Case - Objective of an Exceptional CMIO

“Communication is essential if we are to transform into a value-based health system (Gordon, Deland, & Kelly, 2015).” In today’s healthcare system there are many barriers of communication that must be addressed. Some of the major concerns are inter-organizational communication, patient education, and discharge communication. The lack of clarity between provider to provider or provider to patient can be life threatening for the patient or lead to higher re-admission rates. With the new focus on managed care, organizations need to develop standards of communication. This will help to improve cost of care and improve the overall care of the patient.

As a Chief Medical Officer (CMO), the primary concern would be to develop a plan to educate the patient. One proposed method that would be essential is “Teach Back”. According to Gordon, Deland, and Kelly, (2015) this method of patient education requires that patients summarize information that was given to them. This method allows a patient to explain what they understood and creates an open dialogue between the patient and the care team to develop a better pathway of communication. Moreover, this allows the patient to understand exactly what the care plan is and overtime can influence patient outcome. As a CMO I would also look at technology and what are we doing post discharge to monitor the patients care. An integral part of patient care is post-discharge communication. As a part of a health system it would be important to have a patient health record (PHR) that allows access for the patient to communicate with their care team post discharge. This tool should be used with a standard twenty-four-hour turnaround time. This allows for the triage nurse to properly asses any issue and provide a detailed response. Another thing to consider would be having a 24-hour nurse line for immediate responses. By creating a 24-hour nurse line organizations can triage patients and determine if immediate care is necessary. This helps to reduce unnecessary hospitalizations and reduces patient costs.

Post discharge communication is a fundamental issue. Research by Kripalani et al. (2008) argue that the current methods of communicating discharge summaries are poorly developed and lack transparency. The study indicated that discharge communication between hospital and primary care physicians occurred infrequently. Moreover, important labs that where pending at discharge where rarely communicated to physicians. On average 40% of labs where not reported to physicians and 10% required action. This is alarming and can result in adverse events, higher re-admission rates, and poor quality of care. Marks et al. proposes a tested multimodal method that enhances the discharge process (as cited in Kripalani et al. 2008). This process may be time consuming due to the multiple steps but is more structured. The intervention includes scheduling a follow-up appointment with the primary care at the time of discharge, and provide a detailed discharge summary to the patient. Another thing to consider is leveraging the current technology and sending automated responses to the patient’s primary care. It is also important to develop a process for post discharge monitoring of patient labs. Since there seems to be a disconnect of lab results that are returned post discharge. As a CMO I would request that we develop a notification process to notify a hospitalist and the primary care physician of the results.

Developing models of communication between care teams would be another area of concern. Today’s industry includes medical, administrative, and technical jargon. Three distinctly different types of professions that interact daily through multiple platforms. When communicating with others within the organization it would be essential that you be consciences of the barriers that exist. Implementing the Strategies and Tools to Enhance Performance and Patient safety (TeamSTEPPS) curricula would help alleviate some of the barriers. By implementing this process teams have a better understanding of the various roles and responsibilities. Furthermore, stakeholders within the organization can develop a clear network of communication that would optimize patient care and improve outcomes (AHRQ, 2016).

References:

Agency for Healthcare Research and Quality. (2016). About TeamSTEPPS. Retrieved from: https://www.ahrq.gov/teamstepps/about-teamstepps/index.html

Gordon, J., Deland, E., & Kelly, R. (2015) Let’s talk about improving communication in healthcare. Columbia Medical Review, 1(1), pp23-27. Retrieved from: https://uic.blackboard.com/bbcswebdav/pid-5079757-dt-content-rid-54309427_2/courses/2017.spring.bhis.503.30099/Improving_comm_in_hc.pdf

Kripalani, S., Lefevre, F., Phillips, C., Williams, M., Basaviah, P., & Baker, D. (2008). Deficits in communication and information transfer between hospital-based and primary care physicians. JAMA, 297(8), pp. 831-841. Retrieved from: https://uic.blackboard.com/bbcswebdav/pid-5079757-dt-content-rid-54309434_2/courses/2017.spring.bhis.503.30099/kriplani_2007.pdf