• How New Technology in Nursing Is Improving the Quality of Care

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 23, 2020

    The last three decades have brought remarkable innovations to healthcare. New technology has changed every step of patient care, from how appointments are made to how surgery is performed. Many of these technological platforms have greatly advanced the practice of nursing, allowing for more efficiency also improving the quality of patient care as well as outcomes.

    A 2018 LinkedIn survey of nurses showed that 82 percent believe that technology positively affected their ability to provide care. Digging a little deeper, how is tech helping nurses do their jobs better, and hopefully avoiding burnout? Here are a few examples:

    Electronic Health Records (EHRs): These digital version of a patient’s history can include everything from progress notes to medications, labs, and provider information. It’s a one-stop shop for nurses to both enter and find data, allowing them faster access to information while also improving both the accuracy and amount of patient medical records.

    Failsafes: No human, and no technology, is foolproof. That said, tech-enhanced routine procedures such as automated IV pumps can take over tasks where error could be introduced. And as mentioned before, an EHR close at hand means better data in front of the nurse when needed, which can reduce duplication or delays.

    More Time for Nursing: The nursing shortage across the United States continues, and burnout rates from the COVID-19 pandemic have yet to be assessed. New technology in nursing care, such as telehealth, has emerged to take some of the burden off nurses, allowing them to spend more time with individual patients and interact with families and other caregivers.

    Artificial Intelligence Proving Beneficial for Continuing Education and More

    Another way that technology in nursing is vastly improving nursing is through artificial intelligence, or AI, in the realm of professional learning and development. As an example, HealthStream’s JaneÔ has created a system that personalizes competency development for nurses, allowing for training that meets nurses where they are vs. taking a “one size fits all” approach. The result is customized learning that benefits each learner, identifying risks and opportunities that provide a smart, accessible learning journey to support their career path.

    Jane’s features include:

    • Automatically assign assessments based on a clinician’s profession and specialty area 
    • View assessment results together with percentile rankings and national benchmarks for greater context 
    • View results by clinical topic to determine major areas of focus during orientation 
    • Receive relevant feedback on target areas for development 
    • Identify which clinicians are potential flight risks.
    •  Judgment is assessed using AI and IBM Watson technology for quick, accurate results 

    No technology will ever replace the care and compassion that a skilled nurse offers patients. What it can do, however, is make that nurse’s life easier while supporting the entire care team’s goal of comprehensive care and successful outcomes for each patient.

  • The Complexity of NCQA CVO Certification During the COVID-19 Pandemic

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 22, 2020

    HealthStream regularly publishes guest blog posts like the one below from VerityStream.

    This blog post is based on a webinar - How to Prepare for the NCQA CVO Certification Process Including Virtual Surveys

    NCQA CVO Certification Reduces the Survey and Audit Burden

    For NCQA certification, CVOs can represent individual health system or be commercial operations with a variety of clients. Why is a NCQA Certified CVO important? According to Renee Aird Dengler, RN, MS, CPMSM, CPCS, FMSP, Senior Consultant, VerityStream, who is also an NCQA Surveyor, “Any client of a CVO that's been certified by NCQA is not required to do pre-delegation evaluations. They're also not required to do an annual audit of credentialing files.” Certification eliminates the burden of annual evaluations and audits. Dengler adds, “If anybody's been through all the health plans’ yearly file review audits, they take significant time and it can be stressful—by using a certified CVO, the health plan isn't required to do those surveys or audits.”

    Begin NCQA Certification a Year in Advance

    CVO Certification veteran Dengler recommends beginning the process a year in, giving you adequate time to ensure eligibility and review evaluation standards. NCQA CVO Verification extends to 15 required and optional standards. Each standard has up to five elements, and each element can have as many as seven factors. Dengler offered, “About nine to 11 months before your desired survey date, you should purchase the standards and the interactive survey tool that you will use to submit your information to NCQA. The next important step, that you will want to start early, is to do a gap analysis.” Standards need to be in place at least six months for certification, supported by existing policies, procedures, and documentation.

    Virtual Surveys and Videos Keep the Certification Process Safe

    Applicants submit their standards, a surveyor reviews them, and a conference call occurs to discuss initial findings. The client has five days to provide anything missing. Before the COVID-19 pandemic an onsite survey of 75 files followed. Now virtual surveys will occur, at least through December 2020. The file review must occur online, in whatever way client systems allow, followed by a building security assessment. To accommodate COVID-19, NCQA will rely on previous survey scores for recertifications and require new initial certifications to include a video of all security measures involved in building access and file storage. Once submitted, all information, including any client commentary, is sent by the surveyor to NCQA, where the review oversight committee (ROC) determines the result of the process and notifies the client.

    Memorial Healthcare Is Preparing for Initial CVO Certification with VerityStream’s Help

    Memorial Healthcare (MHS) of Fort Lauderdale is in the midst of its initial NCQA CVO Certification effort.  According to Jennifer Kadis, RN, MSN, Administrative Director, Quality, Utilization and Medical Affairs, Credentialing, Memorial Healthcare, multiple health plans delegate credentials to Memorial, requiring long, intrusive site verification visits. These organizations are looking strictly at NCQA guidelines, making NCQA CVO Certification an obvious choice. They consulted with VerityStream about the appropriate CVO certification version for MHS. A gap analysis focused on infrastructure, documents, processes, governance, and maintenance tasks has guided Memorial Healthcare’s ongoing effort to develop policies and processes, readying them to complete their application in the near future.

    COVID-19 Changed the Recertification Experience for VerityStream CVO

    VerityStream CVO clients range from stand-alone hospitals, integrated health systems, and health plans to surgery centers, federally qualified health centers (FQHCs) and medical groups. After we learned much during NCQA Certification Surveys in 2016 and 2018, the NCQA’s ROC passed our CVO in 2020 with 100% compliance in all 11 elements, including written policies and procedures, our internal quality improvement, and all NCQA verification elements. Interestingly, we converted our files designated for COVID-19 virtual survey to PDFs. Our download process saved significant time; we finished about three hours ahead of schedule. For this particular survey, we kept it simple and factual and separated the NCQA credentialing policies from our other operational credentialing policies and procedures—doing so made it easier to ensure that each NCQA standard was clearly written and re-numbered to match NCQA. We continue to streamline policies and procedures to make NCQA recertification even more efficient next time around.

    Six NCQA CVO Survey Insights

    Our experiences with certifying and recertifying VerityStream CVO, as well as with assisting myriad clients’ successful certification efforts, have given us great insight into the NCQA CVO Certification process. Here are six important guidelines for achieving success with the process:

    1. Live NCQA survey all the time.
    2. Connect with colleagues and industry experts.
    3. Separate NCQA credentialing polices from other internal credentialing policies & procedures to avoid confusion and achieve clarity.
    4. Analyze the impact of changing credentialing systems.
    5. Make the CVO continuous quality program simple.
    6. Expect the unexpected. The COVID-19 pandemic has taught us that lesson!

    These key takeaways will help ensure your organization is prepared for continued employment of virtual surveys as long as the COVID-19 Pandemic makes them necessary. They also will facilitate your understanding of and success with NCQA CVO certification when and if onsite surveys by NCQA again become the rule.

    Standardize Your Privilege Delineation, Request, Granting, Monitoring, and Evaluation Processes

    Looking for a solution to help streamline this process? Privilege by VerityStream automates the clinical competency lifecycle including the standardization of the delineation, request, recommendation, granting, monitoring and evaluation of clinical privileges.

  • The Methodology of Restorative Healthcare

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 21, 2020

    What happens in healthcare when a crisis is past and the need for acute care and rehabilitation services is over? The next steps can be complex to navigate for patients, family members and even healthcare providers, but what happens next can make a significant difference to a patient in terms of their ability to sustain the skills learned in physical rehabilitation.

    Physical rehabilitation and restorative healthcare are complementary to one another, but quite different in nature and goals. Rehabilitation is skilled care provided by licensed therapists and their assistants. The care and assessments are complex and patients might participate in rehabilitation activities up to seven days a week for an extended period of time.

    When a patient has met treatment goals and achieved the full benefit of rehabilitation services and is no longer expected to make further progress, it is important to ensure that they are able to retain the skills that they recovered during rehabilitation. Restorative care is valuable in helping patients to improve and/or prevent further deterioration of their condition, teaching residents how to safely navigate daily tasks, adjusting to new or different physical limitations, preventing complications that could further limit function, and improving the quality of life.

    Restorative Healthcare - The Breadth of Services  

    Once a patient is no longer receiving acute or rehabilitation services, what happens next can help a patient maintain their ability to function at their highest possible level. Restorative nursing focuses on activities that promote physical, mental, and psychosocial well-being. Restorative programs are quite wide ranging and can include the following services:  

    • Passive and active range of motion improvement is probably one of the most common goals for restorative services. Activities and exercises that maintain or improve a joint’s range of motion and flexibility may also focus on ligaments, tendons, muscles, and bones.
    • Bed mobility and the ability to transfer to or out of bed is another of the most common goals of restorative care. Can the patient get out of bed on their own, can they move from one side of the bed to the other, and can they move from the foot to the head of the bed without assistance?
    • Activities of daily life are also frequent goals of restorative care. Activities such as bathing, dressing, and grooming are essential to maintaining function and independence.
    • Braces, splints, and wraps can be essential to maintaining function, but patients frequently need a good orientation on how and when to apply and remove supportive devices. Amputation and prosthesis care is also essential for patients needing to adapt to new amputations.
    • Communication is another key goal of restorative healthcare and might include speech pathology interventions or assessments, help with receptive or expressive communication or reading and writing.
    • Cognitive retraining can help patients with cognition, memory, and management of dementia symptoms.
    • Therapies that address eating, swallowing and dining assistance can help patients with swallowing and other feeding disorders.

    Restorative Healthcare – What are the Goals?

    While rehabilitation medicine and restorative healthcare occupy separate places on the continuum of care, they do have one thing in common. Establishing treatment goals is important for both. Both should have goals that are measurable, unique to the patient, and as specific as possible. The care plan should address these goals and be written with input from the patient and family members. As in any goal-setting efforts, the goals should be specific, reasonable, and attainable within a specific period of time.

    In addition to the overall goals of maintaining optimal physical, mental and psychosocial function, other goals might include:

    • Increasing the patient’s independence
    • Preserving existing function
    • Promoting safety
    • Improving function/minimizing deterioration

    Restorative Healthcare – The Benefits

    Restorative healthcare provides the kinds of interventions that result in a patient’s ability to live safely and independently for a longer period of time. Extending optimal physical and mental skills and retaining and/or improving those gained through more intensive physical rehabilitation are the ultimate benefits of restorative healthcare. Patients receiving restorative care may maintain or experience a slower rate of decline in their ability to perform the activities of daily living and therefore it can help them to maintain a healthier, more independent lifestyle for a longer period of time.

    There is a long list of challenges for providers across the care continuum, outside of acute care. For example, with consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with organizations throughout non-acute care to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care. Learn more about Healthstream solutions for non-acute care organizations.
  • As COVID-19 Spreads, So Does Its Impact on Mental Health

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 20, 2020

    Around the world, COVID-19 has left no one unaffected—there are the hospitalized, the infected, the recovered, those who know someone who has been infected, those mourning, and those wondering if they already were, currently are, or will inevitably be infected. While the stress of this global pandemic weighs differently on each person, there are specific ways it is impacting the mental health of most individuals around our world. Regardless of how each individual feels the stress of the current situation, most of us are spending more energy considering how we handle ourselves and our interactions with others in a way no one in our lifetime has.

  • The Methodology of Restorative Healthcare

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 20, 2020

    What happens in healthcare when a crisis is past and the need for acute care and rehabilitation services is over? The next steps can be complex to navigate for patients, family members and even healthcare providers, but what happens next can make a significant difference to a patient in terms of their ability to sustain the skills learned in physical rehabilitation.

    Physical rehabilitation and restorative healthcare are complementary to one another, but quite different in nature and goals. Rehabilitation is skilled care provided by licensed therapists and their assistants. The care and assessments are complex and patients might participate in rehabilitation activities up to seven days a week for an extended period of time.

    When a patient has met treatment goals and achieved the full benefit of rehabilitation services and is no longer expected to make further progress, it is important to ensure that they are able to retain the skills that they recovered during rehabilitation. Restorative care is valuable in helping patients to improve and/or prevent further deterioration of their condition, teaching residents how to safely navigate daily tasks, adjusting to new or different physical limitations, preventing complications that could further limit function, and improving the quality of life.

    Restorative Healthcare - The Breadth of Services  

    Once a patient is no longer receiving acute or rehabilitation services, what happens next can help a patient maintain their ability to function at their highest possible level. Restorative nursing focuses on activities that promote physical, mental, and psychosocial well-being. Restorative programs are quite wide ranging and can include the following services:  

    • Passive and active range of motion improvement is probably one of the most common goals for restorative services. Activities and exercises that maintain or improve a joint’s range of motion and flexibility may also focus on ligaments, tendons, muscles, and bones.
    • Bed mobility and the ability to transfer to or out of bed is another of the most common goals of restorative care. Can the patient get out of bed on their own, can they move from one side of the bed to the other, and can they move from the foot to the head of the bed without assistance?
    • Activities of daily life are also frequent goals of restorative care. Activities such as bathing, dressing, and grooming are essential to maintaining function and independence.
    • Braces, splints, and wraps can be essential to maintaining function, but patients frequently need a good orientation on how and when to apply and remove supportive devices. Amputation and prosthesis care is also essential for patients needing to adapt to new amputations.
    • Communication is another key goal of restorative healthcare and might include speech pathology interventions or assessments, help with receptive or expressive communication or reading and writing.
    • Cognitive retraining can help patients with cognition, memory, and management of dementia symptoms.
    • Therapies that address eating, swallowing and dining assistance can help patients with swallowing and other feeding disorders.

    Restorative Healthcare – What are the Goals?

    While rehabilitation medicine and restorative healthcare occupy separate places on the continuum of care, they do have one thing in common. Establishing treatment goals is important for both. Both should have goals that are measurable, unique to the patient, and as specific as possible. The care plan should address these goals and be written with input from the patient and family members. As in any goal-setting efforts, the goals should be specific, reasonable, and attainable within a specific period of time.

    In addition to the overall goals of maintaining optimal physical, mental and psychosocial function, other goals might include:

    • Increasing the patient’s independence
    • Preserving existing function
    • Promoting safety
    • Improving function/minimizing deterioration

    Restorative Healthcare – The Benefits

    Restorative healthcare provides the kinds of interventions that result in a patient’s ability to live safely and independently for a longer period of time. Extending optimal physical and mental skills and retaining and/or improving those gained through more intensive physical rehabilitation are the ultimate benefits of restorative healthcare. Patients receiving restorative care may maintain or experience a slower rate of decline in their ability to perform the activities of daily living and therefore it can help them to maintain a healthier, more independent lifestyle for a longer period of time.

    There is a long list of challenges for providers across the care continuum, outside of acute care. For example, with consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with organizations throughout non-acute care to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care. Learn more about Healthstream solutions for non-acute care organizations.
  • What Is Myocarditis and How Is It Linked to COVID-19?

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 20, 2020

    The COVID-19 pandemic has raised awareness of certain conditions that may be caused by an infection with SARS-CoV-2, the virus that causes COVID-19. There is a growing concern that one serious complication of COVID-19 in some of those affected is myocarditis.

    How Does Myocarditis Affect the Heart?

    According to the Mayo Clinic, “Myocarditis is an inflammation of the heart muscle (myocardium)... [that]  can affect… your heart's electrical system, reducing your heart's ability to pump and causing rapid or abnormal heart rhythms (arrhythmias). A viral infection usually causes myocarditis, but it can result from a reaction to a drug or be part of a more general inflammatory condition. Signs and symptoms include chest pain, fatigue, shortness of breath, and arrhythmias. Severe myocarditis weakens your heart so that the rest of your body doesn't get enough blood. Clots can form in your heart, leading to a stroke or heart attack.” The National Organization for Rare Disorders tells us that “In a majority of cases, the symptoms of myocarditis are preceded a few days to weeks by a flu-like illness.”

    How Is Myocarditis Diagnosed?

    The symptoms of myocarditis do not make it easy to discern from some other cardiac diseases. However, according to the Myocarditis Foundation, some “symptoms of heart failure, including shortness of breath, fatigue, inability to tolerate exercise, and associated with difficulty breathing while laying down/sleeping are common to many heart diseases besides myocarditis. One feature that distinguishes myocarditis from other causes of heart failure is that it often follows an upper respiratory or gastrointestinal infection and is due to a specific immune response against the heart itself.” Diagnosis may involve a physical exam, x-ray, electrocardiogram, echocardiogram, MRI, and blood tests for telltale proteins and antibodies. A biopsy can be performed when myocarditis is suspected, allowing heart tissue to be examined on the microscopic level for evidence whether a disease process is present.

    Long Term Impact of Myocarditis

    Harvard Health Publishing advises that the long-term impact of myocarditis is related to its source and the person’s preexisting health. Some good news is that “In generally healthy adults, uncomplicated viral myocarditis can clear up over the course of two or three weeks. Myocarditis can also linger for months before slowly resolving, and sometimes persists indefinitely.” The severity of the disease is linked to whether there is permanent damage to the heart muscle. Harvard offers that “More severe myocarditis can lead to heart failure by causing the heart muscle to balloon out and lose some of its strength or to become thick and stiff. Sometimes the failure is so severe that a heart transplant is needed. By interfering with the heart's tightly controlled pattern of electrical activity, myocarditis can also cause sudden death, or require the placement of a permanent pacemaker.”

    Who Is Most Susceptible to Myocarditis?

    In terms of who gets myocarditis, The National Organization for Rare Disorders tells readers that it is “most frequently diagnosed in younger adults between the ages of 20 and 40 years. Children seem to have a more severe presentation than adults with a greater proportion requiring temporary mechanical circulatory support. Men are generally more frequently affected than women, possibly due to effects of testosterone on the immune reaction to infection. The relative frequency of more common age-related cardiovascular diseases such as coronary artery disease may lead to under diagnosis in the elderly. Certain forms of myocarditis, such as cardiac sarcoidosis, are more common in black than white persons in the U.S.  However, most forms of myocarditis have no known ethnic predisposition.”

    COVID-19 and Myocarditis

    Science Magazine tells us that researchers are currently investigating “Whether SARS-CoV-2, the virus that causes COVID-19, induces cardiac injury including myocarditis more often, or with greater severity, than other viruses…” The body’s immune response to this infection may raise the risk of cardiac inflammation. Runner’s World cautions readers that in the case of COVID-19, exercise while infected “can indeed make COVID-19 worse.” One of the possible reasons is that “intense activity during active infection—even if you’re showing no symptoms—may cause the virus to replicate at a faster rate.” Though we will continue learning about the impact of this disease and how to approach it in terms of exercise and rehabilitation, Runner’s World suggests a  few precautions—(1) Stopping exercise completely for two weeks if diagnosed, and (2) Slowly easing back into activity after that two week period. As our experience with the pandemic continues, we will undoubtedly learn more about successfully accommodating it.

    Improve Patient Outcomes

    HealthStream provides training solutions focused on improved patient outcomes. Using the right tools to help clinicians make informed decisions and reduce costly mistakes minimizes risk while maximizing competence.

    COVID-19 Resources for The Healthcare Industry

    To support caregivers and healthcare organizations as they respond to the COVID-19 pandemic, HealthStream is offering a collection of carefully curated courses to all customers for free. Likewise, Using HealthStream’s Channels platform for video learning, we have a created a free-access COVID19 Channel in response to the COVID19 pandemic, specifically to support healthcare workers and their families. It contains a collection of curated videos provided by HealthStream and HealthStream’s content partners from several trusted sources on YouTube, such as the CDC and Mayo Clinic.

    PLEASE NOTE: The information in the article excerpted here was considered current at the time of its publishing. However, the COVID-19 pandemic is an ever-evolving disaster due to new findings, data, and availability of resources. Please refer to the CDC website for the latest detailed information when you need it.

  • Long-Term Care Feels Ongoing Impact from Civil Money Penalty Reimbursement Programs

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 19, 2020

    Healthcare is experiencing significant change, driven by demographic trends, outdated financial structures, and technological progress, not to mention the glaring problem of COVID-19 and its ramifications throughout the care continuum. Many non-hospital organizations are struggling with how they have long operated. Not only is it becoming harder and harder to retain employees, but everyone in healthcare needs more staff to care for our aging population. At the same time, government oversight and the wide range of measures aimed at improving the quality of care may be inadvertently creating additional problems for already-burdened care providers. Here is a specific challenge affecting this area of care.

    Long-Term Care Continues to Feel the Financial Impact of Civil Money Penalties and Civil Money Penalty Reimbursement Programs

    The Centers for Medicare & Medicaid Services (CMS) may impose Civil Money Penalties (CMPs) against nursing homes and other residential care facilities for either the number of days or for each instance a nursing home is not in substantial compliance with one or more Medicare and Medicaid participation requirements for long-term care facilities. A portion of the CMP fines collected are given back to the states in which the CMPs are imposed. State CMP funds may be reinvested to support activities that benefit nursing home residents and that protect or improve their quality of care or quality of life. An 18-month moratorium was established for these fines by CMS, prior to the planned imposition of stricter guidelines in 2019, so that care providers had time to educate themselves and prepare for the heightened oversight. According to McKnight’s Long-Term Care News, the “Phase 2 requirements were ‘a little bit of a bigger lift’ for facilities, and some providers, particularly in rural areas, were having a hard time getting up to speed” (Stempniak, 2019).

    Subsequently in 2019, in response to requests from the nursing home industry, “The Trump administration’s decision to alter the way it punishes nursing homes has resulted in lower fines against many facilities found to have endangered or injured residents. Federal records show that the average fine dropped to $28,405 under the current administration, down from $41,260 in 2016, President Obama’s final year in office” (Rau, 2019). Current practice does not require inspectors to “to fine facilities unless immediate-jeopardy violations resulted in ‘serious injury, harm, impairment or death.’ Regulators still must take some action, but that could be ordering the nursing home to arrange training from an outside group or mandating specific changes to the way the home operates” (Rau, 2019). According to NPR, “consumer advocates say penalties have reverted to levels too low to be effective” (Rau, 2019).

    In a recent development, CMS announced on June 1, 2020 the imposition of “increased civil monetary penalties (CMPs) for nursing homes with patterns of infection control deficiencies, while also implementing new enforcement of lower-level infection control issues to bolster compliance” (Spanko, 2020). At the time of the announcement, nearly 26,000 nursing home residents had died in the unfolding COVID-19 Pandemic, and about 60,000 infections had been reported. These numbers are expected to increase as the pandemic continues.

    References

    Rau, J., “Trump Administration Cuts The Size Of Fines For Health Violations In Nursing Homes,” NPR, March 15, 2019, Retrieved at https://www.npr.org/sections/health-shots/2019/03/15/702645465/trump-administration-cuts-the-size-of-fines-for-health-violations-in-nursing-hom.

     

    Spanko, A., “CMS to Increase Penalties for Infection Control Violations in Nursing Homes, Reports 26,000 COVID-19 Deaths,” Skilled Nursing News, June 1, 2020, Retrieved at https://skillednursingnews.com/2020/06/cms-to-increase-penalties-for-infection-control-violations-in-nursing-homes-reports-26000-covid-19-deaths/.

     

    Stempniak, M., “Penalty box: CMS official says moratorium on nursing home fines will end in May,” McKnight’s Long-Term Care News, March 8, 2019, Retrieved at https://www.mcknights.com/news/penalty-box-cms-officials-says-moratorium-on-nursing-home-fines-will-end-in-may/.

     

    This blog post continues a series based on our article, Top Issues Across the Care Continuum, which looks more closely at some of the serious concerns of healthcare organizations across the care continuum. Subsequent challenges to be examined include:

    • Short Staffing in Long-Term Care Is Having an Impact on Resident and Financial Outcomes
    • The Patient-Driven Payment Model (PDPM) Has Changed Reimbursement for Physical Therapy in Skilled Nursing Facilities
    • Low Rates for Medicaid Reimbursement, Coupled with Additional Recent State Funding Cuts, May Be Precipitating Skilled Nursing and Long-Term Care Facility Closures.
    • Efforts to Decrease Widespread Antipsychotic Drugs in Long-Term Care Facilities Require Individualized Care Plans.
    • Focused Dementia Care Surveys Are Reducing the Use of Antipsychotic Medication, with Unintended Consequences
    • Infection Control Surveys Reveal a Widespread Problem Across Long-Term Care.

    There is a long list of challenges for providers across the care continuum, outside of acute care. For example, with consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with organizations throughout non-acute care to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care. Learn more about HealthStream solutions for non-acute care organizations.

  • Long-Term Care Feels Ongoing Impact from Civil Money Penalty Reimbursement Programs

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 19, 2020

    Healthcare is experiencing significant change, driven by demographic trends, outdated financial structures, and technological progress, not to mention the glaring problem of COVID-19 and its ramifications throughout the care continuum. Many non-hospital organizations are struggling with how they have long operated. Not only is it becoming harder and harder to retain employees, but everyone in healthcare needs more staff to care for our aging population. At the same time, government oversight and the wide range of measures aimed at improving the quality of care may be inadvertently creating additional problems for already-burdened care providers. Here is a specific challenge affecting this area of care.

    Long-Term Care Continues to Feel the Financial Impact of Civil Money Penalties and Civil Money Penalty Reimbursement Programs

    The Centers for Medicare & Medicaid Services (CMS) may impose Civil Money Penalties (CMPs) against nursing homes and other residential care facilities for either the number of days or for each instance a nursing home is not in substantial compliance with one or more Medicare and Medicaid participation requirements for long-term care facilities. A portion of the CMP fines collected are given back to the states in which the CMPs are imposed. State CMP funds may be reinvested to support activities that benefit nursing home residents and that protect or improve their quality of care or quality of life. An 18-month moratorium was established for these fines by CMS, prior to the planned imposition of stricter guidelines in 2019, so that care providers had time to educate themselves and prepare for the heightened oversight. According to McKnight’s Long-Term Care News, the “Phase 2 requirements were ‘a little bit of a bigger lift’ for facilities, and some providers, particularly in rural areas, were having a hard time getting up to speed” (Stempniak, 2019).

    Subsequently in 2019, in response to requests from the nursing home industry, “The Trump administration’s decision to alter the way it punishes nursing homes has resulted in lower fines against many facilities found to have endangered or injured residents. Federal records show that the average fine dropped to $28,405 under the current administration, down from $41,260 in 2016, President Obama’s final year in office” (Rau, 2019). Current practice does not require inspectors to “to fine facilities unless immediate-jeopardy violations resulted in ‘serious injury, harm, impairment or death.’ Regulators still must take some action, but that could be ordering the nursing home to arrange training from an outside group or mandating specific changes to the way the home operates” (Rau, 2019). According to NPR, “consumer advocates say penalties have reverted to levels too low to be effective” (Rau, 2019).

    In a recent development, CMS announced on June 1, 2020 the imposition of “increased civil monetary penalties (CMPs) for nursing homes with patterns of infection control deficiencies, while also implementing new enforcement of lower-level infection control issues to bolster compliance” (Spanko, 2020). At the time of the announcement, nearly 26,000 nursing home residents had died in the unfolding COVID-19 Pandemic, and about 60,000 infections had been reported. These numbers are expected to increase as the pandemic continues.

    References

    Rau, J., “Trump Administration Cuts The Size Of Fines For Health Violations In Nursing Homes,” NPR, March 15, 2019, Retrieved at https://www.npr.org/sections/health-shots/2019/03/15/702645465/trump-administration-cuts-the-size-of-fines-for-health-violations-in-nursing-hom.

     

    Spanko, A., “CMS to Increase Penalties for Infection Control Violations in Nursing Homes, Reports 26,000 COVID-19 Deaths,” Skilled Nursing News, June 1, 2020, Retrieved at https://skillednursingnews.com/2020/06/cms-to-increase-penalties-for-infection-control-violations-in-nursing-homes-reports-26000-covid-19-deaths/.

     

    Stempniak, M., “Penalty box: CMS official says moratorium on nursing home fines will end in May,” McKnight’s Long-Term Care News, March 8, 2019, Retrieved at https://www.mcknights.com/news/penalty-box-cms-officials-says-moratorium-on-nursing-home-fines-will-end-in-may/.

     

    This blog post continues a series based on our article, Top Issues Across the Care Continuum, which looks more closely at some of the serious concerns of healthcare organizations across the care continuum. Subsequent challenges to be examined include:

    • Short Staffing in Long-Term Care Is Having an Impact on Resident and Financial Outcomes
    • The Patient-Driven Payment Model (PDPM) Has Changed Reimbursement for Physical Therapy in Skilled Nursing Facilities
    • Low Rates for Medicaid Reimbursement, Coupled with Additional Recent State Funding Cuts, May Be Precipitating Skilled Nursing and Long-Term Care Facility Closures.
    • Efforts to Decrease Widespread Antipsychotic Drugs in Long-Term Care Facilities Require Individualized Care Plans.
    • Focused Dementia Care Surveys Are Reducing the Use of Antipsychotic Medication, with Unintended Consequences
    • Infection Control Surveys Reveal a Widespread Problem Across Long-Term Care.

    There is a long list of challenges for providers across the care continuum, outside of acute care. For example, with consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with organizations throughout non-acute care to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care. Learn more about HealthStream solutions for non-acute care organizations.

  • Bring Efficiency and Personalization to Healthcare Training with Adaptive Learning

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 16, 2020

    HealthStream recently surveyed healthcare industry decision-makers in the areas of employee education and development to determine their opinions of adaptive learning and their status in adopting this new approach. We received survey replies from 214 leaders that were collected by HealthStream using an online survey administered in July 2020. Here are some of the specific findings:

    • On Managing Employee Education and Development
    • Ownership of employee education and development is handled in one of two ways in most healthcare organizations. It is either handled exclusively by learning/education professionals (36.5%) or it is handled by a cross-disciplinary team with representatives from HR, nurse leadership, and learning/education professionals (46.0%). It is rare for education and development to be led solely by HR professionals (8.8%) or nurse leadership (6.6%).

    • On Their Biggest Training Problems

      Education and development leaders listed the following as the two biggest problems they face with respect to training:

      • Assignments can be difficult to take (44.2%)
      • Employees do not know why they have been training on the same material for the last 5 years (41.1%)

         

      Very few mentioned “reporting training to an accrediting or regulatory body” as a problem (8.5%).

    • On Determining What Training to Deliver

      Organizations are using a number of methods to determine what learning and training to deliver to staff each year, according to healthcare leaders. Most are using one of the three following sources:

      • Committee of subject matter experts (50.4%)
      • Using general content such as a Rapid Regulatory Courses (48.8%)
      • Relying on executive level decision-making (48.8%)

      Just over one-third are relying on:

      • Last year’s plan (36.4%)
      • Employee research on federal and state requirements (36.4%)

      Please Note: very few are relying on advice from an outside source.

    • On the Use of Assessment Tools

      Fewer than three in ten were using any kind of assessment or tool to determine individual learning or training needs. Some 28.9% were using an assessment or tool to determine individual needs, but half (50.0%) were not using any kind of assessment or tool.

    • On Their Opinion on Education and Development
    • The majority of healthcare leaders recognized that their education and development efforts could be more efficient and that their employees would benefit from an adaptive learning approach; however, most were not currently using adaptive learning in their organization. Leaders expressed the highest level of agreement with this statement, “Our employee education and development programs and courses could be more efficient than they are today” (mean = 8.0).

      Leaders also expressed a high level of agreement with the following three statements:

      • When possible, I would like to see more options for employees to opt out of course material they already know.
      • My organization has a supportive learning culture.
      • An adaptive learning approach will improve the quality of patient care delivered by our organization.

      Comparatively, there were much lower levels of agreement for these statements:

      • Our organization has been researching ways we might implement adaptive learning.
      • Employee development plans are personalized to the needs of the individual employee.

    HealthStream’s Approach to Adaptive Learning

    Adaptive learning involves a focus on the individual and meeting them where they are in terms of skill sets and competency. That translates to tailored programs that, if properly thought out and implemented, can result in heightened employee satisfaction — especially with Millennial and Gen Z cohorts. A bonus is that Gen X and Baby Boomer staff also benefit from the opportunity to demonstrate their years of expertise to test out of areas in which they are fully competent.

    “Today’s learners desire a better way to learn, especially in compliance and mandatory content,” says Vanessa Hoevel, Senior Director of Product Marketing, People and Growth Solutions, HealthStream.

    “It’s really the organizations who have been overly cautious. Learners want microlearning; they only want to learn things that they can’t demonstrate knowledge on currently. They want to fast-track through content that takes into consideration their years of tenure and competency. They are challenging their organizations not to assign everyone the same thing, but rather give them an opportunity to test out and show their knowledge, their competency and their proficiency.”

    Learn more about HealthStream’s adaptive approach to learning.

    This post is the second of two based on our article, “Efficiency and Personalization with Adaptive Learning,” by Robin L. Rose, MBA; Vice President, Healthcare Resource Group, HealthStream. Download the article here.

  • The COVID-19 Pandemic Has People Thinking More About Home-Based Care

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 15, 2020

    Our attention is occupied like never before on the long-term care industry and the majority older adult population who call it home. According to the Claude Pepper Center, an aging-focused institute at Florida State University, “The COVID-19 pandemic has created enormous pressure on the entire health care system, but possibly the most tragic impact has been on the long-term care system for both younger and older people in residential care programs” (Claude Pepper Center, N.D.). Nursing homes are feeling the full force of this impact; 85% of their residents make up the demographic most vulnerable to this disease—people aged 80 years and older. Clearly the threat of COVID-19 is aimed at older adults as a side product of where they are spending their final years. What does it mean for the future of the long-term care industry, which is an undeniably necessary part of the care continuum?

    COVID-19 Is Pushing More Patients to Make Home-Based Care Decisions

    The current pandemic is definitely encouraging care decision-makers to rethink their decisions about older adult care. From a survey of approximately 1,000 family health care decision-makers, Home Health Care News reports that “Over 50% of family members are now more likely to choose in-home care for their loved ones than they were prior to the coronavirus” (Donlan, 2020). A telling development identified in the survey is that “65% of respondents agreed that COVID-19 had completely changed their perception about the best way to care for aging seniors.” Many who had considered a nursing home have “now taken that option off the table.” Feelings about nursing homes appear to be a product of awareness of the death toll from COVID-19 in nursing home facilities across the country. Interestingly, those surveyed expressed that they were “still overwhelmingly confident that in-home caregivers were following necessary protocols during COVID-19.” In addition to pandemic-driven choices, home care also has some appeal from a policy and cost perspective. According to another Home Health Care News article, “Over the past two decades, many home health providers have been able to expand their patient census by poaching patients from SNFs. Often referred to as SNF-to-home diversion, the approach didn’t just benefit home health providers, though. It helped cut national health care spending by shifting care into lower-cost settings” (Holly, 2020). More than ever, people are going to want other options than a facility for aging family members. Adding to the home care trend, according to this article, “hospital-to-home models will also likely continue to gain momentum after the coronavirus.”

    The article also includes:

    • COVID-19 May Accelerate Changes Already Happening in Long-Term Care
    • An Industry Beset by Challenges but Favored by Demographic Trends

    References

    Donlan, A., “Long-Term Care Decision-Makers More Likely to Choose Home Care in COVID-19 Aftermath,” Home Health Care News, June 3, 2020, Retrieved at https://homehealthcarenews.com/2020/06/long-term-care-decision-makers-more-likely-to-choose-home-care-in-covid-19-aftermath/.
    Holly, R., “Predicting COVID-19’s Long-Term Impact on the Home Health Care Market,” Home Health Care News, June 10, 2020, Retrieved at: https://homehealthcarenews.com/2020/06/predicting-covid-19s-long-term-impact-on-the-home-health-care-market/.

    This blog post excerpts a HealthStream article, Envisioning the Future of Long-Term Care During the COVID-19 Pandemic.” Download the full article here.

    HealthStream Solutions for the Long-Term Care Workforce

    There is a long list of challenges facing skilled and long-term care (LTC) providers. Turnover rates, for example, for clinical care in nursing homes range from 55 to 75 percent, with rates among Certified Nurse Assistants (CNAs) approaching 100 percent in some areas. With consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with skilled nursing and LTC facilities to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care.
  • The COVID-19 Pandemic Has People Thinking More About Home-Based Care

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 15, 2020

    Our attention is occupied like never before on the long-term care industry and the majority older adult population who call it home. According to the Claude Pepper Center, an aging-focused institute at Florida State University, “The COVID-19 pandemic has created enormous pressure on the entire health care system, but possibly the most tragic impact has been on the long-term care system for both younger and older people in residential care programs” (Claude Pepper Center, N.D.). Nursing homes are feeling the full force of this impact; 85% of their residents make up the demographic most vulnerable to this disease—people aged 80 years and older. Clearly the threat of COVID-19 is aimed at older adults as a side product of where they are spending their final years. What does it mean for the future of the long-term care industry, which is an undeniably necessary part of the care continuum?

    COVID-19 Is Pushing More Patients to Make Home-Based Care Decisions

    The current pandemic is definitely encouraging care decision-makers to rethink their decisions about older adult care. From a survey of approximately 1,000 family health care decision-makers, Home Health Care News reports that “Over 50% of family members are now more likely to choose in-home care for their loved ones than they were prior to the coronavirus” (Donlan, 2020). A telling development identified in the survey is that “65% of respondents agreed that COVID-19 had completely changed their perception about the best way to care for aging seniors.” Many who had considered a nursing home have “now taken that option off the table.” Feelings about nursing homes appear to be a product of awareness of the death toll from COVID-19 in nursing home facilities across the country. Interestingly, those surveyed expressed that they were “still overwhelmingly confident that in-home caregivers were following necessary protocols during COVID-19.” In addition to pandemic-driven choices, home care also has some appeal from a policy and cost perspective. According to another Home Health Care News article, “Over the past two decades, many home health providers have been able to expand their patient census by poaching patients from SNFs. Often referred to as SNF-to-home diversion, the approach didn’t just benefit home health providers, though. It helped cut national health care spending by shifting care into lower-cost settings” (Holly, 2020). More than ever, people are going to want other options than a facility for aging family members. Adding to the home care trend, according to this article, “hospital-to-home models will also likely continue to gain momentum after the coronavirus.”

    The article also includes:

    • COVID-19 May Accelerate Changes Already Happening in Long-Term Care
    • An Industry Beset by Challenges but Favored by Demographic Trends

    References

    Donlan, A., “Long-Term Care Decision-Makers More Likely to Choose Home Care in COVID-19 Aftermath,” Home Health Care News, June 3, 2020, Retrieved at https://homehealthcarenews.com/2020/06/long-term-care-decision-makers-more-likely-to-choose-home-care-in-covid-19-aftermath/.
    Holly, R., “Predicting COVID-19’s Long-Term Impact on the Home Health Care Market,” Home Health Care News, June 10, 2020, Retrieved at: https://homehealthcarenews.com/2020/06/predicting-covid-19s-long-term-impact-on-the-home-health-care-market/.

    This blog post excerpts a HealthStream article, Envisioning the Future of Long-Term Care During the COVID-19 Pandemic.” Download the full article here.

    HealthStream Solutions for the Long-Term Care Workforce

    There is a long list of challenges facing skilled and long-term care (LTC) providers. Turnover rates, for example, for clinical care in nursing homes range from 55 to 75 percent, with rates among Certified Nurse Assistants (CNAs) approaching 100 percent in some areas. With consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with skilled nursing and LTC facilities to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care.
  • The Challenges of Maintaining Quality Outcomes Through Virtual Care

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 14, 2020

    When HealthStream published our blog post two years ago about the potential value of virtual care, we focused on how virtual care, also known as telehealth or telemedicine, could be a potential solution to a broad set of operational and strategic challenges that healthcare providers and professionals confront on a daily basis. Some of the specific virtual healthcare trends we singled out were to lessen staffing issues, support aging-in-place, reduce the use of the hospital/ER, and to improve care in rural areas. Here in the midst of the COVID-19 Pandemic, these are all true, but they are side benefits of the big reason that the use of telehealth/virtual care has skyrocketed—to prevent infection and maintain care continuity during a pandemic.

    Escalation of Telehealth as a Response to COVID-19

    More recently, we’ve posted a blog about how telehealth became a crucial alternative to in-person visits for patients whose need to stay home was critical, whether due to age or pre-existing conditions. It also was an important pressure valve as clinicians struggled to meet the demand for hospital beds as they were swamped by patient needs and emergencies due to COVID-19. Eventually the pandemic curve flattened, leaving many people to wonder whether the use of telehealth would dwindle or is this now an inflection point where virtual care and telehealth become a norm. From the point of view of provider services, not only has the COVID-19 pandemic pivot to telehealth changed everything about privileging, but we are seeing a pandemic-generated acceptance of telehealth on a professional and payer level that isn’t likely to disappear.

    The Jury Is Still Out on Virtual Care, Quality, and Outcomes

    The healthcare industry is still working to confirm the link between virtual healthcare and quality, as well as improved outcomes. A September 2020 Fierce Healthcare article describes a survey where “close to 60% of physicians have lingering reservations about the quality of care they can provide remotely.” The same article offers that “industry leaders say there needs to be more research on the impact of telehealth to address ongoing concerns about care quality and to evaluate potential barriers for underserved populations.” Also, "Some physicians also expressed concerns over the quality of telehealth visits, such as an inability to conduct a physical exam. Furthermore, for providers too many things may have changed at once, making it difficult for them to assess the independent impact of telehealth on quality of care.”

    The Taskforce on Telehealth Policy is a joint effort between the National Committee for Quality Assurance (NCQA), the Alliance for Connected Care, and the American Telemedicine Association—its focus is to develop “consensus recommendations for policy makers to drive quality and safety standards for digital health care delivery, nationwide.” In September 2020, Healthcare IT News shared that “the task force found that the evidence base for telehealth is strong, particularly when it comes to the remote management of chronic conditions.” Chronic care management is another area where virtual care shows much promise.

    As virtual healthcare becomes more the norm, it has great potential to improve outcomes. A September 2020 Kansas City Business Journal article about the possible advantages of telemedicine includes the following potential benefits that could contribute to improved outcomes:

    • Removing barriers to primary care use
    • Quicker access to care providers
    • Counteracting physician shortages
    • Facilitating linkages to care based on laboratory test results
    • Enabling care for multiple patients at one time via chat and text

    Ultimately, it is too soon to know how virtual care will change the healthcare industry and the patient experience. No one imagined a year ago that telehealth would be playing a role as big as what we now know. Given the growing need for care as our population ages, it is very likely that telemedicine is here to stay.

    Outcomes-Focused Learning Exclusively for the Healthcare Workforce

    There’s a good reason why HealthStream’s workforce education solutions are already trusted by more than 70 percent of healthcare organizations in the United States. HealthStream’s comprehensive suite of learning and competency management tools empowers your people to deliver the best care more easily and effectively than ever before. Powered by the industry’s top content providers, HealthStream connect you to healthcare’s largest learning community with learning customized by you to meet your organization’s unique needs.

  • Three Ways to Avoid Employee Burnout and Improve Culture in Healthcare

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 14, 2020

    The COVID-19 pandemic is overwhelming many parts of healthcare and may be the greatest career challenge ever experienced by many across the industry. However, healthcare was already an industry where stress and pace commonly led to burnout among care providers. The advent of the coronavirus has led to an increase in employee stress and untenable situations for a wide variety of caregivers unlike any we’ve ever known. As a result, understanding ways to counteract burnout and support healthcare employees has never been more important. Here are three steps a healthcare organization can take to address stress and potential burnout.

    • Acknowledge the Situation

    Organizations can begin to deal with burnout (or the potential for it) by acknowledging existing situations and scenarios where it is likely to occur. For example, in the midst of the COVID-19 pandemic it is important to recognize the innate stress that is involved in providing care—not only are healthcare employees putting themselves at risk in their jobs, but those they care for as well. Individuals need to admit the potential for stress. Leaders have to admit there’s only so much they can control about the situation. It helps if those in charge do what they can to alleviate stress, like reducing the workload, removing obstacles, or just communicating steps that are being taken.

    At an organizational level, it is essential to acknowledge what everyone is feeling and talk about the specific signs that you want to be aware of when individuals are starting to feel stressed and specifically burnt out. These signs may include cynicism, a loss of enthusiasm for their work, a decline in joy and satisfaction, increased detachment, and emotional exhaustion. The goal is to combat these reactions, especially before they lead to a drastic response like suicide, which some reports say one in five essential workers may consider at some time. Even a lesser negative reaction that can spread through emotional contagion needs to be countered by acknowledging the need for everyone in healthcare to take care of themselves first, before caring for others. Successful organizations are communicating openly and frequently about what’s happening and being vulnerable as a part of building stronger relationships with employees.

    • Engage the Healthcare Workforce

    A vital question for those in healthcare now is how to stay engaged as individuals and as teams through this crisis. Regardless of role, we must maintain and strengthen our team culture. Engaging your people and staying engaged in your work is a fundamental aspect of creating and maintaining a strong and adaptable culture. One way is to frequently poll staff with a question or two about their reaction to what is going on. A long form annual employee survey is no longer appropriate when healthcare conditions are quickly changing, and compassion fatigue is a risk from the stress of providing healthcare. An important effort is to invest in real-time coaching and learning, like what is already practiced in high-performing organizations. Those kinds of care providers are focused on staff career development as well as what staff members need to know now to be successful with the tasks at hand. Some other important choices to engage staff are to avoid micromanagement, which requires time that healthcare organizations don’t have, and supporting decision-making autonomy, which is important for building employee trust. Other key engagement efforts involve more frequent coaching and mentoring sessions and taking time to really listen to your people at an individual and macro level. Identify barriers to success and focus on staff concerns, understanding that small changes can make a big difference in engagement, as can staying focused on wins and communicating them as quickly and frequently as possible.

    • Recognize Performance

    Not only is there an inherent positive impact for celebrating wins but doing so typically leads to more of them. When we recognize each other for great performance, we are also affirming the values and expectations for which our organization stands. Recognition helps reinforce behavior that a leader hopes to see repeated. While it may only take 30 seconds to tell someone that you appreciate them, research has shown the positive impact on mood, role, clarity, and purpose may last for as long as seven hours. The most effective recognition needs to be (1) timely, (2) authentic, and (3) social whenever possible. If shared in a group the recognition has a multiplier effect, to help reinforce those behaviors across the entire organization.

    This blog post is based on the HealthStream Webinar, “Avoiding Burnout and Improving Culture,” presented by Brad Weeks, Director, Assessments and Performance, HealthStream, and Craig Spilker, Head of Product & Engagement, AMPT.

    HealthStream and our partner AMPT are committed to improving the healthcare workplace by supporting improved employee engagement and development. AMPT enables employees to connect, engage, and grow by allowing them to recognize, share and celebrate moments of greatness. The AMPT platform allows companies to connect their core values to recognition accomplishments, which ultimately drives employee performance. When an employee receives praise for their efforts, their job satisfaction increases, motivation improves, and positive actions are reinforced. Learn more about HealthStream solutions for healthcare employee engagement and retention.
  • Overcoming the Challenges of Fragmented Care

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 12, 2020

    To get to a fragmented care definition, U.S. News & World Report offers the following description, “The U.S. healthcare system is so fragmented that primary care doctors struggle to coordinate patient care as frequently as providers in other high-income countries.” The same article offers that, “For example, just under half of U.S. primary care doctors said they get information from specialists about changes to their patients’ medications or care plans, compared to 70% or more of doctors in Norway, France and New Zealand.”

    Furthermore, according to the same source, not only are our healthcare providers having a problem communicating with each other about patients, but they also are not as available as in other countries. The same survey quoted in the article offered that “American primary care practices were also less likely to have options for patients to see a doctor or nurse after hours other than the emergency room, compared to 90% of practices in Germany, the Netherlands, New Zealand, and Norway. And just 37% of primary care doctors in the U.S. said they or another provider made home visits sometimes or often, compared to 70% or more of physicians in the other 10 countries, according to the study.”

    This research tells us that to ensure continuity of care, we need to support efforts to deliver care beyond the limits of a primary care practice and the limited hours that have long characterized much of American healthcare. Likewise, primary care needs to occupy itself far more with timely information exchange to support more successful care coordination.

    Real Life Examples of Fragmented Care

    Here are a few typical characteristics of fragmented care that apply easily to the U.S. healthcare system:

    Disconnected Medical Specialists – When a patient with multiple chronic conditions gets care from different specialists, it is not uncommon for each to focus on their own task, leaving the patient to follow multiple unconnected care pathways. What’s missing is for someone to oversee all the care and make sure it is coordinated.

