of managing borrowed and limited health care resources in a transparent, socially responsible manner. It is with this in mind and using the concept of stewardship as my guiding principle , that I have created an 8-point plan for health care change for our U.S. healthcare delivery system.
My 8-point plan consists of the following:
- Establish a basic healthcare package for all Americans
- Move from a sick-care system to a well-care system
- Use evidence-based medicine
- Require insurance companies to put patients first
- Encourage physicians and patients to use healthcare resources wisely
- Get doctors in the trenches involved
- Establish a national database for healthcare information
- Create a national agency to promote transparency and accountability regarding healthcare outcomes
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Dr. Dale
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Saturday, April 25, 2009
Rural Medicine Crisis, 2009
Jon Bailey of The Center for Rural Affairs in Lyons, Nebraska, recently highlighted in the center's newsletter this past February a top 10 list of health care issues facing rural America today.
This list is not an all inclusive identification of issues but I must say it is right on the mark. Many of the issues I have been managing for the last 9 months at Nature Coast Regional Health System are related to Bailey's list.
The top 10 list is as follows:
I remind everybody who works on our team that "it is what it is". We must work smarter and not necessarily harder in order to provide our patients with the patient-centered medical home they so readily deserve. The patient is our center of the universe and our focus on the patient cannot waiver even during the most trying of times.
Dr. Dale
This list is not an all inclusive identification of issues but I must say it is right on the mark. Many of the issues I have been managing for the last 9 months at Nature Coast Regional Health System are related to Bailey's list.
The top 10 list is as follows:
- An economy based on self-employment and small businesses
- A growing dependence on and need for public health insurance plans
- A stressed rural health care delivery system
- A healthcare provider and workforce shortage
- An aging rural population
- A sicker and more at risk population
- A need for disease prevention, health promotion and wellness resources
- A lack of mental health services
- A rising dependency on health technology
- An effective emergency medical system
I remind everybody who works on our team that "it is what it is". We must work smarter and not necessarily harder in order to provide our patients with the patient-centered medical home they so readily deserve. The patient is our center of the universe and our focus on the patient cannot waiver even during the most trying of times.
Dr. Dale
Wednesday, April 22, 2009
Welcome to Healthcare Stewardship
Welcome to my blog about healthcare stewardship.
It is my hope to introduce many to the concept of healthcare stewardship. We are entering into a very exciting time in healthcare delivery. I decided about 18 months ago to write a book on this topic. What I thought would be a textbook, Healthcare Stewardship, actually evolved into a potential script for shaping healthcare delivery in the United States. I have taken many of my ideas, supported by others who have written before me, and began applying them in a small rural hospital in Williston, Florida. As the days continue, I hope to be able to chronicle how we are saving this small rural hospital from extinction just like the many that are going away as we speak. Stay with me on my journey and provide me with your thoughts. May we all become healthcare stewards.
Dr. Dale
It is my hope to introduce many to the concept of healthcare stewardship. We are entering into a very exciting time in healthcare delivery. I decided about 18 months ago to write a book on this topic. What I thought would be a textbook, Healthcare Stewardship, actually evolved into a potential script for shaping healthcare delivery in the United States. I have taken many of my ideas, supported by others who have written before me, and began applying them in a small rural hospital in Williston, Florida. As the days continue, I hope to be able to chronicle how we are saving this small rural hospital from extinction just like the many that are going away as we speak. Stay with me on my journey and provide me with your thoughts. May we all become healthcare stewards.
Dr. Dale
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