Wednesday, December 05, 2018

Sharing Hope


Sharing Hope
Valerie J Connor, MA CCC-SLP, MS CHES

The holiday season is often filled with wonder and hope.  Most of us enter this season looking forward to family gatherings, fun activities, and plenty of good food.  However, this is also a time of year that is difficult for many individuals – those going through major life changes or facing difficult illness might have trouble embracing the holidays.  While celebrations abound for some, others start to lose hope.

What is hope?  There are actually two different definitions of hope.  One is “a feeling of expectation and desire for a certain thing to happen.”  The older, more biblical definition of hope is “trust”.  The word “hope” is often referenced in the bible during times of dire circumstances.  Individuals expressing hope not only have expectations and desires, but they also trust their situation will improve despite evidence otherwise.

As healthcare professionals, we meet patients who are experiencing dire circumstances.  Whether it’s a illness, an unfortunate accident, or an emergency procedure, most individuals would rather not choose to seek our services – especially during the holiday season.  When this happens, we are poised with the unique opportunity of providing hope. 

There are several ways healthcare professionals can provide hope in an ethical manner.  Just a few suggestions include:

1.  Communicate effectively.  The most common concern patients express in both acute and rehab care is frustration with communication.  Taking time to keep patients informed is one way to gain their trust and provide hope.
2.  Commit to sit.  Studies have shown that the simple act of sitting with a patient increases their perception of the length of time the caregiver spent with them.
3.  Focus on safety.  Explain procedures that might seem redundant to remind patients their safety is of utmost importance.   
4.  Focus on the human element.  In healthcare, the numbers and data are important, but it’s just as necessary to remember that we are dealing with human emotions.  Keeping this in mind is crucial if we want to give patients hope.

Of course, it’s important not to provide false promises, but hope is not a promise.  It’s trust and assurance that patients can depend on their healthcare team during the worst of circumstances.  This holiday season, let’s not just focus on providing excellent care for patients, let’s also give them hope.

Thursday, November 15, 2018

What is High Reliability?


What Is High Reliability?

High Reliability occurs when organizations operate consistently, without harm or catastrophic events over a long period of time. It is a philosophy that organizations adapt that, at its heart, embraces a collective, persistent mindfulness. Organizations and businesses that adapted principles of high reliability are the aviation and nuclear power industries, to name two. Studying these organizations and the principles they put in place for high levels of consistent safety has greatly influenced the adaption of those same principles and characteristics in healthcare quality and safety.
Leaders in a Highly Reliable Organization (HRO) recognize that the key to high reliability is firmly establishing and nourishing a culture of safety. This culture must be the foundation for “whole system safety.”  Often, healthcare organizations put processes in place that encourage communication and team involvement, to push forward specific performance improvement projects. Instead, safety must be part of the overall culture and embraced at a systems level. Every individual in the organization becomes a part of this systems approach to safety. Continuous learning, monitoring and enhancing processes becomes the overall philosophy and frame of mind for the HRO. This systems approach is seen in the strong principles of leadership that encourages teamwork and ultimately, behavior change, rather than focusing just on a particular technology, team or process.
High reliability can be seen in five principles first named by Weick and Sutcliffe,  and are adapted by HROs to achieve consistently high levels of safety. The first three elements or characteristics focus on the anticipation of failure. The last two underline the importance of committing to the containment of errors and failure.
Characteristics of High Reliable Organizations include:
1.        Preoccupation With Failure. Always alert to what might happen, high reliability embraces the constant search for where things might fail or go wrong. Everyone in the organization is vigilant, and attentive to small problems that might become opportunities for improvement.
2.       Resist the Temptation to Simplify. By being reluctant to accept work processes at face value, employees in an HRO understand the complexity and subtle differences that on the surface seem safe, but underneath can challenge safety.
3.       Sensitivity to Operations. It is crucial that all members of an organization are involved in operations and feel empowered to report deviations and feel safe to speak freely at any time.
4.       Deference to Expertise. In a crisis or emergency the people with the greatest knowledge are not necessarily the people with the greatest authority for decision making. Those individuals that have the most understanding of a threat or process are empowered to offer their unique expertise. This characteristic puts less emphasis on the established hierarchy and places importance on the climate of shared responsibility.
5.       Commitment to Resilience. Teams in HROs respond quickly to system failures, understanding that if error does happen, it is recognized quickly, and dealt with appropriately. This both prevents harm at the time of error identification, and prevents further errors.
The goal in attaining high reliability in healthcare means creating a safety culture that informs and drives all operations in an organization. Leadership must be completely committed to the constantly evolving playbook that looks for failure, quickly implements new processes, and rewards committed and involved individuals and teams.

Spath, P. (2018). Introduction to Healthcare Quality Management. Third Edition. Chicago: Health Administration Press.