    Lack of overall accountability – In the scenario above, there’s not a single person with final responsibility over a person’s care. Without someone in this role, the patient can stay very confused about where care is headed.

    Organization-specific healthcare – Care from providers at different organizations create a big communication and coordination risk. Disparate, unconnected systems don’t contriute to good outcomes for patients with multiple, chronic conditions.

    Poor Communication within an individual provider office – According to a HealthStream blog post, Doctors and nurses in a single office can also have a problem with communication, with a significant negative effect on patient safety, quality of care, patient outcomes, and patient as well as staff satisfaction.

    The Impact of Fragmented Care

    Fragmented care may well be hazardous to patients’ health. Multiple medications and regimens in the absence of care coordination may be a contributor to more frequent hospitalizations and perhaps readmissions. In addition, the cost of fragmented care can be significantly higher for patient and payer alike, connected duplication of diagnostic tests, prescriptions, and overlapping care.

    Nursing’s Role in Fixing America’s Fragmented Healthcare System

    The United States healthcare system has grown increasingly fragmented. Those afflicted by chronic conditions may attend unnecessary appointments, receive confusing and contradictory advice from their doctors, struggle to get to the doctor’s office, and despair at exorbitant out-of-pocket expenses.  Every visit’s comprehensive history taking, counseling, medication reconciliation, and psychosocial intervention must also consider where individuals came from and where they are going and incorporate the full continuum of care, not just the single setting.

    Considering that there are approximately 3.7 million nurses in the United States and registered nurses attend over 50% of outpatient visits, they are poised to play an essential role in ensuring quality and continuity of care delivery in the face of this fragmentation.

    HealthStream Focuses on Nurses and Clinical Development

    At HealthStream we spend a lot of time focused on improving outcomes by supporting and developing the clinical workforce. HealthStream’s jane™ is The World’s First Digital Mentor for Nurses. Jane harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, Jane was designed to power lifelong, professional growth of clinical professionals. JaneTM is an important component of HealthStream’s suite of clinical development solutions.

  • During The COVID-19 Pandemic, Patient Outcomes Should Drive Decision-Making about Credentialing

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 09, 2020

    Credentialing and licensure considerations may be taking a backseat to patient urgency during the COVID-19 crisis. What doesn’t change in this emergency is the responsibility, first and foremost, to make sure that patients are treated appropriately by having care delivered by professionals with the competency to help them, concludes Todd Sagin, President and National Medical Director, Sagin HealthCare Consulting.

    Rely on Common Sense and Consider Patient Outcomes First

    “We can’t lose sight of that as we loosen some of the procedures and processes which we have historically used to assess competence among all privileged practitioners,” he says. “In this time of crisis, I think one of the most important things to keep in mind is that common sense should prevail. If you can do something that makes sense to help patients, then go ahead and do it unless there is a clear prescription against doing it. Be prepared to defend that decision, but you’re going to be given a great deal of latitude in this time. In the midst of a crisis is not where we ask for permission. Instead we do what needs to be done, and we then ask for forgiveness. There is a lot of latitude that we have to make the appropriate decisions on behalf of patients.”

    Credentialing Coming to Terms with ‘Gray Areas’

    “I think that’s one of the hard areas for people that work in the credentialing profession,” adds Vicki Searcy, Vice President, Consulting Services, at VerityStream. “A lot of us don’t like gray areas. We like things to be very defined, and we are in a time right now where we are in some gray areas. That common sense has to prevail is a really important consideration. I think when we make decisions that are in the best interest of the patient, we can defend those.”

    This blog post concludes a series of excerpts from the VerityStream article, “An Upside Down World: Pandemic Creates Process Challenges and Opportunities for Licensure and Credentialing.” The article also covers:

    • Provider Support has a can-do spirit
    • Telehealth plays prominent role in new reality
    • Keeping processes effective, but uncomplicated, will be essential
    • Today’s adaptations and new procedures are likely tomorrow’s business as usual

    PLEASE NOTE: The information in the article excerpted here was considered current at the time of its publishing. However, the COVID-19 pandemic is an ever-evolving disaster due to new findings, data, and availability of resources. Please refer to the CDC website for the latest detailed information when you need it.

    In the midst of continual healthcare change some things stay the same, like the need for comprehensive provider credentialing, privileging, and enrollment processes. In today’s value-based environment, operational efficiency is critical. Conducting manual verifications, completing paper forms by hand or taking time to deliver files to various locations across the hospital or the system is not cost-effective. Learn more about making VerityStream your comprehensive provider solutions partner.

  • Should Providers Be Asked to Withdraw Requests for Privileges?

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 08, 2020

    HealthStream regularly publishes guest blog posts like the one below from Vicki Searcy, Vice President of Consulting Services, VerityStream.

    I get lots of questions from organizations regarding privileging – and many of those questions relate to how privileging recommendations and decisions are made. One of the more common questions is: The provider does not meet our criteria for privileges – should I ask the provider to withdraw the request?

    The following explores situations in which an organization might contemplate asking a provider to withdraw privileges:

    The provider requested privileges for which he/she does not meet qualifications/criteria.

    When the provider does not meet the written/stated qualifications, the decision can be not to grant the privileges because qualifications were not met. This is not a denial of privileges and is not reportable to the National Practitioner Data Bank (NPDB). Essentially, the organization has not made a determination of whether or not the provider is/is not competent because the provider didn’t meet the eligibility requirements to apply. The documentation for the privilege or group of privileges that will not be granted would include a notation that the provider did not meet qualifications and therefore the privilege(s) were not granted. There would be no disruption to the evaluation and decision-making process. The provider would be notified after the Board decision that privilege(s) were not granted because criteria was not met.

    In order to be fair (and avoid challenges that would not easily be defended), the privilege delineation should clearly and unambiguously document the criteria for the privilege(s) in question. For example, if a provider requested privileges that requires specific training (i.e., a residency or fellowship) or clinical activity (must perform 10 procedures during the past 24 months) – this information should be clearly stated on the privilege form. I would not recommend using subjective criteria such as, “applicant must provide evidence of competence acceptable to the Department Chair.”

    The provider might have asked for privileges for which s/he meets the qualifications, but it has been determined that because of competency or conduct issues not to grant the privileges.

    In this case there are two options: (1) Deny the privilege(s) and make a report to the NPDB; (2) Ask the provider to withdraw the request for those privileges.

    If the second option is selected, there are two ways to hand this: (1) the evaluation and decision-making process will need to stop and the request for privileges will need to go back to the applicant so s/he can complete a request for privileges that does not include the privilege(s) in question; or (2) the evaluation and decision-making process can proceed and privilege note(s) can be added to identify that the provider withdrew the request and therefore the privileges were not granted (and supporting documentation to this effect scanned into the software to substantiate the withdrawal).

    Waivers of Privileging Criteria

    There may be occasions when a provider fails to meet the minimum clinical activity requirement, education/training requirement or other standard for a specific privilege or group of privileges. The relevant Department Chair may recommend to the Medical Executive Committee and the Board (via the Credentials Committee if one exists) that the requirement in question be waived – and document the specific rationale for why the requirement is recommended to be waived. The individual who is requesting a waiver is responsible for demonstrating that his or her education, training, experience and competence are equivalent to or exceed the requirements that are requested to be waived. Waiving of requirements should be an unusual occurrence, but it is acknowledged that there may be times when patient safety will not be compromised by alternative methods of assuring competency. Waiving of requirements for privileges is always a Board decision. The Board may grant waivers in exceptional cases after considering the findings of the Medical Executive Committee, the specific qualifications of the individual in question, the quality profile of the individual and his or her performance record in the organization (if the credentialing event is a reappointment).

    Ultimately, the major consideration and decision should be focused on the best interests of patient care and the community served by the organization.

    No individual is entitled to a waiver or to any hearing procedures in the event the Board determines not to grant a waiver. The individual has not received a denial, but rather is simply ineligible to apply for the privileges in question. In the event the Board grants a waiver to any particular individual, that waiver is not intended to act as a precedent for any other provider or group or providers. Each individual request for a waiver should be evaluated on its own merits.

    Standardize Your Privilege Delineation, Request, Granting, Monitoring, and Evaluation Processes

    Looking for a solution to help streamline this process? Privilege by VerityStream automates the clinical competency lifecycle including the standardization of the delineation, request, recommendation, granting, monitoring and evaluation of clinical privileges.

  • How Changing Nurse Demographics Impact Cultural Sensitivity

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 07, 2020

    Nurses play one of the most critical roles in healthcare—there are more nurses than any other profession in the healthcare industry. As the nursing workforce changes and becomes more diverse, their ability to provide culturally sensitive care will likely improve.

    In the United States alone, by one estimate, there are 3.9 million nurses, with a projected need for a million more nurses as soon as this year.  (Haddad & Toney-Butler, 2020). Nurse hiring will continue to be urgent for the foreseeable future. The ongoing problem of nurse shortages can occur for multiple reasons—whether due to an educational system challenged to produce nurses at a speed matching industry needs, and others are related to nurses leaving the profession as a response to burnout, or because it is time to retire. Another dilemma for healthcare is that of nurses are not distributed equally nationwide, which causes problems for locales in the midst of explosive growth while other areas remain stagnant.

    Nurse Demographics Tell a Further Story

    These following data points, cited in a previous HealthStream blog post, demonstrate some of the systemic challenges for the nursing workforce:

    • The U.S. Population Is Aging – By 2029, when the last of the baby boomers retire, the population of those aged 65 or older will be 71 million, a 73% increase from the 41 million of 2011.
    • The Nursing Workforce Is Aging – one million nurses are aged 50 or older, meaning 1/3 will likely retire within the next 15 years
    • We Need More Nurses – Even the states with the lowest growth rates are anticipated to need at least 11% more nurses through 2022
    • Nurse Turnover Is Still a Problem—rates vary from nearly 9% to 37%, depending on location and specialty

    However, according to Arkansas State University, “Today’s nurses are younger, more diverse and more likely to be male than they were even a few years ago. More than ever, members of minority groups are entering nursing, as are more graduates of foreign nursing programs. Education levels are increasing as more college graduates retrain, more nurses return to school and more students choose nursing majors. These nurses are bringing with them a range of perspectives, experience and knowledge that enriches the field. Although the profession is growing, there is still plenty of room for new graduates. Today’s nursing workforce is experiencing rapid change and significant demands coming from a variety of sources.”

    More Men and More Minorities in Nursing Workforce

    The National Nursing Workforce Study offers the following statistics about nursing demographics in their most recent completed study (2017):

    • “Average age of RNs is 51, consistent with the 2015 and 2013 study findings.
    • Data indicates a growing number of male RNs; 9.1% in 2017, compared to 8.0% in 2015 and 6.6% in the 2013 study.
    • 19.2% of RN respondents were minorities, which includes ‘other’ and ‘two or more races.’
    • Percentage of males in LPN/VN workforce increased from 7.5% in 2015 to 7.8% in 2017.
    • LPN/VNs were more racially diverse than their RN counterparts with approximately 29% of LPN/VNs identifying as racial minorities.”

    Greater Diversity Among Nurses May Enhance Cultural Sensitivity in Care

    In an earlier post, HealthStream examined how providing culturally sensitive and competent nursing care may seem like a difficult task, especially in cases where patients’ beliefs and practices are dissimilar or unfamiliar to the nurse. Regardless of individual background, nurses must ensure that they provide equal and ethical care to all patients. A more diverse nursing workforce will likely be more flexible and culturally sensitive in the care they provide.

    Providing culturally sensitive nursing care begins with adherence to a basic principle of healthcare ethics—autonomy. To support autonomy, a nurse respects the patient right to make their own decision, even if it contradicts the morals and beliefs of the healthcare provider. To uphold a patient’s autonomy, a nurse must take into account the patient’s culture. Culture comprises a group’s beliefs, traditions, and customs. However, nurses also must balance reliance on individual thinking and cannot assume that a patient holds certain cultural beliefs simply because that patient identifies with a certain ethnicity, religion, or social group.

    When a nurse first cares for a patient, it is essential that nurses take the time to understand the patient’s own culture. A large part of one’s culture is how they view health and illness. The nurse must address the patient’s personal beliefs and feelings regarding their own health and care and understand how that ties into the patient’s culture.

    HealthStream Focuses on Nurses and Clinical Development

    At HealthStream we spend a lot of time focused on improving outcomes by supporting and developing the clinical workforce. HealthStream’s jane™ is The World’s First Digital Mentor for Nurses. Jane harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, Jane was designed to power lifelong, professional growth of clinical professionals. JaneTM is an important component of HealthStream’s suite of clinical development solutions.

  • A Program for Ensuring Safe Infant Transport – S.T.A.B.L.E.

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 07, 2020

    This blog is the third of three taken from a recent Webinar featuring Lindsay McAlister, BSN, RN; Alexander Walker, PhD, Senior Director, Learning and Research Design, MedStar; Dr. Tamika Auguste, Associate Medical Director and Director OBGYN Simulation, MedStar Health; and Kris Karlsen, PhD, APRN, NNP-BC, FAAN, Program Author and Founder, S.T.A.B.L.E.

    Common Ground – Why S.T.A.B.L.E.?

    According to the Centers for Disease Control (CDC), in 2013 alone 23,446 babies died before their first birthday, and nearly 70% of those deaths occurred in the first month of life. Kris Karlsen, PhD, the Program Author and Founder of S.T.A.B.L.E. offers that, “it's vitally important that all perinatal staff are educationally prepared to take care of the unexpectedly sick and/or preterm infant.” Dr. Karlsen also shared that 10% of babies are born pre-term and those weighing less than 1,000 grams account for half of the annual infant mortality rate in the US. Based on these startling statistics, ongoing education to reduce infant morbidity and mortality is clearly needed. She also addresses the important issue of public trust. Patients trust that hospitals will deliver safe and effective care, even when presented with a suddenly-sick or pre-term infant, but they may not understand that educational preparation and requirements can actually vary quite widely by state and providers are not equally prepared to deal with sick or pre-term infants.

    Ensuring Safe Infant Transport

    Dr. Karlsen also points to the high number of infant transports – approximately 68,000 babies are transferred to higher levels of care each year. “This number of transports underscores the need for staff readiness to recognize the unwell baby and to stabilize and transfer or transport out those babies.” says Dr. Karlsen.

    As an acronym guiding the safe transport of infants, S.T.A.B.L.E. stands for:

    • Sugar and Safe Care
    • Temperature
    • Airway
    • Blood Pressure
    • Lab Work
    • Emotional Support

    How Does S.T.A.B.L.E Fit in With Your Education Plan?

    S.T.A.B.L.E is not just for staff who are taking care of sick babies. The course curriculum actually applies to the everyday care of both well and sick babies. The content for all modules focuses on anticipating problems, recognizing them when they do occur, and then determining the right course of action. The content helps providers learn the best practices that will keep well babies well and avoid a NICU admission and also helps providers organize stabilization care. 

    Who Can Benefit from S.T.A.B.L.E.?

    1. Nurses - S.T.A.B.L.E. is designed to help nurses in a variety of settings from Labor and Delivery and NICU to the Emergency Department where it is not uncommon to find nurses that are somewhat fearful when caring for babies. S.T.A.B.L.E. gives them the tools to help them feel more confident when taking care of these patients.
    2. Pre-hospital providers – The course is a requirement for OB and neonatal transport teams, but it is also helpful for paramedics and emergency medical technicians who are often on the front lines of care of sick babies.
    3. Nursing and medical students – Students will be more prepared for their maternity rotations and their first encounters with obstetric and neonatal patients.
    4. Respiratory therapists, nursing assistants and techs – These providers can also benefit from this education as they are often in a position to recognize a baby who is becoming unwell.
    5. Physicians – Physicians can use S.T.A.B.L.E. education as the foundation for an organized approach to the post-resuscitation stabilization of preterm or unexpectedly sick infants. Team work can be enhanced when both physicians and nurses have taken S.T.A.B.L.E.

    S.T.A.B.L.E – The Program and Educational Methodology

    The program can be delivered in one of two ways. A traditional, classroom model is available as well as an e-learning course that is delivered online and at the student’s convenience. The traditional, classroom model delivers the content over a 1-2-day period and is taught by experts in neonatal nursing, medicine, and respiratory therapy. It includes the course slides and a learner manual and should be renewed every two years.

    HealthStream and S.T.A.B.L.E. have recently partnered to deliver the dynamic S.T.A.B.L.E. program in an online format for the first time ever. The self-paced, online S.T.A.B.L.E. program takes 5.5 to 6 hours to complete and offers e-learners the ability to build their confidence through interactive activities, audio and video presentations, and PDF resources from the S.T.A.B.L.E. manual that can be downloaded or printed. Access the full webinar recording for Preparing Your Staff to Provide Quality Maternal and Neonatal Care.

    Everyday hundreds of newly born infants become ill and require specialized care, yet many caregivers lack the knowledge, skills, and confidence in their ability to provide the necessary care. With the goal to improve the quality of care of sick infants and increase the confidence of those who care for them, HealthStream and S.T.A.B.L.E. have partnered to offer the dynamic S.T.A.B.L.E. program in an online format for the first time ever.
  • Financial Situation for Long-Term Care Worsens, Connected to Reimbursement Rates and Funding Cuts

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 07, 2020

    Healthcare is experiencing significant change, driven by demographic trends, outdated financial structures, and technological progress, not to mention the glaring problem of COVID-19 and its ramifications throughout the care continuum. Many non-hospital organizations are struggling with how they have long operated. Not only is it becoming harder and harder to retain employees, but everyone in healthcare needs more staff to care for our aging population. At the same time, government oversight and the wide range of measures aimed at improving the quality of care may be inadvertently creating additional problems for already-burdened care providers. Here is a specific challenge affecting this area of care.

    Low Rates for Medicaid Reimbursement, Coupled with Additional Recent State Funding Cuts, May Be Precipitating Skilled Nursing and Long-Term Care Facility Closures.

    The reimbursement rate at which CMS pays nursing homes for care of Medicaid residents is shockingly low. In some areas of the country these rates don’t even pay for the full cost of the care being provided. According to the nonprofit National Investment Center for Seniors Housing & Care (NIC), “At around $200 per day, Medicaid is the lowest priced payor source for skilled nursing properties.” Furthermore, this amount is “less than half the rate paid by Medicare and Managed Medicare, $503 and $433, respectively” (Liberman, 2018).

    Medicaid Reimbursement Is Damagingly Low

    A 2015 research study from the American Health Care Association (AHCA), an industry group representing more than 14,000 facilities and housing 5 million seniors, found that “On average, Medicaid reimbursed nursing center providers only 89.4 percent of their projected allowable costs incurred on behalf of Medicaid patients. This means that for every dollar of allowable cost incurred for a Medicaid patient in 2015, Medicaid programs reimbursed, on average, approximately 89 cents.” In states where the cost of care is not completely covered, providers have no choice but “to leverage the other payor sources (Medicare, managed Medicare, and Private [Pay]) to offset losses” (Liberman, 2018). In addition, some states are applying additional cuts to their Medicaid payments to help balance.

    A Widespread Risk of Facility Closure

    Nationwide, the long-term care industry is struggling to survive these challenges to its financial health. For example, “Low Medicaid reimbursement rates have played a role in the closings of 20 nursing homes in the state in the past three years, said Robin Dale, president/CEO of the Washington Health Care Association, which represents the state’s nursing home industry” (Allison, 2020). For 2020, New York State imposed a 1% Medicaid payment cut, “which will reduce gross Medicaid payments, including federal matching aid, by around $125 million in the current fiscal year and about $500 million in following years” (Berger, 2020). Demonstrating the country-wide extent of the problem, Skilled Nursing News describes similar problems in Massachusetts, South Dakota, Wisconsin, Montana, and Texas, where facility closures and financial struggles have been the result of Medicaid cuts and low reimbursement rates (Flynn, 2019).

    References
    Allison, J., “Nursing Homes Fight To Stay Afloat With Low Medicaid Rates,” Skagit Valley Herald, March 1, 2020, Retrieved at https://insurancenewsnet. com/oarticle/nursing-homes-fight-to-stay-afloat-with-low-medicaid-rates#.XqiSU2hKiHt.
    Berger, L., “Nursing homes in New York grapple with Medicaid reimbursement reduction,” McKnight’s Long-Term Care News, January 2, 2020, Re­trieved at https://www.mcknights.com/news/nursing-homes-in-new-york-grapple-with-medicaid-reimbursement-reduction/.
    Flynn, M., “As Medicaid Rates Lag Behind Costs, Unpaid Nursing Home Bills Pile Up,” Skilled Nursing News, March 7, 2019, Retrieved at https://skilled­nursingnews.com/2019/03/as-medicaid-rates-lag-behind-costs-nursing-home-bills-skyrocket/.
    Liberman, L., “Medicaid Reimbursement Rates Draw Attention,” NIC Cares Blog, March 21, 2018, Retrieved at https://www.nic.org/blog/medicaid-re­imbursement-rates-draw-attention/.

    This blog post begins a series based on our article, Top Issues Across the Care Continuum, which looks more closely at some of the serious concerns of healthcare organizations across the care continuum. Subsequent challenges to be examined include:

    • Short Staffing in Long-Term Care Is Having an Impact on Resident and Financial Outcomes
    • The Patient-Driven Payment Model (PDPM) Has Changed Reimbursement for Physical Therapy in Skilled Nursing Facilities
    • Long-Term Care Continues to Feel the Financial Impact of Civil Money Penalties and Civil Money Penalty Reimbursement Programs.
    • Efforts to Decrease Widespread Antipsychotic Drugs in Long-Term Care Facilities Require Individualized Care Plans.
    • Focused Dementia Care Surveys Are Reducing the Use of Antipsychotic Medication, with Unintended Consequences
    • Infection Control Surveys Reveal a Widespread Problem Across Long-Term Care.

    There is a long list of challenges for providers across the care continuum, outside of acute care. For example, with consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with organizations throughout non-acute care to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care. Learn more about Healthstream solutions for non-acute care organizations.

  • Financial Situation for Long-Term Care Worsens, Connected to Reimbursement Rates and Funding Cuts

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 07, 2020

    Healthcare is experiencing significant change, driven by demographic trends, outdated financial structures, and technological progress, not to mention the glaring problem of COVID-19 and its ramifications throughout the care continuum. Many non-hospital organizations are struggling with how they have long operated. Not only is it becoming harder and harder to retain employees, but everyone in healthcare needs more staff to care for our aging population. At the same time, government oversight and the wide range of measures aimed at improving the quality of care may be inadvertently creating additional problems for already-burdened care providers. Here is a specific challenge affecting this area of care.

    Low Rates for Medicaid Reimbursement, Coupled with Additional Recent State Funding Cuts, May Be Precipitating Skilled Nursing and Long-Term Care Facility Closures.

    The reimbursement rate at which CMS pays nursing homes for care of Medicaid residents is shockingly low. In some areas of the country these rates don’t even pay for the full cost of the care being provided. According to the nonprofit National Investment Center for Seniors Housing & Care (NIC), “At around $200 per day, Medicaid is the lowest priced payor source for skilled nursing properties.” Furthermore, this amount is “less than half the rate paid by Medicare and Managed Medicare, $503 and $433, respectively” (Liberman, 2018).

    Medicaid Reimbursement Is Damagingly Low

    A 2015 research study from the American Health Care Association (AHCA), an industry group representing more than 14,000 facilities and housing 5 million seniors, found that “On average, Medicaid reimbursed nursing center providers only 89.4 percent of their projected allowable costs incurred on behalf of Medicaid patients. This means that for every dollar of allowable cost incurred for a Medicaid patient in 2015, Medicaid programs reimbursed, on average, approximately 89 cents.” In states where the cost of care is not completely covered, providers have no choice but “to leverage the other payor sources (Medicare, managed Medicare, and Private [Pay]) to offset losses” (Liberman, 2018). In addition, some states are applying additional cuts to their Medicaid payments to help balance.

    A Widespread Risk of Facility Closure

    Nationwide, the long-term care industry is struggling to survive these challenges to its financial health. For example, “Low Medicaid reimbursement rates have played a role in the closings of 20 nursing homes in the state in the past three years, said Robin Dale, president/CEO of the Washington Health Care Association, which represents the state’s nursing home industry” (Allison, 2020). For 2020, New York State imposed a 1% Medicaid payment cut, “which will reduce gross Medicaid payments, including federal matching aid, by around $125 million in the current fiscal year and about $500 million in following years” (Berger, 2020). Demonstrating the country-wide extent of the problem, Skilled Nursing News describes similar problems in Massachusetts, South Dakota, Wisconsin, Montana, and Texas, where facility closures and financial struggles have been the result of Medicaid cuts and low reimbursement rates (Flynn, 2019).

    References
    Allison, J., “Nursing Homes Fight To Stay Afloat With Low Medicaid Rates,” Skagit Valley Herald, March 1, 2020, Retrieved at https://insurancenewsnet. com/oarticle/nursing-homes-fight-to-stay-afloat-with-low-medicaid-rates#.XqiSU2hKiHt.
    Berger, L., “Nursing homes in New York grapple with Medicaid reimbursement reduction,” McKnight’s Long-Term Care News, January 2, 2020, Re­trieved at https://www.mcknights.com/news/nursing-homes-in-new-york-grapple-with-medicaid-reimbursement-reduction/.
    Flynn, M., “As Medicaid Rates Lag Behind Costs, Unpaid Nursing Home Bills Pile Up,” Skilled Nursing News, March 7, 2019, Retrieved at https://skilled­nursingnews.com/2019/03/as-medicaid-rates-lag-behind-costs-nursing-home-bills-skyrocket/.
    Liberman, L., “Medicaid Reimbursement Rates Draw Attention,” NIC Cares Blog, March 21, 2018, Retrieved at https://www.nic.org/blog/medicaid-re­imbursement-rates-draw-attention/.

    This blog post begins a series based on our article, Top Issues Across the Care Continuum, which looks more closely at some of the serious concerns of healthcare organizations across the care continuum. Subsequent challenges to be examined include:

    • Short Staffing in Long-Term Care Is Having an Impact on Resident and Financial Outcomes
    • The Patient-Driven Payment Model (PDPM) Has Changed Reimbursement for Physical Therapy in Skilled Nursing Facilities
    • Long-Term Care Continues to Feel the Financial Impact of Civil Money Penalties and Civil Money Penalty Reimbursement Programs.
    • Efforts to Decrease Widespread Antipsychotic Drugs in Long-Term Care Facilities Require Individualized Care Plans.
    • Focused Dementia Care Surveys Are Reducing the Use of Antipsychotic Medication, with Unintended Consequences
    • Infection Control Surveys Reveal a Widespread Problem Across Long-Term Care.

    There is a long list of challenges for providers across the care continuum, outside of acute care. For example, with consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with organizations throughout non-acute care to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care. Learn more about Healthstream solutions for non-acute care organizations.

  • Simplified and Streamlined Healthcare Coding

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 05, 2020
    Coders and Physicians eagerly await Evaluation and Management coding changes arriving in January 2021. Streamlining this area of E/M coding is expected to eliminate the burden on audits, because there will be fewer boxes to check on documentation. Download the article to learn more.
  • Exploring Real Solutions to the Opioid Crisis in America

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 02, 2020

    The Opioid crisis continues to wreak a staggering toll on the United States. The National Institute on Drug Abuse tells us, “2018 data shows that every day, 128 people in the United States die after overdosing on opioids.1 The misuse of and addiction to opioids—including prescription pain relievers, heroin, and synthetic opioids such as fentanyl—is a serious national crisis that affects public health as well as social and economic welfare. The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.”

    Substance Abuse and Opioid Misuse Have Created a Public Health Emergency

    The HHS Secretary has declared a public health emergency in response to increased use and abuse of prescription opioids. Professional licensing boards, federal agencies, local law enforcement and multiple provider types are on the front lines of this serious epidemic. Investigative and enforcement actions are originating from a variety of sources under these agencies including the Opioid Fraud and Abuse Unit, Prescription Interdiction and Litigation (PIL) Task Force and data analytics. The following statistics demonstrate the extent of the problem:

    • Sales of prescription opioids have increased 4 times over two decades.
    • Opioid-related deaths have increased 2 times in that same period.
    • The leading cause of accidental death is drug overdose.
    • 75% of heroin users began by misusing prescription opioids.

    Ways to Combat Opioid Misuse

    Just as for other challenging diseases, healthcare providers have some ideas about how to fix the opioid crisis and what to do in response to substance abuse. Some of these solutions to the opioid crisis include:

    • Prevention and Evidence-Based Practice -- The most important effort, according to a HealthStream blog post, is to “prevent the disease from ever happening and use evidence-based practices to treat those affected.”
    • Improved Prescription Management -- Likewise, managing prescriptions better can help, in terms of prescribing less and doing so more appropriately as a means of limiting the drug supply on the street. Proper storage and disposal of leftover drugs in homes.
    • Make Medication-Assisted Treatment Available -- Healthcare providers should ensure that medication-assisted treatment (MAT) is prescribed—it is the most effective known intervention for long term recovery from opioid use disorder (OUD).  MAT combines one of three Food and Drug Administration (FDA) approved medications (methadone, buprenorphine, and naltrexone) with behavioral therapy for preventing relapse and for maintenance treatment of OUD. Healthcare professionals must work to make this treatment more widely available, fight the scorn often directed at those on MAT, and help them get accepted into treatment programs.
    • Increase Regulatory Oversight and Strengthen Compliance Measures – A HealthStream post focused on compliance shares that “in addition, many state legislatures are requiring providers to utilize the Prescription Drug Monitoring Programs (PDMPs) to monitor patients’ previous prescription drug use before prescribing opioids. State licensing boards are using the PDMP as part of licensure renewal by monitoring prescribers’ patterns and some states are releasing data on a providers prescribing practices to an organization’s chief medical officer or director. Also, providers’ prescribing behavior is under close scrutiny. Many providers are voluntarily surrendering their DEA numbers to avoid being subject to the increased risks of prescribing opioids. Providers are required to complete mandatory training on opioid prescribing in several states, and this number may increase.
    • Educate Healthcare professionals – Everyone in healthcare should understand their role and responsibilities in finding solutions to the opioid crisis, from clinicians down to patient access staff. A HealthStream post reminds us that “It's our job in healthcare to know where those who suffer can get help.” Also, “Clinicians and staff should be prepared on what to do when you do come across somebody who's likely experiencing an opioid overdose.”

    Lastly, and perhaps most significantly, there are factors specific to addiction that make the COVID-19 pandemic more dangerous for those susceptible to opioid abuse or other substance-related problems. Complications include social isolation, the exacerbation of existing mental health issues, and the risk of COVID-19 complications. To learn more about these factors that affect efforts to fix the opioid crisis and some recommendations for moving forward under our current special circumstances, click here to access our webinar, The Effects of COVID-19 on the Opioid Crisis.

    Using Training to Improve Patient Outcomes

    HealthStream provides training solutions focused on improved patient outcomes. Using the right tools to help clinicians make informed decisions and reduce costly mistakes minimizes risk while maximizing competence. An outcomes-based delivery system requires it.  HealthStream has partnered with Aspenti Health to offer a comprehensive and cost-effective way to drive the responsible administration of opioids and effectively identify and address opioid use disorder. Learn more at HealthStream.com/Aspenti
  • The Importance of Patient Care Coordination for Outcomes

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Oct 01, 2020

    Given the multiple tracks that healthcare can take, from inpatient to outpatient and even to community settings, there is a need for care coordination and management of the transition between providers and all settings of care. Unfortunately, this coordination is often episodic or overlooked, and it tends to be organized around a specialty, not primary care. Further, transitions frequently occur with no point person held accountable for coordination.

    According to the Agency for Healthcare Research and Quality (AHRQ), “Care coordination in the primary care practice involves deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient's care to achieve safer and more effective care. The main goal of care coordination is to meet patients' needs and preferences in the delivery of high-quality, high-value health care. This means that the patient's needs and preferences are known and communicated at the right time to the right people, and that this information is used to guide the delivery of safe, appropriate, and effective care.”

    Care coordination has been identified as an important way to improve how the healthcare system works for patients, especially in terms of improved efficiency and safety. Most importantly, care coordination applied in a targeted way has the potential for improved outcomes for patients, providers, and payers.

    Some Examples of Care Coordination

    Coordinated care is being implemented throughout the care continuum. You may ask, ‘What does a patient care coordinator do?” Here are some detting-specific examples from the New England Journal of Medicine of patient care coordination and how it can strengthen care:

    1. Primary Care Coordination – some organizations may use a ‘guided primary care’ approach in which an RN has primary responsibility for patients with multiple chronic healthcare conditions. The nurse coordinates with the primary care provider and any specialty providers to ensure that nothing is missed. Not only does this support better adherence to the plan of care, but it can reduce the overall cost of care.
    2. Acute Care Coordination – Handling patients after an emergency has passed and hospital discharge has occurred, acute care coordinators oversee the transition of care, from follow-up visits and prescriptions’ being filled to confirming additional patient instructions. This can impact readmissions and reduce mortality.
    3. Post-Acute/Long-Term Care Coordination – When patients are also residents in a nursing facility, transitions between levels of care involve changes in medication and care plans. Inadequate care transitions are a big risk for this population. Care coordinators in this setting wirk with patients and their caregivers to ensure every understands the care plan, has proper expectations, and advocates for maintaining the best patient quality of life possible.

    How Care Coordination Can Impact Patient Outcomes

    It’s easy to understand why care coordination could make a big different in how one interests with the healthcare system. Here are a few examples that demonstrate the potential impact:

    • ELIMINATE DISJOINTED CARE: Even within a healthcare entity, systems can be disjointed. It is common for processes to vary, sometimes widely, among different areas of an organization, and especially between primary care and specialty sites. Care coordination can smooth out these differences and make the experience feel more like a continuum.
    • PROVIDE REFERRAL CLARITY: Patients may attend an appointment and still be unclear about why they were referred from their primary care provider to a specialist. Care coordination can help with the process of making appointments, as well as with the vital step of what to do after seeing a specialist.
    • LIAISON BETWEEN PRIMARY CARE AND SPECIALIST: Both sides of a specialist referral process may encounter problems with the interaction—Specialists should receive clear reasons for the referral as well as adequate information on any diagnostic tests that have already been done. Primary care physicians need to receive all relevant information about what happened in a referral visit in order to respond and make adjustments to ongoing treatment plans.
    • PREVENT INFORMATION LOSS: Because referral staff deal with many different processes and providers, it is common for essential information to be loss. Care coordination helps prevent snafus involving lost records, ensuring that means care is as efficient as possible.

    Through Care Coordination Nurses Are Changing the Culture

    A previous HealthStream blog post about patient care coordination shared that nurses can change this culture of single-setting handoff by communicating: “Yes, you’re here today, but my colleagues have given me a better picture of where you are in your transition. Because of our time together and my commitment to your care coordination and managing your transition, I now have a better appreciation of where you’re going and who’s going to be taking care of you there.” Under the old paradigm, the message might have been, “This completes your visit today, and thanks for coming. Goodbye.” We now emphasize that the registered nurse is now invested in what’s happening to that person when they’re out of sight. This represents a major change in the way we think about how we provide care.

    HealthStream Focuses on Nurses and Clinical Development

    At HealthStream we spend a lot of time focused on improving outcomes by supporting and developing the clinical workforce. HealthStream’s jane™ is The World’s First Digital Mentor for Nurses. Jane harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, Jane was designed to power lifelong, professional growth of clinical professionals. JaneTM is an important component of HealthStream’s suite of clinical development solutions.

  • HealthStream Learning Yields Measurable Results for Healthcare Practice

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 30, 2020

    Mid Dakota Clinic, a multidisciplinary healthcare practice with several locations in Bismarck, North Dakota offers a wide variety of healthcare services. Director of Clinical Services, Rebecca Baron, is responsible for the organizational training and education needs for all nurses outside of the surgery center, as well as nurse practitioners, physician assistants, and audiologists.

    Challenged by a Time-Intensive, Manual Process for Assigning and Providing Training

    Prior to using HealthStream Learning, Baron had no choice but to follow a cumbersome, manual process when assigning and providing education. Corporate compliance and safety training were also a problem. The Clinic’s solution for this need was originally a set of DVDs that traveled between the main clinic and satellite locations. Staff was required to watch the videos and return completed checklists to Baron.

    Tracking training was an enormous challenge. Most employees often had no idea about the training they had completed because they often submitted their paper forms to education without keeping a copy.

    No one at the organization was happy with this piecemeal and cumbersome training solution. Staff wanted a training option that was more consistent, came from a centralized source, and was easy to track. Among the more career-minded employees there was a desire for more professional development. The Clinic needed to find a solution.

    The Solution Was a Seamless Implementation of HealthStream Learning

    Mid Dakota Clinic was already aware of HealthStream, having used the company for patient-centered survey research in the past. The implementation of HealthSteam Learning was seamless and Baron received hands-on training. This affirmed her initial impression that everyone at HealthStream was “invested in helping her do her job well.” Now, Baron creates trainings from presentations and assigns them to her staff. She also has the option to assign quizzes to measure the extent to which people understand what they are reading and retaining.

    Results Included Flexibility, Saved Time, Reduced Compliance Risk, and Strengthened Development

    By moving to HealthStream Learning, Mid-Dakota Clinic has greatly enhanced how the organization makes strategic use of education and training. The lack of a modern learning solution created compliance risk and endangered patients because of gaps in competency that were directly related to the inability to make learning assignments and track completions easily. Now the organization has gained flexibility from a solution that lends itself to use in a myriad of ways.

    HealthStream Learning has allowed Mid-Dakota Clinic to connect the completion of required learning to the conditions of continued employment. It is no longer possible for staff to sidestep their mandatory training requirements.

    Efficiency has been one of the most significant benefits of using HealthStream Learning. Baron shared that “it’s given us so much time back. For evaluation emails that use to take her six weeks, she can now “probably do this job well in under 40 hours.”

    HealthStream Learning has also been beneficial from a retention and workforce development direction. The advantages start at hiring—the orientation and skills checklist is now built into HealthStream so that “someone can sign off on them right in HealthStream now versus carrying around a giant packet of paper.” The benefits continue into developing even more competent clinicians. Not only is this a demonstration to the community that Mid-Dakota Clinic has a vested interest in staff success, but also that the organization is making a financial investment in employee career advancement.

    Learning & Performance Exclusively for the Healthcare Workforce

    There’s a good reason why HealthStream’s workforce education solutions are already trusted by more than 70 percent of healthcare organizations in the U.S. HealthStream’s comprehensive suite of learning and competency management tools empowers your people to deliver the best care more easily and effectively than ever before. Powered by the industry’s top content providers, HealthStream's Learning & Performance solutions connect you to healthcare’s largest learning community with a learning management system customized by you to meet your organization’s unique needs.
  • Rethinking Healthcare Training for Diversity, Inclusion, and Bias

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 29, 2020
    A Q&A with Jeremy Short, a diversity and inclusion practices expert, about what effective diversity training looks like and why it is vitally important for healthcare organizations, individuals who work in healthcare, as well as patients and their families.
  • Provider Credentialing Adaptations for COVID-19 Hint at Healthcare’s Future

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 29, 2020

    According Vicki Searcy, Vice President, Consulting Services, at VerityStream, “Today’s adaptations and new procedures being established in provider credentialing are likely tomorrow’s business as usual.” And, she adds, the rapid changes coming now will likely lead to long-term evolution not only in the credentialing process, but all across healthcare.

    Embracing Telehealth More Strongly

    “Patients and providers alike are going to be more embracing of telehealth services,” she predicts. “And organizations, once they have experienced the fact that you don’t all have to get together physically to have a meeting, that it can be done effectively from wherever people are by using technology, will be reluctant to go back to old ways of doing things. Some people who are being forced to work remotely now will see the advantages of that and will want to incorporate that into their job once the crisis is over.”

    Automation Works Locally and Long Distance

    And, she offerss, credentialing and privileging can be easily adapted to those likely long-distance workflows as well. “We’ve already got functionality that allows not only the automation of obtaining the information about licensure and so forth, we also have automation on the decision-making process,” she says. “I could be sitting in California and have a department chair on the East Coast on the phone, and that department chair is able to sign on, look at what he or she needs to look at and make a decision. That whole process has been automated and it allows people to move quickly but still keep the business of healthcare and credentialing and privileging moving. With the use of our software, it’s why you would easily be able to automate a credentials committee and to be able to hold it virtually because everything that you need to make decisions is available electronically.”

    This blog post continues a series of excerpts from the VerityStream article, “An Upside Down World: Pandemic Creates Process Challenges and Opportunities for Licensure and Credentialing.” The article also covers:

    • Provider Support has a can-do spirit
    • Telehealth plays prominent role in new reality
    • Keeping processes effective, but uncomplicated, will be essential
    • Patient outcomes should drive “in the moment” decision-making

    PLEASE NOTE: The information in the article excerpted here was considered current at the time of its publishing. However, the COVID-19 pandemic is an ever-evolving disaster due to new findings, data, and availability of resources. Please refer to the CDC website for the latest detailed information when you need it.

    In the midst of continual healthcare change some things stay the same, like the need for comprehensive provider credentialing, privileging, and enrollment processes. In today’s value-based environment, operational efficiency is critical. Conducting manual verifications, completing paper forms by hand or taking time to deliver files to various locations across the hospital or the system is not cost-effective. Learn more about making VerityStream your comprehensive provider solutions partner.
  • Use Modern Nurse Scheduling Solution to Strengthen Staff Engagement & Job Satisfaction

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 28, 2020

    For nursing staff, scheduling can be difficult and a headache. Supervisors have to carve out time to try to align many moving parts, and nurses themselves often have to try to plan much further ahead than is often feasible in order to request time off or a different shift.

    That’s why technology such as NurseGrid, a free, mobile-scheduling app founded by nurses, has found rapid success. The NurseGrid team says that putting scheduling into the hands of nurses themselves and doing so in a fashion that’s nimble and highly responsive, helps boost both staff engagement as well as improve overall job satisfaction, two areas that are crucial in today’s highly competitive nurse-retention landscape.

    “We knew we had to focus on the end users first to create that sort of engagement that we felt nurses deserved inside of hospital departments and in healthcare facilities across the country,’ says Zack Smith, RN, BSN, Strategic Advisor and Founding Member of NurseGrid.

    Building a Nurse Scheduling Solution from Nurses Up, Not Managers Down

    “Instead of starting at the top and focusing on the needs of executives, we wanted to focus on the needs of the bedside nurses that were providing care. So we created the NurseGrid mobile app. The idea was that if we can get enough people using this NurseGrid mobile app, we can continue to iterate on it and get it to be absolutely perfect. As nurses grew to really love the technology, they would then advocate to their hospitals and to their management that they wanted to use this NurseGrid app more officially on their department. In order to do that, we had to connect this to a department tool.”

    Since its inception in 2013, the NurseGrid mobile app has taken off very quickly and now has more than 1.5 million downloads. Its user-friendly interface appealed to nurses, Smith says, who then took it to their managers and asked if it could be used on their unit, or in their department, more widely. That led to NurseGrid Manager, which also is seeing rapid national acceptance because it ties into the need to meet nurses where they are and engage them as partners in scheduling.

    “When I ask, ‘Are you thinking about, or have you developed, a clinical engagement strategy, and how does that strategy incorporate scheduling and staffing?,’ a lot of what I'm hearing as far as focus goes is lowering turnover, recruitment strategies, and involving technology to increase operational efficiencies,” notes Annalise Thomas, Clinical Solution Executive for NurseGrid.

    Less Intrusions Related to Scheduling When Nurses Aren’t Working

    “We know there's a ton of communication that's happening while nurses are at home on their days off with their family and friends,” adds Smith. “Too often for nurses, it feels like their managers and their staffing coordinator are always calling and texting them, which gets into the personal space of their time and their phone. By providing the professional platform that allows a hospital or healthcare facility to contact their staff, NurseGrid provides a delineation between work and personal life for the nurse. This provides a little bit of calm, because they know they don't have to dig through all their personal text messages to find one from work.”

    NurseGrid provides a platform that allows nurses to easily access those communications and communicate back to the hospital, allowing scheduling to occur at a more convenient time, whether during a shift or not, and also creating a professional place for a manager, supervisor or a staffing coordinator to communicate with their staff.

    To learn more about NurseGrid and how the platform works for improved nurse scheduling for everyone involved, click here.

    HealthStream Focuses on Nurses and Clinical Development

    At HealthStream we spend a lot of time focused on improving outcomes by supporting and developing the clinical workforce. That’s why HealthStream and NurseGrid have joined forces to simplify scheduling and staffing management for your facility.
  • Electronic Credentialing – Benefits and Considerations

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 25, 2020

    HealthStream regularly publishes guest blog posts like the one below from Vicki Searcy, Vice President of Consulting Services, VerityStream.

    It has become a “best practice” for healthcare organizations to move to electronic (or paperless) credentialing and privileging. When the idea of paperless credentialing was first introduced, many leaders of medical staff offices (MSPs) did not believe that paperless credentialing would be achieved during their careers.

    Now, however, the majority of organizations that I’m working with are moving as rapidly as they can in that direction—many times at the request of the medical staff leaders involved in credentialing who are tired of wading through paper and being required to have a paper file delivered for evaluation or having to go to the medical staff office to review a file. MSPs are also finding that providers who have recently completed training programs are appalled if they must complete paper applications rather than online applications.

    What steps does an organization take in order to achieve electronic credentialing and privileging? First, someone has to have the vision for moving to a paperless process. Secondly, solutions must be selected that supports the intended method of electronic processing. A well thought out implementation plan is critical.

    Some Benefits of Electronic Credentialing

    The first thing that must occur in the planning process is to determine the outcome that your organization wants to achieve. Organizations that move to electronic credentialing typically have some or all of the following goals:

    • Faster credentialing—increase speed of transmission of information and turnaround of work products (decrease the amount of time it takes to “process” applications and make decisions).
    • Decrease the volume of paper that everyone must submit, complete, handle, file, copy and shred.
    • Improve logistics with regard to dissemination of information (i.e., an online application can be immediately available to an applicant –a mailed paper application won’t be available for several days).
    • More efficient and less labor-intensive credentialing (credentialing staff can assume new responsibilities such as FPPE, designing criteria-based privileges, etc.)
    • Require that applications be submitted complete –design online applications that cannot be submitted until every question is answered and every box is checked.
    • Improve the ability to have documentation of what information was used to make a credentialing decision on a specific date.
    • Use less office space by the elimination of filing cabinets, etc.

    Considerations before Implementation of Electronic Credentialing

    Some additional information should be considered during the planning phase. Ask yourself the following questions:

    • Will our current credentialing and privileging software be able to support the type of electronic credentialing that we envision in our organization?
      • If we scan documents into our credentialing software, will those documents be easily accessible? Will we have to remember what we “named” each scanned document in order to retrieve it?
      • Archiving ability
      • Security.
    • How long will it take us to get from where we are now to a totally electronic process? What type of information systems support will be needed?
    • How will we make the transition from our paper files to electronic files (it is never too early to think about the transition process). Will we shred our current files? Would it be practical to put them in storage?
    • How willing are we—as an organization—going to change the way we do things?

    Electronic credentialing and privileging is not something that is implemented overnight—if you haven’t started moving in this direction, do some research and make sure that your organization has a strategy in place to achieve this best practice. The rewards are well worth the effort.

    The Advanced Automation Engine Powered by Validated Data and Best Practice Content

    CredentialStream is our SaaS solution that enables organizations to automate the validation and monitoring process of provider data, centralized, electronic review of validated provider files, and is the only solution to offer data visualizations based on national proprietary benchmarks.

  • The Opioid Crisis and COVID-19 – Challenges and Strategies for Patients and Providers

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 24, 2020

    This blog post is the second of two taken from a recent Webinar featuring Jill Warrington, MD, PhD., Chief Medical Officer, Aspenti Health and Assistant Professor, Robert Larner College of Medicine, University of Vermont.

    The COVID-19 pandemic presents a unique set of challenges for substance use disorder (SUD) patients—in this webinar Dr. Jill Warrington defines those challenges and presents recommendations on how SUD patients can be supported through the pandemic.

    SUD Patients – Uniquely Vulnerable to COVID-19

    Virtually everyone has been challenged by the pandemic; however, Warrington points out that SUD patients face some unique challenges.

    First, SUD patients have physiological vulnerabilities that make them more susceptible to the virus. Most of the physiological vulnerabilities to COVID-19 are a result of organ damage resulting from drug use. Pulmonary injuries frequently occur when patients smoke (COPD), vape (“Popcorn Lung”), use opioids (Respiratory Depression), or use methamphetamines (Lung Injuries). In addition, methamphetamine use can result in cardiomyopathy, IV drug use may injure heart valves, and opioid use can trigger immune dysfunction; leaving this population particularly vulnerable to the virus.

    Secondly, Dr. Warrington has also identified numerous social determinants of health that leave this population particularly vulnerable in this pandemic. The social determinants for this population range from homelessness to disparities in healthcare access and insurance. Warrington points to incarceration as being particularly problematic. Somewhere between 30% and 50% of the incarcerated population have some sort of substance abuse issue—with little chance to social distance they are left vulnerable to the virus.

    COVID-19 – The Relapse Trigger

    Warrington cites a New York Times article that referred to the pandemic as a “relapse trigger.” In addition to the characteristics of their illness and the physical consequences of drug dependency putting them at risk for COVID-19, the virus can also exacerbate SUD and put them at risk for relapse. Warrington describes SUD as a disease of social isolation. “Social networks are our patients’ lifeline in continuing their path to recovery,” says Warrington. She is concerned that social distancing is re-immersing SUD patients into the environments from which they came which can result in exposure to relapse triggers. In addition, using drugs while alone carries additional risk as no one is available to intervene in the case of an accidental overdose. Social isolation can exacerbate other mental health conditions, particularly anxiety.

    Five Recommendations for Improving Care of People Afflicted by These Two Problems

    The pandemic has created the perfect environment for a global behavioral health crisis. Traditional models for treating this population are not currently options for providers, so what can we do? Warrington has five suggestions to implement now:

    1. Rethink Medication Assisted Treatment (MAT) and embrace telehealth and other digital strategies to maintain accountability and engagement with patients.
    2. Train and scale capacity. Resources were finite prior to the emergence of COVID-19 and have been stretched even further during 2020. Plan now to scale those resources through the pandemic.
    3. Recognize the early warning signs of substance misuse and mental health distress in patients to facilitate early interventions.
    4. Ensure naloxone is available and patients know how to obtain and use it.
    5. Promote the well-being of providers who also are facing stressful personal and professional circumstances.

    Click here to access the entire webinar.

    Improve Patient Outcomes

    HealthStream provides training solutions focused on improved patient outcomes. Using the right tools to help clinicians make informed decisions and reduce costly mistakes minimizes risk while maximizing competence. An outcomes-based delivery system requires it.  HealthStream has partnered with Aspenti Health to offer a comprehensive and cost-effective way to drive the responsible administration of opioids and effectively identify and address opioid use disorder. Learn more at HealthStream.com/Aspenti.
  • Survive or Thrive: Where Long Term Care Goes from Here

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 23, 2020

    Long-term care providers already were facing serious challenges before the COVID-19 pandemic appeared:

    • Over the past several years, CMS has increased pressure on these organizations to improve care by implementing quality measurement and benchmarking programs similar to those already in place in acute care hospitals. Along with these new standards have come increased regulatory scrutiny.
    • In an attempt to improve efficiency and decrease inpatient lengths of stay, hospital leaders have been quicker to move patients from inpatient to post-acute care settings, even though standards for quality and safety may not yet be in place to support these transitions.
    • Organizations throughout the continuum of care struggle to attract and retain staff. Long-term care and home health providers may have turnover rates approaching 80% and offer pay rates in the $10.50 - $12.50 range. Many who work in these organizations are living at or below the poverty line. When workers have physically easier, more lucrative work alternatives in retail establishments, it is not hard to see why demanding jobs providing long-term care or home health assistance can be hard to fill. The high churn among employees subsequently makes it difficult for these organizations to train and develop staff so that a consistent level of quality care can be delivered.
    • Organizations in the continuum of care are facing cuts in reimbursement from Medicaid and other key payers. For example, new rules that abolish automatic 30-day levels of physical therapy as part of a patient rehabilitation program will drastically reduce reimbursement levels. This new rule threatens the viability of as many as 30% of smaller therapy and home health providers.
    • Organizations are also facing challenges dealing with the new abuse icons, preventing resident or customer falls, and implementing more detailed emergency preparedness plans.
    • Creating a perfect storm, COVID-19 has hit these organizations particularly hard, exposing weaknesses in many areas. Organizations have had to put new infection control procedures in place; they have had to procure PPE for staff and train them to use it; and they have encountered shortages in the equipment and supplies needed to provide the best care for COVID-19 residents. One result has been an alarmingly high death rate among those who have contracted COVID-19 in these care environments.

    In our e-Book, Survive or Thrive? Where Long-Term Care Goes from Here, HealthStream takes a broad look at the issues that organizations across the continuum of care are facing. We present the results of a survey HealthStream conducted among healthcare leaders in the long-term care and home health industries, where a high percentage of managers concede the pandemic is the “worst healthcare crisis they have experienced” in their careers. We also discuss the current landscape for long-term care and present a two-part series on trends impacting this industry. Access the e-Book here.

    We hope this information is helpful to you and will inform your own organizational decision-making. For more information about care continuum trends and how HealthStream can help your organization improve outcomes and the workforce that creates them, go to https://www.healthstream.com/continuum.
  • Survive or Thrive: Where Long Term Care Goes from Here

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 23, 2020

    Long-term care providers already were facing serious challenges before the COVID-19 pandemic appeared:

    • Over the past several years, CMS has increased pressure on these organizations to improve care by implementing quality measurement and benchmarking programs similar to those already in place in acute care hospitals. Along with these new standards have come increased regulatory scrutiny.
    • In an attempt to improve efficiency and decrease inpatient lengths of stay, hospital leaders have been quicker to move patients from inpatient to post-acute care settings, even though standards for quality and safety may not yet be in place to support these transitions.
    • Organizations throughout the continuum of care struggle to attract and retain staff. Long-term care and home health providers may have turnover rates approaching 80% and offer pay rates in the $10.50 - $12.50 range. Many who work in these organizations are living at or below the poverty line. When workers have physically easier, more lucrative work alternatives in retail establishments, it is not hard to see why demanding jobs providing long-term care or home health assistance can be hard to fill. The high churn among employees subsequently makes it difficult for these organizations to train and develop staff so that a consistent level of quality care can be delivered.
    • Organizations in the continuum of care are facing cuts in reimbursement from Medicaid and other key payers. For example, new rules that abolish automatic 30-day levels of physical therapy as part of a patient rehabilitation program will drastically reduce reimbursement levels. This new rule threatens the viability of as many as 30% of smaller therapy and home health providers.
    • Organizations are also facing challenges dealing with the new abuse icons, preventing resident or customer falls, and implementing more detailed emergency preparedness plans.
    • Creating a perfect storm, COVID-19 has hit these organizations particularly hard, exposing weaknesses in many areas. Organizations have had to put new infection control procedures in place; they have had to procure PPE for staff and train them to use it; and they have encountered shortages in the equipment and supplies needed to provide the best care for COVID-19 residents. One result has been an alarmingly high death rate among those who have contracted COVID-19 in these care environments.

    In our e-Book, Survive or Thrive? Where Long-Term Care Goes from Here, HealthStream takes a broad look at the issues that organizations across the continuum of care are facing. We present the results of a survey HealthStream conducted among healthcare leaders in the long-term care and home health industries, where a high percentage of managers concede the pandemic is the “worst healthcare crisis they have experienced” in their careers. We also discuss the current landscape for long-term care and present a two-part series on trends impacting this industry. Access the e-Book here.

    We hope this information is helpful to you and will inform your own organizational decision-making. For more information about care continuum trends and how HealthStream can help your organization improve outcomes and the workforce that creates them, go to https://www.healthstream.com/continuum.
  • Six Strategies for Quality Improvement in Maternal and Neonatal Care

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 23, 2020

    This blog is the second of three taken from a recent Webinar featuring Lindsay McAlister, BSN, RN; Alexander Walker, PhD, Senior Director, Learning and Research Design, MedStar; Dr. Tamika Auguste, Associate Medical Director and Director OBGYN Simulation, MedStar Health; and Kris Karlsen, PhD, APRN, NNP-BC, FAAN, Program Author and Founder, S.T.A.B.L.E.

    The Case for Preparedness

    To make the case for our need to improve maternal and perinatal care, Dr. Tamika Auguste starts off with some disappointing statistics on infant and maternal mortality in this country.

    • The U.S. currently ranks 55th of 183 countries in maternal mortality.
    • Up to 74% of all OB claims are related to a lack of clinical judgement.
    • Approximately 34% of maternal death and injury is related to inadequate monitoring.

    Dr. Auguste acknowledges that it is somewhat difficult to determine the root cause of these disappointing figures. Some physicians and researchers believe that the issue is actually a result of better data collection and more accurate reporting of maternal deaths and complications. Or, is it possible that these statistics could simply be reflecting changes in the characteristics of pregnant women? Factors such as advanced maternal age and health issues such as obesity and diabetes may also play a role. However, Dr. Auguste and many of her colleagues believe that these issues are likely accounting for just a small percentage of the problem and that clinical issues directly under the control of providers and healthcare organizations play the most significant role. So, with the problem fairly well defined, where do we begin our improvement efforts?

    Six Strategies for Quality Improvement in Maternal and Neonatal Care

    Dr. Auguste recommends the following tactics for providers and organizations seeking quality improvement in maternal and neonatal care.

    1. Continue to study and share the data. Maternal mortality reviews help us better understand the causes of maternal deaths. Understanding the cause of death is critically important, but Dr. Auguste believes that sharing is also critical as it facilitates learning from one another. She recommends using the data to raise awareness of these clinical issues so that successful interventions from one unit in one hospital can be shared and lead to more significant changes nationally.
    2. Use existing tools. Dr. Auguste cited numerous organizations with robust bundles and toolkits that have been created specifically to address unique OB clinical issues.
    3. Remember to address communication when planning education for providers. Learning that simply addresses clinical skills is missing a critical component. Dr. Auguste believes that providers will make the biggest improvements when they learn how to communicate effectively in an emergency.
    4. Maintain a focus on critical thinking. This includes helping providers feel comfortable enough to do a brief timeout to think through and discuss complicated clinical issues.
    5. Help providers and patients understand and embrace shared decision-making. Dr. Auguste specifically defines this as, “healthcare teams and patients discussing care options, the consequences of those options, other available options, and then making the decision about care together – the healthcare team, the patient and the patient’s family.”
    6. Be mindful of the damaging effects of hierarchies in healthcare organizations. Everyone on the team should be encouraged to speak up regarding safety issues without fear of personal or professional repercussions.

    Educational Solutions  

    Alexander Walker, PhD leads MedStar’s SiTEL (Simulation, Training and Education Laboratory). Dr. Walker advocates a systems-based approach to organization-wide issues that includes education as part of the solution. The first step in the process is a thorough understanding of the problem. Dr. Walker and his team then use this understanding of the problem to design the most effective education that includes the appropriate topics and educational tools. Dr. Walker’s rigorous approach to educational design is just a part of HealthStream’s Quality OB program (co-developed by MedStar SiTEL). The approach produced some very impressive results for the healthcare system. After implementing the Quality OB program, they attained zero serious OB safety events in 2019 and zero lawsuits related to shoulder dystocia in FY 2018-2019.

    Access the full webinar recording here.  

    Maternal care is one of the highest risk levels of care. Not having the right training can lead to poor communication, higher costs, and unnecessary harm. HealthStream offers industry leading solutions that will train your staff to deliver the highest quality of care for mother and baby before, during, and after delivery.  Learn more at HealthStream.com/QualityOB
  • New Rules Change Reimbursement for Physical Therapy in Skilled Nursing

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 23, 2020

    Healthcare is experiencing significant change, driven by demographic trends, outdated financial structures, and technological progress, not to mention the glaring problem of COVID-19 and its ramifications throughout the care continuum. Many non-hospital organizations are struggling with how they have long operated. Not only is it becoming harder and harder to retain employees, but everyone in healthcare needs more staff to care for our aging population. At the same time, government oversight and the wide range of measures aimed at improving the quality of care may be inadvertently creating additional problems for already-burdened care providers.

    The Patient-Driven Payment Model (PDPM) Has Changed Reimbursement for Physical Therapy in Skilled Nursing Facilities

    CMS launched the Skilled Nursing Facility Patient-Driven Payment Model (PDPM) on October 1, 2019. This new payment methodology applying to reimbursement for rehabilitation physical therapy in the skilled nursing environment is a significant direction change for this care setting. According to CMS, “PDPM does not change the care needs of SNF patients, which should be the primary driver of care decisions, including the type, duration, and intensity of skilled therapies, made on behalf of SNF patients,” (APTA, 2019).

    Unintended Consequences: Layoffs and Reduced Work Hours

    Some results of the change were unintended—for example, “almost instantly after the PDPM shift on October 1, Skilled Nursing News received a flurry of e-mails from therapists who were laid off or saw their hours reduced as providers adapted to the new system—which bases reimbursements on resident acuity, and not the sheer volume of services provided” (Spanko, 2020).

    Potential Negative Impact on Outcomes

    One of the new requirements was for 25% of services for all residents to be provided in a group therapy setting (APTA, 2019). Though CMA clearly enacted the measure as a cost-containment measure, so that reimbursement is more closely tied to resident need and ADL Function, rather than the earlier system focused merely on the volume of services provided. Cuts to jobs may have been far deeper than intended, with a negative impact on resident outcomes (Spanko, 2020). Given that certain resident comorbidities have a higher ranking for reimbursement under the PDPM methodology, these conditions may be over emphasized compared to others. As a result, “Based on those incentives, the researchers argue, skilled nursing facilities could begin selectively admitting residents with more acute needs than other patients, while also discharging people home faster due to the gradual decline in reimbursement rates over time. Because therapy no longer generates direct payments, the group also pointed out the potential for under-provision of therapy” (Spanko, 2020). In an effort to rebalance reimbursement to value-based care over volume, the pendulum may have swung too far.

    References
    APTA, “SNF Patient-Driven Payment Model (SNF PDPM),” 12/11/2019, American Physical Therapy Website, Retrieved at https://www.apta.org/PDPM/SNF/.
    Spanko, A., “Confessions of a Therapist Post-PDPM: ‘You’re Not Valuable to Them Because You’re Not Making Money’,” Skilled Nursing News, January 12, 2020, Retrieved at https://skillednursingnews.com/2020/01/confessions-of-a-therapist-post-pdpm-youre-not-valuable-to-them-because-youre-not-making-money/.
    Spanko, A., “Researchers Find ‘Perverse Incentives’ for Skilled Nursing Operators Under PDPM,” Skilled Nursing News, March 30, 2020, Retrieved at https://skillednursingnews.com/2020/03/researchers-find-perverse-incentives-for-skilled-nursing-operators-under-pdpm/.

     

    This blog post begins a series based on our article, Top Issues Across the Care Continuum, which looks more closely at some of the serious concerns of healthcare organizations across the care continuum. Subsequent challenges to be examined include:

    • Short Staffing in Long-Term Care Is Having an Impact on Resident and Financial Outcomes
    • Low Rates for Medicaid Reimbursement, Coupled with Additional Recent State Funding Cuts, May Be Precipitating Skilled Nursing and Long-Term Care Facility Closures.
    • Long-Term Care Continues to Feel the Financial Impact of Civil Money Penalties and Civil Money Penalty Reimbursement Programs.
    • Efforts to Decrease Widespread Antipsychotic Drugs in Long-Term Care Facilities Require Individualized Care Plans.
    • Focused Dementia Care Surveys Are Reducing the Use of Antipsychotic Medication, with Unintended Consequences
    • Infection Control Surveys Reveal a Widespread Problem Across Long-Term Care.

    There is a long list of challenges for providers across the care continuum, outside of acute care. For example, with consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with organizations throughout non-acute care to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care. Learn more about Healthstream solutions for non-acute care organizations.

  • New Rules Change Reimbursement for Physical Therapy in Skilled Nursing

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 22, 2020

    Healthcare is experiencing significant change, driven by demographic trends, outdated financial structures, and technological progress, not to mention the glaring problem of COVID-19 and its ramifications throughout the care continuum. Many non-hospital organizations are struggling with how they have long operated. Not only is it becoming harder and harder to retain employees, but everyone in healthcare needs more staff to care for our aging population. At the same time, government oversight and the wide range of measures aimed at improving the quality of care may be inadvertently creating additional problems for already-burdened care providers.

    The Patient-Driven Payment Model (PDPM) Has Changed Reimbursement for Physical Therapy in Skilled Nursing Facilities

    CMS launched the Skilled Nursing Facility Patient-Driven Payment Model (PDPM) on October 1, 2019. This new payment methodology applying to reimbursement for rehabilitation physical therapy in the skilled nursing environment is a significant direction change for this care setting. According to CMS, “PDPM does not change the care needs of SNF patients, which should be the primary driver of care decisions, including the type, duration, and intensity of skilled therapies, made on behalf of SNF patients,” (APTA, 2019).

    Unintended Consequences: Layoffs and Reduced Work Hours

    Some results of the change were unintended—for example, “almost instantly after the PDPM shift on October 1, Skilled Nursing News received a flurry of e-mails from therapists who were laid off or saw their hours reduced as providers adapted to the new system—which bases reimbursements on resident acuity, and not the sheer volume of services provided” (Spanko, 2020).

    Potential Negative Impact on Outcomes

    One of the new requirements was for 25% of services for all residents to be provided in a group therapy setting (APTA, 2019). Though CMA clearly enacted the measure as a cost-containment measure, so that reimbursement is more closely tied to resident need and ADL Function, rather than the earlier system focused merely on the volume of services provided. Cuts to jobs may have been far deeper than intended, with a negative impact on resident outcomes (Spanko, 2020). Given that certain resident comorbidities have a higher ranking for reimbursement under the PDPM methodology, these conditions may be over emphasized compared to others. As a result, “Based on those incentives, the researchers argue, skilled nursing facilities could begin selectively admitting residents with more acute needs than other patients, while also discharging people home faster due to the gradual decline in reimbursement rates over time. Because therapy no longer generates direct payments, the group also pointed out the potential for under-provision of therapy” (Spanko, 2020). In an effort to rebalance reimbursement to value-based care over volume, the pendulum may have swung too far.

    References
    APTA, “SNF Patient-Driven Payment Model (SNF PDPM),” 12/11/2019, American Physical Therapy Website, Retrieved at https://www.apta.org/PDPM/SNF/.
    Spanko, A., “Confessions of a Therapist Post-PDPM: ‘You’re Not Valuable to Them Because You’re Not Making Money’,” Skilled Nursing News, January 12, 2020, Retrieved at https://skillednursingnews.com/2020/01/confessions-of-a-therapist-post-pdpm-youre-not-valuable-to-them-because-youre-not-making-money/.
    Spanko, A., “Researchers Find ‘Perverse Incentives’ for Skilled Nursing Operators Under PDPM,” Skilled Nursing News, March 30, 2020, Retrieved at https://skillednursingnews.com/2020/03/researchers-find-perverse-incentives-for-skilled-nursing-operators-under-pdpm/.

     

    This blog post begins a series based on our article, Top Issues Across the Care Continuum, which looks more closely at some of the serious concerns of healthcare organizations across the care continuum. Subsequent challenges to be examined include:

    • Short Staffing in Long-Term Care Is Having an Impact on Resident and Financial Outcomes
    • Low Rates for Medicaid Reimbursement, Coupled with Additional Recent State Funding Cuts, May Be Precipitating Skilled Nursing and Long-Term Care Facility Closures.
    • Long-Term Care Continues to Feel the Financial Impact of Civil Money Penalties and Civil Money Penalty Reimbursement Programs.
    • Efforts to Decrease Widespread Antipsychotic Drugs in Long-Term Care Facilities Require Individualized Care Plans.
    • Focused Dementia Care Surveys Are Reducing the Use of Antipsychotic Medication, with Unintended Consequences
    • Infection Control Surveys Reveal a Widespread Problem Across Long-Term Care.

    There is a long list of challenges for providers across the care continuum, outside of acute care. For example, with consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with organizations throughout non-acute care to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care. Learn more about Healthstream solutions for non-acute care organizations.

  • University of Louisville Hospital

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 21, 2020

    Challenge

    The University of Louisville (UofL) Hospital is an academic teaching and research hospital that is part of UofL Health, a fully integrated regional academic health system with five hospitals, four medical centers, and multiple other care facilities. They had been using a manual nurse assessment method that was effective though time-consuming to operate and especially implement. Education coordinators knew this solution would not scale well for consistent use across all hospitals in the system, which was the end goal. However, nurse leaders had understandable concerns that a more automated process would not provide the customized, accurate, and practical results demanded of the program.

    Solution

    UofL Hospital decided to add HealthStream’s Jane™, a dynamic system that identifies gaps and recommends personalized nurse competency plans across the knowledge and clinical judgment domains. They chose Jane™ specifically because they wanted to transition from time-consuming manual processes to a more standardized approach. Jane™ was rolled out in January 2020, and UofL Hospital coordinators quickly found themselves pivoting to use Jane™ to rapidly assess new nurses and efficiently transition existing nurses to additional areas of need, in response to changing care demands during the COVID-19 pandemic.

    Results

    During the first 90 days of using Jane™, UofL Hospital experienced a 50% reduction in time spent managing assessments. The increased speed in delivery of testing, grading, and analysis made it possible for them to complete more than 270 assessments during that time period, as well. The easy, intuitive program was cited as particularly valuable in getting up to speed quickly. Upon review, any concerns about using Jane™ as an assessment solution have been minimized by accurate and objective results. Jane™ also provided the unexpected benefit of allowing the hospital to react quickly during the COVID crisis with minimal disruption. With the impressive results so far, UofL Health intends to implement Jane™ in more of its hospitals.

  • Mobile Nurse Scheduling App Offers Potential to Boost Staffing Efficiency

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 18, 2020

    Attracting and retaining the best nurses is an ongoing and increasingly challenging goal for any healthcare enterprise. One way to get there is by offering comprehensive benefits, which can include much more than a standard package that revolves around pay, insurance, and vacation. For instance, how about a way to handle scheduling that’s not labor intensive and invasive?

    Better Scheduling as a Nurse Retention Strategy

    That’s what NurseGrid offers, and it’s why this free, mobile app is now on the smartphones of more than 1.5 million nurses nationwide. Together with its supervisor element, NurseGrid Manager, the technology is making scheduling easier for everyone involved, says Zack Smith, RN, BSN, Strategic Advisor and Founding Member of NurseGrid.

    “There are so many needs that hospital departments have, and trying to bottle that all into a really smooth user experience was really challenging,” Smith says. “In particular, we wanted nurses of all ages and in all ranges of familiarity with technology to feel comfortable using our mobile app. We feel confident that we did that. And then a lot of those nurses were finding such satisfaction in it that they took it to their managers and saying, ‘You should really check this out to see if we can begin using this on our unit or department,’ which led to NurseGrid Manager popping up all over the nation.

    Better Engagement = Simplified and More Streamlined Staffing

    “Connecting nurses and supervisors quickly and easily arounds staffing has enhanced both engagement and satisfaction,” Smith says, a point echoed by Annalise Thomas, Clinical Solution Executive for NurseGrid.

    “The way the two elements work within a facility are what makes them superior scheduling tools,” Thomas says. “We have the front end, which is our schedule creation, and then we have that back end of timekeeping,” she explains. “We're not trying to take over either of these but really elevate both of them. As we navigate new workflows, we have to figure out how to fill these gaps that are creating inefficiencies. We see that in the intersection between schedule creation and timekeeping, NurseGrid is able to give employees the transparency through real-time connectivity. Then it allows managers to put time towards other key areas that need to be taken care of while increasing their staff engagement.”

    Better Technology Solves the Nurse Scheduling Conundrum

    Using technology to increase both staff satisfaction as well as operational efficiencies has long been seen as a healthcare magic bullet. Amanda Brooks, Manager of Customer Success at NurseGrid, explains how NurseGrid and NurseGrid Manager makes this goal a reality.

    “On the app, by tapping into my shift tomorrow, I have full insight into who I'm going to be working with, what that shift is going to look like,” Brooks explains. “Let’s say I'm working my day-RN shift within the NICU. If my manager included any notes, that information will be available to me in the app. Then if I tap another section, I get full insight into the schedule for that day. I have visibility into who I'm going to be doing handoffs with from the night shift, who's working at my exact shift, and then who I'm going to be handing off with for that upcoming night shift as well, in addition to who's unscheduled for that day.”

    Users can also connect with their colleagues, and view schedules in order to swap shifts, get managerial approval for those, request time off and interact in many other ways. “One of our most popular newer features is to be able to compare schedules. This makes it incredibly easy to plan for shift trades and also make plans outside of work as well,” Brooks says. And on the managerial side, “When your hospital is connected to NurseGrid Manager, and you have multiple departments, they will be tied to a staffing pool so you can have insight across the facility,” she adds.

    To learn more about NurseGrid, NurseGrid Manager, and how the platform works to improve nurse scheduling for everyone involved, click here.

    HealthStream Focuses on Nurses and Clinical Development

    At HealthStream we spend a lot of time focused on improving outcomes by supporting and developing the clinical workforce.  That’s why HealthStream and NurseGrid have joined forces to simplify scheduling and staffing management for your facility.
  • Improve Healthcare Training with Adaptive and Personalized Learning

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 17, 2020

    Many healthcare organizations have reached a crossroads in terms of their education and training initiatives. Dual concerns about training as many have always done it have reached a head. Organizations are encountering difficulties finding the time required for traditional training. Employees are becoming disgruntled and expressing frustration about taking the same training over and over on the same material.

    Learning that is personalized to an employee’s position and knowledge base can make a significant difference in the effectiveness of a training program. To measure the degree to which healthcare organizations need to change how they use training and learning for strategic and compliance purposes, HealthStream recently surveyed industry decision-makers in the areas of employee education and development to determine their opinions of adaptive learning and their status in adopting this new approach. This blog post includes some highlights of the findings based on replies from 214 leaders that were collected by HealthStream using an online survey administered in July 2020.

    Common Organizational Challenges for Healthcare Training

    According to the healthcare leaders who participated in the survey, their organizational education and development programs are challenged by assignments that can be difficult for staff to take and by employees who are frustrated by having to repeatedly train on the same material. Below are the specifics we learned from survey responses:

    • There’s significant room for decision-making about individualized training programs. Organizations are relying on a number of different internal sources to determine what training to assign in the upcoming year. Assignments are not likely to be informed by assessments that can pinpoint individual learning needs.
    • Leaders believe that adaptive learning programs could provide much value for improving the effectiveness of learning and training initiatives. The healthcare leaders we surveyed saw many advantages to using an adaptive learning approach, including improved efficiency, learner satisfaction, learner engagement, and time savings.
    • Healthcare employees shouldn’t have to train continually on materiel they know well, and patient outcomes would benefit if we used adaptive learning. Healthcare leaders strongly agreed with these statements:
      • I would like to see more options for employees to opt out of course material they already know.
      • An adaptive learning approach will improve the quality of patient care delivered by our organization.

    We asked those surveyed about how training and development works in their organization. Here are four additional findings from the survey about healthcare learning:

    Leadership Structure - Ownership of employee education and development is handled in one of two ways in most healthcare organizations. It is either handled exclusively by learning/education professionals (36.5%) or it is handled by a cross-disciplinary team with representatives from HR, nurse leadership, and learning/education professionals (46.0%).

    Training Decision-making - Organizations are using a number of methods to determine what learning and training to deliver to staff each year. Most are using one of the three following sources: subject matter experts committee (50.4%), general content from another source, such as Rapid Regulatory Courses (48.8%), or executive level decision-making (48.8%). Last year’s plan (36.4 %) and federal/state requirements (36.4%) were also high on the list.

    Training Assessments - Fewer than three in ten were using any kind of assessment or tool to determine individual learning or training needs. 28.9% were using an assessment or tool to determine individual needs, but half (50.0%) were not using any kind of assessment or tool.

    Need to Improve Education and Development - The majority of healthcare leaders recognized that their education and development efforts could be more efficient and that their employees would benefit from an adaptive learning approach; however, most were not currently using adaptive learning in their organization. Leaders expressed the highest level of agreement with this statement, “Our employee education and development programs and courses could be more efficient than they are today” (mean = 8.0).

    This survey affirms HealthStream’s approach to adaptive learning, based on the idea that healthcare learners want to focus on training that expands their knowledge and competency.  These individuals want to fast-track through content that takes into consideration their years of tenure and competency. We are helping healthcare organizations avoid assigning every employee the same training, and rather giving them an opportunity to test out and show their knowledge, competency, and proficiency. To learn more, download the survey report by Robin L. Rose, M.B.A., Vice President, Healthcare Resource Group, HealthStream, on which this blog post is based, Efficiency and Personalization with Adaptive Learning.
  • San Juan Regional Medical Center

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 16, 2020

    Challenge

    San Juan Regional Medical Center (SJRMC) is a 198 bed, nonprofit, community owned hospital, with a commitment to good stewardship principles that enhance services and care. Though they had been utilizing the Performance Based Development System (PBDS) to assess nurse competency for 19 years, the growing organization needed to adapt to changing clinical needs. Their “wish list” of items for improvement included a program that offered a more detailed description of nurse progress, indicators for targeting strengths and weaknesses, feedback on and prioritization of problems, and the precision of a quantifiable score as opposed to a rating.

    Solution

    Noting that HealthStream’s Jane™ would immediately fulfill many of their wish list items, SJRMC began using Jane™ for new graduate nurses, transitioning staff, and traveling nurses. Leaders noted that with transitioning nurses, Jane provided assessment of competency gaps, recommendations for personalized competency plans at scale, and evidence-based learning options. Additionally, travelers expressed relief that the system of testing was so much easier now. Overall, leadership felt the change provided “phenomenal” results—specific benefits awarded kudos included the support HealthStream provided with Jane™

    Results

    SJRMC experienced a reduction in CLABSI and CAUTI, two common healthcare-acquired infections (HAIs), due to their improved orientation program that includes Jane™. Significant time and cost savings were other valued impacts. SJRMC estimated educators saved an average eight hours per nurse assessment by reducing the time spent preparing, proctoring, reviewing results, writing plans, and meeting with students or managers. With an average $280 savings per assessment, SJRMC realized more than $40,000 in savings within the first seven months. Reduced assessment anxiety among staff was another plus, as was the quantifiable data on staff learning.

  • The Importance of Joint Commission Maternal Health Standards and How They Were Compiled

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 16, 2020

    This article excerpts a HealthStream article by Trisha Coady, BSN, RN, Senior Vice President and General Manager of HealthStream’s Clinical Solutions, about the new perinatal care standards that have been issued by the Joint Commission.

    The new Joint Commission Standards for maternal and perinatal safety establish multiple requirements for improving maternal care and outcomes. For example, they call “for maternity units to keep life-saving medications immediately accessible. Hospitals also must plan for the rapid release of blood supplies for transfusions” (Stein, 2019). Because a rapid response is often essential when dealing with complications, the standards focus strongly on making equipment and medication available for when they are needed.

    Who Is the Joint Commission?

    As an independent, not-for-profit organization, The Joint Commission is our country’s oldest and largest standards-setting and accrediting body in healthcare. It accredits and certifies more than 22,000 healthcare organizations and programs across the United States. The mission of the Joint Commission is to “continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.” Their corresponding vision is to ensure that “all people always experience the safest, highest quality, best-value health care across all settings.”

    Why Is Joint Commission Accreditation Important?

    In addition to their obvious value as a contributor to better care, maternal patient safety, and outcomes, compliance with these and other Joint Commission standards has a clear value for healthcare organizations in multiple official directions. Some of the most important plusses may include qualification for participation in Medicare or Medicaid, being a prerequisite for eligibility for insurance reimbursement, fulfilling some state regulatory requirements, and may qualify an organization for a reduction in the cost of liability insurance.

    How the Maternal Safety Standards Were Compiled

    In their efforts to prepare hospitals for the new standards, a new R3 Report from the Joint Commission provides guidelines for 13 new elements of performance (EPs). This report includes the requirements, each supplemented with a corresponding rationale and reference. An important attribute of these standards is that they are the product of some of the most advanced U.S. expertise in maternal health outcomes. In addition to compiling data from an extensive literature review and public field review, The Joint Commission consulted with a Technical Advisory Panel (TAP) of subject matter experts in maternal health and a Standards Review Panel (SRP) of clinicians and administrators to provide an insider’s perspective. Organizations involved in putting together these standards included The Alliance for Innovation on Maternal Health (AIM), a source for valuable recommendations, whose program’s maternal safety bundles provide best practices for maternity care. The Standards also incorporate advice from the American College of Obstetricians and Gynecologists (ACOG), the California Maternal Quality Care Collaborative (CMQCC), and other national experts in evidence-based practice for maternal healthcare.

    The new standards were published online in the Spring 2020 E-dition update for the hospital program, and in print in the 2020 Update 1 for the Comprehensive Accreditation Manual for Hospitals; however, organizations will not be held to these requirements during surveys until January 2021.

    In addition, the article includes:

    • Uncovering the Serious Problems That Exist in Maternal Healthcare
    • Statistics about Maternal Health Outcomes and Disparities
    • What Are Some of the Specific Maternal Health Problems?

    Reference

    Stein, L., “Hospital safety fix targets maternal mortality rate for postpartum hemorrhage, preeclampsia,” USA Today, Updated October 29, 2019, Retrieved at https://www.usatoday.com/story/news/investigations/2019/10/28/maternal-mortality-rate-fix-preeclampsia-postpartum-hemorrhage/4084169002/.

    Download this article, “New Joint Commission Guidelines Target Poor Maternal Mortality Outcomes,” to learn about the new Joint Commission safety standards for the improvement of maternal and perinatal care, and why it has taken so long for the US to understand the need for them.

    HealthStream Focuses on Clinical Development

    At HealthStream we spend a lot of time focused on improving outcomes by developing the clinical workforce. HealthStream’s jane™ is The World’s First Digital Mentor for Nurses. Jane harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, Jane was designed to power lifelong, professional growth of clinical professionals. JaneTM is an important component of HealthStream’s suite of clinical development solutions.

  • For Provider Credentialing During COVID-19, Keep Processes Effective, But Uncomplicated

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 15, 2020

    Threading the needle between “just in time” credentialing and licensure in order to deploy desperately needed caregivers quickly and ensuring that compliance and other safeguards are being met can be difficult. According to Vicki Searcy, Vice President, Consulting Services, at VerityStream, it doesn’t have to be.

    Don’t Make Credentialing More Complicated Than Necessary

    “I worry that organizations will make credentialing more complicated than what they need to,” she says. “This is a national emergency, and what you have to do is keep your head focused on patient needs and suspend some of the things that you would normally do in a thorough credentialing and privileging process. Systems and facilities will, of course, do what they can to confirm the identity and as much about competency as there is time for. And their activities are going to be supervised. But the vast majority of physicians and other healthcare providers volunteering to work in this emergency situation are not going to be there for bad reasons. We’ve got to have a little trust here — we have to provide care to patients and keep them safe, and trust that the other things will follow.”

    Credentialing Automation Can Ease Some Burdens

    The peace of mind automated systems such as CredentialStream can and will provide, such as that core automation to check licensure and review for sanctions alongside other safety measures that are in place, allows providers to focus on patients. And new workflows created for the COVID-19 situation have created further automations that will create operational efficiencies long after the current situation has ended.

    “Automation has always been important to our clients; that’s why they’re part of VerityStream,” she points out. “They may be experiencing it in a different way right now, but what we want to do is keep pushing the envelope and become even more automated. Our customers want to move in that direction as well, so I think we will only pick up speed.”

    This blog post is the second in a series of excerpts from the VerityStream article, “An Upside Down World: Pandemic Creates Process Challenges and Opportunities for Licensure and Credentialing.” The article also covers:

    • Provider Support has a can-do spirit
    • Telehealth plays prominent role in new reality
    • Today’s adaptations and new procedures are likely tomorrow’s business as usual
    • Patient outcomes should drive “in the moment” decision-making

    PLEASE NOTE: The information in the article excerpted here was considered current at the time of its publishing. However, the COVID-19 pandemic is an ever-evolving disaster due to new findings, data, and availability of resources. Please refer to the CDC website for the latest detailed information when you need it.

    In the midst of continual healthcare change some things stay the same, like the need for comprehensive provider credentialing, privileging, and enrollment processes. In today’s value-based environment, operational efficiency is critical. Conducting manual verifications, completing paper forms by hand or taking time to deliver files to various locations across the hospital or the system is not cost-effective. Learn more about making VerityStream your comprehensive provider solutions partner.

  • Quadruple Aim: Improving Population Health

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 14, 2020

    Chronic diseases account for seven of the top 10 causes of death in the United States, and 86 percent of annual healthcare spending. It’s evident that this segment of the population, most often seniors, requires greater clinician and caregiver acuity.

    This webinar session will explore how providers can improve health, control costs, and achieve a critical component of Quadruple Aim by raising caregiver acuity for high-burden health conditions and effective evidence-based interventions. 

  • Short Staffing in Long-Term Care Is Having an Impact on Resident and Financial Outcomes

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 14, 2020

    Healthcare is an industry in the midst of transformation driven by demographic change, financial instability, and technological advance, not to mention the immediate issue and yet to be determined ramifications of the COVID-19 pandemic. Many non-hospital organizations across the care continuum are reeling from challenges to how they have long operated. Not only is it becoming harder and harder to retain employees, but everyone in healthcare needs more staff to care for our aging population. At the same time, government oversight and the wide range of measures aimed at improving the quality of care are not likely to go away anytime soon.

    Short Staffing in Long-Term Care Is Having an Impact on Resident and Financial Outcomes

    Staffing levels are one of the most important determinants of whether a long-term care facility is providing adequate care. However, many nursing homes have employee coverage issues and are failing the meet the CMS requirement “that a registered nurse be on-site at least eight hours every day” (Rau & Lucas, 2019). To verify staffing levels as part of the ratings effort for the Nursing Home Compare Website, CMS now requires facilities to submit their payroll records. A Kaiser investigation found that “nursing homes had fewer nurses and caretaking staff than they had reported to the government, according to new federal data, bolstering the long-held suspicions of many families that staffing levels were often inadequate” (Rau, 2018).

    Understaffing is extremely important, as it “can indirectly cause nursing home abuse because overwhelmed and underpaid nursing home staff members and caregivers are more likely to be abusive to a nursing home resident” (Nursing Home Abuse Center, 2019). Inadvertent neglect is a natural product of understaffing—residents are dependent on caregivers who are stretched too thin. Increased psychological problems may result, as well as physiological conditions. The reasons for understaffing  are varied—it may be intentional on the part of some organizations as a strategy to reduce labor costs. Nursing facilities also may have a serious problem finding and retaining adequately trained nurses. High turnover among staff results in a greater burden on those who stay, leading to stress and burnout. Payroll records submitted to Nursing Home Compare “reveal frequent and significant fluctuations in day-to-day staffing, with particularly large shortfalls on weekends” (Rau, 2018).

    References

    Nursing Home Abuse Center, “Understaffing in the Nursing Home,” November 14, 2019, Retrieved at https://www.nursinghomeabusecenter.com/ nursing-home-neglect/understaffing/.

    Rau, J., “Most nursing homes are not adequately staffed, new federal data says,” PBS Newshour, July 13, 2018, Retrieved at https://www.pbs.org/news­hour/health/most-nursing-homes-are-not-adequately-staffed-new-federal-data-says.

    Rau, J., and Lucas, E., “Short-Staffed Nursing Homes See Drop In Medicare Ratings,” Kaiser Health News, May 3, 2019, Retrieved at https://khn.org/ news/short-staffed-nursing-homes-see-drop-in-medicare-ratings/.


    This blog post begins a series based on our article, Top Issues Across the Care Continuum, which looks more closely at some of the serious concerns of healthcare organizations across the care continuum. Subsequent challenges to be examined include:

    • The Patient-Driven Payment Model (PDPM) Has Changed Reimbursement for Physical Therapy in Skilled Nursing Facilities
    • Low Rates for Medicaid Reimbursement, Coupled with Additional Recent State Funding Cuts, May Be Precipitating Skilled Nursing and Long-Term Care Facility Closures.
    • Long-Term Care Continues to Feel the Financial Impact of Civil Money Penalties and Civil Money Penalty Reimbursement Programs.
    • Efforts to Decrease Widespread Antipsychotic Drugs in Long-Term Care Facilities Require Individualized Care Plans.
    • Focused Dementia Care Surveys Are Reducing the Use of Antipsychotic Medication, with Unintended Consequences
    • Infection Control Surveys Reveal a Widespread Problem Across Long-Term Care.

    There is a long list of challenges for providers across the care continuum, outside of acute care. For example, with consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with organizations throughout non-acute care to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care. Learn more about Healthstream solutions for non-acute care organizations.

  • What is the COVID-19 Pandemic Changing about the Future of Long-Term Care

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 11, 2020

    Current events have focused our attention like never before on the long-term care industry and on the mostly older adult population who make it their home. According to the Claude Pepper Center, an aging-focused institute at Florida State University, “The COVID-19 pandemic has created enormous pressure on the entire health care system, but possibly the most tragic impact has been on the long-term care system for both younger and older people in residential care programs” (Claude Pepper Center, N.D.). Nursing homes are feeling the full force of this impact; 85% of their residents make up the demographic most vulnerable to this disease—people aged 80 years and older. By mid-June the United States had already reached a grave milestone, where “the fatality count in nursing homes has topped 50,000, about 43% of the 116,700 deaths tracked in the country” (Soucheray, 2020). This has occurred even though nursing home residents represent less than 1% of the United States population. A June 2020 analysis in the Wall Street Journal found that “cases in nursing homes stand at 250,000, a likely undercount as not all states have reported nursing home cases uniformly” (Soucheray, 2020). Clearly this threat is focused on older adults as a result of the environments in which they are spending their final years. What does it mean for the future of the long-term care industry, which is an undeniably necessary part of the care continuum?

    COVID-19 May Accelerate Changes Already Happening in Long-Term Care

    According to an article posted by WHYY, the NPR affiliate in Philadelphia, “As the baby boomer generation ages, hospital systems, government agencies and insurers have been shifting long-term care away from costly institutions and toward the home for at least a decade. Many experts predict that the risks posed by COVID-19 may accelerate that process, whether the system is ready for it or not” (Feldman & Benshoff, 2020). The same article emphasizes the importance for nursing home operations and finances of “patients discharged from the hospital to recover after operations like joint replacements, or short-term illness like COVID-19, that come with higher reimbursement rates.” The reporters offer that “Many nursing homes subsidize the care of their long-term patients through those short-term patients, who stay for just a few weeks.” One way the long-term care industry may hope to deal with the growing needs of our rapidly aging population is to shift more aging care to the home, so that valuable, higher-dollar rehabilitative services needs can continue to be met.

    The article also includes:

    • COVID-19 Is Pushing More Patients to Make Home Care Decisions
    • An Industry Beset by Challenges but Favored by Demographic Trends

    References

    Claude Pepper Center, “COVID-19’s Impact on Long-Term Care,” Website, Retrieved at https://claudepeppercenter.fsu.edu/coronavirus-covid-19-and-you/covid-19s-impact-on-long-term-care/.
    Feldman, N., and Benshoff, L., “‘Nursing homes as we know them are over’: COVID-19 fuels push to home-based care,” WHYY, June 12, 2020, Retrieved at https://whyy.org/articles/nursing-homes-as-we-know-them-are-over-covid-19-fuels-push-to-home-based-care/.
    Soucheray, S., “Nursing homes might account for 40% of US COVID-19 deaths,” Center for Infectious Disease Research and Policy (CIDRAP), June 16, 2020, Retrieved at https://www.cidrap.umn.edu/news-perspective/2020/06/nursing-homes-might-account-40-us-covid-19-deaths.

     

    This blog post excerpts a HealthStream article, Envisioning the Future of Long-Term Care During the COVID-19 Pandemic.” Download the full article here.

    HealthStream Solutions for the Long-Term Care Workforce

    There is a long list of challenges facing skilled and long-term care (LTC) providers. Turnover rates, for example, for clinical care in nursing homes range from 55 to 75 percent, with rates among Certified Nurse Assistants (CNAs) approaching 100 percent in some areas. With consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with skilled nursing and LTC facilities to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care.

  • Bring Efficiency and Personalization to Healthcare Training with Adaptive Learning

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 10, 2020

    Employers recognize that, moving forward, staff education and development activities need to be more efficient and personalized to individual employee needs. Thanks to advances in machine learning and artificial intelligence in the healthcare industry, leaders can now use an approach called “adaptive learning” to improve the way learning is delivered. Through the use of various assessments and tests, an organization can now tailor learning to the exact needs of the group or individual. There is now no need to waste staff time taking courses that cover material they already know or that do not apply to their specific work needs.

    Where Employee Education Leaders Stand on Adaptive Learning

    HealthStream recently surveyed industry decision-makers in the areas of employee education and development to determine their opinions of adaptive learning and their status in adopting this new approach. The following is a report based on replies from 214 leaders that were collected by HealthStream using an online survey administered in July 2020.

    Summary of Survey Findings

    According to the healthcare leaders who participated in the HealthStream survey, their organizational education and development programs are challenged by assignments that can be difficult for staff to take and by employees who are frustrated by having to repeatedly train on the same material.

    • Organizations are relying on a number of different internal sources to determine what training to assign in the upcoming year. Assignments are not likely to be informed by assessments that can pinpoint individual learning needs.
    • The healthcare leaders we surveyed saw many advantages to using an adaptive learning approach, including improved efficiency, learner satisfaction, learner engagement, and time savings.
    • Healthcare leaders strongly agreed with these statements:
      • I would like to see more options for employees to opt out of course material they already know.
      • An adaptive learning approach will improve the quality of patient care delivered by our organization.

    HealthStream’s Approach to Adaptive Learning

    Adaptive learning involves a focus on the individual and meeting them where they are in terms of skill sets and competency. That translates to tailored programs that, if properly thought out and implemented, can result in heightened employee satisfaction — especially with Millennial and Gen Z cohorts. A bonus is that Gen X and Baby Boomer staff also benefit from the opportunity to demonstrate their years of expertise to test out of areas in which they are fully competent.

    “Today’s learners desire a better way to learn, especially in compliance and mandatory content,” says Vanessa Hoevel, Senior Director of Product Marketing, People and Growth Solutions, HealthStream.

    “It’s really the organizations who have been overly cautious. Learners want microlearning; they only want to learn things that they can’t demonstrate knowledge on currently. They want to fast-track through content that takes into consideration their years of tenure and competency. They are challenging their organizations not to assign everyone the same thing, but rather give them an opportunity to test out and show their knowledge, their competency and their proficiency.”

    Learn more about HealthStream’s adaptive approach to learning.

    This post is the first of two based on our article, “Efficiency and Personalization with Adaptive Learning,” by Robin L. Rose, MBA; Vice President, Healthcare Resource Group, HealthStream. The follow-up blog post will present some specific survey findings about adaptive learning in healthcare.
  • COVID-19 and the Opioid Crisis – How This Pandemic is Shaping the Opioid Crisis in 2020

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 09, 2020

    This blog post is taken from a recent Webinar featuring Jill Warrington, MD, PhD., Chief Medical Officer, Aspenti Health and Assistant Professor, Robert Larner College of Medicine, University of Vermont.

    The Opioid crisis was already a significant problem for healthcare before the COVID-19 pandemic began to change everything. Dr. Jill Warrington began her discussion of how COVID-19 has reshaped the opioid crisis with a look back at what was happening before COVID-19 really emerged as a threat in 2019. “It is important to understand where we were then, if we are to really understand the impact that COVID-19 has had on the opioid crisis,” said Warrington.

    The Baseline -2019

    Warrington and her colleagues use a number of metrics to help them evaluate the status of various opioid-related issues. There are three metrics on which Dr. Warrington and her colleagues are particularly focused. They are:

    1. The Number of Buprenorphine-Waivered Providers. This measure serves as a proxy to help researchers understand treatment capacity. Warrington shared that this number has increased exponentially over the last 15 years as the government has become more flexible in issuing the waivers and healthcare systems are increasingly recognizing the importance of buprenorphine in treating patients with opioid use disorder.

      However, Warrington points out that this metric has some limitations. First, there are still many patients on waiting lists for treatment, so it is not necessarily a real indicator of system capacity. Secondly, Warrington points out that just 10% to 30% of SUD (Substance Use Disorder) patients are in care which means that 70% to 90% of those patients are not being served despite a much-expanded network of buprenorphine-waivered [BP1] providers.

    2. Opioid Prescribing Rates. This measure helps researchers determine the risk for patients of developing opioid use disorder. Warrington points out that great strides have been made in opioid prescribing rates.

      There has been a steady decline in this metric since 2012 – the peak prescribing year. However, Warrington points out that providers are still prescribing enough opioids to support 50% of the population. While the momentum is in the right direction, the US has still not made the progress seen in some other countries.