Patient Safety Network. High Reliability. Agency for Healthcare Research and Quality Website. https://psnet.ahrq.gov/primers/primer/31/high-reliability

Chassin, M., Loeb, J. (2013). High-reliability health care: Getting there from here. The Milbank Quarterly. 91(3), p459-490.

Federico, F. (2018). Is your organization highly reliable? Healthcare Executive. 13(1): 76-79.

Brynes, J., Teman, S. (2018). The Need for High Reliability. In The Safety Playbook: A healthcare leader’s guide to building a high-reliability organization. Health Administration Press. 29-33.

Katie Cross, MSN, RNC-OB, LCCE

Sunday, November 04, 2018

Genetic Testing…and Me


Genetic Testing…and Me

Written by: Valerie J Connor, MA CCC-SLP, MS CHES

Some years go quickly and are just as quickly forgotten.  Others stick with you because they were memorable.  For example, I specifically remember 2nd grade because I survived the chicken pox and our family took an amazing trip to Washington D.C.  I also specifically recall 6th grade, because my younger brother was born.  Of course, 2001 and 2004, will always be important, as those were the years that my children were born.  The other years are pretty much a blur of jumbled memories.  This year – 2018 – will likely stick with me for the rest of my life.  It is the year I found out I am a carrier of the BRCA2 gene mutation.

Over 10 years ago, my dad’s first cousin lost her battle with ovarian and breast cancer.  Before she died, she decided to get genetically tested.  Keep in mind, this was relatively new technology and not widely done, so I consider her to be a bit of a trailblazer.  Her genetic tests results inspired her sister and brother to be tested, along with my dad’s sister – my aunt (Doris).  Doris tested positive for the BRCA2 gene mutation.  She encouraged my dad to be tested, but he was hesitant.  The topic came up in general conversation, but I was young, busy with two small children, and not too concerned.

Jump ahead about 12 years.  During this time, my aunt did everything right.  Due to a previous hysterectomy, she no longer had her ovaries, so ovarian cancer was not a concern.  She was considered “high risk”, so she alternated mammograms with MRI testing every six months.  She consulted with an oncologist who prescribed various anti-cancer medications as the years progressed.  In 2018, a small tumor was found during a routine MRI.  Within weeks, a double mastectomy with reconstruction was scheduled.  Fortunately for Doris, the cancer did not spread and no extra treatments were required. 

As soon as my aunt was diagnosed with breast cancer, my health and wellbeing took front stage.  I immediately called my primary care physician who referred me to a genetic counselor through Genesis Health Systems.  I honestly didn’t even know that position existed and I work for Genesis.  My spit was collected and shipped off to the same genetic testing facility my aunt’s doctor had used.  Apparently, it is helpful if you use the same testing facility so they can compare results – it reduces false positives.  Depending on how you look at it, I lost the genetic lottery.  There was a 50/50 chance I carried the gene mutation, and I was on the losing 50%.

Since that time, I have had an oophorectomy – removal of both ovaries and fallopian tubes.  BRCA2 gene mutation carriers have a 45% chance of developing ovarian cancer, but ovarian cancer is difficult to detect.  Once it’s detected, it’s extremely hard to treat.  The decision to remove my ovaries was simple.  Once the ovaries were removed, my risk of developing breast cancer went from 85% to 45%.  Although I miss estrogen coursing through my body, apparently it is not helpful to people with the BRCA2 gene mutation.

Yesterday I had my first (and possibly last) breast MRI.  I meet with a surgeon in a few weeks and we’ll discuss options.  I haven’t completely decided yet, but I don’t relish the thought of taking anti-cancer drugs or getting tested every 6 months.  I’m more of a “just fix it and forget it,” type gal, so I’m leaning toward surgical options.
However, just because I remove my ovaries and breasts, I won’t be completely free of cancer risks.  I’m still at high risk for pancreatic cancer. 

I’ve spoken about this journey with many people over the last few months.  The reactions are a mix of sympathy and questions.  I encourage everyone to consider professional genetic testing if there is familial history of cancer.  Pop-science versions are available, but these tests might only look at very specific genetic markers and not the entire spectrum.  Also, once you send off your DNA to a service such as 23andme, you lose all rights to privacy.  With professional genetic testing, your DNA results are protected by HIPAA’s Privacy Rule, as well as a slew of other ethical protections.

The genetic counselors at Genesis were amazing at asking all the right questions and pointing me in the right direction.  Testing was completely covered by my insurance, as have the subsequent doctors visits and surgery.  It’s empowering to have all this knowledge at my disposal.  I can be pro-active and make decisions without the complications of fear and urgency.

Eventually, my two kids will have to be tested.  BRCA2 is a cancer that develops later in life, so there is no rush.  They also have a 50/50 percent chance of inheriting the gene mutation.  I sincerely hope they win the genetic lottery.