    3. Opioid-Related Overdose Deaths. Warrington describes this as the most direct measure of the impact of the opioid crisis and therefore the most important. The news on this metric is somewhat mixed. Based on data from 2015-2020, the rate of opioid-related overdose deaths continues to rise, however, the rise in the rate has slowed somewhat. Dr. Warrington mentions that although they’ve seen progress in drug overdose statistics, this is an unsustainable trajectory.

    20202 – The Epidemic Within the Pandemic

    Warrington describes the ecosystem that supports opioid use disorder patients as “already fragile,” as 2019 rolled over into 2020. There are more buprenorphine providers, but the number still falls short of what is needed. There have been reductions in the number of opioid prescriptions, but the reduction is probably not sufficient. And finally, while somewhat abated, the number of overdoses is still rising.

    According to the American Medical Association, as of June 18, 2020, there were more than 30 states reporting increases in opioid-related deaths, mental health crises, suicide, and relapse. In addition, there are some rather alarming statistics on the use of drugs and alcohol during the pandemic. Warrington shared that:

    • There has been a 250% increase in online alcohol sales.
    • The increase in episodes of binge drinking is estimated to be 25%.
    • It is estimated that there has been a 40% increase in the use of medications for non-medical reasons.
    • There has been a 43% increase in the use of illicit drugs.

    While these figures may be somewhat shocking, they probably should not really surprise us. The pandemic has caused considerable economic and social distress with the loss of jobs creating financial stress for many and the loss of viable options for childcare creating considerable stress for those that still do have jobs. Concerns about health and the health of family members also creates additional stress.

    In addition, while the healthcare delivery system including providers, payors, and in some cases, the government, has responded to the pandemic in a truly heroic fashion, it was also fundamentally unprepared to deal with the crisis. Treatment centers that were underfunded found themselves struggling and most reported having to make reductions in their services in order to remain open.

    Lastly, and perhaps most significantly, there are factors specific to addiction that make the pandemic more dangerous for these patients. Factors such as social isolation, the exacerbation of existing mental health issues and the risk of COVID-19 complications. To learn more about these factors and Warrington’s recommendations for moving forward, click here to access the entire webinar.

    Improve Patient Outcomes

    HealthStream provides training solutions focused on improved patient outcomes. Using the right tools to help clinicians make informed decisions and reduce costly mistakes minimizes risk while maximizing competence. An outcomes-based delivery system requires it.  HealthStream has partnered with Aspenti Health to offer a comprehensive and cost-effective way to drive the responsible administration of opioids and effectively identify and address opioid use disorder. Learn more at HealthStream.com/Aspenti

  • Improve Maternal Mortality Rates Using POEP

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 08, 2020

    This blog is the first of three taken from a recent Webinar featuring Lindsay McAlister, BSN, RN; Alexander Walker, PhD, Senior Director, Learning and Research Design, MedStar; Dr. Tamika Auguste, Associate Medical Director and Director OBGYN Simulation, MedStar Health; and Kris Karlsen, PhD, APRN, NNP-BC, FAAN, Program Author and Founder, S.T.A.B.L.E.

    Lindsay McAlister is a clinical obstetric specialist at HealthStream and has nursing experience in labor, delivery, recovery, and postpartum. While she no longer provides direct patient care, she is still an advocate for improvement in maternal mortality rates.

    Orientation and Nurse Retention

    The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) has partnered with HealthStream to offer POEP (Perinatal Orientation and Education Program). AWHONN’s mission is to empower and develop nurses and that really starts with quality orientation and education programs that help prepare nurses to provide the highest quality care for mothers and babies.

    POEP is designed to serve as both an orientation for nurses that may be new to the perinatal unit as well as continuing education for experienced staff. McAlister stresses the importance of orientation to nurse retention – an ongoing issue for virtually every healthcare organization in the US. “There is a lot at stake when we bring a new nurse into our hospital to deliver care,” said McAlister. In addition, whether that new nurse is coming straight out of a nursing program or transferring from another discipline, McAlister points out that those nurses likely only have about one semester or six months of women’s health education, which further underscores the importance of establishing a baseline of evidence-based best practices based on the most recent data. POEP can help your organization prepare nurses and help them become confident in their skills.

    Turning the Tide on Rising Maternal Mortality Rates – Educational Solutions

    POEP includes 15 different modules that provide detailed education on topics that range from prenatal to postpartum care. The content addresses the normal course of labor and delivery in addition to complications that may occur during labor and delivery. Additionally, infant care and neonatal complications are covered. McAlister also shared the importance of the patient experience. Patient care is not simply the physical aspects of care, but the emotional and social aspects as well. This program addresses the full range of the physical aspects of care and there is also a section to prepare caregivers to help patients cope with perinatal loss from both a physical and emotional standpoint.

    Engaging and Interactive Educational Solutions Focused on Maternal Mortality

    So, if your organization uses POEP, what can you expect? The program includes:

    • Online modules that focus on the essentials of perinatal education
    • Narration, video and animation
    • Knowledge checks
    • Pre- and post-tests
    • Reference lists, speaker notes and participant handouts
    • User manuals for participants and administrators
    • CNE contact hours

    POEP is recommended for both new and experienced nurses and can also be used as a tool for advanced practice nurses preparing for exams. The content is regularly revised and updated to reflect current best practices and can also support a blended learning approach that includes both instructor-led training and online content.

    Access the full webinar recording for Preparing Your Staff to Provide Quality Maternal and Neonatal Care.

    Maternal care is one of the highest risk levels of care. Not having the right training can lead to poor communication, higher costs, and unnecessary harm. HealthStream offers industry leading solutions that will train your staff to deliver the highest quality of care for mother and baby before, during, and after delivery.

  • Specific Results from HealthStream’s Long-Term Care Survey about COVID-19

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 08, 2020

    COVID-19 has wreaked havoc with our nation’s long-term care (LTC) facilities. As this was happening, HealthStream sought to hear directly from providers “on the front lines” to understand their greatest challenges and needs. To this end, HealthStream surveyed 365 facility leaders during April/May of 2020. Some of our general findings included:

    • Most leaders felt this pandemic was the worst healthcare crisis they had encountered during their lifetime.
    • Leaders believed staff had been well-trained in the use of Personal Protective Equipment (PPE), but they did not have the supply of PPE that was needed to keep staff safe.

    Problems with Hiring and Retaining Staff for Long-Term Care

    Some 37.1% of healthcare leaders reported that it is harder to attract new workers to their facility because of COVID-19, and more than one-fourth (28.3%) noted that they had lost staff who were worried about their personal risk in caring for residents during the pandemic.

    Despite the risks, very few leaders were being encouraged to leave their jobs. Just over one in ten (11.5%) said they had been encouraged to leave their job for safety’s sake.

    Protective Gear and Training for It Are a Challenge

    In the midst of the pandemic crisis, leaders expressed concern that staff training was lacking and that there was a shortage of protective gear and testing supplies.

    • Very few leaders (20.3%) strongly agreed that they had the protective gear they needed to care for COVID-19 patients. Even if they had had the gear they needed, many did not think their staff was adequately trained in how to use it.

    Safety, Quality, and COVID-19 Preparation Are Priorities

    Six in ten leaders (59.7%) believed their staff was well-trained in how to use personal protective equipment (PPE); The three top priorities for continuum leaders during this pandemic are:

    • Keeping staff safe
    • Maintaining a high quality of care
    • Knowing what to do when residents present with symptoms of COVID-19 owever, that meant four in ten were not as likely to agree that this was the case.

    More than 90% of leaders strongly agreed that these were the top issues. Just over half (51.6%) strongly agreed that attracting additional staff was a priority.

    The majority of post-acute leaders were looking for support from HealthStream in these two areas:

    • Training on how to care for residents diagnosed with COVID-19
    • Keeping clinical staff safe from infection
    • Nearly half (47.2%) wanted help retaining staff during this time.

    About Survey Respondents

    HealthStream surveyed 365 continuum healthcare leaders during April/May of 2020. The majority of respondents represented skilled nursing facilities (89.3%), independent/assisted living facilities (12.9%), or rehabilitation facilities (8.8%). [Please note: The percentages here add up to more than 100 because respondents could select more than one choice.) The majority of respondents were between the ages of 45 and 64 (62.1%). Nearly two-thirds (64.5%) had worked in the healthcare industry for more than 20 years. The majority of respondents were from Clinical/Nursing leadership (50.3%), but over one-fourth (28.2%) were in Executive Leadership.

    This blog post is an excerpt from the article, “COVID-19 Has Forever Changed Long-term Care,” by Robin L. Rose, MBA, Vice President, Healthcare Resource Group, HealthStream. Download it here.  A subsequent blog post will present more detailed findings about recruitment, training, protective gear, and priorities of this care setting during the COVID-19 pandemic.

    HealthStream Solutions for the Long-Term Care Workforce

    There is a long list of challenges facing skilled and long-term care (LTC) providers. Turnover rates, for example, for clinical care in nursing homes range from 55 to 75 percent, with rates among Certified Nurse Assistants (CNAs) approaching 100 percent in some areas. With consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with skilled nursing and LTC facilities to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care.

  • What’s Next for Infant Stabilization Education?

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 04, 2020

    When S.T.A.B.L.E. and HealthStream formally announced their partnership and the upcoming launch of their online course set for March 2020, COVID-19 was a distant threat. In fact, it was not until the day of HealthStream’s press release about the partnership that the coronavirus received the name we all know by now, “COVID-19.” Yet with the arrival of March, national shelter-in-place orders were issued, and an unanticipated new reason for online learning existed.

    COVID-19 Affirms the Importance of Quality Online Training

    “I can’t imagine a better time to have the online course available—it will really address the educational needs of providers during this challenging time,” said Karlsen when discussing the timely launch of S.T.A.B.L.E.’s online course. Due to COVID-19, educators across every field are now pressed to find new ways to teach their students and convert their classroom curriculum into online material. Healthcare providers are not exempt from this, and the partnership between HealthStream and the S.T.A.B.L.E. Program provides a much-needed online option for providers to seamlessly complete their neonatal education program.

    Stabilization Is a Key Goal for Pre-Term Infants

    When talking about preterm babies, Karlsen explained that 0.7% of all babies born in the United States every year weigh less than one kilogram, and those 0.7% contribute to half of all infant mortality every year. Karlsen feels passionately that stabilization should start the moment the preterm baby is born. “Attention to preventing hypothermia and appropriately supporting breathing can often preclude the need to resuscitate the baby. Following delivery, the S.T.A.B.L.E. curriculum is useful to comprehensively give the baby the best possible start” said Karlsen. Adding to this, Karlsen said, “We have to focus on best practices for taking care of not only extremely low birth weight infants, but all infants.” Using the S.T.A.B.L.E. Program to educate nurses, doctors, respiratory therapists, midwives, emergency technicians, and any healthcare provider who may come in contact with an infant is a step towards improving those outcomes.

    Focused on Better Neonatal Outcomes

    A transition to online programming supports Karlsen’s long existing vision for the program and her hopes for the future of infant stabilization. Twenty years ago she could not have predicted technology would advance her program in this way, broadening the scope of the program through its accessibility. Karlsen explains, “My vision is that every member of the perinatal healthcare team, regardless of birth setting, will participate in the S.T.A.B.L.E. Program education, creating a stronger educational foundation that can be used when taking care of mothers and babies. An online course offering supports this effort by making the S.T.A.B.L.E. curriculum more accessible to healthcare workers in rural areas, midwives, and medical and nursing students who are preparing for their first maternity rotation at the hospital.”

    Karlsen’s passion about impacting neonatal outcomes is communicated through S.T.A.B.L.E.’s mission: Provide evidenced-based effective education to help reduce infant mortality and morbidity, improve neonatal outcomes, and improve the quality of life for infants and their families. “If our curriculum reaches one person who goes on to do the right thing for the baby, then we’ve done something very good,” Karlsen concludes.

    This blog post excerpts an article, “The S.T.A.B.L.E. Program’s Timely Transition to Online Learning: An Interview with Founder Dr. Kristine Karlsen.” The article also includes:

    • S.T.A.B.L.E.’s Informal Neonatal Transport Education Beginnings
    • Who is S.T.A.B.L.E. for?
    • Furthering the Program’s Reach through Online Education
    • Parallel Growth—S.T.A.B.L.E. Program and the Need for Stabilization Education

    Learn more about infant stabilization education by downloading the article.

    S.T.A.B.L.E. embodies HealthStream’s commitment to helping clinicians achieve better outcomes in myriad ways, from higher quality, evidence-based perinatal care to decreasing emergency department errors that can have a serious patient impact.

  • Using Telehealth to Help Flatten the COVID-19 Curve

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 03, 2020

    Telehealth has been instrumental in flattening the COVID-19 infection curve by keeping both well and sick patients at home, allowing high-risk individuals to reduce their exposure, screening potential COVID-19 patients, and reducing the spread among healthcare workers. Included in the CDC recommendations for healthcare facilities (2020) is the guidance to utilize telehealth: “Leveraging telemedicine whenever possible is the best way to protect patients and staff from COVID-19.”

    The following actions demonstrate the ways telehealth has crucially bridged the gap during this unprecedented time and how healthcare organizations have worked to make telehealth widely accessible during the coronavirus pandemic.

    1. Virtual triage for COVID-19 cases reduces unnecessary in-person assessments.

      Currently, telehealth is recommended by many healthcare facilities as the first step in receiving treatment. This alternative triage strategy keeps sick patients who can be cared for at home from coming to healthcare facilities for face-to-face triage or unnecessary treatment, reducing the spread to others. Many healthcare organizations and state health departments offer COVID-19 hotlines to guide individuals through the process of initial self-assessment. Reducing the number of exposed and sick healthcare providers is key to preventing a reduced healthcare workforce.

    2. Remote appointments with physicians and mental health providers support stay-at-home and social distancing orders and reduce the spread of infection.

      While current stay-at-home orders vary by state, utilizing telehealth for medical and mental health appointments continues to help reduce the spread of COVID-19. Since the beginning of the coronavirus pandemic in the US, there has been an increase in patients who have avoided preventative visits with their physicians, likely in order to reduce their risk of getting infected. Similarly, some providers have deferred elective and preventative visits, reducing their exposure to the virus. Telehealth provides a solution—allowing patients and doctors to reduce the spread by remaining apart when not medically necessary while ensuring important preventative appointments are kept. This is especially important for the elderly and those at high-risk.

    3. CMS increases access for Medicare telehealth services, allowing the at-risk to stay home.

      In March, CMS announced they were broadening their services to expand access to Medicare telehealth services. In the past, payer reimbursement was a significant barrier to telehealth, but these emergency policy adjustments provide easier access and a wider range of available services from patients’ doctors. This temporary coverage greatly impacts those who are high-risk by allowing them to access their doctors from home. Alongside this waiver, CMS made it easier for patients to utilize telehealth by permitting them to hold these virtual appointments from home and by waiving penalties for HIPAA violations against providers who utilize everyday communication technologies.

    4. Organizations are working hard to keep up with privileging telehealth providers.
    5. Historically, credentialing has been one of many barriers to telehealth. When the shut-downs began and demand for telehealth exploded, many organizations scrambled to privilege their providers for telehealth services. Then, CMS made emergency provisions to state-level licensing requirements that make it easier for doctors, nurse practitioners, clinical psychologists, dietitians, midwives, licensed clinical social workers, and more to use telehealth to care for their patients.

      Vicky Searcy, Vice President Consulting Services, VerityStream, a HealthStream company, explains that there is always a lot of confusion in the healthcare industry surrounding requirements related to privileging telehealth providers, and now is not an exception. VerityStream is working hard alongside organizations to streamline these processes so that organizations can keep up with the demand of disaster privileging processes now and be prepared for the future implications of these new provisions.

    This blog post excerpts HealthStream’s article, “4 Ways Telehealth Is Impacting the Fight Against COVID-19.” Download it here.

    To support caregivers and healthcare organizations as they respond to the COVID-19 pandemic, HealthStream is offering a collection of carefully curated courses to all customers for free. Likewise, Using HealthStream’s Channels platform for video learning, we have a created a free-access COVID19 Channel in response to the COVID19 pandemic, specifically to support healthcare workers and their families. It contains a collection of curated videos provided by HealthStream and HealthStream’s content partners from several trusted sources on YouTube, such as the CDC and Mayo Clinic.

  • Acute Healthcare Is Feeling the Impact of COVID-19

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 02, 2020

    Against the harrowing backdrop of the COVID-19 pandemic, HealthStream conducted a survey of acute care healthcare leaders in May of 2020. We had heard a great deal about the heroism of front-line staff and their efforts to care for patients, even though they lacked adequate protective equipment and medical supplies such as ventilators. We wanted to hear more of the story from the managers and executives who were in charge behind the scenes, including what they are worried about and their priorities as they continue to navigate their teams through this pandemic.

    Acute Healthcare Is Reeling from the Impact of COVID-19

    Most survey respondents were actively involved in the treatment of COVID-19 patients. Some 70.1% reported that they were currently treating COVID-19 patients. An additional 25% said they were preparing to treat COVID-19 patients.

    Most hospital leaders had high confidence in their ability to care for pandemic patients. The majority of leaders said they were either VERY (19.6%) or MOSTLY (35.8%) confident of their ability to care for COVID-19 patients.

    Hospital leaders have been deeply impacted by the Coronavirus pandemic. Leaders strongly agreed (mean score = 8.8) that this pandemic has been the worst health crisis they have faced in their lifetime. They highly agreed that the outbreak has had a major impact on their facility (mean = 8.5) and that they are taking a hard financial hit at their facility (mean = 8.5). Here, leaders are corroborating the bleak financial news reported above by the AHA.

    With a mean score of 8.2, leaders also admitted that this pandemic will forever change how they operate their facility.

    Are Hospitals Prepared for COVID-19?

    In the graph below, leaders were less likely to agree that they have all the training, protective gear, and testing equipment they need. Many are also concerned that they will be infected by the virus while at work.

    Staffing Issues

    Many leaders conceded that the virus had caused staffing issues.

    • Most agreed that it is harder to attract new workers with the pandemic sweeping the country.
    • Others agreed that their hospital has lost clinical staff because they are afraid of contacting the virus while at work.

    Hospital Priorities in the Face of COVID-19

    Hospital leaders listed staff safety, quality of care, and COVID-19 training as top priorities for their facility.

    The Importance of Training During COVID-19

    Many respondents have used HealthStream’s learning platform to meet their training needs during the pandemic.

  • Nearly four in ten (38.9%) have used the HealthStream platform to access complementary courseware that was provided by the Centers for Disease Control (CDC).
  • Some 28.5% have used the platform to train new employees on COVID-19 protocols and procedures.

    There were several areas where respondents would like to receive more support from HealthStream. Top mentions included:

  • Keeping yourself and other clinical staff safe from infection (66.2%)
  • Training on how to care for patients diagnosed with COVID-19 (60.0%)
  • Training on how to use Personal Protective Equipment (PPE) (50.3%)
  • Communicating with patients during this pandemic (49.7%)

    • Keeping staff safe during this pandemic was listed as the top priority, with a mean score of 9.8.
    • The following activities tied in second place with scores of 9.7:
      • Maintaining a high quality of care
      • Training staff on how to care for patients with COVID-19
      • Knowing what to do when patients present with symptoms of COVID-19
    • The lowest priority was attracting additional staff during the pandemic (mean = 6.0).

    About Survey Respondents

    HealthStream interviewed 840 healthcare leaders using an online survey tool during May of 2020. The majority of respondents represented hospitals that were part of a health system (60.6%) or a stand-alone hospital (14.8%). Most were between the ages of 45 – 64 (64.8%). More than half (54.8%) had worked in the healthcare industry for more than 25 years. Respondents were from senior Clinical/Nursing leadership (36.9%) or held Manager (27.2%) or Director (16.8%) level titles within their hospital. More than seven in ten (71.2%) worked as a leader in a clinical or nursing department in their organization; some 30.1% held a leadership role in education. [NOTE: Responses in the graph below total more than 100 because survey participants could check more than one answer.] Nearly two-thirds of respondents (73.6%) are current HealthStream customers.

    This blog post is the second based on “Hospital Leaders Say Covid-19 Is Worst Health Crisis of Their Career,” an article by Robin L. Rose, MBA, Vice President, Healthcare Resource Group, HealthStream.  Future posts will discuss survey results about the impact of COVID-19, organizational confidence, training, adequate equipment, priorities, and unmet needs during the pandemic.

    To support caregivers and healthcare organizations as they respond to the COVID-19 pandemic, HealthStream is offering a collection of carefully curated courses to all customers for free. Likewise, Using HealthStream’s Channels platform for video learning, we have a created a free-access COVID19 Channel in response to the COVID19 pandemic, specifically to support healthcare workers and their families. It contains a collection of curated videos provided by HealthStream and HealthStream’s content partners from several trusted sources on YouTube, such as the CDC and Mayo Clinic.

    PLEASE NOTE: The information in the article excerpted here was considered current at the time of its publishing. However, the COVID-19 pandemic is an ever-evolving disaster due to new findings, data, and availability of resources. Please refer to the CDC website for the latest detailed information when you need it.
  • Credentialing as Telehealth Is Playing a Prominent Role in Our New COVID-19 Reality

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Sep 01, 2020

    Another major shift in care delivery has been the rapid rise in existing telehealth operations and deployment of new or expanded ones. Already seen as an efficient, cost-effective way to enhance care in rural areas, telehealth can now close the physical gap between providers and patients who may be nearby but cannot leave home. This also is an area where a more rapid licensure and credentialing process can be beneficial.

    The National Emergency Declaration Involves Good News for Telehealth

    And once again, the National Emergency declaration provides some good news:

    • HIPAA guidelines around telehealth have been relaxed for this national emergency. HHS has announced that it will exercise “enforcement discretion” and will not impose penalties for noncompliance with regulatory requirements during the “good faith provision of telehealth” services during the COVID-19 national emergency
    • Telehealth regulations around billing for Medicare services to Medicare patients have been waived under Section 1135 of the Social Security Act, and the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 provided for $500 million in telehealth reimbursements.

    “Telehealth is skyrocketing because we’ve got to keep our healthcare workers safe,” says Vicki Searcy, Vice President, Consulting Services, at VerityStream. “If a person can be treated via the use of technology, that’s going to be a plus. In some organizations where there are insufficient intensivists you can provide some of those services remotely.”

    The challenge will be not just to stand up a telehealth service, but also explore how changed and relaxed rules affect service delivery — and who can provide services, another element of a changed credentialing and licensure landscape.

    Expedited Credentialing for Telehealth

    “Credentialing managers know they need to expedite approvals, but what are the state regulations as far as licensing requirements are concerned? People are still going to need to do a good bit of research to see what they can and can’t do,” she says. “At VerityStream we’re working with providers to see how to use our automation capabilities for checking licenses, checking for sanctions, and creating workflows as it relates to telehealth. We’re helping them set up an operation that is going to be the most efficient but still meet all of the regulatory requirements. We’re working to help people understand why they don’t need to fully credential all of the telehealth providers, but how they can take advantage of credentialing by proxy and what they need to actually have in their credentialing system.”

    This blog post is the second in a series of excerpts from the VerityStream article, “An Upside Down World: Pandemic Creates Process Challenges and Opportunities for Licensure and Credentialing.” The article also covers:

    • Provider Support has a can-do spirit
    • Keeping processes effective, but uncomplicated, will be essential
    • Today’s adaptations and new procedures are likely tomorrow’s business as usual
    • Patient outcomes should drive “in the moment” decision-making

    PLEASE NOTE: The information in the article excerpted here was considered current at the time of its publishing. However, the COVID-19 pandemic is an ever-evolving disaster due to new findings, data, and availability of resources. Please refer to the CDC website for the latest detailed information when you need it.

    In the midst of continual healthcare change some things stay the same, like the need for comprehensive provider credentialing, privileging, and enrollment processes. In today’s value-based environment, operational efficiency is critical. Conducting manual verifications, completing paper forms by hand or taking time to deliver files to various locations across the hospital or the system is not cost-effective. Learn more about making VerityStream your comprehensive provider solutions partner.

  • What Does Successful Patient Access Training Look Like?

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 31, 2020

    This blog post excerpts the HealthStream article, “Two Key Strategies for Improving Patient Access Success in Healthcare: How Continuing Education and KPI Monitoring Can Make Patient Access More Effective,” by  Mary Beth Rozell, Sr. Director of Revenue Cycle Solutions at HealthStream’s partner nThrive, and Susan Gurzynski-Wells, RHIA , Senior Product Manager, Revenue Cycle, HealthStream.

    Price transparency and consumerism have a direct impact on today’s hospital Patient Access operation and more changes are coming in 2021 due to new, stringent Federal and State regulations. Considered the hospital’s “front door,” the role of Patient Access has traditionally begun with the initial patient encounter — where staff confirm patient identity, verify insurance status and more.

    Healthcare reform has changed the role of Patient Access substantially, focusing revenue cycle leadership more on the expanding role and expertise of its Patient Access staff. Today’s Patient Access expert is tasked with capturing patient information, as well as educating and supporting a range of individuals—patients, hospital personnel, and providers—helping to ensure comprehensive, quality healthcare service delivery and patient satisfaction.

    What Does Successful Patient Access Training Look Like?

    A customer of HealthStream and nThrive provides staffing for their largest clients across multiple locations. To prepare staff members, this organization provides a comprehensive Patient Access Training program. Along with organizational specific training, they assign nThrive Education online courses via HealthStream to supplement their training and reduce content creation costs at the local level.

    HealthStream Patient Access courses from nThrive Education provide:

    • Broader Array of Patient Access/Revenue Cycle Education – Prepares learners beyond what is possible during initial in-person orientation training
    • Extensive Orientation for Patient Access Roles – Newly hired staff are better prepared for meeting client needs
    • Efficient Use of Training Time – In-house training reduced from four to three days, decreasing the amount of necessary resources
    • Individual Training Path Reports – Adaptive learning targets areas where new employees need more focus
    • Consistency in Staff Onboarding – Assigning the same suite of courses helps create a workforce whose preparation, knowledge and performance is more uniform, and aligns with the client’s expectations

    The organization has received positive trainee feedback regarding the HealthStream Patient Access courses from nThrive Education. Confidence is high placing individuals in these roles, knowing they are well-trained and evaluated.

    According to the organization’s spokesperson, “Training is a big piece of onboarding and proficiency, and it’s very specific in the extent to which it matches client needs.” She emphasizes the importance of learning that complements the organization’s commitment, adding that “the client expects a certain level of expertise in the work our people are doing. If we’re placing people in the organization who don’t have that level, it’s very clear from the start.” In addition to helping new employees bridge the gap between experience and knowledge, HealthStream and nThrive Education training helps the organization “use trainee test scores and the individual’s time required to complete certain modules to determine the subjects where more focused time should be spent to best serve the client’s needs.”

    Patient Access Success Is A Group Effort

    Successful Patient Access in the hospital or healthcare system depends on the work and commitment of many; it’s about patient interaction, education, transparency, accuracy, and providing clean information that feeds the revenue cycle downstream. It’s an area of the revenue cycle that is drawing more attention in the healthcare industry and will continue to do so as reforms continue to strengthen the clarity between hospitals, patients and payors.

    This blog post concludes our series about successful patient access training and how to achieve it. Download the full article from which it is an excerpt, “Two Key Strategies for Improving Patient Access Success in Healthcare: How Continuing Education and KPI Monitoring Can Make Patient Access More Effective.”

    Patient Access Education

    All staff with patient access responsibilities must perform effectively to ensure the success of the revenue cycle in its entirety. With the shift toward high-deductible health plans and the growth in newly insured individuals, Patient Access is faced with communicating and collecting increasingly larger amounts for which patients are financially responsible. In addition to patient communications, these employees must fully understand insurance plans, coordination of benefits, medical necessity and ABNS, and the importance of the demographic and insurance information they collect and record. Our training provides Patient Access employees with the necessary training to ensure patients understand their financial obligations and payment options. This information, when communicated properly, increases payment collection and reduces days of AR.
  • The S.T.A.B.L.E. Program Ensures Critically Important Infant Stabilization Care

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 28, 2020

    When S.T.A.B.L.E. and HealthStream formally announced their partnership and the upcoming launch of their online course set for March 2020, COVID-19 was a distant threat. In fact, it was not until the day of HealthStream’s press release about the partnership that the coronavirus received the name we all know by now, “COVID-19.” Yet with the arrival of March, national shelter-in-place orders were issued, and an unanticipated new reason for online learning existed.

    Who is S.T.A.B.L.E. for?

    When asked which healthcare providers should enroll in this course, Karlsen said, “The S.T.A.B.L.E. Program is intended for any caregiver who will take care of mothers and babies. That includes emergency medical personnel who might be called to a home delivery or to help a neonate who gets sick after being discharged home. It includes the nurses, nursing assistants, and LPNs who provide care for mothers and babies, including babies in the NICU, in small and large hospitals. It also includes family practice physicians, pediatricians, and emergency room personnel.” Karlsen added that transport team members often require S.T.A.B.L.E. course completion for their staff. Today, the S.T.A.B.L.E. Program is used for outreach education, continuing education, and as a hospital requirement to work with perinatal patients— both mothers and babies and in the NICU.

    Furthering the Program’s Reach through Online Education

    Now, through a new partnership with HealthStream, the S.T.A.B.L.E. Program is available online. Commenting on the partnership, Karlsen said, “The S.T.A.B.L.E. Program was developed to meet the educational needs of healthcare providers who must be ready to deliver critically important stabilization care to infants. To make the program more widely available and easily accessible, partnering with HealthStream to offer an online version was an ideal solution—as their workforce platform has an immediate, broad reach to the nation’s healthcare providers, including their neonatal and obstetric care teams.”

    The mnemonic Karlsen created in the eighties proved to hold true over time and still represents the six assessment and care modules of the program: Sugar, Temperature, Airway, Blood pressure, Lab work, and Emotional support. A seventh module, Quality Improvement, stresses the professional responsibility of improving and evaluating care provided to sick infants. The new, updated online offering covers the same curriculum as the traditional classroom course, but can be completed online at the student’s pace.

    Guaranteed Training Consistency

    Having the S.T.A.B.L.E. course online guarantees students are consistently taught the same materials. Karlsen explained, “As the author of this curriculum, it’s important to me to ensure the consistent delivery of the program material to every student. The classroom setting always has its own challenges, and sometimes part of the message gets left behind. With this online offering, I have been able to put all of the important aspects of the S.T.A.B.L.E. Program into the course. The S.T.A.B.L.E. Learner Manual served as my guide for developing the transcript. In addition, to stress key points or to allow the Learner to go more in-depth, I also included pages from the Learner Manual as PDFs.”

    S.T.A.B.L.E. Course outline

    This blog post excerpts an article, “The S.T.A.B.L.E. Program’s Timely Transition to Online Learning: An Interview with Founder Dr. Kristine Karlsen.” The article also includes:

    • S.T.A.B.L.E.’s Informal Neonatal Transport Education Beginnings
    • Parallel Growth—S.T.A.B.L.E. Program and the Need for Stabilization Education
    • What’s Next for Infant Stabilization Education

    Learn more about infant stabilization education by downloading the article.

    S.T.A.B.L.E. embodies HealthStream’s commitment to helping clinicians achieve better outcomes in myriad ways, from higher quality, evidence-based perinatal care to decreasing emergency department errors that can have a serious patient impact.
  • Four Ways COVID-19 Has Healthcare Re-envisioning Workforce Development

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 27, 2020

    Workforce Development is an essential area of healthcare that is always changing. In the same way that research findings alter evidence-based practice to support better patient outcomes, we enhance how we provide training, improve clinicians’ skills, and manage employees to make them more effective, efficient, and engaged caregivers. The COVID-19 pandemic has made it more important than ever to assess how we provide workforce learning and manage healthcare employees, and to rethink some of our accepted notions about using training to improve care.

    Here are four ways healthcare is re-imagining workforce development in response to COVID-19:

    1. Cross-training Has Never Been So Important

      Meeting the emergency care needs of patients stricken during the COVID-19 pandemic can completely alter the proportions of care provided within many healthcare organizations—especially in those where elective procedures and outpatient care have long been a major source of revenue and income. Suddenly, much of that care was suspended as COVID-19 cases swamped ERs and took over ICUs. Many organizations found themselves adding whole ICU wards and suspending all non-emergent care. Specialists and clinicians who would usually be busy had little care in their areas and were conscripted to join the large teams providing COVID-19 care, and support staff needed training for new needs in these areas. Sometimes this involved additional training and significant learning on the job. Clinical cross-training in other care areas might speed the ability of health systems to respond even more effectively to major crises.

    2. Performance-guided Learning Helps Maximize Educational Benefits at a Crucial Moment.

      Healthcare professionals have little time to spare for activities that are not productive and meaningful. Repetitive annual training, both in terms of results and perception, runs counter to a workplace that should invest in every employee by celebrating and capitalizing on their strengths while offering support and assistance in areas that need further development. For that to happen, education, whether initial, one-time, annual, or remedial, needs to be tied to an individual’s performance. That way, their unique areas of strength and/or weakness can be identified—and that data can inform the specific development path they should take to achieve maximum benefit and an enhanced skill set. Known as performance-guided learning, this concept is an alignment of skill assessment and tailored education that takes development to a new level.

    3. Online Learning Is More Essential Than Ever.

      Many healthcare organizations still rely heavily on traditional classroom-based learning. There’s no denying that this method of education plays a vital role in training clinicians and everyone in healthcare to provide excellent care and achieve better outcomes. However, learning in a classroom environment does not work easily during the COVID-19 pandemic, when we are relying on social distancing for safety. Resuscitation training is just one example where training that facilitates social distancing is a necessary adjustment. The webinar recording available here discusses how clinicians can engage in self-paced, self-directed resuscitation training from the American Red Cross, while meeting all regulatory requirements.

    4. Employee Recognition Must Be a Focus at a Time When Employee Performance is Key.

      The COVID-19 pandemic has made a high level of performance necessary as healthcare systems are challenged by emergency conditions. Healthcare workers are having to make unexpected decisions in the midst of equipment shortages and fears for their own health, while encountering a viral disease about which we are still learning. This is an environment where high levels of performance are mandatory, and employee recognition is an important factor supporting their performance. Healthcare organizations with recognition-rich cultures in place are able to bring out the best in their people, not only for the moment, but often for the long term. Receiving a genuine moment of recognition connects to an employee’s strengths, purpose, and goals, such that the impact can linger and affect performance well beyond a predetermined time frame. Encouraging positive workforce behaviors through frequent, authentic, public recognition should be at the forefront of any effort to encourage activities that support employee engagement and performance.


    Learning & Performance Exclusively for the Healthcare Workforce

    There’s a good reason why HealthStream’s workforce education solutions are already trusted by more than 70 percent of healthcare organizations in the United States. HealthStream’s comprehensive suite of learning and competency management tools empowers your people to deliver the best care more easily and effectively than ever before. Powered by the industry’s top content providers, HealthStream's Learning & Performance solutions connect you to healthcare’s largest learning community with learning customized by you to meet your organization’s unique needs.

    PLEASE NOTE: The information in the article excerpted here was considered current at the time of its publishing. However, the COVID-19 pandemic is an ever-evolving disaster due to new findings, data, and availability of resources. Please refer to the CDC website for the latest detailed information when you need it.

  • COVID-19 Has Forever Changed Long-Term Care

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 26, 2020

    COVID-19 has wreaked havoc with our nation’s long-term care (LTC) facilities. As this was happening, HealthStream sought to hear directly from providers “on the front lines” to understand their greatest challenges and needs. To this end, HealthStream surveyed 365 facility leaders during April/May of 2020. Some of our findings included:

    • Most leaders felt this pandemic was the worst healthcare crisis they had encountered during their lifetime.
    • Leaders believed staff had been well-trained in the use of Personal Protective Equipment (PPE), but they did not have the supply of PPE that was needed to keep staff safe.

    Safety for staff and residents/clients was a key theme throughout this survey. The top three priorities for LTC facilities during this pandemic were:

    • Keeping staff safe
    • Maintaining a high quality of care
    • Knowing what to do when individuals present with symptoms of COVID-19

    The following report details the state of long-term care during the spring of 2020 and the results of our study.

    Results

    America’s long-term care facilities have been overwhelmed by COVID-19. According to recent data aggregated by The New York Times (NYT), roughly one-third of all coronavirus deaths have occurred in these facilities (Yourish et al., 2020). As of mid-May, NYT estimated that the virus had infected more than 153,000 at some 7,700 long-term care facilities, and there have been 28,100 deaths.

    As the graph below shows, long-term care facilities accounted for only 11% of cases but 35% of all COVID-19 deaths.

    Deaths related to long-term care facilities

    A recent article in Forbes notes, “Nursing homes have been the tragic epicenter of COVID-19. There, residents are often frail, coping with multiple medical conditions, living in crowded buildings, making them highly susceptible to the coronavirus. Low-wage caregivers typically work at multiple nursing homes, hiking their odds of exposure to the virus” (Farrell, 2020).

    With this information as background, HealthStream recently surveyed 365 leaders in post-acute care. We wanted to understand the concerns, challenges, and needs of this hard-hit industry. We found an industry laser-focused on safety and quality, and one that will be forever changed by the pandemic.

    More than three-fourths indicated that COVID-19 was the worst health crisis they had experienced in their lifetime (76.0%). Over half (53.4%) strongly agreed that the pandemic has had a major impact on their facilities, and nearly half (48.0%) believed the industry has been forever changed by the pandemic.

    This blog post is an excerpt from the article, “COVID-19 Has Forever Changed Long-term Care,” by Robin L. Rose, MBA, Vice President, Healthcare Resource Group, HealthStream. Download it here.  A subsequent blog post will present more detailed findings about recruitment, training, protective gear, and priorities of this care setting during the COVID-19 pandemic.

    HealthStream Solutions for the Long-Term Care Workforce

    There is a long list of challenges facing skilled and long-term care (LTC) providers. Turnover rates, for example, for clinical care in nursing homes range from 55 to 75 percent, with rates among Certified Nurse Assistants (CNAs) approaching 100 percent in some areas. With consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with skilled nursing and LTC facilities to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care.

  • COVID-19 Pandemic Escalated the Value for Care Using Telehealth

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 25, 2020

    When national stay-at-home orders were enacted in March 2020 to slow the spread of COVID-19, there was a quick and dramatic shift to working from home if possible, teach students using online platforms, and convert face-to-face appointments into virtual meetings. This transition’s impact stretched across all sectors, healthcare included.

    Telehealth services have been expanding in recent years, with some organizations and providers launching swiftly ahead with the available technology. Others have been slow or resistant to transition any services online, not wanting to abandon in-person appointments and clinic hours. Some patients have found it impossible to use telehealth services due to the countless barriers that keep telehealth from being widely accessible, such as payer reimbursement and access to necessary technology.

    Though telehealth services were already on the rise, 2020 escalated the need for these services with the arrival of COVID-19. Telehealth became a lifeline for patients with a critical need to stay home and for healthcare workers who were fighting diligently to ensure there were enough hospital beds for those flooding through their doors. As the weeks passed and the curve flattened, many states began to reopen, prompting the question—will the use of telehealth dwindle or is this a moment in which telehealth becomes a permanent healthcare option?

    Is Telehealth Here to Stay?

    Nearly all healthcare organizations now offer telehealth services, and this new shift is unlikely to dissolve once the crisis is over. In a webinar addressing some of the intricacies of privileging telehealth providers, Vicky Searcy, Vice President Consulting Services, VerityStream, a HealthStream company, reflected on how this pandemic is fundamentally changing the way patients receive healthcare services. Searcy says, “This is undoubtedly going to change forevermore the way healthcare services are delivered. And I think that the longer this pandemic goes on, the more firmly entrenched the whole idea of the use of telehealth services will be. It’s going to be impossible to go back.”

    Using Telehealth to Help Flatten the Curve

    Telehealth has been instrumental in flattening the curve by keeping both well and sick patients at home, allowing high-risk individuals to reduce their exposure, screening potential COVID-19 patients, and reducing the spread among healthcare workers. Included in the CDC recommendations for healthcare facilities (2020) is the guidance to utilize telehealth: “Leveraging telemedicine whenever possible is the best way to protect patients and staff from COVID-19.”

    Telehealth Beyond the Coronavirus Pandemic

    When asked in an interview for Modern Healthcare (2020) if this pandemic means telehealth has “come of age,” Paul Black, CEO of Allscripts, replied, “Absolutely. This is the tipping point for telehealth. Never again will the default workflow for seeing most patients/consumers be instructions to come to the office, urgent care clinic or hospital emergency room.”

    As many wonder if this is the moment signaling that telehealth is here to stay, and US healthcare providers and patients adjust to using FaceTime or Zoom to check in, it seems that there may be no turning back. The question one should ask is, is that a bad thing? When some telehealth programs report reductions in hospitalizations by almost 90% and ER visits by 50%, as seen in the Chronic Care Management Program at Frederick Memorial Hospital (Wicklund, 2019), it seems like a good option to have in the middle of a pandemic.

    This blog post excerpts HealthStream’s article, “4 Ways Telehealth Is Impacting the Fight Against COVID-19.” Download it here.

    To support caregivers and healthcare organizations as they respond to the COVID-19 pandemic, HealthStream is offering a collection of carefully curated courses to all customers for free. Likewise, Using HealthStream’s Channels platform for video learning, we have a created a free-access COVID19 Channel in response to the COVID19 pandemic, specifically to support healthcare workers and their families. It contains a collection of curated videos provided by HealthStream and HealthStream’s content partners from several trusted sources on YouTube, such as the CDC and Mayo Clinic.

  • Urgent Healthcare Staffing Needs of the COVID-19 Pandemic Led to Changed and Expanded Roles

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 24, 2020

    This blog bost is the second in a series excerpting our article, “Pandemic Crisis Reveals Need for ‘New Normal’ When It Comes to Cross-Training: An Interview with Trisha Coady, Senior Vice President & General Manager of Clinical Solutions, HealthStream.”

    “When elective surgeries stopped, people who were furloughed at ambulatory surgery centers for example were brought into hospitals,” she says. “These were people that may have never worked in a medical-surgical or critical care unit. At the same time, we also heard that unit secretaries and nursing students were being trained to provide basic care coordination, similar to unlicensed personnel. In essence, we had to think about how we could cross-train or upskill healthcare workers to effectively care for patients at a higher level of acuity than what they were accustomed to.”

    The curricula HealthStream quickly curated were therefore bundled to address the cascading needs of healthcare organizations across many settings:

    • COVID-Related: All employees that needed a refresher on hand hygiene, PPE, and transmission precautions, as well as evolving information about COVID-19.
    • Unlicensed: Employees who normally play a supportive role in patient or resident care needed additional training in areas such as vital signs and specimen collection.
    • Basic Licensed: Employees who normally provide basic patient care, such as LPNs, or RNs not as familiar with a hospital sub-acute setting needed additional training in areas such as respiratory emergencies and more advanced assessment.
    • Advanced Licensed: Current medical-surgical or sub-acute clinical staff who could most quickly transition to critical care units and needed additional training on ventilators and ARDS.
    • Self-Care: All employees to help mitigate burnout and as a reminder of the importance of self-care—diet, rest, quiet time.

    “All of this had to be done within days to weeks,” Coady recalls. “Leaders had to quickly assess who had the necessary competencies to move from sub-acute to critical care, and determine how to backfill their sub-acute departments, as well as how to staff testing sites. The effort was monumental.”

    “The team at HealthStream, along with a number of generous, thought-leading firms, showed such a tremendous commitment to getting these 170+ free resources quickly launched across the country. EBSCO Health, nThrive, American Academy of Critical Care Nurses (AACN), Sigma, echelon, and Skillsoft all provided their time and expertise to our community of healthcare organizations.”

    The uptake was widespread. In just over a month, HealthStream recorded over 1,500,000 enrollments of its cross-training bundles and COVID-specific, customer-authored courses across more than 4,000 facilities.

    The article also includes:

    • Helping to prepare healthcare organizations for pandemic-related urgencies
    • Cross-training, individualized coursework likely the ‘new normal’
    • Shifting employee development in healthcare
    • Resuscitation training as an ideal candidate for the COVID-19 aware environment
    • Proven benefits of learning and professional development should spur continued engagement
    • Diversified learning strategies to support healthcare readiness
    • The Effect of COVID-19 on the Opioid Crisis

    Download the full article, “Pandemic Crisis Reveals Need for ‘New Normal’ When It Comes to Cross-Training: An Interview with Trisha Coady, Senior Vice President & General Manager of Clinical Solutions, HealthStream.”

    As our flagship nursing workforce development solution, HealthStream’s jane™ is The World’s First Digital Mentor for Nurses. JaneTM harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, JaneTM was designed to power lifelong, professional growth of clinical professionals. JaneTM is an important component of HealthStream’s suite of clinical development solutions.

  • How Does Healthcare Revenue Cycle Recover from COVID-19?

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 21, 2020

    The COVID-19 pandemic has had a significant impact on the healthcare industry, and the revenue cycle function has not been spared. Suddenly, our healthcare system became largely focused on inpatient care, as patients with serious, life-threatening complications due to COVID-19 overwhelmed hospitals. In many cases these patients have ended up in the ICU, where a significant number are intubated and then potentially ventilated for significant periods of time. At the same time, visits to doctors’ offices, as well as elective surgeries and other outpatient procedures, were mostly put on hold—partly because many more healthcare professionals were needed to provide emergency and inpatient care, especially in the places where pandemic victims presented early in large numbers. The suspension of much non-emergent care was also connected to the need to enact far more stringent COVID-19 safety measures for every healthcare environment.

    Revenue Cycle’s Needs Have Changed

    Naturally, the sudden change in care had an effect on revenue cycle operations. Staff members who were used to code for outpatient procedures and other non-emergent outpatient care weren't needed at the same volume. Simultaneously, their counterparts skilled in coding for inpatient care were overwhelmed by the volume of billing and processing. Many hospitals, who had become reliant on expensive outsourced coders, suddenly realized that this component of the coding workforce could be eliminated. These were typically the first part of the revenue cycle workforce to be furloughed.

    Multiple months after the onset of the pandemic, COVID-19 is not over, with parts of the United States heavily in its grip and infections increasing in some areas. At the same time, the healthcare system is opening up again to provide a broader range of non-COVID care, albeit under far more stringent conditions.

    Meeting Coding Needs as the Healthcare System Reopens

    Now that many healthcare organizations have reduced their dependence on outsourced coding, how can they meet their coding needs as care volumes and patient procedures recover? One is to use training and education to transition revenue cycle staff into other positions, and especially to prepare them for specialties and specialized coding. Ultimately, the most cost-effective option is for healthcare organizations to develop their own coders, and to bring coding back in house. As the volume of care returns, doing so will pay off in terms of expertise and staffing flexibility.

    Grow Your Own Coders and Coding Specialists

    In partnership with nThrive, the Transitions program from HealthStream was expressly designed to expand the coding workforce. This product, which enables healthcare organizations to train skilled medical coders in as few as 11 weeks, won a Brandon Hall award for a project where the State of Vermont and the U.S. Department of Labor Apprentice Program partnered to expand the skills of the local workforce. According to nThrive, the average cost of recruiting a coder is $6,000; however, the cost for a subscription to the nThrive education to develop a coder is just $1200. For about one-sixth of the cost, no wonder it makes sense to upskill existing staff in your efforts to expand your coding workforce. Likewise, nThrive offers education for coding specialties, including assessments that allow organizations to tailor training to learner needs. Learn more about how nThrive education can help prepare your organization’s revenue cycle function respond to the challenges of COVID-19 and get back to business afterwards.

    PLEASE NOTE: The information in the article excerpted here was considered current at the time of its publishing. However, the COVID-19 pandemic is an ever-evolving disaster due to new findings, data, and availability of resources. Please refer to the CDC website for the latest detailed information when you need it.

  • Four Constants in the Future of Medical Services Professionals (MSPs)

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 20, 2020

    HealthStream regularly publishes guest blog posts like the one below from Vicki Searcy, Vice President of Consulting Services, VerityStream.

    Sometimes it is comforting to be reminded that not everything is changing, especially when we are experiencing a lot of uncertainty in our personal and professional lives. In this issue, I’d like to focus on some of the things that will not change as we move forward in 2020 and beyond.

    1. Healthcare organizations still need to credential and privilege providers (physicians, dentists, podiatrists, psychologists, nurse practitioners, physician assistants, etc.). The investigation of a provider's background, including education/training, certification, etc. has not been dismissed as not important. In fact, I would say that the opposite is true. Credentialing and privileging is as important today as it has ever been – and perhaps has been elevated in significance because of the consequences to healthcare organizations of not doing credentialing well. The need to assure that providers are competent to provide the care that is needed by our patients has never been more important.

    2. Healthcare organizations need MSPs who have credentialing/privileging knowledge and are capable of identifying providers with issues that should be carefully evaluated before privileges are granted. MSPs who can facilitate a decision-making process that factors in all issues, documents how issues were dealt with and can carefully adhere to policies and procedures are very valuable to the healthcare organizations that employ them.

    3. The stream of provider data that is initiated and verified during the credentialing process is enormously valuable to healthcare organizations. I can’t tell you how often I hear healthcare executives say that they want the credentialing database to be the “source of truth” for provider data for other business applications. The responsibility for collecting and maintaining critical data has given well-positioned MSPs a seat at the table with organization executives/decision-makers.

    4. The need for skilled meeting managers will not disappear. Organizations need MSPs who can work effectively with medical staff and other leaders to carefully orchestrate meetings that have high visibility and impact – such as a Medical Executive Committee (MEC). I’ve been to a lot of MEC meetings during my time in this profession – and I’ve seen the good, the bad and the just plain terrible. The key to great meeting planning is to plan a meeting in a way that gets to the desired outcome – on time! If you can write the minutes most of the time before the meeting occurs, you are doing excellent work! Whether or not meetings in the future are held in person or virtually, there will always be a demand for MSPs who recognize that managing a meeting is much more than preparing an agenda and taking minutes.

    I love the energy and enthusiasm that MSPs have for their work that contributes so substantially to patient safety. You know that what you do is important – and although the way that you achieve successful outcomes will be influenced by technology and other factors - the skills you bring to the table are valued and needed.

    The credentialing process can be a very complicated and long process. Renee Zimmerman gives us her keys to making the process succeed. Download the VerityStream White Paper, 6 Essentials for Achieving Rapid and Successful Centralization.

    The Advanced Automation Engine Powered by Validated Data and Best Practice Content

    CredentialStream is our SaaS solution that enables organizations to automate the validation and monitoring process of provider data, centralized, electronic review of validated provider files, and is the only solution to offer data visualizations based on national proprietary benchmarks.

  • What Makes Covid-19 the Worst Health Crisis Most of Us Have Seen?

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 19, 2020

    After living through the first four months of emergency response to the coronavirus pandemic, healthcare leaders are stepping back to assess the longer-term challenges they are facing from this unprecedented health threat. First, the COVID-19 crisis has exposed many cracks in our healthcare system, ranging from an inadequate supply chain for personal protective equipment (PPE) to the disproportionate impact the virus has had on America’s underserved population (Landi, 2020).

    Second, COVID-19 cases are continuing to rise throughout the U.S., with no end in sight. Leaders are realizing that the past four months were not just a one-time spike in patients—the uptick in cases is continuing, and there may even be a harsher outbreak coming later this year. In May and June, as “stay at home” restrictions were lifted and various re-opening plans were implemented, cases throughout much of the country began to skyrocket (CDC, 2020).

    Growing Use of Telehealth

    Third, the use of telehealth is booming as a result of the need to maintain social distancing during the pandemic. Neil Patel, president of HealthBox, was recently quoted by Fierce Healthcare as sharing, “We’ve seen health systems doing a decade’s worth of work in the span of a few months” (Egan, 2020). Telehealth systems that were rapidly put together to serve the immediate need formed by COVID-19, now must be re-examined and retooled for the long term.

    COVID-19’s Financial Pressures for Healthcare

    And finally, not only were hospitals absorbing the influx of COVID-19 patients and subsequent supply shortages, they were also suffering large financial losses as profitable elective surgeries and primary care appointments were being postponed. According to a recent American Hospital Association (AHA) report, COVID-19 has created unparalleled financial pressures for America’s hospitals and health systems.

    The AHA recently released a report detailing the magnitude of the financial pressures hospitals and health systems are facing. The AHA estimated a total four-month financial impact of $202.6 billion, or an average of $50.7 billion per month (AHA, 2020). Prior to the pandemic, the Congressional Budget Office had already predicted that between 40% - 50% of hospitals could have negative margins by 2025. (AHA, 2020).

    A Survey of Acute Care Hospital Leaders

    Against this harrowing backdrop, HealthStream conducted a survey of acute care healthcare leaders in May of 2020. We had heard a great deal about the heroism of front-line staff and their efforts to care for patients, even though they lacked adequate protective equipment and medical supplies such as ventilators. We wanted to hear more of the story from the managers and executives who were in charge behind the scenes. What are they worried about and what are their priorities as they continue to navigate their teams through this pandemic?

    This blog post is the first excerpt from “Hospital Leaders Say Covid-19 Is Worst Health Crisis of Their Career,” an article by Robin L. Rose, MBA, Vice President, Healthcare Resource Group, HealthStream.  Future posts will discuss survey results about the impact of COVID-19, organizational confidence, training, adequate equipment, priorities, and unmet needs during the pandemic.

    To support caregivers and healthcare organizations as they respond to the COVID-19 pandemic, HealthStream is offering a collection of carefully curated courses to all customers for free. Likewise, Using HealthStream’s Channels platform for video learning, we have a created a free-access COVID19 Channel in response to the COVID19 pandemic, specifically to support healthcare workers and their families. It contains a collection of curated videos provided by HealthStream and HealthStream’s content partners from several trusted sources on YouTube, such as the CDC and Mayo Clinic.

    PLEASE NOTE: The information in the article excerpted here was considered current at the time of its publishing. However, the COVID-19 pandemic is an ever-evolving disaster due to new findings, data, and availability of resources. Please refer to the CDC website for the latest detailed information when you need it.

  • Five Recommendations for Patient Access Education

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 18, 2020

    This blog post excerpts the HealthStream article, “Two Key Strategies for Improving Patient Access Success in Healthcare: How Continuing Education and KPI Monitoring Can Make Patient Access More Effective,” by  Mary Beth Rozell, Sr. Director of Revenue Cycle Solutions at HealthStream’s partner nThrive, and Susan Gurzynski-Wells, RHIA , Senior Product Manager, Revenue Cycle, HealthStream.

    Price transparency and consumerism have a direct impact on today’s hospital Patient Access operation and more changes are coming in 2021 due to new, stringent Federal and State regulations. Considered the hospital’s “front door,” the role of Patient Access has traditionally begun with the initial patient encounter — where staff confirm patient identity, verify insurance status and more.

    Healthcare reform has changed the role of Patient Access substantially, focusing revenue cycle leadership more on the expanding role and expertise of its Patient Access staff. Today’s Patient Access expert is tasked with capturing patient information, as well as educating and supporting a range of individuals—patients, hospital personnel, and providers—helping to ensure comprehensive, quality healthcare service delivery and patient satisfaction.

    PATIENT ACCESS PLAYS A CRUCIAL ROLE IN THE REVENUE CYCLE

    In many healthcare organizations, the Patient Access team is the unsung hero, yet it often receives the least amount of training. Lack of Patient Access training can be a disrupter to revenue cycle success and patient satisfaction. According to recent studies, upwards of 50% of claim denials are due to errors occurring in frontend revenue cycle processes, such as registration and eligibility. Just a single misstep in any of the necessary functions can result in many downstream consequences, including poor patient care, fraud charges resulting from inappropriate billing, lost revenue due to denials or inadequate copay collection and potential loss of the healthcare organization’s license.

    WHAT CAN A COMPREHENSIVE PATIENT ACCESS EDUCATION PROGRAM OFFER HOSPITALS?

    According to Darcelle Johnson, Senior Manager of Education Content Development at nThrive Education, providing colleagues with healthcare education that expands their skill sets and future opportunities can help hospitals and healthcare organizations overcome the challenge of employee retainment. She recommends that providers:

    1. Invest in an online education system to keep colleague knowledge current while maintaining standards of proficiency
    2. Perform team assessments to identify knowledge and skill gaps that could affect the revenue cycle
    3. Fill knowledge deficiencies and increase colleague skill levels through course assignments based on assessment results
    4. Provide colleagues with opportunities for growth within your organization by offering certification and badge programs that broaden and enhance skill levels
    5. Offer webinars that help colleagues maintain credentials and stay current with regulatory updates  

    Future installments in the series will envision successful patient access training how to achieve it. Download the full article, “Two Key Strategies for Improving Patient Access Success in Healthcare: How Continuing Education and KPI Monitoring Can Make Patient Access More Effective.”

    Patient Access Education

    All staff with patient access responsibilities must perform effectively to ensure the success of the revenue cycle in its entirety. With the shift toward high-deductible health plans and the growth in newly insured individuals, Patient Access is faced with communicating and collecting increasingly larger amounts for which patients are financially responsible. In addition to patient communications, these employees must fully understand insurance plans, coordination of benefits, medical necessity and ABNS, and the importance of the demographic and insurance information they collect and record. Our training provides Patient Access employees with the necessary training to ensure patients understand their financial obligations and payment options. This information, when communicated properly, increases payment collection and reduces days of AR.

  • HealthStream’s Resuscitation Programs Create Safe, Community-Based Learning Environment

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 17, 2020

    Can something as “hands-on” as CPR training be taught virtually? The answer is yes—and that type of remote learning was already in place prior to the COVID-19 pandemic, thanks to the American Red Cross Resuscitation Suite™ a cutting-edge partnership between HealthStream and the American Red Cross.

    “The suite was already popular and has become even more so as training centers and live, instructor-led classes have been drastically reduced and even eliminated in some parts of the country. But the need remains, especially when it comes to easing the burden on already overwhelmed frontline healthcare providers. The combination of online learning and mannikin-based live competency testing creates a safe way for learning all levels of Red Cross CPR skills and do so in a self-paced, self-directed learning environment,” says John Dymond, Associate Vice President of Simulation Programs at HealthStream, who has worked with hundreds of healthcare organizations to improve life-support training.

    A Virtual Training Center for Resuscitation

    “HealthStream has established a virtual training center for the ability to launch and deliver onboarding of these types of solutions to our customers,” Dymond explains. “So even though COVID-19 has had a dramatic impact on the world and in healthcare, we are still moving forward by helping organizations deliver life-support training and resuscitation solutions.”

    The American Red Cross Resuscitation SuiteTM succeeds because it is:

    Adaptive: It reduces seat time through personalized learning plans.

    Flexible: Choose your preferred skills practice interval by student group.

    Easy: Improved tools for leaders and managers to achieve compliance.

    “One of the key benefits of this program ties directly into what is going on in the country today, which is the improvement of resuscitation,” Dymond says. “The guidelines are saying that more practice on a regular basis improves CPR skills. Clearly we would all agree that if you do something on a more regular basis, you're going to be better at it. What this program offers is an interval-based technology giving your organization the ability to schedule training on three, six, 12, or 24-month intervals.

    Multiple Aspects of Support Also Drive Successful Resuscitation Training Adoption

    The resuscitation suite also ties in many elements of provider and student support, ensuring that any issues can be quickly and easily resolved. Those include:

    • Implementation specialists for personalized assistance through the setup process
    • Expert online and web-based coaching
    • An online community featuring resources, discussion boards, and more
    • Weekly webinars with experts on cutting-edge topics
    • A hub with all user data, so you can stay on top of overdue or expiring certificates

    “Our community site is set up so you don’t have to contact customer support or a specific account executive,” Dymond explains, “You can go right to the community, and you can talk to your peers. You can discuss how to make things better in your organization with your peers and get answers to queries and questions like: Hey, we're struggling with this. We're having trouble having adoption of that. How can we improve on these areas? What are the best practices? What have you done to make your environment more receptive to the learning that you want your staff to embrace? The community is one of those areas where you can go to speak about your specific needs and get real answers from your peers.”

    To learn more about the American Red Cross Resuscitation Suite, and HealthStream’s resuscitation programs, view our webinar, CPR Skills: Safely (re)Certify BLS, ALS, and PALS Using Virtual Learning. Learn more about industry-leading CPR training from the American Red Cross that also facilitates social distancing.

  • Gaging the Readiness of New Perinatal Safety Standards of Nurses | HealthStream

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 14, 2020

    This article excerpts a HealthStream article, “The Joint Commission’s New Standards for Perinatal Safety: HealthStream Surveys Organizations About Their Readiness,” by Linda Zimmer, MSN, RN, Product Manager, Quality & Risk, HealthStream.

    The United States has a serious problem with maternal healthcare and outcomes; currently we rank 55th among industrialized nations in terms of maternal mortality. To begin to implement the significant measures necessary to improve this poor ranking and decrease the frequency of maternal death and morbidity, The Joint Commission has introduced two new Perinatal Safety standards that will now take effect January 1, 2021. Having originally been scheduled for July 1, 2020, the standards implementation deadline was extended six months as a response to the Covid-19 pandemic. The privileging standards specifically address measures that all healthcare organizations should take to address complications that occur with alarming frequency in pregnant and delivering women—maternal hemorrhage and severe hypertension/preeclampsia.

    HealthStream Surveyed Healthcare Leaders about Organizational Preparedness for These New Perinatal Safety Standards

    HealthStream surveyed nearly 150 leaders in nursing and healthcare education about the New Perinatal Care Standards, to gain insight about whether they were ready for Joint Commission surveyors who’d be looking for evidence of their implementation. We also wanted their honest opinion about whether they thought the standards would improve perinatal care and maternal healthcare outcomes.

    WILL THE NEW STANDARDS IMPROVE PERINATAL CARE?

    CMS Standards

    We asked respondents to rate the following statement from 1 (“Strongly Disagree”) to 10 (“Strongly Agree”): “CMS’s new elements of performance for maternal safety will improve maternal outcomes in our organization.” At 8.03, the average indicates a preponderance of opinion that the standards are helpful.

    WILL U.S. HEALTHCARE ORGANIZATIONS BE READY TO IMPLEMENT THE STANDARDS BY THEIR DEADLINE?

    At the time of the survey, the deadline for implementation still had not been delayed by six months to accommodate the demands of the Covid-19 Pandemic. We asked respondents to rate the following statement from 1 (“Strongly Disagree”) to 10 (“Strongly Agree”): “Our organization will be ready to implement the Joint Commission’s new elements of performance for maternal safety by the deadline of July 1, 2020.” With an average score of 7.58, it was clear that most participants felt that their organizations would be ready to implement the standards.

    Maternal Safety Standards

    ITEMS THAT WERE FULLY IMPLEMENTED AS OF MARCH 2020

    Respondents were asked about the implementation status for each of the individual elements of performance. They were asked to respond, “Fully implemented it,” “Partially implemented it,” or “Not yet begun to implement it” for each of the 16 elements.

    The top 3 Fully Implemented elements were:

    3 implemented elements

    The area least likely to be fully implemented was “Reviewing severe hypertension/preeclampsia cases that meet criteria established by the hospital to evaluate the effectiveness of the care, treatment, and services provided to the patient during the event” with only 41%.

    Implementation Percentage

    Clearly, there’s a significant amount of work yet to be done by U.S. hospitals and other healthcare providers to be ready for these new Joint Commission standards. The extension of this deadline may allow considerably more time for healthcare organizations to implement extra training programs and other measures to fulfill these requirements.

    Download the full article to learn how healthcare organizations responded to the survey and to assess your own progress on meeting new maternal safety standards compared to other U.S. organizations.

    HealthStream Focuses on Clinical Development

    At HealthStream we spend a lot of time focused on developing the clinical workforce. HealthStream’s jane™ is The World’s First Digital Mentor for Nurses. Jane harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, Jane was designed to power lifelong, professional growth of clinical professionals. JaneTM is an important component of HealthStream’s suite of clinical development solutions.

  • Survive or Thrive? Where Long-Term Care Goes From Here

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 13, 2020
    In this four article eBook, HealthStream takes a broad look at the various issues that long-term care organizations are facing. We present the results of a COVID-19 survey conducted among healthcare leaders, we review top issues that are changing the delivery of care, and what the future of long-term care will look like in a post-pandemic world.
  • Validating Jane AI Competency System In Critical Thinking Assessments

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 13, 2020

    This blog post is the first of two that excerpt a HealthStream article, “The Validity of the JaneTM Competency System AI Critical Thinking Assessments,” by Randy L. Carden, Statistical Consultant, HealthStream.

    The development of critical thinking/judgment skills by nurses is of paramount importance in the healthcare industry today. Factors, such as the following, have all converged to make the development of advanced critical judgment skills a top priority:

    • A growing senior population requiring nursing care
    • A high percentage of seasoned nurses taking retirement
    • Nursing shortages in many areas of the country
    • Increased patient acuity in many settings
    • The need to bring new nurses up-to-speed as quickly as possible

    It has long been thought that these types of skills could only be developed through years of on-the-job training and experience. Now, however, we are finding that artificial intelligence (AI) can play a major role in providing efficient, comprehensive tools for enhancing critical judgment.

    The paper excerpted by this blog post details psychometric studies conducted by HealthStream to evaluate whether computers can perform as well as human evaluators in assessing critical thinking skills in nurses.

    FINDINGS

    Once all assessment completions were obtained, all data was sent to Perception Health, an independent analytics firm, where an analysis was conducted to determine the relationship between the Jane™ scores and human scoring via a trained RN using “model answers” established by PBDS.

    The Pearson Correlation Coefficient was used to evaluate the relationship. The results of the statistical analysis found a strong, positive correlation between the Jane™ scores and the human RN rating scores, r = 0.827. The Pearson Correlation Coefficient ranges from negative one to positive one. A correlation coefficient near zero indicates no relationship between the variables. A correlation coefficient of 0.20 - 0.30 (either positive or negative) is considered a weak correlation. A correlation coefficient between 0.40 – 0.60 (either positive or negative) is indicative of a moderate relationship. A correlation coefficient of 0.80 or higher (either positive or negative) demonstrates that the two variables are strongly related. Thus, the results of the study indicated that there was a significant, strong positive relationship between Jane’s™ evaluative scores and the human (RN) ratings.

    SUMMARY/CONCLUSIONS

    The purpose of the study was to investigate the validity of Jane™ as an evaluative tool to assess the critical thinking/ judgment of nurses. Twenty-eight complete evaluation sets were used in the study. Jane™ scores were compared to the scores of a trained RN rater. It was found that there was a strong relationship between Jane™ ratings and human ratings. Thus, the construct validity of Jane™ has been established by this study.

    The article from which this blog post was taken includes the following additional information and findings about our validation of  janeTM:

    • Background
    • Purpose of the Study
    • How the Study Was Conducted
    • Participants
    • Validity and Reliability of PBDS
    • Content Validity
    • Construct Validity
    • Predictive Validity
    • Reliability

    HealthStream Focuses on Clinical Development

    At HealthStream we spend a lot of time focused on developing the clinical workforce. HealthStream’s jane™ is The World’s First Digital Mentor for Nurses. Jane harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, Jane was designed to power lifelong, professional growth of clinical professionals. JaneTM is an important component of HealthStream’s suite of clinical development solutions.

    Download the full article, “The Validity of the janeTM Competency System AI Critical Thinking Assessments,” in which we investigate the assessments on which janeTM is built.

  • What is the Difference between Proctoring and Precepting?

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 12, 2020

    HealthStream regularly publishes guest blog posts like the one below from Vicki Searcy, Vice President of Consulting Services, VerityStream.

    The issue of the differences between proctoring and preceptorships are still misunderstood in some organizations. So it is time to revisit this subject to make sure that we all have a good understanding of when to use proctoring and when a preceptorship would be indicated.

    The Joint Commission, in their 2007 standards for the Medical Staff, introduced a new concept—that of Focused Professional Practice Evaluation (FPPE). The principle behind the requirements associated with FPPE is that when new applicants are granted privileges, an organization has information that suggests competence. It is the organization’s responsibility to confirm competence during a practitioner’s introduction into the organization.

    Many organizations use “proctoring” as a tool to confirm competence during the initial FPPE period. Proctoring may be performed concurrently (watching a provider perform a procedure, for example) or retrospectively (an evaluation typically carried out by review of the patient record).

    It is important to understand what proctoring is—and what it is not. These are two terms that are sometimes used by medical staff organizations interchangeably. However, they have very different meanings.

    Proctoring is the process through which skills and/or knowledge that a provider asserts he/she already possesses are confirmed.

    Precepting is the process through which a provider gains experience and/or training on new skills and knowledge. Therefore, precepting would not be an appropriate method to use to confirm competency. It would be an appropriate method to train someone on a new skill.

    The American Society for Gastrointestinal Endoscopy published a paper in 1999 on Proctoring for Hospital Endoscopy Privileges which has an excellent description of the role of a proctor:

    Role of the Proctor:

    • Acts as an independent and unbiased monitor to evaluate, not teach, the technical and cognitive skills of another physician.
    • Does not directly participate in patient care and has no physician/patient relationship with the patient being treated.
    • Represents the hospital and or governing body and is responsible to the hospital or governing body in connection with credentialing of physicians seeking endoscopic privileges.
    • Does not receive a fee directly related to patient care. A proctor may or may not receive a fee from the hospital or governing body as compensation for time spent in proctoring services.

    This same paper goes on to describe a preceptor as follows: A preceptor is an instructor or teacher. When teaching an endoscopic practice to a trainee, a physician is responsible for the actions of that trainee as well as himself/herself.

    Clinical learning does not stop when a residency or fellowship is completed. Continued learning and skills acquisition is required if providers are to have a contemporary and relevant clinical practice. Clinical education/experience is a life-long process. A well organized and targeted preceptorship can assist providers with a skills refresher when specific clinical skills have not been recently performed or in obtaining supervised human subjects experience after didactic training has been completed. A well run and well documented program will ensure that privileging criteria is met prior to granting clinical privileges.

    Make sure that your organization is clear on what is and is not expected of a proctor. And—if your organization determines that establishing a preceptorship program would be of value—it will be necessary to resource the preceptorship program in order to assure that it is well-defined and that one of the outcomes is documentation that confirms how a provider acquired new skills and/or knowledge.

    National Proprietary Benchmarks Power Privileging Insights

    Take proctoring to the next level with Insights by VerityStream. We offer Focused Professional Practice Evaluation metrics segmented by specialty, privilege cluster; condition; time frames and volumes; and percent completed, retained, changed. Learn More about Insights by VerityStream.
  • The Impact of COVID-19 on Healthcare Credentialing and Licensure

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 12, 2020

    The medical profession is justifiably known for rising to a crisis, and the response to COVID-19 is no different. Every day, tireless professionals on the front lines are providing outstanding patient care while creating on-the-spot workarounds for equipment shortages and other issues.

    That same can-do spirit is also fully present in the profession’s support teams, who are streamlining processes and reinventing systems in order to deploy caregivers as quickly as possible to where they are most needed. One result is that the credentialing and licensure process looks very different now than it did just a few weeks ago, says Vicki Searcy, Vice President, Consulting Services, at VerityStream.

    “One of the greatest challenges now is making sure that you have the right physicians and other healthcare professionals ready to deal with the care that’s needed,” Searcy says. “If you are a health system, that may involve putting procedures in place for moving people around within your system. If you are a freestanding hospital, you may need to provide emergency privileges to care providers who have not been part of your healthcare organization in the past.”

    “In the face of this pandemic, it’s pretty clear that everyone’s facing a workforce challenge,” continues Todd Sagin, President and National Medical Director, Sagin HealthCare Consulting. “And not just privileged practitioners, but all kinds of healthcare clinicians and non-clinicians are in short supply in certain localities. We’re worried in particular about privileged practitioners in some key areas: hospitalists, for example, intensivists, pulmonologists who can help manage ventilators and respiratory therapists. These are some of the areas where it is anticipated that the needs will be most acute, and there are pools of retired practitioners and part time practitioners, who are not necessarily doing today what they have done in the past, that can be accessed to try and bolster the workforce.”

    Onboarding these practitioners as rapidly as possible is a heavy lift, but it has been made somewhat easier by the ground-breaking changes that have come as result of the National Emergency declaration on March 13:

    • Certain requirements with regards to background checks and other kinds of requirements to vet providers to enroll them in Medicare are waived. There are two types of these “blanket” waivers:
    • Provider Locations. CMS has waived requirements that out-of-state providers be licensed in the state where they are providing services when they are licensed in another state.
    • Enrollment in Medicare. CMS is allowing new, non-certified Part B suppliers, physicians, and non-physician providers to expeditiously obtain temporary Medicare billing privileges. CMS is also waiving certain application fees, criminal background checks, and site visits with respect to provider enrollment.

    This blog post is the first in a series of excerpts from the VerityStream article, “An Upside Down World: Pandemic Creates Process Challenges and Opportunities for Licensure and Credentialing.” The article also covers:

    • Telehealth plays prominent role in new reality
    • Keeping processes effective, but uncomplicated, will be essential
    • Today’s adaptations and new procedures are likely tomorrow’s business as usual
    • Patient outcomes should drive “in the moment” decision-making

    PLEASE NOTE: The information in the article excerpted here was considered current at the time of its publishing, 7/30/20. However, the COVID-19 pandemic is an ever-evolving disaster due to new findings, data, and availability of resources. Please refer to the CDC website for the latest detailed information when you need it.

    In the midst of continual healthcare change some things stay the same, like the need for comprehensive provider credentialing, privileging, and enrollment processes. In today’s value-based environment, operational efficiency is critical. Conducting manual verifications, completing paper forms by hand or taking time to deliver files to various locations across the hospital or the system is not cost-effective. Learn more about making VerityStream your comprehensive provider solutions partner.

  • Education to Improve Neonatal Transport Safety Leads to Better Infant Healthcare Outcomes

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 10, 2020

    When S.T.A.B.L.E. and HealthStream formally announced their partnership and the upcoming launch of their online course set for March 2020, COVID-19 was a distant threat. In fact, it was not until the day of HealthStream’s press release about the partnership that the coronavirus received the name we all know by now, “COVID-19.” Yet with the arrival of March, national shelter-in-place orders were issued, and an unanticipated new reason for online learning existed.

    Pandemic Underscores Need for Online Education Options

    While S.T.A.B.L.E. was not pushed into transitioning their content online due to the pandemic, their preparedness allowed them to make a seamless launch during a time when accessing education online is more important than it ever has been. HealthStream recently spoke with Dr. Kristine Karlsen, the creator and director of the S.T.A.B.L.E. Program, about the program’s newly broadened capacity to reach the nation’s healthcare providers at a crucial time.

    S.T.A.B.L.E.’s Informal Neonatal Transport Education Beginnings

    Dr. Kristine Karlsen began her work as a Neonatal Nurse Practitioner in 1982, a time when neonatal transport was a new domain and there lacked any formal neonatal resuscitation or stabilization education. When transport duties were added to Karlsen’s role in the NICU, - community hospital staff often asked her to return to their facility to teach them about the neonatal issues they just encountered: respiratory distress, prematurity, hypoglycemia, surgical problems, and more. With hopes of creating a practical way for her community hospital staff to learn, retain, and recall the crucial lessons of post-resuscitation/pre-transport stabilization care of sick infants, Karlsen created a mnemonic-based educational tool, and thus, S.T.A.B.L.E. was born.

    Parallel Growth—S.T.A.B.L.E. Program and the Need for Stabilization Education

    Out of the need for outreach education targeting neonatal pre-transport stabilization, Karlsen developed the internationally recognized program that exists today. The S.T.A.B.L.E. Program focuses on improving the knowledge and skills of each member of the perinatal healthcare team that provides care to both well and sick infants. In the U.S. alone, 10% of babies are born preterm, and there are approximately 70,000 neonatal transports each year—a staggering number that emphasizes the importance of the S.T.A.B.L.E. Program content.

    Improving Obstetric Healthcare

    First introduced as a company in 1996, S.T.A.B.L.E. has grown internationally to include instructor training and courses available in more than 45 countries. Since 2001, more than 615,000 neonatal and obstetric healthcare providers have completed a S.T.A.B.L.E. Program learner course in an instructor-led training session. S.T.A.B.L.E. is the most widely distributed and implemented neonatal education program to focus exclusively on the post-resuscitation/pre-transport stabilization care of sick infants.

    In 2015, S.T.A.B.L.E. surveyed over 1,000 of their instructors. When asked if they had noticed any improvement in neonatal stabilization in their hospital or region, 94% of participants reported they had observed improvement. Some 43% reported “significant improvement” and over half (51%) reported they had observed “some improvement.” Only 6% of participants reported they saw no improvement, but many of those respondents also commented that they had just begun the program or had not formally assessed outcomes.

    Reflecting on the successes of the program, Karlsen said, “I truly believe that the program does make a big difference in the lives of families who benefit from the good care their babies received because of the staff’s educational preparedness. Having a healthy family is the paramount goal, and empowering nurses and physicians with the education they need to make the right decisions when these babies are sick is very meaningful.”

    “Having a healthy family is the paramount goal, and empowering nurses and physicians with the education they need to make the right decisions when these babies are sick is very meaningful.”

    This blog post excerpts an article, “The S.T.A.B.L.E. Program’s Timely Transition to Online Learning: An Interview with Founder Dr. Kristine Karlsen.” The article also includes:

    • Who is S.T.A.B.L.E. for?
    • Furthering the Program’s Reach through Online Education
    • What’s Next for Infant Stabilization Education

    Learn more about infant stabilization education by downloading the article.

    S.T.A.B.L.E. embodies HealthStream’s commitment to helping clinicians achieve better outcomes in myriad ways, from higher quality, evidence-based perinatal care to decreasing emergency department errors that can have a serious patient impact.

  • Specific Maternal Health Problems Targeted for Improvement by the Joint Commission

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 07, 2020

    This article excerpts a HealthStream article by Trisha Coady, BSN, RN, Senior Vice President and General Manager of HealthStream’s Clinical Solutions, about the new perinatal care standards that have been issued by the Joint Commission.

    Multiple health conditions occur during pregnancy and after delivery that put the mother and child’s lives at risk. Three of the most significant are explicitly addressed in these new Joint Commission Guidelines. Understanding them, as well as understanding the standard treatments for avoiding or addressing them, can help a reader understand just how negligent some healthcare providers have been in their precautions.

    Post-Partum Hemorrhage

    According to the Children’s Hospital of Philadelphia, “Postpartum hemorrhage is excessive bleeding following the birth of a baby. About 1 to 5 percent of women have postpartum hemorrhage and it is more likely with a caesarean birth. Hemorrhage most commonly occurs after the placenta is delivered. The average amount of blood loss after the birth of a single baby in vaginal delivery is about 500 ml (or about a half of a quart). The average amount of blood loss for a cesarean birth is approximately 1,000 ml (or one quart). Most postpartum hemorrhage occurs right after delivery, but it can occur later as well” (CHOP.edu, n.d.). In addition to assessing mothers for hemorrhage risk, clinicians should monitor for cumulative blood loss during delivery and have a treatment cart with supplies nearby.

    Severe Hypertension

    Maternal hypertension, also known as gestational hypertension, “is a form of high blood pressure in pregnancy. It occurs in about 6 percent of all pregnancies. Another type of high blood pressure is chronic hypertension--high blood pressure that is present before pregnancy begins” (CHOP.edu, n.d.). Treatment involves “measurement and assessment of BP and urine protein for all pregnant and postpartum women” (Council on Patient Safety in Women’s Health Care, 2015) and medication treatment and other escalation measures as needed.

    Preeclampsia

    The Mayo Clinic shares that “Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys. Preeclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had been normal” (Mayo Clinic Staff, n.d.). According to the Preeclampsia Foundation, prevention and timely treatment occurs when the healthcare provider watches “for signs of instability in the mother, including very high blood pressure that’s not responding to antihypertensive drugs, signs the kidneys and/or liver are failing, and a reduced number of red blood cells or platelets. Providers also watch closely for indications of an impending seizure or signs the brain is about to stroke and may treat the patient with magnesium sulfate (an anticonvulsant specifically used for preeclampsia). Antihypertensive drugs will be used if blood pressure rises to dangerously high levels, 160/110 or higher” (Preeclampsia.org, 2018). The Joint Commission Standards establish multiple requirements for improving maternal care and outcomes. For example, they call “for maternity units to keep life-saving medications immediately accessible. Hospitals also must plan for the rapid release of blood supplies for transfusions” (Stein, 2019). Because a rapid response is often essential when dealing with complications, the standards focus strongly on making equipment and medication available for when they are needed. 

    In addition, the article includes:

    • Uncovering the Serious Problems That Exist in Maternal Healthcare
    • Why is Joint Commission accreditation important?
    • How the maternal safety standards were compiled

    Download this article, “New Joint Commission Guidelines Target Poor Maternal Mortality Outcomes,” to learn about the new Joint Commission safety standards for the improvement of maternal and perinatal care, and why it has taken so long for the US to understand the need for them.

    HealthStream Focuses on Clinical Development

    At HealthStream we spend a lot of time focused on improving outcomes by developing the clinical workforce. HealthStream’s jane™ is The World’s First Digital Mentor for Nurses. Jane harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, Jane was designed to power lifelong, professional growth of clinical professionals. JaneTM is an important component of HealthStream’s suite of clinical development solutions.

  • Efficiency and Personalization with Adaptive Learning

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 06, 2020

    HealthStream recently surveyed industry leaders in the areas of employee education and development to understand their opinions on adaptive learning and how they are implementing a personalized approach.

    Find out the results of the survey in this white paper as well as:

    • The most prevalent education and training challenges facing healthcare organizations
    • How organizations currently use assessment tools to tailor education and training
    • Why an adaptive and personalized approach to learning benefits both the employee and organization

    Download the article to learn more.

  • The Future of Medical Services Professionals (MSPs)

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 06, 2020

    HealthStream regularly publishes guest blog posts like the one below from Vicki Searcy, Vice President of Consulting Services, VerityStream.

    I saw the recent NAMSS announcement regarding Become Tomorrow's MSP Today.  It made me stop and think about how this profession has changed since I entered it more than 35 years ago.  I believe that the ongoing COVID-19 pandemic has made many of us reflect on our personal and professional lives and what lies ahead.

    Personally, I have always known how important my family is to me, but recent events have brought us all closer together even though we aren’t able to be physically together. I will never again take our time together for granted—and especially the ability to share a meal and hug.

    Seven Reasons the Medical Services Profession Has Changed

    When I think about how the medical services profession has changed over the past 30+ years, I think that changes have occurred for the following reasons:

    1. Drive for recognition from within the profession

      Individuals within the profession recognized the importance of the services that they were providing and pushed for recognition and a voice. They came to be perceived as doing much more than just performing a clerical function. Today, many MSPs are in executive/management positions—and with the education credentials to match. The National Association Medical Staff Services has grown along with the profession to more than 6,000 members.

    2. Recognition of the importance of credentialing and privileging

      Making sure that providers are competent is much more emphasized today than it was in the past. In the past, credentialing and privileging was something that organizations did to pass a survey. Providers routinely were granted temporary privileges before any primary source verification was completed. Today, credentialing and privileging is what we do to assure competent care to patients. Privileging today is much more rigorous than it was in the past. Years ago, privileges were a laundry list that frankly, no one paid much attention to. Privileging is now perceived to be a cornerstone of an organization’s quality improvement processes.

    3. Managed care

      One of the huge changes that has occurred was the realization that in order for an organization to get paid, providers needed to be credentialed. And with the increased number of employed providers, the importance of getting the credentialing process done in a timely manner became a focus of attention by the C-suite. This makes it challenging for those who are responsible for management of credentialing and privileging processes—how to speed it up, without sacrificing quality.

    4. Technology

      Software vendors rose to the occasion and developed tools that automated credentialing and privileging. Organizations were more willing to pay for the software because the benefits of automation include faster credentialing and the need for less staff. MSPs who have embraced and mastered the use of new technology have been more successful than those who have resisted optimizing the use of technology.

    5. Emphasis of onboarding

      As mentioned previously, the employment of providers has driven organizations to complete credentialing faster. It has also made organizations address onboarding procedures – to organize the processes involved in recruitment, contracting, credentialing, orientation, etc., into a more coordinated and synchronized process in order to achieve less duplication of activities and a higher degree of provider satisfaction.  This has allowed MSPs to expand the services offered by their department beyond traditional credentialing and privileging.

    6. Source of truth

      Provider data maintained in the credentialing database is aspired to be the source of truth throughout an organization and is downloaded into other business applications, including the organization’s patient record system and billing system. This has increased the importance of the provider data and those individuals who collect and maintain that data.

    7. Mergers and acquisitions.

    M&As have created new job opportunities for those MSPs who have the education and experience to take on new roles. Almost all health systems include a CVO (credentials verification organization) which offers a job opportunity for manager/director of the CVO. Health systems also are large enough to include a system-level database administrator to assure that all components of the system adhere to use of the credentialing software in a way that meets organization objectives. Frequently, enrollment services are included in the scope of the CVO services which offers additional job opportunities. Additionally, a system level executive position responsible for oversight of the CVO services and also individuals who work the hospital medical staff offices is becoming the norm. Finally, there is an emerging position for an individual (usually clinical) who is designated responsibility for managing the privileges for the health system (frequently this individual is hired to assist with standardization of privileges across a health system).

    Five Predictions about the Future for Medical Service Professionals

    So given all these changes, what is ahead for MSPs? If we have learned one thing from COVID-19, it is probably that situations can change rapidly. Nothing is carved in stone. That being said, however, here is what I predict about the MSPs of tomorrow and how they will work

    1. MSPs will have more education with many positions requiring a minimum of a bachelor’s degree and a master’s degree required for management positions.
    2. There will be more positions that require clinical experience – these positions will support privileging, ongoing assessment of clinical competence and peer review.
    3. There will be more positions that will require proficiency to mine, analyze and report data. Predictive analytics will be part of the skill sets necessary for the increasing number of data positions.
    4. There will continue to be standardization of credentialing and privileging in health systems. Because of the ability to connect electronically with providers for meetings, and for evaluation of credentialing and privileging, the number of medical staff offices in hospitals will decrease, with the work centralized at the system level. The days of physicians coming by the medical staff office to review a paper file (and the MSP showing the physician where to sign) are pretty much over.
    5. Many individuals will continue to work from home – the necessity to work exclusively from an office has proven to be unnecessary for those organizations that have software that facilitates electronic credentialing and privileging as well as electronic review and evaluation of credentials files.

    We have experienced, with COVID-19, how quickly changes can occur. For example—many MSPs recently went from working in an office every day to working from home overnight. We are resilient! And – we know how to work with providers. This profession is never dull – and it will continue to offer the diversity of work and stimulation that will attract the next generation of MSPs to carry on the important work of credentialing and privileging!

    The credentialing process can be a very complicated and long process. Renee Zimmerman gives us her keys to making the process succeed. Download the VerityStream White Paper, 6 Essentials for Achieving Rapid and Successful Centralization.

    The Advanced Automation Engine Powered by Validated Data and Best Practice Content

    CredentialStream is our SaaS solution that enables organizations to automate the validation and monitoring process of provider data, centralized, electronic review of validated provider files, and is the only solution to offer data visualizations based on national proprietary benchmarks.
  • The COVID-19 Pandemic Has Emphasized the Need for Healthcare Cross-Training

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 05, 2020

    This blog bost is the first in a series excerpting our article, “Pandemic Crisis Reveals Need for ‘New Normal’ When It Comes to Cross-Training: An Interview with Trisha Coady, Senior Vice President & General Manager of Clinical Solutions, HealthStream,” by Christie Kerwin, MSN, RN; AVP, Clinical Development, HealthStream.

    As healthcare systems and providers across the United States began to prepare for the onslaught of COVID-19 earlier this year, there were many unknowns: How many patients would arrive at doctor’s offices and emergency rooms in those first days and weeks? How quickly would those numbers rise? Would there be enough equipment and supplies?

    And perhaps most importantly, would there be enough personnel to support the predicted increases in patient volume in both the early stages and over time? There was no simple answer to that last concern, because so much more was involved than simply moving personnel about like pieces on a chessboard. For example, how do we transition idled operating-room nurses into overflowing critical care units? It was a good idea and those individuals were more than up to the challenge, but they would need specific training—and need it fast.

    HealthStream Responded Rapidly with Necessary Nurse Training

    HealthStream saw that rising need and responded by rapidly curating and collecting a series of courses to offer its customers. Those included everything from reviews of current guidelines for infection control across various care settings to other frontline needs such as ventilator safety and precautions for airborne pathogens. Courses on best practices for using personal protective equipment (PPE), as well as refresher courses on proper hand hygiene to control and prevent the spread of infection, were understandably popular, as was a course on Acute Respiratory Distress Syndrome (ARDS). And stepping away from the clinical side, the course bundles also included modules for back-office functions, such as coding for COVID-19 related care, as well as other administrative topics that would ensure all areas of operation would continue smoothly as staff were pulled in many different directions.

    Frontline Clinical Staff Needed Education to Be Prepared for Anything

    “For the best chance at positive outcomes, healthcare leaders really needed to ensure their frontline clinical staff had a baseline level of competence,” says Trisha Coady, Senior Vice President & General Manager of Clinical Solutions for HealthStream. “Unfortunately, education and professional development have often been de-prioritized despite being one of the most cost-effective tools an organization has to achieving the quadruple aim.”

    However, even healthcare organizations who have robust training in place had to contend with the suddenness of the COVID-19 pandemic, coupled with the fact that a predicted 20 percent of healthcare workers themselves were likely to contract the virus.

    “We knew the U.S. was going to have a surge of COVID patients enter our hospitals, and then end up in critical care units. At the same time, many frontline staff would exit the workforce, at least temporarily, due to COVID-related illness. Given our systems have never had to cope with an issue of this scale before, I believe we all wondered how our organizations would handle this very unique challenge. We heard from one hospital leader who mentioned, ‘We had 25 patients come in at once and we were flattened.’ What were they going to do if 200 came in?”

    Further complicating matters was the need to either re- or cross-train staff not just in areas like nursing, where a chronic shortage exists nationwide, but also in just about every other area of care. That meant training had to be comprehensive, quick, and effective, Coady says.

    The article also includes:

    • HealthStream curricula assembled for rapid retraining needs
    • Cross-training, individualized coursework likely the ‘new normal’
    • Shifting employee development in healthcare
    • Resuscitation training as an ideal candidate for the COVID-19 aware environment
    • Proven benefits of learning and professional development should spur continued engagement
    • Diversified learning strategies to support healthcare readiness
    • The Effect of COVID-19 on the Opioid Crisis

     

    Download the full article, “Pandemic Crisis Reveals Need for ‘New Normal’ When It Comes to Cross-Training: An Interview with Trisha Coady, Senior Vice President & General Manager of Clinical Solutions, HealthStream.”

    As our flagship nursing workforce development solution, HealthStream’s jane™ is The World’s First Digital Mentor for Nurses. JaneTM harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, JaneTM was designed to power lifelong, professional growth of clinical professionals. JaneTM is an important component of HealthStream’s suite of clinical development solutions.

  • Envisioning the Future of Long-Term Care During the COVID-19 Pandemic

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 04, 2020
    Current events, including the COVID-19 pandemic, have focused our attention like never before on the long-term care industry and on the mostly older adult population who make it their home. Download the article to learn more about the future of long-term care and the trends impacting the rate of change.
  • Top Issues Across the Care Continuum - Part Two

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 04, 2020
    In this second part, HealthStream covers how the long-term care industry is struggling to deal with a variety of issues across the care continuum. Some such as preventing falls and ensuring emergency preparedness have been concerns for these facilities for quite some time; others such as new regulatory oversight and handling the COVID-19 pandemic are new to the mix. Download part two of the article to learn more about the top issues.
  • Top Issues Across the Care Continuum - Part One

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 04, 2020
    The healthcare industry is in the midst of transformation driven by demographic change, financial instability, and technological advance, not to mention the immediate issue and yet to be determined ramifications of the COVID-19 pandemic. Download part one of the article to learn more about the top issues.
  • Five Survey Findings about Compliance Training in Healthcare (Part 1)

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 04, 2020

    HealthStream recently surveyed U.S. healthcare leaders about their organizations’ compliance training solutions in order to better understand customers’ approach to complying with government regulations and accrediting body requirements and to gain insight into organizations’ compliance training needs. The questions asked for HealthStream’s Annual Report on Compliance covered several topics, including compliance training, customer priorities, and future product interest. The following are some notable conclusions that can be drawn from the survey results about compliance training in healthcare.

    1. Half of all healthcare organizations in the study reported they have a Compliance Officer who takes ownership of compliance training in their organization.

      Over a quarter (27.1%) said a combination of professionals from their organization are in charge of training. Only a few organizations reported they have either a Quality Committee, Learning/Education Professionals, Chief Nursing/Medical Officer, or a Privacy Officer take responsibility for this task. Specific to OSHA/Accreditation training, nearly 40% of organizations rely on a combination of those professionals for training.

    2. Quality, regulatory training, patient safety, Joint Commission, and HIPAA Privacy were identified as the top five areas selected for training among participating healthcare organizations.

      When asked how their organizations determine which compliance/regulatory training to deliver to staff, the top three responses were “review training data from prior year” (42.3%), “it is determined by Compliance Officer “(41.8%), and “meet as a team where everyone provides their suggestions” (41.2%). Some (38.1%) of respondents reported they deliver the same training every year. In order to keep current with changing regulations, the majority (65.4%) of healthcare organizations reported their in-house staff researches federal and state requirements.

    3. The top priority over the next 18 months for surveyed healthcare organizations is to improve patient safety.

    Respondents were given a list of 10 items and asked to rate their importance on a scale of 1 to 10, with 1 being “not at all important” and 10 being “extremely important.” The following items rose to the top, rated as the most important areas to organizations:

    • Improving patient safety (9.4)
    • Workforce training and development (9.0)
    • Reducing compliance risk (9.0)
    • Promoting a harassment-free workplace (8.8)
    • Reducing burnout and bringing joy to the workplace (8.6)
    • Preventing phishing and other security threats (8.6)

    Respondents were also asked to similarly rate the importance of certain areas to their organizations’ training initiatives. Participants selected the following as the most important areas for compliance training initiatives over the next 18 months:

    • Improving Patient Safety (9.0)
    • Reducing Compliance Risk (9.0)
    • Employee Satisfaction and Engagement with Training (8.9)
    • Training Directed to New Generations of Learners (8.4)

    This blog post is the first in a series of excerpts from an article about HealthStream’s Annual Report on Compliance. HealthStream provides online healthcare compliance training solutions to help health systems, facilities, and organizations across the care continuum comply with government regulations and accrediting body requirements. These online training courses span the areas of Billing & Corporate Compliance, HIPAA, Privacy & Security, Research Compliance, and Workforce compliance. These courses are recognized for using video and other interactive elements to engage learners, increase retention, and change staff behavior.

  • Performance Measurement To Improve Patient Access Management

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Aug 03, 2020

    This blog post excerpts the HealthStream article, “Two Key Strategies for Improving Patient Access Success in Healthcare: How Continuing Education and KPI Monitoring Can Make Patient Access More Effective,” by  Mary Beth Rozell, Sr. Director of Revenue Cycle Solutions at HealthStream’s partner nThrive, and Susan Gurzynski-Wells, RHIA , Senior Product Manager, Revenue Cycle, HealthStream.

     

    Price transparency and consumerism have a direct impact on today’s hospital Patient Access operation and more changes are coming in 2021 due to new, stringent Federal and State regulations. Considered the hospital’s “front door,” the role of Patient Access has traditionally begun with the initial patient encounter — where staff confirm patient identity, verify insurance status and more.

    Healthcare reform has changed the role of Patient Access substantially, focusing revenue cycle leadership more on the expanding role and expertise of its Patient Access staff. Today’s Patient Access expert is tasked with capturing patient information, as well as educating and supporting a range of individuals—patients, hospital personnel, and providers—helping to ensure comprehensive, quality healthcare service delivery and patient satisfaction.

    The Growing Role of Patient Access

    Healthcare industry challenges, such as a payor mix shift and rising patient debt, have also expanded the role of Patient Access Managers into upfront collections at healthcare organizations across the country. A robust health information technology suite and Patient Access presence assist in securing patient out-of-pocket costs and/or alternative payment solutions, integral to maintaining a healthy bottom line. From the first patient interaction, today’s Patient Access team:

    • Schedules healthcare service appointments
    • Determines patient insurance eligibility
    • Enters required demographic and billing data
    • Collects co-pays and discusses alternative payment solutions

    The bar is set high regarding responsibilities required of a Patient Access team. They must operate at maximum performance levels, create a positive patient experience, and protect revenue integrity by ensuring appropriate insurance reimbursement and patient payments for services rendered. 

    How can hospitals and healthcare organizations ensure their Patient Access team is executing at a high level? Implementing key performance indicators (KPIs), providing education, and mentoring your Patient Access representatives comprise an impactful first step to achieving patient satisfaction and revenue cycle success. This blog post is the first in a series discussing key strategies for improving patient access success.

    Develop and Monitor Key Performance Indicators (KPIs) for Patient Access

    To ensure a high level of productivity and accuracy, Patient Access operations should be measured on KPIs to monitor quality, process, financial, and customer service. Healthcare organizations throughout the medical industry have established guidelines on appropriate Patient Access KPIs with examples, including:

    1. QUALITY – A best practice benchmark for duplicate medical records is 2% or less says American Health Information Management Association (AHIMA). Duplicate medical records can lead to patient safety issues. Patient Access has the best opportunity to validate patient identification and prevent duplication by reviewing key identifiers.

    2. PROCESS - Benchmark for resolving prior authorization and medically necessary services are both key for successful denial prevention. According to the National Associations of Healthcare Access Management (NAHAM) the benchmark is >90%. As part of patient scheduling/intake, the Patient Access team must validate that authorizations are in place and services are medically necessary.

    3. FINANCIALS – Benchmark for point-of-service cash as percentage of total cash collected is >2% says the Healthcare Financial Management Association (HFMA). Patient Access staff must be familiar with the various types of up-front cash collection required.

    4. PATIENT SATISFACTION – Benchmark for patient wait time is <10 minutes says HFMA. An impactful first encounter is key to preserving loyalty and ensuring that patients return for future services. A patient’s experience, including registration and wait time impacts their decision to become a loyal consumer. Accompanying KPIs with specific department goals leads to positive outcomes, making certain that you set your team up for success.

    Future installments in the series will address the importance of patient access training and education. Download the full article, “Two Key Strategies for Improving Patient Access Success in Healthcare: How Continuing Education and KPI Monitoring Can Make Patient Access More Effective.”

    Patient Access Education

    All staff with patient access responsibilities must perform effectively to ensure the success of the revenue cycle in its entirety. With the shift toward high-deductible health plans and the growth in newly insured individuals, Patient Access is faced with communicating and collecting increasingly larger amounts for which patients are financially responsible. In addition to patient communications, these employees must fully understand insurance plans, coordination of benefits, medical necessity and ABNS, and the importance of the demographic and insurance information they collect and record. Our training provides Patient Access employees with the necessary training to ensure patients understand their financial obligations and payment options. This information, when communicated properly, increases payment collection and reduces days of AR.
  • Validating the JaneTM Competency System AI Critical Thinking Assessments

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 31, 2020

    This blog post is the first of two that excerpt a HealthStream article, “The Validity of the JaneTM Competency System AI Critical Thinking Assessments,” by Randy L. Carden, Statistical Consultant, HealthStream.

    The development of critical thinking/judgment skills by nurses is of paramount importance in the healthcare industry today. Factors, such as the following, have all converged to make the development of advanced critical judgment skills a top priority:

    • A growing senior population requiring nursing care
    • A high percentage of seasoned nurses taking retirement
    • Nursing shortages in many areas of the country
    • Increased patient acuity in many settings
    • The need to bring new nurses up-to-speed as quickly as possible

    It has long been thought that these types of skills could only be developed through years of on-the-job training and experience. Now, however, we are finding that artificial intelligence (AI) can play a major role in providing efficient, comprehensive tools for enhancing critical judgment.

    The paper excerpted by this blog post details psychometric studies conducted by HealthStream to evaluate whether computers can perform as well as human evaluators in assessing critical thinking skills in nurses.

    Background

    Human evaluators have long been relied upon to judge performance and to score tests and assessments. With the advent of artificial intelligence and machine learning, it raises the question of how well can a computer analyze responses of nurses who are asked to evaluate a clinical situation or dilemma? The following study sought to answer this question by comparing computer scoring with human scoring of nurse responses to clinical dilemmas. This study assesses the validity of the Jane™ competency system AI critical thinking assessments as an evaluative tool in scoring responses of RNs in situations where critical judgment is required.

    Purpose of the Study

    The purpose of this study was to test the validity of Jane™ (leveraging IBM Watson with HealthStream’s proprietary scoring algorithm). Validity is the degree to which a test, instrument, or assessment measures what it purports to measure. In this study a particular type of validity was evaluated—construct validity. Construct validity has to do with the degree to which an instrument measures a particular dimension, concept, or construct. In this case it relates to the degree to which Jane™ measures the critical thinking/judgment of a sample of nurses as they indicate how they would respond to various nursing dilemmas and situations. In the current study, if Jane™ scores correlate with a known measure of the construct in question, then construct validity will be established. In this study, Jane™ scores were compared to scores of a trained, human RN using “model answers” established by PBDS.

    How the Study Was Conducted

    In order to assess the critical thinking of participants, nurses viewed and then reacted to a series of videos that were approximately 2-3 minutes in duration. Specific videos were assigned to participants based on the nurse’s specialty area. After viewing a video segment, nurse participants were asked to do the following:

    1. Identify the primary emerging issue or problem
    2. Describe the clinical observations that supported the perceived emerging issue/problem
    3. Identify action strategies that they would take
    4. Identify the rationale or reasoning supporting the action they planned to take

    Nurse responses to the critical judgment videos were compared to “model answers” that have been developed through 30+ years of response data and evidence-based practice. The nurse responses to the videos were evaluated by a team of nurses who have deep experience using the “model answers.”

    Jane™ was “trained” by leveraging artificial intelligence, powered by IBM Watson, and the PBDS database which contains more than 15 million data points of completed assessment responses. This training included identification of problems, observations, actions, and rationale based on “model answers” established for PBDS.

    Proprietary grading/scoring algorithms were developed by using the “model answers” with consultation and interpretative guidance by specially trained nurse raters. The next step included sending selected evaluations to an experienced lead nurse rater. The nurse rater evaluated 28 sets, which included 8 conversations per set, yielding a total of 224 conversations.

    Participants

    In order to evaluate the construct validity of using Jane™ and HealthStream’s proprietary scoring algorithm, nurses across three nationally recognized healthcare systems were recruited to take the critical thinking assessments. As a result, over 326 completions were obtained. Twenty-eight complete evaluations sets were selected across all score ranges for final comparison between Jane™ and human ratings.

    The subsequent post in this series will include the following findings about janeTM:

    • Summary/Conclusions
    • Validity and Reliability of PBDS
    • Content Validity
    • Construct Validity
    • Predictive Validity
    • Reliability

    HealthStream Focuses on Clinical Development

    At HealthStream we spend a lot of time focused on developing the clinical workforce. HealthStream’s jane™ is The World’s First Digital Mentor for Nurses. Jane harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, Jane was designed to power lifelong, professional growth of clinical professionals. JaneTM is an important component of HealthStream’s suite of clinical development solutions.

    Download the full article, “The Validity of the janeTM Competency System AI Critical Thinking Assessments,” in which we investigate the assessments on which janeTM is built.

  • The S.T.A.B.L.E. Program’s Timely Transition to Online Learning

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 30, 2020

    When S.T.A.B.L.E. and HealthStream formally announced their partnership and the upcoming launch of their online course set for March 2020, COVID-19 was a distant threat. Yet with the arrival of March, national shelter-in-place orders were issued, and an unanticipated new reason for online learning existed.While S.T.A.B.L.E. was not pushed into transitioning their content online due to the pandemic, their preparedness allowed them to make a seamless launch during a time when accessing education online is more important than it ever has been. HealthStream recently spoke with Dr. Kristine Karlsen, the creator and director of the S.T.A.B.L.E. Program, about the program’s newly broadened capacity to reach the nation’s healthcare providers at a crucial time. Download the article to learn more.

  • An Upside Down World Pandemic Creates Process Challenges & Opportunities for Licensure & Credentialing

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 30, 2020

    The medical profession is justifiably known for rising to a crisis, and the response to COVID-19 is no different. Every day, tireless professionals on the front lines are providing outstanding patient care while creating on-the-spot workarounds for equipment shortages and other issues. That same can-do spirit is also fully present in the profession’s support teams, who are streamlining processes and reinventing systems in order to deploy caregivers as quickly as possible to where they are most needed. One result is that the credentialing and licensure process looks very different now than it did just a few weeks ago, says Vicki Searcy, Vice President, Consulting Services, at VerityStream. Download the article to learn more.

    PLEASE NOTE: The information in this article was considered current at the time of its publishing, 7/30/20. However, the COVID-19 pandemic is an ever-evolving disaster due to new findings, data, and availability of resources. Please refer to the CDC website for the latest detailed information when you need it.

  • Hospital Leaders Say COVID-19 Is Worse Health Crisis of Their Career

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 30, 2020

    After living through the first four months of emergency response to the coronavirus pandemic, healthcare leaders are stepping back to assess the longer-term challenges they are facing from this unprecedented health threat.

    • The COVID-19 crisis has exposed many cracks in our healthcare system
    • COVID-19 cases are continuing to rise throughout the U.S., with no end in sight
    • The use of telehealth is booming as a result of the need to maintain social distancing during the pandemic
    • Not only were hospitals absorbing the influx of COVID-19 patients and subsequent supply shortages, they were also suffering large financial losses as profitable elective surgeries and primary care appointments were being postponed

    Download the article to learn more.

    PLEASE NOTE: The information in this article was considered current at the time of its publishing, 7/30/20. However, the COVID-19 pandemic is an ever-evolving disaster due to new findings, data, and availability of resources. Please refer to the CDC website for the latest detailed information when you need it.

  • 4 Ways Telehealth is Impacting the Fight Against COVID-19

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 30, 2020

    When national stay-at-home orders were enacted in March 2020 to slow the spread of COVID-19, there was a quick and dramatic shift to working from home if possible, teach students using online platforms, and convert face-to-face appointments into virtual meetings. This transition’s impact stretched across all sectors, healthcare included. Telehealth services have been expanding in recent years, with some organizations and providers launching swiftly ahead with the available technology. Others have been slow or resistant to transition any services online, not wanting to abandon in-person appointments and clinic hours. Some patients have found it impossible to use telehealth services due to the countless barriers that keep telehealth from being widely accessible, such as payer reimbursement and access to necessary technology. Download the article to learn more.

    PLEASE NOTE: The information in this article was considered current at the time of its publishing, 7/30/20. However, the COVID-19 pandemic is an ever-evolving disaster due to new findings, data, and availability of resources. Please refer to the CDC website for the latest detailed information when you need it.

  • New HealthStream Survey Results: COVID-19 Has Forever Changed Long-Term Care

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 30, 2020

    HealthStream recently surveyed long-term care facility leaders about their organizations' greatest challenges in order to better understand their priorities for keeping staff and residents safe during the pandemic.. Download the article to learn more.

    PLEASE NOTE: The information in this article was considered current at the time of its publishing, 7/30/20. However, the COVID-19 pandemic is an ever-evolving disaster due to new findings, data, and availability of resources. Please refer to the CDC website for the latest detailed information when you need it.

  • Understanding Core Privileges Form Components & Best Practices

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 30, 2020

    HealthStream regularly publishes guest blog posts like the one below from Angela Beardsley, CMPSM, CPCS, Consultant and Jackie Jones, CPMSM, Senior Consultant; VerityStream

    Based on the CMS and other Accrediting body requirements, it is a best practice to organize privilege forms by specialty, not by medical staff organization departments. If privileges are organized by medical staff organization departments, it may lead to confusion about the criteria/qualifications required to apply for the privileges. Additionally, organizing privilege forms by medical staff organization departments may lead to very lengthy forms, and providers may inadvertently request privileges outside of their specialty or scope of practice. Once privilege forms are organized by specialty, there are certain components that typically should make up each specialty’s privilege form.

    Components of a Privilege Form

    Required Qualifications:

    At the beginning of a privilege form, before the actual privilege detail, it is best practice to have a section for Required Qualifications.

    • The criteria listed here should address required education/training, continuing education (if applicable), board certification requirements (if applicable) as well as clinical experience (activity and outcomes), for both for Initial Privileging and Re-privileging. This is what helps to determine if the provider is competent to perform the privileges they are requesting. To determine competency, the first question is always: Did the provider perform it?; the second question is: How well did the provider perform it?
    • Also, any additional privilege criteria that is required would be listed in this section as well. For example, manufacturer designated training or supervising/collaborating requirements for Advanced Practice Professionals.
    • Core privilege criteria should always be objective so that it can be consistently and uniformly applied across all specialties and providers.

    Privilege Detail

    After the Required Qualifications, next is the actual Privilege Detail. Privilege detail should be written so that privileges with similar criteria and transferable skills are grouped together. Under Privilege detail the privileges are typically categorized as follows:

    Primary/Core Privileges

    Since the CMS requires that Core Privileges must be able to be modified, when formatting Core Privilege detail, it is imperative to ensure that the providers requesting privileges as well as the clinical reviewers making recommendations, are able to modify the Core Privileges. On an electronic privilege form, the privileges within the Core Privilege group would need to be listed out individually, so that each privilege detail can be “checked” or “unchecked” as opposed to on a paper privilege form where Core Privileges within a group/paragraph could be crossed out.

     

    Cognitive Privileges

    This is where the admitting, history and physical exam, and the evaluate, diagnose, manage and treat type privileges would be listed.

     

    Procedural Privileges

    Procedural privileges should be written/defined in such a way, that enables the medical staff organization to easily monitor the performance of the privileges/procedures granted to providers, to ensure providers are not exceeding the scope of the privileges granted to them. This is a CMS requirement, as well as a requirement by other Accreditation Organizations.

     

    Advanced Privilege Clusters

    Advanced Privileges/Procedures that required Additional Training, such as a Fellowship, or maybe training for a specific advanced procedure during their Residency (for example, formal training during a residency is required for advanced laparoscopic procedures); another example might be required manufacturer recommended training (as is the case with Transcatheter Aortic Heart Valve Replacement (TAVR) ).

     

    Conditions - Focused Professional Practice Evaluation (FPPE)/Proctoring

    After Privilege detail, some organization’s privileges forms may have the actual requirements FPPE (Focused Professional Practice Evaluation) or Proctoring (as called by some organizations). FPPE/Proctoring is a requirement by some Accreditation Organizations (like TJC, DNV, and HFAP). This is the process for confirmation of competency of the full scope of privileges granted and should be implemented as soon as new privileges are granted to a provider.

     

    Provider Acknowledgement

    Next, there should be a Provider Acknowledgement section on the privilege delineation. This is the attestation that the provider is only requesting those privileges they are currently competent for based on their education/training and current experience. It should also indicate that any restriction on the clinical privileges granted to the provider are waived in an emergency situation, and in such situation their actions are governed by the applicable section of the health care organizations Medical Staff Bylaws or other related documents.

     

    Clinical Reviewer(s) Recommendation

    The final component of the privilege form for discussion is the section for the Clinical Reviewer (for example, Specialty Chiefs, Dept. Chairs, Chief of Staffs, CMOs) to make their recommendation regarding the privileges requested by the Provider. This would include any Privilege Conditions, Modifications, Deletions or explanations, and it also may include comments related to the FPPE/Proctoring recommendation (if applicable).

    Once privilege forms have been developed, medical staff organizations should have a plan for regular review and updating of all privilege forms in order to keep privilege forms relevant and in alignment with current requirements. Some privilege forms will require annual review while others might be reviewed every other year.

    Additionally, in between formal review periods, medical staff organizations should have policies and procedures in place for when new procedures/privileges/technology need to be added to their privilege delineations. The medical staff organization must determine that the privilege/procedure in question should be added to the scope of services for the medical staff organization and must develop criteria for what providers will be eligible to apply for the new privilege/procedure.

    Ready to be a privileging superstar? See how VerityStream's Privilege solution can help you fortify patient care, satisfy providers, and comply with industry regulations. To learn more, download our article about the “Top Reasons to Automate and Standardize Privileging with Veritystream's Privilege Solution.”

    Kick Off the Clinical Competency Lifecycle with Privilege

    The healthcare system is going through a volume-to-value transformation with the goal of controlling costs and improving patient outcomes. Rigorously assessing the clinical competency of your caregivers is more important than ever before. Privilege by VerityStream automates the clinical competency lifecycle including the standardization of the delineation, request, recommendation, granting, monitoring and evaluation of clinical privileges. With a library of continuously updated forms (best-practice, evidence-based, specialty-specific forms) and FPPE Insights, Privilege eliminates the need to conduct time-consuming research on new procedures and update privilege

  • Are Organizations Ready for The Joint Commission’s New Standards for Perinatal Safety?

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 29, 2020

    This article excerpts a HealthStream article, “The Joint Commission’s New Standards for Perinatal Safety: HealthStream Surveys Organizations About Their Readiness,” by Linda Zimmer, MSN, RN, Product Manager, Quality & Risk, HealthStream.

    The United States has a serious problem with maternal healthcare and outcomes; currently we rank 55th among industrialized nations in terms of maternal mortality. To begin to implement the significant measures necessary to improve this poor ranking and decrease the frequency of maternal death and morbidity, The Joint Commission has introduced two new Perinatal Safety standards that will now take effect January 1, 2021. Having originally been scheduled for July 1, 2020, the standards implementation deadline was extended six months as a response to the Covid-19 pandemic. The standards specifically address measures that all healthcare organizations should take to address complications that occur with alarming frequency in pregnant and delivering women—maternal hemorrhage and severe hypertension/preeclampsia.

    Specifics about the New Perinatal Safety Standards

    The new standards will appear under the Provision of Care, Treatment and Services (PC) chapter at PC.06.01.01 and PC.06.01.03 in the Comprehensive Accreditation Manual for Hospitals. The standards address prevention, early recognition, and timely treatment of maternal hemorrhage and severe hypertension/preeclampsia. Some of the standards require Joint Commission-accredited hospitals to:

    • Develop written evidence-based procedures to identify and treat the conditions
    • Stock easily-accessed hemorrhage supply kits
    • Provide role-specific education to all staff and providers who treat pregnant/postpartum patients at least every two years
    • Conduct response procedure drills at least annually
    • Educate patients on signs and symptoms that warrant care during hospitalization and after discharge

    To prepare hospitals to meet these new standards, The Joint Commission has issued a new R3 Report that provides guidelines for the 13 new elements of performance (EPs) that fall under the standards. The report provides the requirement, rationale and reference for each EP.

    HealthStream Surveyed Healthcare Leaders about Organizational Preparedness for These New Perinatal Safety Standards

    HealthStream surveyed nearly 150 leaders in nursing and healthcare education about the New Perinatal Care Standards, to gain insight about whether they were ready for Joint Commission surveyors who’d be looking for evidence of their implementation. We also wanted their honest opinion about whether they thought the standards would improve perinatal care and maternal healthcare outcomes.

    Who Responded to the Survey?

    HealthStream surveyed approximately 150 healthcare clinical and educational professionals about their organizations’ state of readiness to comply with these new standards. Of the respondents, more than 63% represented acute care hospitals, nearly 10% worked in corporate healthcare, more than 6% worked in outpatient surgery or a birthing center, and 21% worked in other healthcare roles. In terms of the leading respondent titles, more than 42% were nurse managers; more than 13% had a leadership role involving Quality, Risk Management, Compliance, Infection Control, or Safety; more than 12% were Directors of Nursing; and nearly 11% were Leaders of Learning or Education. Questions asked in the survey included:

    • Will the New Standards Improve Perinatal Care?
    • Will U.S. Healthcare Organizations Be Ready to Implement the Standards by Their Deadline?
    • What Required Measures Were Fully Implemented as of March 2020?

    Download the full article to learn how healthcare organizations responded to the survey and to assess your own progress on meeting new maternal safety standards compared to other U.S. organizations.

    HealthStream Focuses on Clinical Development

    At HealthStream we spend a lot of time focused on developing the clinical workforce. HealthStream’s jane™ is The World’s First Digital Mentor for Nurses. Jane harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, Jane was designed to power lifelong, professional growth of clinical professionals. JaneTM is an important component of HealthStream’s suite of clinical development solutions.

  • Pandemic Crisis Reveals Need for “New Normal” When It Comes to Cross-Training

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 28, 2020
    As we entered an unprecedented, global healthcare crisis with the COVID-19 pandemic, the essence of community and cross training would never be more apparent.

    HealthStream quickly curated and released a collection of free courses, along with its thought leading partners, to its healthcare community. Caregivers and healthcare organizations have been able to tap into a wide variety of content relevant to COVID-19, including current guidelines for infection control across various care settings, ventilator safety, precautions for airborne pathogens, and coding of COVID-19 related care.
  • New HealthStream Survey Results: 5 Findings about Compliance Training in Healthcare

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 28, 2020

    HealthStream recently surveyed U.S. healthcare leaders about their organizations' compliance training solutions in order to better understand their approach to complying with government regulations and to gain insight into organizations' compliance training needs. Download the article to learn more.

  • Introduction to Privileges: Credentialing versus Privileging and CMS Requirements

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 28, 2020

    HealthStream regularly publishes guest blog posts like the one below from Angela Beardsley, CMPSM, CPCS, Consultant and Jackie Jones, CPMSM, Senior Consultant; VerityStream.

    For Medical Services Professionals (MSPs) who are new to the profession or even seasoned MSPs who are not regularly involved in privileging processes and are interested in a brief refresher, the following are some privilege basics.

    Credentialing Vs. Privileging

    Credentialing is "the process of assessing and confirming the license or certification, education, training, and other qualifications or a licensed or certified healthcare practitioner."

    Privileging is "the process of authorizing a healthcare practitioner’s specific scope and content of patient care services."

    Centers for Medicare & Medicaid Services (CMS) Requirements for Privileging

    "The Centers for Medicare & Medicaid Services (CMS), is part of the Department of Health and Human Services (HHS)." The "CMS develops Conditions of Participation (CoPs) and Conditions for Coverage (CfCs) that health care organizations must meet in order to begin and continue participating in the Medicare and Medicaid programs. These health and safety standards are the foundation for improving quality and protecting the health and safety of beneficiaries." The CMS CoPs related to Privileging are:

    § 482.12 Condition of participation: Governing body

    (a) Standard: Medical staff. The governing body must:

    (6) Ensure the criteria for selection are individual character, competence, training, experience, and judgment; and

    (7) Ensure that under no circumstances is the accordance of staff membership or professional privileges in the hospital dependent solely upon certification, fellowship, or membership in a specialty body or society.

     

    § 482.22 Condition of participation: Medical staff

    (c) Standard: Medical staff bylaws. The medical staff must adopt and enforce bylaws to carry out its responsibilities. The bylaws must:

    (6) Include criteria for determining the privileges to be granted to individual practitioners and a procedure for applying the criteria to individuals requesting privileges.

     

    Specific CMS Requirements for Hospital Medical Staff Privileging

    Additionally, the CMS requirements for hospital medical staff privileging are outlined in the CMS letter dated November 12, 2004, which requires the hospital’s governing body to ensure "that all practitioners who provide a medical level of care and/or conduct surgical procedures in the hospital are individually evaluated by its medical staff and that those practitioners possess current qualifications and demonstrated competencies for the privileges granted." The letter further states:

    • Specific privileges for each category must clearly and completely list the specific privileges or limitations for that category of practitioner.
    • The specific privileges must reflect activities that the majority of practitioners in that category can do and that the hospital can support.
    • It cannot be assumed a practitioner can perform every task/activity/privilege listed/specified for the applicable category of practitioner.
    • The individual practitioner’s ability to perform each privilege must be assessed and not assumed.
    • If the practitioner is not competent to perform one or more tasks/activities/privileges, the list of privileges is modified for that practitioner.
    • The Medical Staff must actually examine each individual practitioner’s qualifications and demonstrated competencies to perform each task/activity/privilege he/she has requested from the applicable scope of privileges for their category of practitioner.
    • Components of practitioner qualifications and demonstrated competencies would include at least: current work practice, special training, quality of specific work, patient outcomes, education, maintenance of continuing education, adherence to medical staff rules, certifications, appropriate licensure, and currency of compliance with licensure requirements.

    Accrediting Bodies and Healthcare Organizations to which Privileging is Applicable

    The "CMS also ensures that the standards of accrediting organizations recognized by CMS (through a process called "deeming") meet or exceed the Medicare standards set forth in the CoPs/CfCs." Health Care Organizations seeking CMS approval may choose to be surveyed either by an accrediting body, such as The Joint Commission (TJC), Healthcare Facilities Accreditation Program (HFAP), and DNV-GL; or by state surveyors on behalf of CMS. Types of healthcare organizations to which the CMS standards apply and also at which Privileging is typically applicable are hospitals (including acute care, critical access and psychiatric), surgery centers, mental or behavioral health centers, and Federally Qualified Health Centers (FQHCs). This is not to say however, that there are not other healthcare organization types that perform privileging, these are just the most common, and also the ones that typically have other Accreditation Standards (TJC, HFAP, DNV-GL, AAAHC, HRSA) related to privileging that they must meet as well, in addition the CMS’s CoPs related to privileging.

    Ready to be a privileging superstar? See how VerityStream's Privilege solution can help you fortify patient care, satisfy providers, and comply with industry regulations. To learn more, download our article about the “Top Reasons to Automate and Standardize Privileging with Veritystream's Privilege Solution.”

  • Key Strategies For Improving Patient Access Success in Healthcare

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 27, 2020
    Healthcare reform has changed the role of Patient Access substantially, focusing revenue cycle leadership more on the expanding role and expertise of its Patient Access staff. This article focuses on how continuing education and KPI monitoring can make the patient access team more effective. Download the article to learn more.
  • Updated Information about COVID-19 for Healthcare Professionals

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 27, 2020

    HealthStream has recently posted an updated July 2020 version of our article, “2019 Novel Coronavirus Pandemic: What Healthcare Professionals Need to Know,” by Joanne Tate, BSN, RN; Accreditation and OSHA Standards Courseware Author, HealthStream. Here’s an abbreviated sample of the article’s contents:

    How Many People Are Affected?

    Statistics included in the article demonstrate just how serious this ongoing pandemic has become in the United States. As of July 12, 2020, there were:

    • U.S. confirmed cases - 3,236,130
    • U.S. deaths - 134,572
    • GLOBAL cases - 12,552,765
    • Global deaths - 561,617

    Signs and Symptoms

    COVID-19 causes respiratory illness with symptoms of fever or chills, cough, and shortness of breath. Symptoms range from mild, as with the common cold, to deadly. Other symptoms include fatigue, muscle or body aches, headache, new losses of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea. The incubation period is thought to extend to 14 days with most developing symptoms within 11.5 days. Signs and symptoms are similar in children, but they are usually milder.

    Treatment

    It remains true that there is no effective vaccine or antiviral agent for this infection, and treatment is supportive to manage symptoms. In the months since COVID-19 became a serious problem, the healthcare industry has learned much about treating the virus and its symptoms as public and private organizations work around the clock to develop a vaccine. The article links to clinical management guidelines from the American Society of Hematology, the National Institutes of Health (NIH), The Society of Critical Care Medicine, the World Health Organization (WHO), and the American Thoracic Society.

    Exposure Risks for COVID-19

    The article discusses situations where you might be at risk for contracting the disease due to how you work or where you live. It also lists individuals who are more at risk due to age or underlying health conditions.

    Testing for COVID-19

    Clinicians are encouraged to use their judgment to determine if a patient has signs or symptoms compatible with COVID-19 and whether the patient should be tested. Clinicians should consider testing for other causes of respiratory illness, such as influenza, in addition to testing for SARS-CoV-2. It is essential to recognize that detection of one respiratory pathogen (e.g., influenza) does not exclude the potential for co-infection.

    Avoiding COVID-19 Infection for the General Population

    Although most states have re-opened by easing up on stay-at-home orders, certain CDC guidelines are advised and may become mandatory, including:

    • Social distancing of 6 feet or more
    • Wearing face masks in public settings, especially when social distancing is difficult to maintain
    • Frequent hand hygiene and avoidance of touching your eyes, nose, and mouth with unwashed hands

    Infection Control and Prevention for Healthcare Workers

    Infection control and prevention means using evidenced-based practices to prevent and contain infections. They include administrative policies and procedures, environmental hygiene, work practices, and appropriate use of PPE. All healthcare workers, including those paid and unpaid, who work in a healthcare setting and who encounter patients during admission, assessment, care, housekeeping, specimen collection, and triage, for instance, must implement infection control precautions.

    The transmission risk is more likely when symptoms are present because shedding is more common during that time with most viruses. What we do know now is that the virus spreads easily from person to person, in fact, more efficiently than influenza but not as efficiently as the measles. Some people without symptoms may be able to spread the virus. This is why the CDC has strongly advised social distancing. Those who go out in public should wear a cloth mask to protect others.

    It is important to be mindful of the fact that when droplets of various sizes enter the air through coughing or sneezing, they can land in the mouths and noses of people nearby (within 6 feet) and can then be inhaled. They can also land on surfaces and it may be possible that a person can get COVID-19 from touching a contaminated surface, then touch their eyes, nose or mouth. Thus, hand hygiene is extremely important. This is also why recommendations for PPE include the use of N95 respirators, gloves, eye shields and gowns.

    The article lists multiple strategies for containing the virus. Here are just a few of them:

    • Screening of all people who enter a healthcare facility
    • Practice cough etiquette and hand hygiene
    • Use standard precautions, assuming that every patient is potentially infected or colonized with a potentially transmissible pathogen.
    • Use respiratory protection (i.e., a respirator) that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator before performing any aerosol-generating procedures.
    • Use contact precautions, especially to protect eyes.

    This blog post is just a brief overview of our updated article. Download the full article with COVID-19 information for practicing healthcare professionals.

    To support caregivers and healthcare organizations as they respond to the COVID-19 pandemic, HealthStream is offering a collection of carefully curated courses to all customers for free. Likewise, Using HealthStream’s Channels platform for video learning, we have a created a free-access COVID19 Channel in response to the COVID19 pandemic, specifically to support healthcare workers and their families. It contains a collection of curated videos provided by HealthStream and HealthStream’s content partners from several trusted sources on YouTube, such as the CDC and Mayo Clinic.

  • New Joint Commission Guidelines Target Poor Maternal Mortality Outcomes

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 24, 2020

    This article excerpts a HealthStream article by Trisha Coady, BSN, RN, Senior Vice President and General Manager of HealthStream’s Clinical Solutions, about the new perinatal care standards that have been issued by the Joint Commission.

    January 1, 2021 is the new deadline for U.S. hospitals to adopt new Joint Commission safety standards for the improvement of maternal and perinatal care. The original deadline of July 1, 2020 was delayed due to the healthcare crisis that has been created by the Covid-19 pandemic. Failure to enact measures that comply with these new standards at the Joint Commission-accredited facilities where “4 out of 5 babies nationally are delivered” (Stein, 2019) could put their reimbursement, reputation, and patient care seriously at risk. What is the background behind these new requirements and why did it take so long to understand the need for them?

    Serious Problems Exist in Maternal Healthcare

    Many Americans were shocked when it became public knowledge that our maternal mortality rate was unacceptably high, surpassing by a significant margin that of all other highly developed countries. For nearly 30 years, the maternal mortality rate in the U.S has risen, even as it was stable or falling elsewhere among developed countries. We are now 55th among industrialized countries in the world. Until recently, the decentralized nature of our healthcare system made it hard to know just how poor outcomes were for new mothers and their infants.

    Healthcare organizations had largely blamed issues in maternal health on “problems beyond their control. Almost universally they’ve pointed to poverty and pre-existing medical conditions as the driving factors in making America the most dangerous place in the developed world to give birth” (Young et al, 2019). That excuse has kept us from really looking at the performance of doctors and nurses in maternity units, with disastrous results. We now have a better idea due to the work of reporters and researchers at USA Today, whose investigative series, “Deadly Deliveries,” looked in depth at the statistics and the reasons why many U.S. healthcare organizations are doing such an unacceptable job caring for mothers at the time of delivery. Even more importantly, when maternal health measures in the Standards were implemented in California in 2009, the statewide death rate per 100,00 births fell by more than half by 2015 (USA Today, n.d.).

    One terrible detail about maternal care complications and fatalities is that “thousands of women suffer life-altering injuries or die during childbirth because hospitals and medical workers skip safety practices known to head off disaster” (Young, 2019). Best practices to protect maternal patients are well-known—many of them are not complicated and require little in the way of complex technology. Because life-protecting measures are overlooked, “Women are left to bleed until their organs shut down. Their high blood pressure goes untreated until they suffer strokes. They die of preventable blood clots and untreated infections. Survivors can be left paralyzed or unable to have more children” (Young, 2019).

    Dismal Statistics about Maternal Healthcare

    The statistics about maternal health are heart-breaking:

    • 700 women die every year in childbirth.
    • 50,000 women are injured every year during childbirth.
    • 50% of deaths and severe maternal injuries could be prevented or reduced with better medical care.
    • A typical hospital has a childbirth complication rate of 1.5%.
    • For some hospitals, the rate of childbirth complications is at least twice the national norm, regardless of race and unrelated to whether a patient has insurance.
    • Overall, black mothers are three times as likely to die in childbirth as white mothers.

    In addition, the article includes:

    • What are some of the specific maternal health problems?
    • Why is Joint Commission accreditation important?
    • How the maternal safety standards were compiled

    Download this article, “New Joint Commission Guidelines Target Poor Maternal Mortality Outcomes,” to learn about the new Joint Commission safety standards for the improvement of maternal and perinatal care, and why it has taken so long for the US to understand the need for them.

    HealthStream Focuses on Clinical Development

    At HealthStream we spend a lot of time focused on developing the clinical workforce. HealthStream’s jane™ is The World’s First Digital Mentor for Nurses. Jane harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, Jane was designed to power lifelong, professional growth of clinical professionals. JaneTM is an important component of HealthStream’s suite of clinical development solutions.

  • The Benefits of a Clinical Ladder Nursing Program

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 22, 2020

    According to a 2019 Modern Healthcare article that looked at how training and workforce development is changing across healthcare, especially in hospitals, “Day-to-day operations can put coaching and development on the back burner. But lower unemployment rates, market competition, nursing and physician shortages, tighter profit margins, and stagnant wages have reprioritized these recruitment strategies from routine HR work to a strategic initiative.”

    The same article mentions Woman’s Hospital in Baton Rouge, LA, which “has responded by developing job-specific competency-based assessments and individualized training and development plans for all team members. As more employees seek promotion opportunities than what is available, it has expanded the definition through lateral moves or additional responsibilities.” The embodiment of this new approach to career development is a clinical ladder program focused on keeping nurses in their bedside patient treatment positions even as they work to receive higher salaries related to “teaching, research and leading or joining a committee, task force or project work.”

    Developing Nursing Careers Beyond Novice & Advanced Beginner

    The Association of Clinical Research Professionals (ACRP) adds to the understanding of Career Ladder Programs, sharing that they “are commonly designed as professional development tools to reward nurses for education and certification, research, clinical skills, and leadership. The idea behind clinical ladder programs stems from Patricia Benner’s “novice to expert” theory, which centers around the competence of the nurse through stages: novice, advanced beginner nurse, competent, proficient, and expert.” Not only are these programs a means of advancement; they are also a way to encourage retention, increase competency, and improve care quality, and have a positive impact of work satisfaction. ACRP adds, “Progression up the clinical career ladder is typically conditional upon the nurse meeting defined criteria of clinical excellence, skills and competence, professional expertise, and educational attainment.”

    Benefits to Nurses of a Clinical Ladder Nursing Program

    For nurses themselves, career ladders provide multiple potential benefits.

     

    Career Advancement

    According to ACRP, this kind of program “creates the opportunity to advance the nurse’s skills and career, while simultaneously allowing the nurse to stay at the bedside.”

    New Research-oriented Career Directions

    Some nurses may decide they want to change career directions toward clinical research management. Accordingly, “The skills acquired as part of the ladder program can be utilized in leadership positions involving project management, team building, supervisor roles, process improvement, and unit outcomes.” Other nurses may want a greater degree of “ownership in improving the quality of patient care.” This may connect to incorporating evidence-based practice or even becoming “research nurses publishing and contributing to the evidence in clinical research.&rdquo

    Increased Nursing Salaries

    ACRP offers that “As clinical research nurses continue to advance up the ladder, this can contribute to more recognition, and with that comes monetary compensation. Clinical research nurse achievement through clinical ladder programs can be further evaluated annually and compensated accordingly.”

     

    Organizational Benefits of a Clinical Ladder Nursing Program

    Healthcare organizations also can benefit from establishing clinical ladder programs for their nurses. In essence, a career ladder often promotes employee engagement, which translates into improvement in terms of “staff retention, productivity, and job satisfaction.” These positive impacts develop for multiple reasons. For example, “When nurses participate, it allows the healthcare system to recognize clinical nurses, highlighting their advancement and accomplishments. When clinical research nurses contribute to the quality of the [research] center, it in turn becomes a reflection of the organization and enhances research participants’ experiences.” ACRP adds that “Research nurses who are active in a clinical ladder program contribute to the different complex systems of the center by actively engaging in quality improvement, participant satisfaction and safety, and staff engagement. Being a part of the clinical ladder program elevates research nurses to increased levels of involvement in all of these areas and, in turn, helps engage peers and increases professionalism within the unit.”

    Whether it’s to have a role in problem-solving or transforming policies and procedures, an engaged nurse participating in a clinical ladder program is more likely to connect his or her personal goals and anticipated outcomes with those of the organization. It’s also highly likely that career ladders can lead to improved patient outcomes and higher quality care. In closing, “Having professional development programs like those involving clinical ladders in place encourages employee growth while showing organizational investment in nurses’ careers.”

    Healthcare Workforce Management

    Making decisions that impact your patient population relies on understanding and engaging your workforce. Many organizations struggle with ongoing access to their professionals’ career activities and credentials. This information is key to making meaningful decisions related to staffing, development, Magnet®, clinical journey initiatives, and succession management.

    As our flagship nursing workforce development solution, HealthStream’s jane™ is The World’s First Digital Mentor for Nurses. Jane harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, Jane was designed to power lifelong, professional growth of clinical professionals. JaneTM is an important component of HealthStream’s suite of clinical development solutions.

  • The Joint Commission’s New Standards for Perinatal Safety: HealthStream Surveys Organizations About Their Readiness

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 21, 2020
    The U.S. currently ranked 55th among industrialized nations in terms of maternal mortality. To improve this poor ranking and decrease the frequency of maternal death and morbidity, the Joint Commission has introduced two new Perinatal Safety standards.

    HealthStream surveyed healthcare professionals about their organizations’ state of readiness to comply with these new Joint Commission standards.
  • New Joint Commission Guidelines Target Poor Maternal Mortality Outcomes

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 21, 2020
    In 2021, U.S. hospitals will be required to adopt new Joint Commission safety standards for
    the improvement of maternal and perinatal care.

    Download this article to learn about the background behind these new safety standards and why it take so long for the US to understand the need for them.
  • The Validity of the Jane Competency System AI Critical Thinking Assessments

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 21, 2020
    It has long been thought that a nurse's critical thinking/judgment skills could only be developed through years of on-the-job training and experience. However, we are finding that artificial intelligence (AI) can play a major role in providing efficient, comprehensive tools for enhancing critical judgment.

    This study assesses the validity of the Jane™ competency system AI critical thinking assessments as an evaluative tool in scoring responses of RNs in situations where critical judgment is required.
  • Six Ways Healthcare Analytics Can Improve Patient Care

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 21, 2020

    According to Wikipedia, Healthcare analytics involves “data collected from four areas within healthcare; claims and cost data, pharmaceutical and research and development (R&D) data, clinical data (collected from electronic medical records (EHRs)), and patient behavior and sentiment data.” This area of healthcare is growing rapidly in the United and focuses on clinical analysis, financial analysis, supply chain analysis, as well as marketing, fraud and HR analysis. In essence, healthcare analytics looks for patterns in healthcare data that can inform ways for care and outcomes to be improved at the same time that excessive healthcare costs can be controlled.

    How Healthcare Analytics Can Improve Care Outcomes

    Healthcare analytics has the potential to improve healthcare in ways we are only beginning to realize. Here are some of them that are already becoming reality:

    Streamlining Operations

    CIO Magazine describes how “Kaiser Permanente is reducing patient waiting times and the amount of time hospital leaders spend manually preparing data for operational activities using a combination of analytics, machine learning, and AI. The healthcare consortium's Operations Watch List (OWL), developed as part of its "Insight Driven" program, is a mobile app that provides a comprehensive, near real-time view of key hospital quality, safety, and throughput metrics, including hospital census, bed demand and availability, and patient discharges.” This app uses data from the organization’s electronic medical record to power leadership decision-making. Some of the benefits already identified are reduced admission wait times, speedier emergency department responses, and far less time spent manually preparing data.

    Using Predictive Analytics to Reduce Hospitalizations

    The same CIO article offers that the Emergency Department at Chicago’s Northshore University HealthSystem is using data and analytics to assess patients suffering chest pain, to help determine who needs to be admitted for observation and who can be sent home safely. Some of the benefits of this approach are shorter wait times, more free beds for those who really need them, lower costs, and more efficient use of staff time. According to CIO, “NorthShore CIO Steve Smith says it has reduced the Chest Pain Observation Days rate by 10 percent without increasing the rate of ED returns, mortality, or morbidity.”

    Improving Care While Reducing Costs

    Miami’s Jackson HealthSystem (JHS) is using a data integration engine to focus on improving care and controlling costs. CIO shares how the organization identified “’high utilizers’ of JHS's emergency department (ED). High utilizers are patients, typically underfunded, who use the ED for primary care, often because they aren't aware of other options.” The system alerts providers when ED high utilizers enter one of the JHS Eds and “provide information about the patient, what service line they're in, where they're currently located, and what's currently being done with them. Case managers can then meet with them and help them get into a more appropriate service line.”

    Limiting Intensive Care Stays

    Philadelphia’s Penn Medicine was already focused on getting ICU patients off ventilators before the COVID-19 pandemic made it a priority. The CIO article cited earlier describes the organization’s data driven dashboard designed “to alert respiratory and nursing staff when interventions were needed and when patients might be ready to be weaned from ventilators.” The article offers that the “application has helped Penn Medicine reduce the time patients spend on a mechanical ventilator by more than 24 hours.”

    Improving Collaborative Data Exchanges

    An article from Fierce Healthcare tells us that the COVID-19 pandemic has inspired “typically competitive markets [to] come together to mobilize and exchange data quickly.” In a specific example, “Rush Medical and neighboring Chicago acute care centers are collaborating to share bed capacity data. This partnership has added reaction time for both case and emergency management to mitigate ambulance diversions and inform on-the-ground staff of abnormal fluctuation in patient flows.”

    Enhancing Cross-functional Cooperation

    Fierce Healthcare also relates that “A few organizations have begun to oversee collaboration among emergency management and patient safety teams to open their doors safely and efficiently to non-COVID-19 patients. These partnerships have created innovative strategies like using emerging technologies units to repurpose video camera analysis (which is often utilized for retail analytics) to now ensure physical distancing is enforced and at-risk populations remain safe on large campuses.”

    Using Healthcare Analytics to Power Workforce Development

    HealthStream’s vision is to improve patient outcomes through the development of healthcare organizations' greatest asset: their people. That’s why we are working to make it possible for healthcare organizations to make organizational decisions that are informed by healthcare workforce data analytics. Human Resources maintains huge amounts of people data, and this data is critical to business operations. Some healthcare organizations are utilizing predictive analysis to increase their overall ability to predict attrition risks, to select high performance job applicants, analyze engagement, understand employee productivity and performance, determine leadership training needs and potential, and manage staffing needs based on leave of absence trends.

    HealthStream commitment to analytics-driven workforce development in healthcare is embodied by our flagship nursing workforce development solution, jane™, the World’s First Digital Mentor for Nurses. JaneTM harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, JaneTM was designed to power lifelong, professional growth of clinical professionals. JaneTM is an important component of HealthStream’s suite of clinical development solutions.

  • How To Improve Transitional Care Communication

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 20, 2020

    Transitional care plays an important role for anyone ending a hospital stay and headed for further recovery in the home or other care facility. According to an article in the American Journal of Nursing, this area of care “encompasses a broad range of services and environments designed to promote the safe and timely passage of patients between levels of health care and across care settings. High-quality transitional care is especially important for older adults with multiple chronic conditions and complex therapeutic regimens, as well as for their family caregivers” (Naylor & Keating, 2009).

    The Agency for Healthcare Research and Quality (AHRQ) shares that care transitions “increase the risk of adverse events due to the potential for miscommunication” as responsibility for care continuity is given to new parties. One reason is that every hospital discharge is a complex process representing a time of significant inherent vulnerability for patients. Safe and effective transfer of responsibility for a patient’s medical care relies on effective provider communication with patient comprehension of discharge instructions.

    Communication Best Practices for Care Transitions

    The National Transitions of Care Coalition identifies seven opportunities to use communication as a tool for improved transitional care. Here they are with some of their component activities that make up a better transitional care model:

    1. Provide Medication Management

      Ensure safe use of medications through education of the patient, family and caregivers.  Some ways to do this involve:

      • Teach back methods to establish understanding of medication plan
      • Explain what medications to take, emphasizing any changes in the regimen
      • Review each medication’s purpose, how to take each medication correctly, and important side effects to watch out for
      • A medications management plan that includes how to get them, confirmation that all parties understand, and an integrated approach between physicians and pharmacist
    2. Conduct Transition Planning

      Facilitate the move from one level care to another, guided by an experienced transition practitioner who is part of the healthcare team. Components include:

      • Assessment of home environment and patient care needs after discharge
      • Education about self-care management and expectations tailored to patient and family literacy level
      • Standardized discharge/transition documents to patient and new care setting, as applicable
    3. Provide Patient and Family Education

      Education and counseling of patients and families works to enhance their active participation in their own care including informed decision making. Features include:

      • Understanding what worsening condition looks like, especially ‘red flags’ and what to do about it
      • Tailored education to health literacy
      • Ensure understanding by having recipients explain it back to you
    4. Oversee Information Transfer

      Share important care information among patient, family, caregiver and healthcare providers in a timely and effective manner. Recommendations include:

      • Timely transfer of critical patient information, preferably within 24 hours.
      • Use of specifically designed tools, like a Transfer Tool, Transition Record, or Transition Summary
      • Care coordinators to facilitate provider-patient communication
    5. Ensure Follow-Up Care

      Ensure that Patients and families get timely access to key healthcare providers after an episode of care as required by the patient’s condition and needs. Strategies include:

      • Confirmation of any primary care or specialist appointments
      • Schedule any necessary follow-up testing before discharge
      • Access to a 24-7 help line
      • Expedited access to post-acute care
      • RN follow up call immediately post-discharge to monitor patient condition
      • Frequent contact helps detect subtle changes in patients’ conditions and quick reactions
      • to changing medical, functional, and psycho-social problems
    6. Facilitate Healthcare Provider Engagement

      The appropriate provider should demonstrate ownership, responsibility, and accountability for the care of the patient and family/caregiver at all times. Activities include:

      • Identify personal physician for ongoing relationship
      • Care plans that align with accepted evidence-based guidelines
      • Coaching patient on self-care
      • Written instructions given to patient and family
      • Facilitate communication among providers about patient status and progress
      • Coordinated approach to patient care
    7. Demonstrate Shared Accountability across Providers and Organizations

    It is possible to enhance the transition of care process through securing accountability for care of the patient by both the healthcare provider (or organization) transitioning and the one receiving the patient. This involves:

    • Clearly communicating the patient’s plan of care, and being available for any questions afterwards
    • Ensuring continuity of provider responsibility for patient care at all times
    • Requiring an acknowledgement that plan of care has been received and understood

    Improving transitional care is one of the ways healthcare organizations can work to avoid unnecessary readmissions, which drive up the cost of healthcare. Organizations across the care continuum are paying lots of attention to improving care transitions, especially now that higher acuity patients in recovery and rehabilitation are commonly being found outside of hospitals. Learn about HealthStream’s solutions for workforce development across the continuum of care.

  • Effective Recognition Programs Have Unlimited Impact on Healthcare Employees

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 17, 2020

    This blog post excerpts the HealthStream article, Effective Recognition: The Right Way to Influence Behavior, by Craig Spilker, Head of Product + Engagement, AMPT, and Brad Weeks, Director, Performance Assessment  and Development, HealthStream.

    With monetary rewards, managers can be limited in how and when they can acknowledge positive behavior. This may not only deter recognition from happening, but also may strain relationships between team members and managers. Instead of a limited pool of resources defining how and when a manager acknowledges employee performance, employee performance determines the how and when of recognition.

    Effective Recognition Programs Have More Impact than a Rewards-Based Program.

    In the highly regulated environment of healthcare, reimbursement and pay structure can change at any time, impacting any budget not tied directly to patient care. When healthcare leaders are thinking about how to motivate employees, they should consider lower cost alternatives that can be sustainable and not impacted by budget cuts. Taking an employee reward system away from a workforce due to lack of funds will have a more detrimental impact on the employee experience than not implementing one at all.

    Rewards and tangible motivators do not need to be eliminated entirely, they just should not be the foundation of how and why we motivate our employees to deliver high-quality patient care or other job responsibilities that allow the organization to live their purpose. Encouraging positive workforce behaviors through frequent, authentic and public recognition should be at the forefront with rewards being reserved for larger accomplishments such as years of service and/ or to encourage activities that change processes vs. behaviors that change engagement and performance.

    About AMPT

    AMPT is an employee engagement platform powered by social recognition and communication amongst the workforce. Employers connect with AMPT to strengthen the company’s core values by assessing their strengths and providing personal and meaningful affirmation. Through this process, employees are aligned with the foundation for company culture and help foster the way success is defined and measured. AMPT empowers organizations to take effective recognition to the next level by making it easy for employees to provide meaningful feedback to each other and quickly cascades recognition across the workforce to connect and influence the behavior of all employees.

    This article also includes:

    • “Reward” and “Recognition” Are Not Synonyms
    • 83% of Employees Prefer Authentic Recognition over Rewards
    • Recognition Vs. Rewards: Why Effective Recognition Wins
    • Effective Recognition Strengthens Relationships between Employees, Teams,And Managers

    Compensation & Rewards Exclusively for Healthcare

    HealthStream Compensation & Rewards Solutions optimize your workforce’s compensation by automating inefficient error-prone processes and promoting a pay-for-performance culture to help retain staff. Interoperable with HRIS, performance, and financial systems, HealthStream Compensation brings your organization a secure, auditable healthcare compensation workflow that results in more accurate compensation decisions, and better allocation of merit and bonus dollars.

  • Top 5 Leadership Strategies to Implement Change in Healthcare

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 16, 2020

    A recent article in the Harvard Business Review discusses healthcare change management and how organizations and the entire system is challenged by the impact of COVID-19. There is some suggestion that “Many aspects of how U.S. health care has historically operated, including some elements of the fee-for-service business model, were the very things that left us vulnerable to the crippling impact of Covid-19 on our systems of care.” The same article insists that there is no going back to business as usual. Furthermore, “Building this new reality requires accelerating the positive transformations we have already made, undertaking some fundamentally new ones, and determining which of the activities we have stopped that we should not resume.”

    Leadership Strategies for Effecting Healthcare Change

    From their conversations with 20 CEOs at a variety of healthcare organizations across the U.S., Becker’s Hospital Review has come up with the following five strategies for how to implement change in healthcare:

    1. Integrating a healthcare organization in both a horizontal and vertical direction

      The leadership of an organization truly has to work together as a unified team with shared goals and operating principles. As changes cascade vertically, they can occur as part of a systemic overhaul, affecting everyone in the organization equally. No one needs to feel left out or exempt.

    2. The CEO as change agent

      Acting as more than a capable administrator, this leader has to embody the transformation. He or she must be a change agent who “can win the ‘hearts and minds’ of employees, physicians, the community and a diverse array of stakeholders.” In addition, “The CEO and his or her team must think broadly, entertain unfamiliar and often uncomfortable frameworks, operate well in ambiguity, set a high bar for performance and demonstrate the core values that underlie action.” Here’s a HealthStream blog about effective healthcare leadership styles.

    3. Focusing on Culture as a Strategic Initiative

      Healthcare organizations that are looking to transform themselves must make culture a priority. According to Becker’s Hospital Review, “An increasing number of hospital CEOs are hiring outside expertise to guide them through a multi-year process of culture change, starting with aligning the C-suite around goals, values, process and commitment.” Leadership-directed transformation strategies in healthcare often focus on culture.

    4. Altering the Executive Team to Reflect Desired Change

      Patient-centric care may call for a different mix of leadership strategies in healthcare across positions and skills, as well as for new executives who are adept at the analytical and interpersonal sides of managing caregivers. As Becker’s Hospital Review puts it, “Analytically, they must understand the dramatic shifts taking place in the industry and grasp the many implications for business and operations. Relationally, they must forge partnerships, establish trust and implement change within the organization and with strategic partners.” Listen to a HealthStream recorded webinar about transformative leadership.

    5. Decide What Is Most Important for the Organization and Focus There

      Even as they approach transformation efforts, healthcare organizations are nevertheless tasked with the complexity of continuing to provide care. There’s always the risk that caregivers and leaders at all levels may burnout due to the intensity, the diversions, and the stress involved. It may be a good idea to them to seriously consider what regular efforts and processes can be stopped. Becker’s Hospital Review suggests that care organizations “sharpen the focus on what is important” and “reinforce strategic priorities, culture, metrics and focus on the patient.”

    References:

    Becker’s Hospital Review, “Reinventing Healthcare: 5 Strategies for Successfully Leading Change,” N.D., Retrieved at https://www.beckershospitalreview.com/hospital-management-administration/reinventing-healthcare-5-strategies-for-successfully-leading-change.html.
    Slotkin, J., Murphy, K., and Ryu, J., “How One Health System Is Transforming in Response to Covid-19,” Harvard Business Review: June 11, 2020, Retrieved at https://hbr.org/2020/06/how-one-health-system-is-transforming-in-response-to-covid-19

    Healthcare Workforce Leadership Development

    Of all your responsibilities, creating an environment for leaders to thrive is possibly the most important. Identifying emerging leaders, cultivating existing leaders, and planning for the future all represent a significant investment of time and resources. HealthStream Leadership Development Solutions empower HR professionals to help high-potential employees grow into high-performance leaders with powerful assessment, learning, and tracking tools.
  • What Skills Are Best for Healthcare Case Management?

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 15, 2020

    According to the Case Management Society of America, “Case Management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost effective outcomes.” Nurse Journal adds to that description, offering that a professional in this position “oversees the monitoring of long-term care plans for patients of different backgrounds. These nurses typically work with a specific type of patient who requires constant, ongoing medical care. Patients can include geriatrics, cancer patients, and individuals with HIV. Case management nurses work with other medical professionals to cultivate effective long-term care plans to ensure patients receive the highest quality of healthcare available.”

    What Case Managers Do

    Case managers oversee everything that happens to patients from the moment of admission, throughout treatment, and up to discharge from a hospital or another healthcare facility. These professionals provide guidance for the long-term care of patients, which includes decision-making about any important treatment options.

    Nurse case managers cooperate and collaborate with varied teams of medical professionals to facilitate comprehensive care plans that are tailored to individual patients' histories of medical treatment and illness. According to Nurse Journal, “These professionals research the most modern procedures and treatments for their nursing specialty, overseeing treatment plans and updating them whenever necessary. Nurse case managers schedule surgeries and arrange doctor's appointments for patients and monitor their medication usage. Additionally, these nurses educate patients and their caregivers about the different resources and treatment options available to them.”

    About Certified Case Managers

    According to study.com, many certified case managers generally hold a bachelor's degree in nursing, psychology, counseling, or other relevant areas. Some can have a master's degree in health, human or education services or a related field, while others may complement an associate's degree in health or human services with a registered nurse license. It is common for case managers to intern in their field before working full-time or pursuing certification. Typically, certified case managers should have foundational knowledge of social work principles and procedures to do their jobs.

    Important Case Management Skills

    HealthStream partner HCPro has identified the following skills that are needed to be an effective case manager. Many of these are critical to successful case management:

    • Clinical Experience and Knowledge – A clinical background and experience are vital to understand the care a treatment a patient needs and is receiving.
    • Communication – Case managers must communicate effectively with their patients and every healthcare professional involved in care.
    • Time management – Time is of the essence when it comes to healthcare, and case managers have many competing responsibilities. Getting everything done is vital when a patient’s life is at stake.
    • Decision-making and problem-solving – Case managers have to be decisive as well as resourceful about finding ways to eliminate roadblocks to care.
    • Organizational – Too many details are involved in patients’ healthcare for the person in charge to be disorganized.
    • Autonomy – A case manager has to be comfortable with working alone and making choices without a backup. Time and urgency especially may not allow consultations with others.
    • Conflict resolution – Acting in the best interests of a patient can lead to conflicts with others in healthcare. Not only must case managers stand their ground, but they need to find a way to turn conflict into collaboration.
    • Teamwork – Healthcare typically involves a team of professionals. The case manager must be skilled at working with others.
    • Delegation – part of using time wisely and being effective is allowing others to take control, provide care, and take action.
    • Political savvy – Effective case managers understand how to go about their jobs without causing hard feelings and bruising colleagues’ egos. This skill is especially important for getting things done.
    • Tolerance – Case management is guided by the principle that all people deserve effective healthcare. Identity and cultural differences have no impact on this responsibility. For example, nurses who work with patients in HIV case management must be understanding of the cultural stigma of HIV and AIDS when conducting their duties, and work to quell any potential intolerance in the medical facility for the comfort of the patient.
    • Commitment – Ensuring excellent patient care has to be the guiding principle and motivation for every decision and action in case management.
    • Role modeling – A case manager should embody the seriousness of his/her mission at all times.
    • Teaching – In everything a case manager does, there’s an opportunity to teach someone why –patients, colleagues, and other care professionals need to learn what drives great care.
    • Cultural sensitivity – A patient may be culturally different from the case manager. This fact in no way changes the patient’s need for effective, often life-enhancing care.

    According to HCPro, “It is difficult to prioritize these skills, and they may all come into play at various times for effective case managers. Case managers must consider that on any given day they may need to call on many of these skills in order to effectively accomplish their job. It is the combination of these skills and the flexibility of the individual carrying them out that will make the difference.”

    Case Management Training

    With the Affordable Care Act changing reimbursement models, case managers must ensure quality care for their patients, provide effective communication to their patients and patients’ families, and coordinate physician documentation within medical records.  They also have to understand and provide guidance on correct patient status, assist with medical necessity denial management, reduce readmissions, and overcome discharge barriers.

    Decisions made and actions carried out by case managers affect the quality of patient care and organizations’ reimbursement, therefore implementing a training program is imperative to the success of your organization. Our solution was developed by experts to provide essential case management training that addresses key care coordination issues and mitigate financial and compliance risk.

  • What a New Nurse Can Expect in the First Month on the Job

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 10, 2020

    The challenges of nursing school have ended, graduation is in the rear-view mirror, and a new job beckons. New graduate nurses find this to be one of the most exciting times of their careers, and their more seasoned counterparts have fond memories of those early days on the job as well. They also have some memories that aren’t so rosy, so it’s wise to know what to expect when first stepping out as a new nurse.

    Let’s look at a new nurse’s journey for the first month, and see where the opportunities and potential missteps might be:

    Week 1: Onboarding

    In almost every case, however, the first week will be one of paperwork and policies. A new nurse is eager to get to that bedside but will be wise to listen carefully and read what they’re signing. Company policies are important, and so is understanding what they mean, and how they can support every employees’ growth.

    Week Two: Diving into the Details

    Most healthcare providers now have some kind of onboarding program for new nurses. That may be a full-blown residency program, or something smaller that still provides good orientation and allows the new nurse to get acclimated. Many new nurses know this coming in — it may have been the deciding factor in their decision to join this provider — and this is what they’ve been waiting for. Just as in the first week, it’s essential to slow down and read the fine print. Paying attention up front means retaining information that will be essential down the road. Here’s a previous blog post about nurse orientation.

    Week 3: Working Alongside a Mentor

    By this point, most new nurses will have met their fellow hires, as well as begun to have interaction with their mentors, or preceptors. Those individuals are highly skilled at training and development and are eager to see new nurses get off to a great start. That means pushing and nudging to overcome doubts, as well as pulling on the reins to discourage moving too fast. It’s a new relationship, and the transition can involve necessary mistakes and changes in direction. This effort and process requires time and attention from both parties, just like any other.

    Week 4: Setting Goals, Giving Feedback

    As the new nurse closes in on 30 days, their individual path will begin to take shape. Some may have discovered they wish to move in a different direction of care than they originally thought. Others may already be eyeing continuing education opportunities, as well as a management track. It’s never too early to set goals and then map out a plan to be in service to them. Establishing benchmarks and the strategies to achieve and surpass them will be one of the most satisfying interactions a new nurse and their mentors will have over the coming months and years.

    The important thing to remember, for new nurses and their colleagues alike, is that these are people who are only weeks removed from being full-time students. They are still in learning mode, and properly channeled that can be a huge help in a smooth onboarding experience. Providing a growing number of opportunities for questions and professional exploration early on will benefit the new nurse in terms of confidence and skills growth. In the case of Millennials, these are tech-savvy people who are adept at multitasking and are attuned to immediate and frequent recognition of work well done. They also want a transparent workplace, and value an open give-and-take environment.

    For the employer, adapting to those needs, especially those around recognition and collaboration expected by very junior staffers, has challenges. Doing so, however, and laying out a visible career path for these very motivated new nurses will result in job satisfaction, better patient care and, very importantly, lower turnover.

    At HealthStream we spend a lot of time focused on developing and retaining the nursing workforce. HealthStream’s jane™ is The World’s First Digital Mentor for Nurses. Jane harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, Jane was designed to power lifelong, professional growth of clinical professionals. JaneTM is an important component of HealthStream’s suite of clinical development solutions.

  • The Care Continuum Is Bracing for Widespread Change Due to Demographics and Financial Pressure

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 09, 2020

    As America ages at an increased pace, the impact will be felt across the care continuum. Senior living will be especially affected as it works to adopt a medical model that also blends aspects of the hospitality and healthcare industries. Concurrently, older adults’ expectations about their accommodations continue to rise, even as their medical needs increase. Residential care environments will soon need to be able to track medication management electronically. When you take into account that the typical person over age 65 averages six maintenance medications daily, it’s not hard to predict that more care will also be required. With 10,000 people reaching age 65 every day, it is projected that we will need more than 3 million additional senior housing units by 2040. Where separate levels of residential and supportive care have been the rule, the care continuum will blur into one where all services can be provided, culminating in an environment that is patient-centric rather than care setting-specific (PointClickCare.com, 2015). At the same time, one area of the continuum is on the threshold of serious turmoil. For the home health sector, the Payment-Driven Groupings Model (PDGM) took effect January 1, 2020. This massive CMS reimbursement overhaul is another patient- and reimbursement-focused wave of change, where therapy will now be tied to patient characteristics, rather than being reliant on a predetermined number of visits. Predictions about the impact include cash flow issues for some home health care providers, more than 30% of whom are expected to close. Consolidations among agencies may take place rapidly, and some experts fear the development of home health care deserts, which CMS plans to monitor closely. As part of this transformation, telehealth is expected to begin to play a sizeable role, for remote monitoring of conditions and data collection linked to reducing readmissions. Nearly 30% of home health care agencies have said they plan to launch telehealth services by 2021. A final worry for home health and boon for compliance professionals is the official CMS commitment to hunt more aggressively for fraud (Holly, 2020).

    References

    Holly, R., “The Top Home Health Trends of 2020,” Home Health Care News, January 6, 2020, Retrieved at https://homehealthcarenews.com/2020/01/ the-top-home-health-trends-of-2020%EF%BB%BF/Hol.

     

    PointClickCare.com, “2020 Vision: The Future of Senior Living,” 2016, Retrieved at https://blog.pointclickcare.com/2020-vision-future-senior-living/.

    This blog post is an excerpt from the longer HealthStream article, Trends That Will Shape the Next Decade in Healthcare. Focused on the people providing healthcare, HealthStream is committed to helping customers address and solve big problems in our industry. From hospitals to long-term care and across the care continuum, there are challenges stemming from demographic changes, governmental mandates, and the need for higher care quality. Download the webinar, Ten Healthcare Trends for 2020, where Robin Rose, Vice President, Healthcare Resources Group, HealthStream discusses this information in detail. HealthStream is dedicated to improving patient outcomes through the development of healthcare organizations' greatest asset: their people. Learn more about our healthcare workforce development solutions.

  • Exploring the Pros and Cons of Nurse Residency Programs

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 08, 2020

    Many new nurses are taking part in nurse residency programs, and no wonder. They are a great way to bridge the gap between school and full-time nursing career. So do an increasing number of healthcare providers who are creating programs with an eye toward not just a smooth onboarding, but also higher job satisfaction and retention. This blog post focuses on nurse residency program pros and cons.

    First, realize that the idea of nurse residency isn’t new. These programs are the latest iteration of what went before in terms of internships, externships, preceptorships, new-hire classes, and other mechanisms to transition student nurses more easily to the challenges of practice. And like their predecessors, not all programs are the same. They may have different lengths of engagement —anywhere from six weeks to a year — alongside various methods to test of skill sets, a certain type of cohort and mentor structure and other differentiators. What they do all have in common is three chief goals:

    Improve critical competencies: New nurses are getting used to hands-on patient care, and also navigating facility policies and procedures. A residency program provides learning opportunities to help them enhance evidence-based decision making so that they grow a variety of critical skills simultaneously.

    Reduce turnover: Hiring and onboarding nurses is expensive and can lead to gaps in patient care and other negative business outcomes. The first-year turnover range for new nurses ranges anywhere from 17 percent to 25 percent, and most say that their departure was stress related.  A residency program has the safety valves to help lower that anxiety, as well as provide opportunities for in-the-moment teaching and mentoring that will improve outcomes and job satisfaction.

    Better patient care: New nurses are eager to be at the bedside. They’re also new nurses, and so are nervous. A residency program, with its focus on mentoring and cohort learning, provides the opportunity for safe, effective care to be modeled and adopted. Measurable goals alongside attention to quality metrics and improvement methods means better-supported new nurses as well as happier patients and the corresponding outcomes.

    As an example, look at the work being done at CHRISTUS Southeast Texas – St. Elizabeth. Their Nurse Residency Pathway, on which they partnered with HealthStream, utilized online learning courses to enhance learning in a flexible manner for residents as well as stretch  a limited education budget. That, paired alongside with an effort to increase new nurse's confidence in their ability to provide quality patient care, paid strong dividends for the facility. Here is some input from the first cohort:

    • “The Nurse Residency Pathway is strong in supporting new nurses and making us feel important and valued. I also feel we formed relationships that will make us more confident and more apt to seek help if needed.”
    • “It built my confidence up to be on the floor and helped me realize I have a support system and that I am not alone.”
    • “It has helped me to transition into my professional role as a nurse.”

    Another major befit for residents and management alike is a program’s focus on hands-on, face-to-face learning. That, in tandem with online coursework, has meant a reduction in manuals and worksheets that can be misplaced, damaged or lost.

    Drawbacks Can Include Time Commitment, Scarcity

    This is not to say that a nurse residency program is for everyone. Many if not most require participants to enter into a contractual arrangement with the employer. That makes it hard to quit if the fit’s not right. The pay can sometimes be lower than what a new nurse might otherwise obtain, because the program is seen as a valuable benefit and thus a part of compensation. (The flip side of that is that after completing the program, there can be a significant bump in both pay grade and title.) Programs also have size caps, and so competition to get into one can be stressful.

    There’s also a lot of evolution within the residency-program ranks in terms of coursework and content, meaning participants will likely be facing new challenges frequently. Still, a nurse residency program must be a work in progress in order to be relevant. Changing patient-care processes, evolving technology and a host of other variables mean that a program must be nimble and ready to change quickly — just as is expected of its participants. When you look at nurse residency program pros and cons, the positives far outweigh the negatives, especially when it comes to patient outcomes.

    As Shirley Sampson DNP, MA, RN, RN-BC, NEA-BC, Coordinator of the Nurse Residency Program at Stanford Health Care, puts it in a HealthStream Q&A, “The reality of the workplace is light years apart from what new nurses experience in school. The learning gained in nursing school doesn’t always prepare these new nurses for practicing and for handling a large number of patients. Challenges include having the emotional intelligence to care for the complex patient that we face nowadays, time management, and possessing the right clinical skills, just to name a few.”

    At HealthStream we spend a lot of time focused on developing the nursing workforce. HealthStream’s jane™ is The World’s First Digital Mentor for Nurses. Jane harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, Jane was designed to power lifelong, professional growth of clinical professionals. JaneTM is an important component of HealthStream’s suite of clinical development solutions.

  • Sample Questions for Nurse Peer-Interviews

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 07, 2020

    Not all aspects of nursing, and certainly not all nurses, are the same. A diversifying field, both in terms of specialized types of care and advancement opportunities, means that nurses have more career paths and options than ever before. It also means that, when conducting nursing peer interviews, their potential future colleagues must be able to zero in on problem areas as well as those of excellence and expertise.

    Peer interview nursing questions can be the doorway into assessing many different areas: mental preparedness, emotional state and physical well-being. Because the sessions are peer-led, they can be less formal than annual performance reviews, or even a walking check-in with a supervisor. But of them to work, the questions have to be on point. Here are some areas to explore:

    Behavior-Based Questions Assess Competency

    A good nursing peer interview question set will look at performance obstacles as well as competency. This way, the review team can identify roadblocks that are stifling growth and creating barriers to patient care. Consider these peer interview questions nursing candidates can be asked:

    • What would you say the chief barrier to your getting your work done is?
    • How would you remove that issue?
    • What’s an idea you’d love to put into place if you could do it tomorrow?
    • How’s the communication between you and your team, and your supervisors?
    • What’s the one thing you love best about every day at work?

    Emotional Depth Can Be Harder to Gauge

    Exploring a nurse’s emotional range is a tougher nut to crack. By nature, caregivers are empathetic, and can wear their heart on their sleeve. Still, the process of going through peer interview nursing questions can identify strengths and weaknesses here as well:

    • When you have been particularly challenged in the workplace, how have you practiced self-care?
    • Are you able to convey your thoughts and feelings about an issue to your team, or supervisor?
    • Do you see yourself as a diplomat in tense situations, either with the team or with a patient and his or her family?
    • If you get an answer you don’t like in a conversation with a peer or supervisor, how do you feel?

    The Challenge of Assessing Physical Limits Without Setting Limitations

    Nursing is a demanding job. Hours on your feet, moving heavy equipment, lifting patients — it can create significant health conditions. The goal for the nursing peer review team is to empathize and not make it appear that someone is being assessed purely on their ability to perform a specific task or set of tasks:

    • How important do you think it is to follow best practices around patient lifting and other strenuous tasks?
    • What is a task that is increasingly challenging for you, and how could that situation be improved?
    • Do you feel you are provided the equipment and tools necessary to limit the risk of injury?
    • And if not, do you feel comfortable raising that issue?

    The nationwide nursing shortage continues. Hiring the best staff is vital to success for healthcare providers, and retention also plays a huge role. Using a series of challenging, thoughtful questions is essential at hiring, and also will play a role in successful peer interview nursing processes. Creating a dialogue provides the opportunity to not only assess competencies and strengths, it also allows the review team to learn a great deal about the person they are considering bringing onboard. And that, in turn, helps to develop a friendly and collegial environment from the very start.

    Previously, HealthStream published a series of blog posts that included an even more exhaustive list of example peer interview questions nursing candidates can be asked, broken out by subject:

    At HealthStream we spend a lot of time focused on developing the nursing workforce. HealthStream’s jane™ is The World’s First Digital Mentor for Nurses. Jane harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, Jane was designed to power lifelong, professional growth of clinical professionals. JaneTM is an important component of HealthStream’s suite of clinical development solutions.

  • Recognition Vs. Rewards: Why Effective Recognition Wins for Healthcare Employees

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 02, 2020

    This blog post excerpts the HealthStream article, Effective Recognition: The Right Way to Influence Behavior, by Craig Spilker, Head of Product + Engagement, AMPT, and Brad Weeks, Director, Performance Assessment ; and Development, HealthStream.

    Effective recognition occurs when employees receive trusted, authentic feedback from a peer, manager, and/ or leader about how their actions impacted their team’s objectives or the organization’s purpose.

    When employers use rewards to motivate, they are attaching performance to a tangible object. Effective recognition, on the other hand, has a psychological impact. It connects employee performance to intrinsic motivators, such as why they perform, and sends the message that the behaviors they exhibited are in alignment with how the employee defines success.

    As a result, effective recognition will have a longer lasting impact ; as it better connects to ongoing performance. Where a reward has a target or a milestone in place that once achieved causes an employee to start over. On the other hand, receiving a genuine moment of recognition connects to an employee’s strengths, purpose, and goals so the impact will linger and affect performance well beyond a predetermined time frame.

    Rewards, while set-up with good intentions, may even have a negative impact on employees’ performance. ; People that do not expect a reward perform better than those that do; introducing rewards can discourage and result in poorer performance from top performers as the reward crowds out these individuals’ intrinsic motivators. Using authentic recognition as a motivator will not only continue to engage top performers, but it will help managers and leaders impact the performance of the less engaged workforce by exemplifying how the employee is contributing to the organization’s goals and vision.

    Effective Recognition Strengthens Relationships Between Employees, Teams, and Managers

    Unlike reward systems that can be manipulated or create a competitive environment among team members, acknowledgment of employee performance by a peer or manager creates an environment of camaraderie. Employees share positive accolades because they know it impacts their co-worker’s performance and therefore the organization, not because they want to help the co-worker obtain points. In healthcare where teamwork is directly tied to quality, motivating employees to work towards collective rather than individual gain is important to the organization and the patients served.

    When done correctly, authentic recognition between teammates will also lead to stronger relationships between employees and managers, as it gives managers insight and the ability to coach employees on their strengths. As healthcare is making the shift from retroactively looking at errors and mistakes to proactively understanding and replicating what is working well, authentic recognition is playing a vital role in improving individual performance and creating positive environments that foster a better employee experience.

    This article also includes:

    • “Reward” and “Recognition” Are Not Synonyms
    • 83% of Employees Prefer Authentic Recognition over Rewards
    • Authentic Recognition Is Unlimited
    • Effective Recognition Programs Have More Impact than a Rewards-Based Program

    Compensation & Rewards Exclusively for Healthcare

    HealthStream Compensation & Rewards Solutions optimize your workforce’s compensation by automating inefficient error-prone processes and promoting a pay-for-performance culture to help retain staff. Interoperable with HRIS, performance, and financial systems, HealthStream Compensation brings your organization a secure, auditable healthcare compensation workflow that results in more accurate compensation decisions, and better allocation of merit and bonus dollars.

    Summary:

    When employers use rewards to motivate, they are attaching performance to a tangible object. Effective recognition, on the other hand, has a psychological impact. It sends the message to employees that the behaviors they exhibit are in alignment with how the employer defines success.
  • Automated Nurse Cross-Training Needs to Be in Place Before the Next Pandemic

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jul 01, 2020

    This blog post by Trisha Coady, Senior Vice President Clinical Solutions, HealthStream, is written in conjunction with HealthStream’s participation in the National Healthcare CNO Summit Fall 2020, which occurs September 21-22, 2020, in Chicago.

    From the onset of the COVID-19 pandemic in the United States, the demand for nurse cross-training has risen dramatically. In addition to the increased care demands where COVID-19 infections are spreading, up to 20 percent of healthcare workers are become infected, requiring their quarantine. Hospitals are likely to become overwhelmed, and organizations need to quickly identify which of their nurses can most easily be cross-trained and then determine how much training was necessary. Although Chief Nursing Officers have always considered the ongoing development of frontline staff as a critical industry endeavor, many found it a challenge to secure the necessary resources and ensure they were equipped to practice at their full potential.

    The Impact of a Public Health Emergency

    When a public health emergency occurs that disrupts nearly all aspects of the healthcare delivery system, most organizations will prioritize the needs of those who deliver care. Think about it in terms of how the risk or reward grows the closer you get to the patient. Given the low cost of deployment and potential for widespread return there is definitely an opportunity to rethink how we develop nurses. 

    The Challenge of Ensuring Frontline Staff Is Prepared for a Pandemic

    Before COVID-19 emerged as a serious problem, I had already spoken to multiple CNOs who had identified the tremendous opportunity to provide broader and more sustainable outcome improvement across various areas in healthcare. It was apparent this would require an individualized and ongoing approach to competency development, as well as a focus on critical thinking to ensure knowledge and skills were being applied more consistently into practice. It is unfortunate that under present circumstances, many are engaged in immediate initiatives whose ability to generate meaningful improvement will dissipate over time, presenting a challenge to organizations already operating with limited margins.

    With Resource Constraints How Do We Make a Cross-Training Initiative Work?

    A primary obstacle to success is determining how this could be operationalized given the degree to which time and other resources are limited commodities in healthcare. Unlike most other industries, the average span of control in healthcare is 40 for a typical nurse manager, as opposed to 10. More than any other industry, healthcare must begin leveraging innovative technologies and automation.  Any significant healthcare issue like COVID-19 faces similar challenges and requires a similar, scalable approach.  

    Looking to Artificial Intelligence (AI) as a Solution

    The genesis of any effective solution typically arises from a community of like-minded people with shared experiences and intelligence. They commonly have a more complete awareness of the problem being solved, which should always come before any technology is considered. Many leaders did not want to use blanket education or transactional learning methods that often fail to inspire learner engagement. The ideal solution also needed to create an intelligent matchmaking system between nurses and content that also appreciated the unique workflows within complex healthcare organizations. 

    Focused on Nursing Workforce Development

    HealthStream has been working for multiple years to help nursing and healthcare solve some of its workforce development and training challenges. As part of that effort we acquired two highly regarded nurse-led assessment firms that had a combined 40 years of data and experience. To complement them, our teams have developed a proprietary clinical taxonomy that triangulates student information, assessment outcomes, and development content to create individualized learning paths. For the essential critical thinking component of development, we felt strongly this could not be achieved through multiple choice and instead should replicate real-life. That is why we have leveraged artificial intelligence and natural language processing, engaging nurses in scenarios through a chat interface. 

    We’ve created a system allowing leaders and educators to quickly identify their top performers, as well as those who require additional support through individual and aggregate assessment results. Effectively, we have created an intelligent system that identifies nurses’ competency gaps and recommends personalized development plans at scale. Given the ability to approach competency development as a continuous process, this allows organizations to be in a constant state of readiness with their frontline staff. 

    COVID-19 Emphasizes the Primacy of Nursing Care

    While many still unknown things in healthcare may change as a result of COVID-19, one thing will stay the same—nurses have been and will always be at the bedside 24-7 providing care. To be in a constant state of readiness, like we are now experiencing, and ensure all nurses are equally competent, Chief Nursing Officers will need to leverage technologies that can individualize competency plans at scale. My hope is that we will see greater investment in developing next-level people with systems that appreciate the complexities of our healthcare environment.

    About the National Healthcare CNO Summit Fall 2020

    The 22nd National Healthcare CNO Summit is the premium forum bringing senior level nursing executives and solution providers together. The Summit offers an intimate environment for a focused discussion of key new drivers shaping the healthcare industry. Taking place at The Intercontinental, Chicago, Illinois, September 21-22, the Summit includes presentations on examining COVID-19 response, strengthening the workforce in a nursing shortage era, new technologies that impact healthcare, and understanding what quality healthcare means.

    As our flagship nursing workforce development solution, HealthStream’s jane™ is The World’s First Digital Mentor for Nurses. JaneTM harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, JaneTM was designed to power lifelong, professional growth of clinical professionals. JaneTM is an important component of HealthStream’s suite of clinical development solutions.

  • COVID-19 Symptoms and Testing – What Healthcare Professionals Need to Know

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 30, 2020

    by Joanne Tate, BSN, RN, Accreditation and OSHA Standards Courseware Author, HealthStream

    Many months have passed since that first confirmed case of COVID-19 was identified in the United States on January 22, 2020. With time, we rapidly learned a lot about the disease, including how SARS-CoV-2 is transmitted, how to protect ourselves and others, and common signs and symptoms of the disease. We are still learning, and information may change over the course of time as we learn more. This blog will review common symptoms and update you on testing options to help you determine who should be tested.

    COVID-19 Symptoms

    Symptoms can range from mild to severe. People with heart and lung disease, diabetes, and other chronic conditions are at greater risk of developing severe complications of COVID-19.

    Symptoms may appear within 2 to 14 days after exposure to the virus. The CDC states that clinicians should use their judgment to determine if a patient has signs or symptoms compatible with COVID-19 and whether the patient should be tested.

    People with the following symptoms may have COVID-19:

    • Fever or chills
    • Cough
    • Shortness of breath or difficulty breathing
    • Fatigue
    • Muscle or body aches
    • Headache
    • New loss of taste or smell
    • Sore throat
    • Congestion or runny nose

    Self Checker

    Serious symptoms of COVID-19 are hypoxia and ventilation failure which require immediate medical attention. Patients present with trouble breathing, cyanosis, persistent pain or pressure in the chest, new confusion, or difficulty in staying awake. In terms of patient and public education, the CDC has an app on their website to help individuals make decisions about seeking medical care and testing. You can refer individuals to this app, called the Coronavirus Self-Checker.

    Source Control

    Transmission can occur via asymptomatic or pre-symptomatic individuals and therefore, the CDC recommends that patients and visitors wear a cloth mask (preferably their own) upon entering and while in your facility. If people do not come with a mask, one can be offered as supplies allow. This is source control. Remind patients and visitors to wash their hands if they need to adjust their mask to avoid cross-contamination of surfaces or self-contamination if they touch their eyes, nose, or mouth.

    Testing

    Keep in mind that testing recommendations from the CDC are based on what is known about COVID-19 and is subject to change as more is learned.

    There are two types of tests:

    1. Viral Testing: Tests for the virus itself (i.e., nucleic acid or antigen testing) and
    2. Diagnostic Testing: Tests for antibodies to the virus

    Let’s take a closer look at each of these tests.

    1. Viral Testing 

    Viral testing is recommended by the CDC to detect acute infection. There are two types of viral tests.

    a. Nucleic Acid Amplification Tests

    The molecular Reverse Transcription-Polymerase Chain Reaction (RT-PCR) detects nucleic acids from SARS-CoV-2. As you may recall from biology, nucleic acids store and transfer genetic information and are present in DNA and RNA.

    b. Antigen Tests

    Antigen tests detect proteins on the surface of the virus.

    2. Diagnostic Testing

    Diagnostic testing is done for people with symptoms or those who are asymptomatic with known or suspected recent exposure to SARS-CoV-2.  This helps to control transmission by using quarantine or isolation measures.

    Viral testing also helps to determine if the disease is resolved and when to discontinue transmission-based precautions in health care settings, when to stop isolation outside of health care, and when healthcare workers can return to work after being infected. Viral tests that have received Emergency Use Authorization ( EUA) can be found on the U.S. Food and Drug Administration (FDA) website. (U.S. Food & Drug Administration, 2020)

    Testing should also be done for vulnerable populations who reside in close quarters for extended periods of time (e.g., long-term care facilities, correctional and detention facilities) and/or settings where critical infrastructure workers (e.g., healthcare personnel, first responders) may be disproportionately affected. Early identification could reduce the risk of widespread transmission in these situations.

    The CDC specifically recommends testing for all neonates born to women with COVID-19, regardless of whether there are signs of infection in the neonate.

    Surveillance

    Viral testing is also used for surveillance if it is conducted among asymptomatic individuals without known or suspected exposure. It helps with:

    • Early identification of infection
    • Identification of transmission hot spots
    • Characterization of disease trends

    Most viral tests require the use of a nasal swab to collect the specimen which can be tested at the point of care or sent to a laboratory. For instance, one point of care test takes advantage of Abbott’s ID NOW platform, already in thousands of doctors’ offices across the country. It offers results within a few minutes. Laboratory testing may take 1-2 days once received by a lab.

    Proper collection is one of the most important steps in diagnosing any disease. The CDC is now recommending nasopharyngeal swabs for collection although oropharyngeal remain an acceptable specimen type.  

    Providers are encouraged to work with their local or state health departments to coordinate testing through public health laboratories. Providers may also use their own test if they have received an EUA from the FDA to do so. All positive tests should be reported. Specimen collectors and lab personnel should be aware of and follow storage and shipping requirements.

    Antibody Testing

    Antibody or serology testing is not authorized by the FDA to diagnose COVID-19. This is because antibody development is an indicator of an immune response to an exposure to some antigen and not the virus itself. It may take 1-3 weeks for antibodies to develop in an infected person, and if tested before antibodies develop, the test will yield negative results.  A test may also yield negative results if the individual being tested has a weakened immune response. A person can react falsely positive to an antibody test if the individual was infected with a coronavirus other than SARS-CoV-2, such as with the common cold. Testing for other possible causes of symptoms, such as influenza, may rule out COVID-19, although it is possible for a person to be co-infected with both viruses at the same time.

    There is value in the antibody test though, if used together with a viral diagnostic test because the antibody test can support a clinical assessment for people who present late in their illness, such as with children who are suspected to have post-infectious syndrome (multisystem inflammatory syndrome in children) caused by SARS-CoV-2. Antibody tests can also help determine whether the individual being tested was previously infected—even if that person never showed symptoms. A positive result should not be interpreted that the person is immune and does not need to maintain social distancing, use of PPE, or other such measures.

    Antibody testing may be used in individuals who have recovered from COVID-19 for evaluation when considering convalescent plasma donations.

    Antibody tests that have been approved under an EUA can be found on the FDA website. (U.S. Food & Drug Administration, 2020). The American Medical Association recommends that physicians are aware of the regulatory status of tests and have a good understanding of antibody test limitations and potential results.

    Antibody Testing and Public Health

    Serology testing is used for surveillance to help us understand how many SARS-CoV-2 infections have occurred:

    • At various points in time
    • In different areas of the country
    • Within various populations

    Antibody tests can help us understand the dynamics of SARS-CoV-2 transmission in the general population and identify groups at higher risk. It can also help us understand:

    • How much of the U.S. population has been infected
    • How much the infection rates are changing over time
    • Risk factors associated with SARS-CoV-2
    • How many U.S. citizens had mild or no symptoms
    • How long antibodies can be found after SARS-CoV-2 infection

    If many people are tested using the antibody test, it can inform physicians and researchers of how the immune response develops and whether or how long, a person who has recovered from the virus is at a lower risk of infection if they are exposed to the virus again. We still do not know the answer to this.

    The CDC is conducting seroprevalence surveys (investigations using serology testing) on a large scale in certain geographic areas, in some communities, and in specific populations. These investigations will help the CDC determine the incidence of SARS-CoV-2 infection and will guide control measures such as social distancing. By using seroprevalence surveys, the CDC can learn about the total number of people that have been infected, including those infections that might have been missed because they had mild or no symptoms and didn’t seek medical care.

    The CDC is collaborating with other government agencies to evaluate the performance of commercially manufactured antibody tests. Some of these tests have received EUA from the FDA.

    The CDC, the FDA, and other federal, state, and local agencies are playing a critical role in protecting the public’s health during the COVID-19 pandemic. Learning all that you can and staying informed through the federal guidance sites is the responsibility of every healthcare professional. The reference list below provides you with links to key topics discussed in the article.

    Free COVID-19 Resources from HealthStream

    To support caregivers and healthcare organizations as they respond to the COVID-19 pandemic, HealthStream is offering a collection of carefully curated courses to all customers for free. Likewise, Using HealthStream’s Channels platform for video learning, we have a created a free-access COVID19 Channel in response to the COVID19 pandemic, specifically to support healthcare workers and their families. It contains a collection of curated videos provided by HealthStream and HealthStream’s content partners from several trusted sources on YouTube, such as the CDC and Mayo Clinic.

    References

    • American Medical Association. (2020, May 14). Serological testing for SARS-CoV-2 antibodies. Retrieved June 18, 2020, from American Medical Association: https://www.ama-assn.org/delivering-care/public-health/serological-testing-sars-cov-2-antibodies
    • Centers for Disease Control and Prevention. (2020, June 2). Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19). Retrieved June 19, 2020, from Centers for Disease Control and Prevention: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
    • Centers for Disease Control and Prevention. (2020, May 22). Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for COVID-19. Retrieved June 19, 2020, from Centers for Disease Control and Prevention: https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html
    • Centers for Disease Control and Prevention. (2020, May 23). Interim Guidelines for COVID-19 Antibody Testing. Retrieved June 18, 2020, from Centers for Disease Control and Prevention: https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/antibody-tests-guidelines.html
    • Centers for Disease Control and Prevention. (2020, June 13). Overview of Testing for SARS-CoV-2. Retrieved June 18, 2020, from Centers for Disease Control and Prevention: https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing-overview.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Fclinical-criteria.html
    • Centers for Disease Control and Prevention. (2020, May 23). Serology Testing for COVID-19 at CDC. Retrieved June 18, 2020, from Centers for Disease Control and Prevention: https://www.cdc.gov/coronavirus/2019-ncov/lab/serology-testing.html
    • Centers for Disease Control and Prevention. (2020, May 23). Test for Past Infection (Antibody Test). Retrieved June 18, 2020, from Centers for Disease Control and Prevention: https://www.cdc.gov/coronavirus/2019-ncov/testing/serology-overview.html
    • Office of the Assistant of the Secretary for Health. (n.d.). Guidance – Proposed Use of Point-of-Care (POC) Testing Platforms for SARS-CoV-2 (COVID-19). Retrieved June 18, 2020, from Centers for Disease Control and Prevention: https://www.cdc.gov/coronavirus/2019-ncov/downloads/OASH-COVID-19-guidance-testing-platforms.pdf
    • U.S. Food & Drug Administration. (2020, June 17). FAQs on Testing for SARS-CoV-2. Retrieved June 18, 2020, from https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-testing-sars-cov-2#serology
    • U.S. Food & Drug Administration. (2020, June 18). In Vitro Diagnostics EUAs. Retrieved June 19, 2020, from U.S. Food & Drug Administration: https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/vitro-diagnostics-euas

    PLEASE NOTE: The information in this blog post was considered current at the time of its publishing, 6/30/20. However, the COVID-19 pandemic is an ever-evolving disaster due to new findings, data, and availability of resources. Please refer to the CDC website for the latest detailed information when you need it.

     

  • Healthcare's Priority on Maternal & Perinatal Health

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 30, 2020

    The United States healthcare industry is long overdue in its need to be more focused on improving care during pregnancy and childbirth. According to Health Affairs, “reports finding that the U.S. has the worst maternal health outcomes in the developed world” (Devore, 2020), have led to greater attention from the government, politicians, and healthcare providers to improve the overall cost and quality of maternal health care. Not only has the maternal mortality rate doubled from 1991 to 2014, but “700 women die of complications related to pregnancy each year in the United States, and two-thirds of those deaths are preventable” (Delbanco et al, 2019). The same Harvard Business Review article adds that “American women have the greatest risk of dying from pregnancy complications among 11 high-income countries” (Delbanco et al, 2019).

    Eliminating Disparities in Care is the Goal

    New care models must be developed to overcome the huge disparities in care given across groups distinguished by their age, race, and payer status, and more attention has to be paid to complicating factors that are becoming more common, like advanced maternal age and comorbidities such as hypertension, obesity, and diabetes. Not only are commercial insurers and state Medicaid programs testing maternal health bundles, but there will be efforts on the national level to enhance this area of care. Learning and workforce development programs will play an important part in improving pregnancy and childbirth outcomes.

    References

    Delbanco, S. et al, “The Rising U.S. Maternal Mortality Rate Demands Action from Employers,” Harvard Business Review, June 29, 2019, Retrieved at https://hbr.org/2019/06/the-rising-u-s-maternal-mortality-rate-demands-action-from-employers.
    Devore, S., “Five Health Care Trends For 2020,” Health Affairs, January 13, 2020, Retrieved at https://www.healthaffairs.org/do/10.1377/hblog20200110.65292/full/

     

    This blog post is an excerpt from the longer HealthStream article, Trends That Will Shape the Next Decade in Healthcare. Focused on the people providing healthcare, HealthStream is committed to helping customers address and solve big problems in our industry. From hospitals to long-term care and across the care continuum, there are challenges stemming from demographic changes, governmental mandates, and the need for higher care quality. Download the webinar, Ten Healthcare Trends for 2020, where Robin Rose, Vice President, Healthcare Resources Group, HealthStream discusses this information in detail. HealthStream is dedicated to improving patient outcomes through the development of healthcare organizations' greatest asset: their people. Learn more about our healthcare workforce development solutions.

  • Why Automating Provider Procedure Data Collection Can Ensure Patient Safety

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 29, 2020

    Author: Joe Morris, Writer, HealthStream

    When provider procedure data makes the news, healthcare professionals who are directly involved—or even on the periphery—sit up and take notice.

    Recently, when a Modern Healthcare article reported that less than a quarter of hospitals that voluntarily completed the LeapFrog Groups' 2019 Hospital survey fully met the standard for all eight high-risk procedures (selected by a LeapFrog panel of patient-safety experts that found a strong correlation between patient outcomes and the number of times the procedure was performed), it got a lot of attention, says Vicki L. Searcy, Vice President, Consulting Services, VerityStream.

    “This is not just related to how many times a specific provider did something; it's related to the amount of times that an organization does something,” Searcy says. “The report also identifies whether hospitals actively have processes in place to screen surgeries to make sure that they're necessary before they are actually performed, to make sure that surgeries aren't being done when they're not necessary to inflate the numbers,” she adds. “Some of the highlights from the 2019 report include: No. 1, the majority of hospitals are still electively performing high-risk procedures without — in their opinion — the adequate ongoing experience to do so.”

    So, how does this affect the granting of clinical privileges? What’s the relationship between procedure data and privileges?

    “First of all, there is a process for, and steps in, privileging, the first being that an organization decides if certain procedures or patient care activity should even be conducted at all,” Searcy says. “If an organization would determine if they're going to engage in one of those eight procedures, or not, that is the first step in privileging. Then it would need to develop criteria for what types of providers can perform those procedures, and then the third step is applying the criteria to requests for the privilege.

    Monitoring Privileges for Safety and Adherence to Guidelines

    “The fourth step is really the continual monitoring of those procedures to make sure, No. 1, providers are exercising the privileges that they've been granted and not exceeding what they've been granted; and secondly, what are the outcomes so that we can continuously monitor the effectiveness of what is being done,” Searcy says. “It is what you do when you renew or reappoint somebody's clinical privileges as you’re evaluating should they continue to have these privileges based upon the data that shows outcomes.”

    As a part of the process, these initial areas of competency are evaluated:

    • Training
    • Skills
    • Behavior
    • Experience

    That’s followed by ongoing competency evaluations that include:

    • Evaluating a provider's current performance in your organization or in other organizations where a provider is clinically active
    • Performance includes factors such as professionalism, interpersonal and communication skills
    • Data about the exercise of clinical privileges — what privileges is somebody exercising?

    “Competency is determined based upon two different types of information, the first being recent experience and the other element being the acceptability of measured outcomes of that experience,” she explains. “When the provider exercised the privileges, meaning performed the procedure, how did it come out? What was the outcome? Were there problems? You’ve got to have data that's going to tell you the answers to both of those questions.”

    The Right Approach Helps Gather Necessary Data

    That’s why, when designing a privileging approach, it's critical to group or cluster privileges and procedures that require similar knowledge and skills, Searcy says.

    “I know when we talk about clinical activity requirements there's a lot of questions that come up about when you should set a clinical activity requirement,” she points out. “You should establish those requirements when it's important to have sufficient case activity to evaluate. But not all specialties, such as those that are more consultative in nature. have clinical activity requirements. In those cases, you're primarily looking for evidence of ongoing clinical practice.”

    That said, even if a provider doesn't meet a clinical activity requirement it doesn't have to mean automatic relinquishment of those privileges. It does, however, mean that caution and stepped-up monitoring should occur.

    “You might have some system of oversight or proctoring for situations where the clinical activity requirement hasn't been achieved, and the provider wants to retain the privileges so that you can allow continuation of the privileges with some level of oversight for a period of time,” she says. “Because there may be valid reasons why someone was unable to meet a clinical activity requirement, you want to allow them the ability to keep on practicing. However, when you get surveyed, the continuation of granting privileges that are not exercised over and repeatedly is not going to make your privileging process look good to a surveyor.” Bottom line is that privileging is meant to protect patients – that is the primary reason why there is a concern related to competency. We can’t allow providers to have privileges that we don’t know that they are competent to provide.

    Clinical Activity, Performance Reports Offer Actionable Insights

    Credentialing software can support the need to track and report volumes, as well as indicator-based performance evaluation. For example, Performance Privileges is a feature of VerityStream’s Privilege solution, and it sets out to answer the question of, “How many?” toward that end of determining competency based on volume, says Sarah Cassidy, Solution Executive, Privilege and Evaluate, VerityStream.

    For instance, to mitigate an organization’s risk, you can bring to the forefront providers who are falling out of minimum volume requirements. If someone isn’t performing enough of a procedure for you to be able to aptly measure competency, you'll be alerted and empowered to take appropriate action, Cassidy says.

    Then the occurrence of providers who might be performing procedures that they aren't currently granted can be flagged. These procedure volume reports feature the ability to compare individual provider volumes to those of their peers, as well as drillable data points. When I say drillable, I mean down to the encounter level, she adds.

    “The ability to see the details behind each procedure performed is important because that really informs data validation processes and informs discussions when presenting this data to clinicians,” she explains. “Providers and clinical reviewers alike have access to these reports via a provider-facing portal, and then these reports can be used in making either self-guided improvements or in informing critical decisions around renewing privileges, perhaps assigning oversight requirements or possibly even revoking privileges in severe circumstances.”

    Want to learn more about this topic? Watch the recording of our webinar: Automate Collection of Provider Procedure Data to Ensure Patient Safety, a VerityStream Industry Insight webinar. Learn more about how Verity provides Credentialing, Privileging, Enrollment, and Evaluation for Health Systems and Health Plans.

  • Effective Recognition is the Right Way to Influence Behavior Among Healthcare Employees

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 26, 2020

    This blog post excerpts the HealthStream article, Effective Recognition: The Right Way to Influence Behavior, by Craig Spilker, Head of Product + Engagement, AMPT, and Brad Weeks, Director, Performance Assessment and Development, HealthStream.

    Employees who feel valued for their contributions will outperform and are far more likely to stay with an organization.

    Best-in-class healthcare organizations—those that are not only winning the “Best Place to Work” awards but those being acknowledged for high quality, safe, and patient-centered care—are doing so in part because they have recognition-rich cultures in place that bring out the best in their people.

    “Recognition is absolutely tied back to employee engagement. A highly engaged workforce is a highly productive workforce that provides a safer environment.” - Eric Barber CEO, Mary Lanning Healthcare, and three-time Great Workplace Award Winner.

    These organizations do not rely heavily on monetary rewards or trinkets to show appreciation but instead simply ensure that honest and authentic feedback between all employees is consistent, frequent, and tied back to the organization’s purpose.

    “Reward” And “Recognition” Are Not Synonyms

    Too often when managers and leaders start thinking about how to better motivate employees, the conversation gravitates towards tangible incentives—those things we think employees need to feel more engaged. Unfortunately, when we lead with incentives, we lose sight of what engaged employees want.

    83% Of Employees Prefer Authentic Recognition Over Rewards

    It is not erroneous to think employees might need a reward. An individual employee will work for a reward. However, using rewards as the foundation of a recognition-rich culture is not necessary, and can be a deterrent when trying to impact the ongoing performance and drive of an entire team or workforce.

    This article also includes:

    • Recognition Vs. Rewards: Why Effective Recognition Wins
    • Effective Recognition Strengthens Relationships between Employees, Teams, and Managers
    • Authentic Recognition Is Unlimited
    • Effective Recognition Programs Have More Impact than a Rewards-Based Program

    Compensation & Rewards Exclusively for Healthcare

    HealthStream Compensation & Rewards Solutions optimize your workforce’s compensation by automating inefficient error-prone processes and promoting a pay-for-performance culture to help retain staff. Interoperable with HRIS, performance, and financial systems, HealthStream Compensation brings your organization a secure, auditable healthcare compensation workflow that results in more accurate compensation decisions, and better allocation of merit and bonus dollars.

  • Credentialing in a Crisis - Business Continuation in the Time of COVID-19 (Part 2)

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 25, 2020

    By Joe Morris, Writer, HealthStream

    The onset of the COVID-19 pandemic meant sudden, dramatic change throughout the world of healthcare. From properly equipping personnel for front-line patient care to conducting back-office business in a virtual setting, every day brought new challenges.

    That has certainly been true in credentialing and privileging arena, where virtual processes have met the need, and relaxed governmental regulations have also allowed for workarounds in emergency situations, says Angela Beardsley, BSBS-IT, CPMSM, CPCS, Consultant, Consulting Services at VerityStream. Here are some suggestions for improving your credentialing under current circumstances.

    Create Workstreams to Smooth Advanced-Review Process

    Advanced review of the credential’s file is another critical component to the success of a virtual credentials committee meeting. Preparation for credentials meetings can be done at a time more convenient for the physicians, as file review can be completed electronically, at their own pace in advance of a scheduled meeting.

    “You can assign files to specific committee members in advance of the meeting,” notes Kurtz. “If you do that, make sure that you communicate the expectation for the reviewer to speak to their assessment of the file during the meeting. Alternatively, you can allow all community members to have access to review the files. If all are reviewing the files this may look more like an opportunity to bring up any concerns.”

    Some file-distribution options for the credentialing packet include:

    • Credentialing solution: Does it have the functionality to support confidential and secure virtual review and approvals?
    • Committee/Board management applications: These allow for securing confidential distribution of meeting materials and packets for review and approval.
    • PDF Routing: Convert review documents to PDF binder and distribute that via secure email, or secure shared folder or site.

    It’ll also be key to make sure reviewers have proper device access and training so that they can view and engage with the materials.

    Virtual Committee Meetings Complete the Process

    All the above activity sets the stage for virtual committee meetings. There are several routes to go when setting these up:

    • Consent agenda meeting: no physical meeting occurs, and the meeting is opened for a defined time period for committee members to review, comment, and make their recommendations.
    • Audio-only meeting: Participants are connected via a phone system and not required to have a computer or any other electronic device.
    • Web meeting: Participants are connected via a web meeting tool or application such as WebEx, GoToMeetings, Skype, Zoom or Microsoft Teams. A web meeting requires a computer or other electronic device such as a tablet or smartphone, with a secure and optimal internet connection.
    • Web meeting with video: Same as above, with a video component.

    “Once you've determined which type of virtual meeting is best for you, then the next step in preparing for a virtual committee meeting is to set expectations ahead of the meeting,” Beardsley says.

    • Can some people can be in a conference room while others are remotely connected, or is everyone connecting remotely?
    • Does just joining the meeting count as being present or do you have to actually be an active participant during the meeting to be considered present?
    • Will participants need to be able to focus on shared documents or be on video for discussion?

    Ensure ahead of time that all participants will be adhering to confidentiality expectations.

    Be prepared:

    • Establish and distribute the agenda in advance
    • Know the technology in advance
    • Test the phone connection with one of the participants to ensure the quality
    • Test the web meeting to ensure understanding of transitions and options
    • Login early to open and establish the connection of the electronic tool or application being used
    • Have a plan to reduce side conversations and to ensure all participants have an opportunity to speak and be heard

    There are many other issues to consider, such as getting signatures, and there are virtual and electronic options available for those. As with the above, the key is to be prepared so that all activities around credentialing can be conducted as swiftly and efficiently in a remote setting as they would be in a live one.

    Consider this an opportunity to convert the usual daily process from paper to electronic. If not using credentialing software solution that's electronic, this is a good time to explore those options. And start considering any policies or bylaws that need to be revised to allow for the full electronic process from start to finish.

    Learn more about how VerityStream provides Credentialing, Privileging, Enrollment, and Evaluation for Health Systems and Health Plans.

  • Checking In On Nurse Practitioner Residency Programs

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 24, 2020

    A variety of factors have led to an increase in demand for primary care—an aging population with greater healthcare needs, changes in insurance options for large numbers of previously uninsured people, accountable care models, and consumerism for starters. The increasing demand is tough to meet with the current supply of primary care physicians, so increasingly the solution seemed to be nurse practitioners. If anything the need for nurse practitioners continues to grow. Estimates have put the shortage of primary care physicians at about 45,000 by this year. However, much has changed in the years since the introduction of the Accountable Care Act, so are nurse practitioners still in high demand or has demand declined as the rolls of the uninsured have once again increased?

    Quantifying Demand – Where Are We Now?  

    The Bureau of Labor Statistics anticipates that openings for nurse practitioners in the US will increase by 25% between 2018 and 2028 – a growth rate that far exceeds the estimated 7% growth rate across all other occupations as estimated by the bureau for the same time period. If the Bureau of Labor Statistics projections are correct, this will result in an increase of approximately 62,000 nurse practitioner jobs. You can read more of the bureau’s statistics on nurse practitioners by clicking here https://www.bls.gov/OOH/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm

    Additionally, there was a fairly rapid expansion of education programs to support nurses who wanted this and other advanced practice degrees.

    What Contributes to High Demand for Nurse Practitioners?

    There are some reasons to believe that the growing need for nurse practitioners will persist. These factors are contributory.

    1. As mentioned earlier there has been a persistent and significant shortage of primary care physicians as new physicians gravitate toward specialties that are more lucrative and potentially offer a better work life balance than primary care. This trend shows no signs of reversal making regular increases in demand for nurse practitioners and the programs that train them likely for the foreseeable future.
    2. There is also an increasing demand for primary care. As the supply of primary care physicians has shrunk, the demand for primary care has increased. The 2018 National Resident Matching Program (NRMP) matched just 2,730 residents with primary care residencies; that included family medicine, internal medicine and pediatrics. That number enrolled in nurse practitioner residency programs is far exceeded by the deficit of more than 23,640 primary care physicians that is expected by 2025. Conversely, more than 80% of the graduates of nurse residency practitioner programs are prepared in primary care.
    3. Nursing has gained more respect as a career. Effective models of patient-centered care, nurse magnet programs, rapid-fire changes in technology and increasing demands for efficacy and efficiency in healthcare have helped elevate the profession and has led to better career and educational opportunities for nurses.
    4. Many services that were formerly hospital-based are now delivered in outpatient settings. Increasing pressures on the inpatient length of stay and financial pressures resulting in more cost-effective models of care have resulted in more procedures (and more healthcare jobs) being moved to outpatient settings.
    5. The senior age cohort uses healthcare services at a higher rate and this cohort is the fastest growing segment of the population. An older, sicker population will drive the need not just for additional primary care services, but those that specialize in gerontology.
    6. Retail clinics are a growing segment of the primary care market. In 2007, there were just 300 retail clinics. Now there are more than 2,000 clinics and the industry value is estimated to be approximately $7.5 billion. The streamlined, low-cost business model has had ups and downs with some players (CVS and Target) increasing their number of clinics and others (Walgreens) appearing to exit the market altogether. The clinics still have a large footprint in primary care and largely employ nurses and nurse practitioners.

    These trends do not appear to be reversing which will likely result in an ongoing demand for nurse practitioners and programs to train them.

    Contact HealthStream to speak to a solutions expert to learn more about our courses related to nurse practitioner residency programs

  • Reducing Obstetric Risk Factors Through Management

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 23, 2020

    As recently as the 1980s, pregnant women over the age of 35 were routinely described as elderly mothers. During that time, these patients were also relatively rare. Today, many women are delaying childbearing, and pregnancy in women over the age of 35 is considerably more common.

    Advanced maternal age (AMA) still comes with increased risks for pregnant women and their babies, but improvement in technology and the management of labor and delivery has resulted in better outcomes for them. Additionally, AMA is now more frequently defined in medical literature as 40 to 45 years old.

    So how did we get here, to a place where we need to put much more effort into high risk obstetrics? What are the changes that led to improved outcomes for older pregnant women?

    Addressing Safety Issues in High-Risk Maternity Patients

    Appropriate management of high-risk patients is essential to making pregnancy, labor and delivery safer for patients in this cohort. An obstetric risk assessment is key in many situations. Where should we focus our attention when planning training and education for providers? OB clinical competency is a good place to start.

    Consider the following when planning to maintain clinical skills for obstetrical providers.

    1. Electronic Fetal Monitoring (EFM) - What kinds of skills and knowledge does your team really need to be able to consistently identify the early warning signs of fetal and maternal distress? EFM provides the best insight to providers and is the optimal way to reduce stillbirths and neonatal convulsions.
    2. Postpartum Hemorrhage (PPH) – PPH is a rare, but serious complication. Recognition of the signs and symptoms of PPH is important as is an understanding of the conditions that tend to increase the risk for PPH.
    3. Hypertension in Pregnancy – Both chronic and pregnancy-induced hypertension is associated with advanced maternal age. The risks associated with hypertension during pregnancy are serious and, in some cases, life-threatening. They include preeclampsia, placental and fetal growth abnormalities, pre-term delivery and placental abruption.
    4. Shoulder Dystocia – Estimates of incidence rates for shoulder dystocia vary quite widely, but the condition is believed to be present in 0.02 to 2.1% of all births (although some estimates are as high as 10%). The condition is associated with fetal macrosomia, maternal hypertension and maternal diabetes, but in many cases, none of these conditions will be present making shoulder dystocia somewhat difficult to predict. Helping staff to recognize the presentation of shoulder dystocia and to understand the diagnostic methods and optimal interventions are essential for a safe birth.
    5. Trial of Labor After Cesarean (TOLAC) – While a successful outcome of a TOLAC may be safer overall for laboring women, the risks of TOLAC include uterine rupture which can have serious maternal and fetal implications. Providers need training on the identification of the best candidates for TOLAC, the optimal setting for TOLAC, and the signs and symptoms that would indicate a need for a cesarean delivery.
    6. Effective Communication and Event Disclosure – At this point, the benefits of disclosing information about adverse events for patients, physicians, and healthcare organizations are well known. Best practices in effective communication are essential to the success of the dialogue. Understanding what information should be communicated and the optimal way in which to communicate that information is key for your staff.

    Improving Perinatal Outcomes – The Must Haves

    Improving perinatal outcomes means safer pregnancy and delivery for all women including the increasing numbers of women of advanced maternal age has long been a goal in healthcare. So what is the best way to support providers facing high risk obstetrics who are striving to provide safe and effective obstetrical care?

    Make sure your program includes the following:

    • Pre-assessment of provider knowledge to help customize educational focus and goals thus saving time and training costs
    • Use competency-based training that focuses on high-risk patient safety issues
    • Right-size the learning modules to insure higher levels of learner engagement, retention and focus on the key learning objectives
    • Use virtual microsimulations to enhance the critical thinking that is essential in managing high risk pregnancy, labor and delivery
    • Use a learning performance dashboard to enable efficient and informed decision-making
    • Build an inter-disciplinary approach that is accredited by the ANCC and the ACCME to insure understanding of best practices and the latest clinical information

    Lastly, build an inclusive program for physicians, nurses, nurse midwives and anesthesiologists so that all disciplines are adequately prepared to manage obstetrical risk.

     

    Learn more about reducing obstetrical risks in our comprehensive online courses 

     

  • Five Lessons Learned from Successful CVOs

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 20, 2020

    HealthStream regularly publishes guest blog posts like the one below from Vicki Searcy, Vice President of Consulting Services, VerityStream.

    When I started consulting 25 years ago, an emerging area in credentialing was the development of Credentials Verification Organizations (CVOs). At that time, many of us thought that CVOs would be a component of a medical society or hospital association—and I worked with these types of organizations to establish CVOs across the country. Later, I started working with healthcare organizations to establish CVOs specifically for health systems and this ultimately became the type of CVOs I most often assisted. I surveyed CVOs for several years for NCQA and saw a wide variety of CVOs with different types of operations and scope of services.

    An Explosion of CVOs

    Over the past three to five years, there has been an explosion of the development of CVOs in health systems. This is largely due to the proliferation of health systems during the past few years. The VerityStream consulting group is either working in an environment where a new CVO is being established, we are in the process of operationally improving an existing CVO by implementation of various software solutions or we are in an onboarding environment where the “CVO” services are expanded to include involvement with recruiting, contracting, HR, credentialing, provider data management/interfaces, and payer enrollment.

    Having been involved in the CVO industry for so many years, I’ve seen impressive successes—and, unfortunately, some spectacular failures. I’ve seen boxes of paper files returned to hospitals when a CVO connected with a hospital association failed. I’ve surveyed medical society CVOs where files were several inches thick and it was impossible to identify what data was provided to a specific hospital and when. I’ve been in CVOs so large and so busy that they had individuals who did nothing but verifications of licensure, or DEA registrations, etc. I’ve also worked with health systems where the CVO was functioning so effectively that no one in the hospitals could envision taking back credentialing and doing it facility by facility.

    Five CVO Lessons Learned – Best Practices

    1. Clearly define the scope of services provided by the CVO vs. the participating facilities. Make sure that there are quality processes in pace to assure files are complete (and adhere to agreed-upon standards) prior to releasing the files to the participating facilities.
    2. Standardize the CVO work product—don’t customize. CVOs that are highly customized to the needs/wants of a particular customer/facility often fail—or the cost of doing business in this type of environment is so high that the operation becomes insupportable.
    3. Limit access to a shared database for accountability and data integrity. The more individuals that you have entering and manipulating data in a shared database, the more likely it is that there will be inconsistent data. Most health systems want the practitioner data from the credentialing database to be the “source of truth” and to be interfaced to multiple business applications. Keep the data clean!
    4. Don’t sell the idea of implementing a CVO by promising decreased staff in the medical staff offices. Focus on the staffing needed to provide the scope of services of the CVO. The facilities that participate in the CVO services can evaluate the staffing needed to provide their scope of services. Eventually, decreased staff in medical staff offices may be possible once credentialing is centralized. But in a CVO start-up, usually more staff is needed for a period of time while the CVO is implemented. There is often new software installed and implemented, policies and procedures to be developed, etc. Once the CVO has been in place and operations are stable, it is time to re-evaluate staffing requirements. One CVO that I worked with was able to reduce staff by half once they went entirely electronic—but it took a year to get to that place (and no jobs were lost—staff were deployed to facility medical staff offices or other positions within the health system).
    5. Don’t change operating procedures every month. Most health systems that have a CVO have some type of an operations committee made up of representatives of the facilities that use the CVO services. Unless there is an immediate need to change an operating procedure (a new regulatory requirement, for instance)—policies and procedures should be evaluated annually and revised by the group as necessary/advisable. This helps avoid having operating procedures be a moving target—which can destabilize the CVO.

    There will, I’m certain, be many changes in how health system CVOs operate in the future. We are already seeing interesting variations related to the scope of services in CVOs based upon technology which is available now or CVOs that focus on onboarding. There are numerous CVOs that provide credentialing and enrollment services. Some CVOs provide support for facility privileging (particularly when privileges are standardized across a health system). It will be interesting to continue to watch the development of CVOs in the coming years.

    The credentialing process can be a very complicated and long process. Renee Zimmerman gives us her keys to making the process succeed. Download the VerityStream White Paper, 6 Essentials for Achieving Rapid and Successful Centralization.

    Learn more about how VerityStream provides Credentialing, Privileging, Enrollment, and Evaluation for Health Systems and Health Plans.

  • Most Popular Nursing Blog Posts from HealthStream So Far in 2020

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 19, 2020

    At HealthStream we spend much of our time focused on nurses—especially on finding solutions to their workforce development challenges and to providing ways to make their jobs less conducive to stress and burnout. We often publish blog posts focused on nurses, who are key to improving outcomes throughout healthcare. Here are our most popular nursing-focused blog posts so far in 2020.

    Preventing Nurse Burnout – Five Strategies

    HealthStream discusses being vigilant about identifying symptoms of and preventing burnout by providing interventions to help nurses and healthcare organizations.

    Introducing Jane — The First Digital Nurse Advisor

    HealthStream has introduced the Jane™, the first-ever AI-based competency assessment solution using a conversational format, to help quickly and accurately onboard both new and experienced nurses.

    Preventing the Spread of the Three Most Common Blood-Borne Pathogens

    Understand how to prevent the spread of the three most common blood-borne pathogens. Know the essential elements in the creation of a safety culture that will minimize the risks of exposure to blood borne pathogens for employees and patients.

    Successful Patient-Centered Care in Nursing

    There are impediments to implementing patient-centered care (PCC) in which nurses will play a key role to improve outcomes as well as the experience of care.

    3 Ways Nurse Management Can Improve Communication

    Here is a list of 3 ways nursing management can improve communication to quit overwhelming staff with information and contact, from HealthStream.

    The Benefits of Using Artificial Intelligence to Individualize Nurse Orientation and Training

    Healthcare organizations’ outcomes can benefit when they use a system based on artificial intelligence (AI) to ensure the competence, readiness, and ability of their nursing staff.

    Recommendations for Tackling Nurse Burnout

    Though we hear a lot about physician burnout, this condition is also a significant problem in nursing. To reduce the likelihood of nurse burnout, healthcare organizations should take an active role in developing and fostering resilient environments.

  • Credentialing in a Crisis - Business Continuation in the Time of COVID-19 (Part 1)

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 18, 2020

    By Joe Morris, Writer, HealthStream

    The onset of the COVID-19 pandemic meant sudden, dramatic change throughout the world of healthcare. From properly equipping personnel for front-line patient care to conducting back-office business in a virtual setting, every day brought new challenges.

    That has certainly been true in credentialing and privileging arena, where virtual processes have been stood up to meet the need, and relaxed governmental regulations have also allowed for workarounds in emergency situations, says Angela Beardsley, BSBS-IT, CPMSM, CPCS, Consultant, Consulting Services at VerityStream.

    Temporary and Disaster Privileging

    “All our jobs are changing daily, as are the requirements from the federal government,” Beardsley says. “The Joint Commission, HVAC, and DMV all have provisions for some type of temporary privileges: urgent patient care need, low income tenants, temps pending board approval and also for disaster privileges. So, depending on which organization you are accredited by, please make sure to check those standards to see what modified initial and credentialing privileging processes work best for you during this time. It is also imperative to check your organization's medical staff bylaws and policies to ensure that whatever modified process you are considering implementing, it is in alignment with your own organizations’ defined processes.”

    Proper Packet Preparation Still Essential for Success

    Virtual processes for credentialing reviews and approvals will still utilize packets, and so those must be prepared with the same careful vigilance as always, says Meghan Kurtz, BA, MS, CPCS, Senior Consultant, Consulting Services at VerityStream.

    “Whether you're using your own software solution or your manually configuring a PDF package, it’s important to determine what elements are actually going to go into your application packet,” Kurtz says. Packet content should include:

    • Executive summary. A narration of findings, this replaces an in-person conversation that would occur during the meeting during file review. This is the opportunity to communicate any issues that have been found.
    • Profile report. A snapshot of your practitioner. It's going to tell the reviewer about their education, training, certification, affiliations, their work history, their licenses, and claims history, and is usually information obtained from a credentialing database.
    • Pertinent/relevant documents. These are any primary source verifications with issues. Typically flagged items include a state license sanction, or action on the state license or any claims verifications that came back. Include your references and evaluations.
    • Privilege request documentation. Typically the privilege request form.

    “When doing these, consider the file size of that packet,” Kurtz advises. “Remember, this is no longer something that they can quickly scan through or you can actually parse out into individual sections with labels. This is going to be one consolidated document. You might be sending that via email, so you want to make sure that it's not too large that it would be rejected. Some items that you’d often want to omit would be additional forms, such as attestation, CME attestations, citizenship attestations and anything that does not really help the reviewer make an informed credentialing decision.”

    Learn more about how VerityStream provides Credentialing, Privileging, Enrollment, and Evaluation for Health Systems and Health Plans.

  • Most Popular Talent Management Blog Posts So Far in 2020

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 17, 2020

    There’s a good reason why HealthStream’s talent management are used by more than 70 percent of healthcare organizations in the U.S. HealthStream’s comprehensive suite of learning competency, and talent management tools for healthcare empowers your people to deliver the best care more easily and effectively than ever before. Here are our most popular talent management-focused blog posts so far in 2020.

    Feelings & Emotional Intelligence Impact on Healthcare Training

    Learn how feelings directly impact how we learn and retain information through emotional intelligence and how it relates to healthcare training, from HealthStream.

    Millennial, Gen X, & Baby Boomers, How do Their Work Ethics Differ

    Understand the variance in work ethics, approach to authority, and collaboration among Baby Boomers, Generation X, and Millennials in healthcare.

    Understanding Sexual Abuse & Harassment

    Learn the importance of understanding the intricacies and responses required for companies and people who encounter sexual abuse and harassment.

    Using Certifications and Badges to Recognize Training Achievements in Healthcare Revenue Cycle Staff

    Any education program used for revenue cycle staff should provide visible proof of achievement. Attaining a certification or badge, such as a UB-04, which covers medical terminology, or modifiers, is a sound way to make that happen.

    Individualized Learning Benefits the Employee and the Healthcare Organization

    Individualizing training to each learner’s needs is where performance-guided learning has such appeal. By assessing an employee’s performance and then connecting it with how he or she learns and develops, an entirely new approach to workforce education is possible.

    Planning Annual Required Training – A Healthcare Compliance Case Study

    To illustrate the difficulty that a typical healthcare provider may encounter when planning annual required training, we offer the example of just one role in a single state—a respiratory therapist in Tennessee

    Six Reasons to Prioritize Employee Recognition Over Rewards in Healthcare

    Effective recognition occurs when an employee receives authentic feedback from a peer, manager and/or leader as to how his/her actions impacted team objectives or the organization’s purpose. Here are six reasons to prioritize employee recognition over rewards in healthcare.


    The Future of Learning and Talent Development in Healthcare – Survey Results (Part 2)

    To evaluate healthcare industry perceptions about talent management, learning, and development, HealthStream surveyed leaders about the strategic use of learning within talent management programs. Here we discuss findings about leadership and the importance of learning content.

  • Resuscitation Rates – Where Is the Improvement?

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 16, 2020

    Survival rates for inpatient sudden cardiac arrest have been stagnant for years. This is the case even as the American Heart Association (AHA) has had a goal of increasing sudden cardiac arrest survival rates from the current rate of approximately 15% to 38%.

    Resuscitation Quality Improvement – A Clear Path to Higher Survival Rates?

    The goal was ambitious, and it was believed that these results would primarily be achieved by improving the Cardiopulmonary Resuscitation (CPR) skills of healthcare providers. The AHA had compelling research that indicated that the likely culprit in poor survival rates for sudden cardiac arrest was the rapid deterioration of the psychomotor skills associated with high quality CPR.

    Healthcare organizations were (and in many cases still are) providing biennial CPR training. That schedule meets most local, state and national regulatory requirements. However, the AHA’s research showed that the skills associated with high-quality CPR actually began to deteriorate within three to six months. The AHA began an extensive campaign to share the research results and try to move healthcare providers to more frequent training. The research was compelling and the recommendations to increase the frequency and change the modes of training were well-received, so why haven’t survival rates improved?

    Barriers to Improvements in CPR Survival Rate

    At this point, little is known about why these recommended training interventions had so little impact on survival rates, but there are some likely culprits.

    • It is estimated that one-third or more of cardiac arrest deaths may be avoidable. The first line of defense is not CPR training; it is prevention. Hospitals have struggled to implement programs that would reduce the incidence of sudden cardiac arrest.
    • Many healthcare organizations have simply not adopted the recommendation for more frequent training. Fears about cost, time requirements, and other resources for more frequent training may have contributed to this reluctance in spite of the fairly widespread acceptance of the data that supports more frequent training.
    • Many healthcare organizations still do not have a multidisciplinary team that is responsible for cardiac arrest outcomes. These organizations may not be taking advantage of the data from outcomes and processes that would help them make the best recommendations for improvements in processes and also recommend changes in how staff are trained to do CPR.
    • The one-size fits all approach of many training programs may be less effective than those that are customizable to the needs of students.

    Solutions That Work

    What should come next? How do we take hold of what we know about the optimal means of training healthcare providers on how to deliver high-quality CPR?

    HealthStream has partnered with the American Red Cross for a solution that can help healthcare organizations respond effectively and efficiently to the data that suggests a need for more frequent training. The American Red Cross Resuscitation Suite:

    • Is built on rigorous science that informs the training guidelines – The International Liaison Committee on Resuscitation (ILCOR), the American Red Cross and its Scientific Advisory Council have informed every step of the development of this content. Users can be confident in the research-based recommendation for its optimal as well as the ways and means of achieving that training.
    • Provides a customizable approach that is designed to provide the optimal training frequency for each type of student.
    • Creates competence and confidence in users.
    • Is customizable and adaptive while still delivering the most advanced CPR training.
      • Stimulates critical thinking using real-life scenarios. The Suite includes videos and simulations featuring real physicians and nurses in hospital settings demonstrating the kinds of critical thinking and decision-making important to successful outcomes.
    • Provides flexibility with content that can be accessed at any time from any device.

    Smarter, More Flexible Choices for CPR Training

    The recommendation for considerably more frequent CPR training may seem daunting, but the right educational tools can help healthcare organizations educate providers on the very latest guidance on CPR using a streamlined educational tool that can save time (and money) in the certification process while still insuring that the student is receiving training that is based on the very latest science on what constitutes high-quality CPR.   

    When lives are at stake, can everyone on your staff respond quickly and competently to a resuscitation event? Many healthcare leaders are concerned that despite rising costs of training, resuscitation rates have not improved in the last decade. The American Red Cross Resuscitation Suite ™ for BLS, ALS and PALS empowers healthcare organizations to be in control of a customizable adaptive program, saving the organization money while participating in the next wave of resuscitation advancement.

  • The Retail Environment Challenge to Healthcare Keeps Growing

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 15, 2020

    Expectations about the convenience of healthcare are changing, exemplified by the embrace of healthcare within a retail environment. The New York Times reported in 2018 that people are now flocking to clinics and urgent care centers located in strip malls or shopping centers. Some 12,000 are already scattered across the country in these kinds of more accessible locations. At the same time, office visits to primary care doctors declined 18 percent from 2012 to 2016, even as visits to specialists increased (Abelson & Creswell, 2018).

    Convenience and Availability Are Big Issues

    Patients are more interested in appointment hours that work better with a working schedule, including evenings and weekends. Another development with larger implications involves the merger of retail drugstore chains like CVS with insurance providers like Aetna. The impact on provider networks, advertising, etc. could be significant. In addition, much of healthcare is waiting to see what Amazon and other big players in the digital economy may do to disrupt the traditional ways that healthcare is provided, supplied, and scheduled.

    Reference

    Abelson, R., and Creswell, J., “The Disappearing Doctor: How Mega-Mergers Are Changing the Business of Medical Care,” April 7, 2018, The New York Times, Retrieved at https://www.nytimes.com/2018/04/07/health/health-care-mergers-doctors.html.

    This blog post is an excerpt from the longer HealthStream article, Trends That Will Shape the Next Decade in Healthcare. Focused on the people providing healthcare, HealthStream is committed to helping customers address and solve big problems in our industry. From hospitals to long-term care and across the care continuum, there are challenges stemming from demographic changes, governmental mandates, and the need for higher care quality. Download the webinar, Ten Healthcare Trends for 2020, where Robin Rose, Vice President, Healthcare Resources Group, HealthStream discusses this information in detail. HealthStream is dedicated to improving patient outcomes through the development of healthcare organizations' greatest asset: their people. Learn more about our healthcare workforce development solutions.

  • Supporting Credentialing Staff Working From Home (Part 2)

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 12, 2020

    By Joe Morris, Writer, HealthStream

    This blog post is based off of an Industry Insight Webinar: Disaster and Telehealth Privileging During the COVID-19 National Emergency.

    The concept of working remotely, or working from home (WFH), has gained a great deal of attention in recent years. For some industry sectors, it makes sense because employees are based around the country, even the world, and so keeping office space would be cost-prohibitive. For others, WFH is seen as an essential part of a competitive incentives package, particularly for Millennial and Generation Z employees. And now, of course, WFH has become a reality for businesses of all types and sizes, including healthcare providers, say VerityStream’s Lisa Rothmuller, AVP for Consulting Services, and Kay Lynn Akers, Consulting Advisor.

    Set realistic expectations about WFH for everyone involved

    There are many other areas to consider when mapping out what’s expected in a WFH setting, Rothmuller says.

    “When the decision is made to become remote, you need to have policies and set expectations regarding the work schedule for your remote employees. If you're a medical staff office, a CVO or an office that supports them and you're available between certain working hours, then plan the remote coverage for those hours as well,” she explains. “If one employee works 7-to-4 in the office, then those are the expected hours they will be available and working at home. Be sure that those are communicated and tracked and when there are slips in coverage time, talk to the employee to be sure they're clear on what those expectations are.”

    “It's also important to identify the tools that will be used during those set work hours,” she continues. “For example, if a medical staff coordinator typically uses their credentialing software during those hours, it's expected that while they are in working from home, they are in the system as well. Do they need to be available by phone chat, email as well during those hours? Make sure this is clear with each of your remote employees.”

    Short- and long-term tips

    And finally, some tips and tricks to help people settle into a WFH environment, and to achieve success if they continue to work remotely over time.

    Treat WFH as you would going into the office.

    Get up, get dressed, go to work. Does your attire really matter when you're working at home? Maybe not as much, but it certainly does help with routine and structure.

    Flexibility is key.

    These are very challenging times. Remind staff that we're all contributing to help get through these times and that you may need to flex in your roles and responsibilities in the short term.

    Stay connected with co-workers.

    Setting up fun events like fitness challenges to keep people connected during this time is really important.

    Set up virtual meetings with staff to bring everyone on the same page with the changes daily.

    It’s also not too soon to begin considering the lessons employees and employers are learning now. When the pandemic ends, what will be next in terms of remote work? A result of this forced experience may result in more employers having WFH as a popular and effective option moving forward, Akers says.

    “Your employees are going to feel that they're trusted, that you've trusted them to do their work at home,” she says. “And it also gives them flexibility. Maybe if it doesn't matter that I work 8-to-5, I can start work at 6 a.m. because I have a dental appointment in the middle of my day. So I have that flexibility to work maybe when it's convenient, as long as it doesn't conflict with me completing my work.”

    Learn more about how VerityStream provides Credentialing, Privileging, Enrollment, and Evaluation for Health Systems and Health Plans.

  • Seven COVID-19 Pandemic-Related Blog Posts from HealthStream

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 11, 2020

    The blog posts HealthStream has already published in connection with the Covid-19 Pandemic range from what healthcare professionals need to know to the ramifications of working remotely and how healthcare looks different to those working on the frontlines of care. Here are links to what we have posted so far:

    Preventing Viruses: Strategies of Containment, Protection, & Prevention

    Understand how the severity of the COVID-19 pandemic can be lessened by strategies of containment, protection, and prevention to make the community and healthcare workers safer.

    What Healthcare Officials Need to Know About the Coronavirus COVID-19 (Part 1)

    Global health officials are on alert about COVID-19 coronavirus that has not been previously recognized in humans and causes a mild to deadly respiratory illness.

    What Healthcare Professionals Need to Know About the Coronavirus COVID-19 (Part 2)

    Learn about recommended isolation precautions to use around potential COVID-19 coronavirus patients for healthcare professionals to—identify, isolate, and inform.

    What Healthcare Professionals Need to Know About the Coronavirus COVID-19 (Part 3)

    HealthStream advises readers to follow multiple important steps throughout the continuum of care for infection control and prevention involving coronavirus COVID-19.

    Handling N95s, Ventilated Face Masks, and Social Distancing

    Here's how to follow the guidelines for infection control and deal with the shortage of personal protective equipment (PPE) caused by Covid-19, from HealthStream.

    Benefits & Challenges of Working Remotely in Times of Crisis

    HealthStream examines the benefits and challenges of working remotely while Americans are applying “social distancing” in an effort to stop the spread of Covid-19.

    Nursing on the Frontlines: How the Covid-19 Crisis Is Changing Standard Hospital Procedures

    An RN writes “During the Covid-19 pandemic, my fellow infection preventionists (IPs) and I have still been rounding the hospital, observing infection control practices, and providing education; however, the degree to which we are performing these tasks has expanded greatly…"

    PLEASE NOTE: The information in this blog post was considered current at the time of its publishing, 6/11/20. However, the COVID-19 pandemic is an ever-evolving disaster due to new findings, data, and availability of resources. Please refer to the CDC website for the latest detailed information when you need it.

  • Effective Recognition: The Right Way to Influence Behavior

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 10, 2020
    Best-in-class healthcare organizations—those that are not only winning the “Best Place to Work” awards but those being acknowledged for high quality, safe, and patient-centered care—are doing so in part because they have recognition-rich cultures in place that bring out the best in their people. Download the article to learn more about the importance of effective recognition programs.
     
  • HealthStream Community - The Next Level of HealthStream Customer Support

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 10, 2020

    By Brittney Wilson, RN, User Engagement Manager, HealthStream

    The world is looking different in 2020. The Coronavirus pandemic has made it clear that quick and easy access to accurate information is so important. Since long before the current situation made this undeniable, HealthStream has been working to ensure our customers receive the information they need quickly and easily. We have been collaborating directly with our customers to understand what information they need to do their job well. We heard their feedback and desires loud and clear.

    Do you want quick and easy access to HealthStream product training, videos, and tools to do your job well? We’ve answered your call with the new HealthStream Community.

    Easy Access to HealthStream Technical and Support Documentation

    Community Support Documentation

    HealthStream Community has made it easier than ever to access product documentation on demand. For example, if you want the latest administrator guide for the new Jane product, simply navigate to the Jane page. You’ll find up-to-date guides, documentation, technical information, and product education to get the most out of your HealthStream purchase.

    In addition to easily finding information via intuitive navigation, the powerful Community search engine puts all available support material, discussions, questions and answers at your fingertips.

    The HealthStream Network Effect

    One of the many benefits of being a HealthStream customer is the ability to leverage our robust network. The HealthStream Community gives you direct access to other users of the same products and services.

    The Community is private and exclusive to HealthStream clients and is only accessible to those administering and supporting HealthStream products. Importantly, it allows you to ask your questions in a safe environment with users just like you.

    What Questions Can I Ask?

    You have many options! The HealthStream Community is available for you to ask questions about HealthStream products, healthcare industry trends and issues, and other topics that impact the important work you do.

    Examples:

    • How are other HealthStream administrators adapting their onboarding programs to accommodate social distancing?
    • How are others adapting the live training components of their Nurse Residency programs?
    • What is the best way to leverage Checklist for employee onboarding?

    Product Enhancements and Feedback

    HealthStream Community's System Enhancements

    Two of HealthStream’s core values are “Delighting Customers” and “Driving Innovation.” As a result, we are constantly looking for opportunities to improve your experience. You can suggest product enhancements and ideas in our new Ideas portal.

    Once your idea is submitted, we work behind the scenes to review, prioritize, and implement as many requests as we can while keeping you updated on their status.

    Evolving HealthStream Customer Support

    HealthStream Community's Evolving Support

     

    We know that your desire to access information is paramount. We’ve worked to evolve the HealthStream Customer Service model to give you on-demand access to the resources you need, as well as the ability to ask peers and HealthStream product experts your questions.

    We’re Always Here for You

    The HealthStream Customer Service team is still here for you. However, we know that you want additional resources to solve your problems, including quick access to information and the ability to connect with others for recommended practices and advice.

    We’ve answered your call and will continue to evolve our support as we grow together and focus on our mission to improve the quality of healthcare by developing the people that deliver care.

    Ready to Join the New HealthStream Community?

    HealthStream Community's Homepage

    Join the new HealthStream Community today!

     

  • Use JaneTM as a Personalized Nurse Advisor to Support Retention Improvement

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 09, 2020

    Few people who work in healthcare can be unaware of the significant challenge many organizations face with nurse retention, especially from the looming issue of nurse shortages. A previous HealthStream blog post shares that “While historically nursing shortages have been driven by a variety of factors, the current shortage actually resembles earlier ones in that it is partially driven by an increase in demand. An aging population and their increasing healthcare needs has led to an increase in demand that has well exceeded the nursing workforce. In addition, the historically female profession has had retention issues now that women have a greater variety of career options. Nurse-led efforts to improve opportunities, pay, and working conditions have led to improvements in retention and work-life balance; yet, demand for nurses continues to exceed supply, resulting in an increased focus on retention.”

    Standardized Assessment and Training Can Be a Nurse Retention Problem

    There are many occasions when a standardized approach to nurse orientation, assessment, and training fails to create a retention-friendly environment. For example, an experienced clinician may resent being assigned the same introduction to your organization and your approach to patient care that an inexperienced new graduate is also required to complete. At the same time, it is essential for new graduate nurses just starting their careers to get adequate orientation training. Otherwise, they may feel lost, accompanied by some degree of anxiety and even panic. What if you inadvertently lead these novice nurses to ultimately question their choice of a career? Organizations want to avoid investing significant time and resources getting new hires ready to care for patients just to have them quit from the stress and frustration of not feeling adequately prepared.

    JaneTM as a Tool for Improving Nurse Retention

    HealthStream has established the JaneTM system as a highly reliable, effective, and evidence-based method for the assessment and validation of clinical competency—with the ultimate goal of more targeted orientation, personalized developmental training, and individualized on-going maintenance of competency. A big contributor to nurse turnover is burnout, which nurses may experience due to the stress of an overwhelming workload or from feeling inadequately prepared for their jobs. Here are some of the ways JaneTM works as a personal nurse adviser to support nurse retention:

    • Personalized Development Plans

      Supporting a methodical approach to expanding the use of critical thinking in daily nursing practice, JaneTM connects to post-assessment development reflective plans that guide next steps in clinicians’ professional journeys.

    • Investment in Clinician Competency

      Healthcare organizations need to be certain staff members are competent and able to provide high quality care. Regular assessments are one way to ensure whether employees are qualified or need training to become so.

    • Investment in Well-trained Colleagues

      There’s no need to worry that colleagues are providing substandard care when Jane is used to regularly assess their competency and help them fill any knowledge gaps.

    • Support Lifelong Learning for Nursing Career Success

      In nursing the reliance on evidence-based practice means the standards for competent care are constantly changing and improving. For long-term career success, nursing professionals must engage in continuous training and education. Jane facilitates regular advancement, using individual assessments as a guide.

    • Assist Nurses to Change Their Career Focus and Switch Departments

    Sometimes the cure for burnout may be to change nursing environments, which also can change standard practices and require new training. JaneTM facilitates the competency assessment and training that may be necessary for those switching to a new clinical specialty, where different kinds of patients, treatments, and healthcare situations are involved.

    HealthStream’s jane™ is The World’s First Digital Mentor for Nurses. Jane harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, Jane was designed to power lifelong, professional growth of clinical professionals. JaneTM is an important component of HealthStream’s suite of clinical development solutions.

  • Working from Home: Support Credentialing Staff in a Remote Environment (Part 1)

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 08, 2020

    By Joe Morris, Writer, HealthStream

    This blog post is based off of an Industry Insight Webinar: Disaster and Telehealth Privileging During the COVID-19 National Emergency.

    The concept of working remotely, or working from home (WFH), has gained a great deal of attention in recent years. For some industry sectors, it makes sense because employees are based around the country, even the world, and so keeping office space would be cost-prohibitive. For others, WFH is seen as an essential part of a competitive incentives package, particularly for Millennial and Generation Z employees. And now, of course, WFH has become a reality for businesses of all types and sizes, including healthcare providers, say VerityStream’s Lisa Rothmuller, AVP for Consulting Services, and Kay Lynn Akers, Consulting Advisor.

    The Primary Importance of Technology

    So, how to make the most of a WFH situation? Start with technology, says Akers, who breaks it down into major categories:

    Computers. If your employees don’t have company-issued laptops, can they bring their desktop machines home? What restrictions are there for using a home computer? Is there a VPN network to enhance security for remote operations?

    Internet connection. Does a home office have the right speed for web and video conferencing? Is the home network and router configuration properly password protected?

    Telephones. According to the CDC, only 43 percent of American households had a landline as of the end of 2018. Will employees use company issued or personal cell phones, web-calling programs or some other communication method?

    Printers. In medical staff offices, there could be sensitive, personal health information being received. So when allowing staff to work remotely, printing documents must be very clearly communicated. So, if your organization is not paperless yet, this should also be considered.

    Peripherals. Don’t forget things like pens, notepads, cables, mice, mouse pads, headphones, monitors and all the other things found in the regular office workspace.

    Program access. Do employees need VPN to access network files, programs? Can you use One Drive or SharePoint or other solutions for centralized secure documents storage?

    Location, location, location

    Technical concerns aside, a WFH situation can also be greatly enhanced — or diminished — by the setup of the physical location.

    “The area you work in when remote affects how successful you may be,” Akers says. “Where will you be working in your home? You want to locate or identify a location which is comfortable, yet if possible separate from where others may be roaming about and causing interruptions.”

    And whether you're using a home office, a dining room table, kitchen table or office desk think about ergonomics, she notes, pointing out that “eight hours or more is sitting on the couch with a laptop is definitely not ergonomic.”

    Learn more about how VerityStream provides Credentialing, Privileging, Enrollment, and Evaluation for Health Systems and Health Plans.

  • How is the Healthcare Revenue Cycle Adapting to COVID-19?

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 05, 2020

    HealthStream regularly hosts in-person and virtual meetings among customers to encourage connections with one another and enhance the value of using our solutions. These meetings involve sharing best practices with one another, and often customers learn about industry issues and how HealthStream can help solve them. A recent virtual meeting of the Revenue Cycle Special Interest Group focused on how healthcare organizations are adapting to the demands and necessities of the COVID-19 Pandemic. HealthStream staff and customers were joined by Revenue Cycle solution experts from nThrive education. Below are three major trends in healthcare Revenue Cycle operations that our customer and partner experts covered during that session.

    Functional Transitions within Healthcare Revenue Cycle

    One effect of the COVID-19 Pandemic has been to alter the kinds of care many organizations are finding themselves providing to patients. With a greater focus on Emergency Department and inpatient care, the coding knowledge for these areas is in much higher demand. Healthcare providers need access to Revenue Cycle education that will assist their staff in roles that are needed now more than ever before. nThrive’s Transitions Program is an ideal solution for bringing staff up to speed for new roles. Individuals that need to switch responsibilities are offered a base knowledge assessment, and then are provided with a list of courses and practice opportunities as preparation for the new role. Readiness of every candidate to perform effectively is confirmed in a final assessment. This assessment allows organizations to respond to their altered patient and payor mix while ensuring Revenue Cycle functions are keeping up to date with how the pandemic is changing healthcare.

    Revenue Cycle Implications of the Burgeoning Use of Telehealth

    Major increases have occurred in the use of telemedicine and telehealth. This has come about from Medicare’s Section 1135 Waiver, which allows for covered home-based visits for telemedicine. The providers are not just physicians and nurse practitioners—they include psychologists, therapists, and licensed clinical social workers. The root of telehealth’s rise lies in the reluctance of patients to visit healthcare facilities due to COVID-19 infection fears. Many people are now using this option for short check-ins and regular e-visits, which are now paid at the same rate as in-person visits. After Medicare’s approval, some other payors are following suit.

    Another Revenue Cycle issue for telehealth involves audits. Though they are not currently being done, there’s no reason to think this will permanently be the case. Coding problems may occur if the provider is a nurse or physician assistant. It is extremely important during every telehealth visit to get consent from the patient and communicate that the session involves a charge.

    Patient Access Needs Have Increased for Emergency Departments

    As Emergency Departments have become the center of activity during the COVID-19 Pandemic, many organizations need to shift patient access employees to that environment. With the drop off in elective surgeries, hospitals have had to shift staff to those areas with a greater need. However, there are special considerations for patient identification that apply in the emergency care setting. Whereas typical registration may involve as many as 17 data points, that in the ED may be limited to as few as three when patient safety is an overriding concern. Imagine the potential for patient misidentification and duplicate medical records as the visit starts with drive-through testing from an automobile. The good news is that registration can be completed from the bedside, once a patient is safe and stable. For patient access training to prepare staff for the ED, distance learning and competency assessments are available from nThrive. One of the customers in this meeting offered that her organization started every new Patient Access employee in the ED, as a “trial by fire.” Another offered that her organization cross-trained patient access staff across many care environments for staffing flexibility as patient volumes fluctuated.

    Revenue Cycle Solutions from HealthStream

    All staff with Patient Access must perform effectively to ensure the success of the revenue cycle in its entirety. With the shift toward high-deductible health plans and the growth in newly insured individuals, Patient Access is faced with communicating and collecting increasingly larger amounts for which patients are financially responsible. In addition to patient communications, these employees must fully understand insurance plans, coordination of benefits, medical necessity, ABNS, and the importance of the demographic and insurance information they collect and record. nThrive Education provides Patient Access employees with the necessary training to help ensure that patients understand their financial obligations and payment options. This information, when communicated properly, increases payment collection and reduces days of AR.

    PLEASE NOTE: The information in this blog post was considered current at the time of its publishing, 06/05/20. However, the COVID-19 pandemic is an ever-evolving disaster due to new findings, data, and availability of resources. Please refer to the CDC website for the latest detailed information when you need it.

  • COVID-19 and the Complexities of Telehealth Privileging (Part 2)

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 04, 2020

    By Joe Morris, Writer, HealthStream

    This blog post is based off of an Industry Insight Webinar: Disaster and Telehealth Privileging During the COVID-19 National Emergency.

    Telehealth gains prominence as restrictions are loosened

    Another major shift in care delivery has been the skyrocketing use of existing telehealth operations and deployment of new or expanded ones. Already seen as an efficient, cost-effective way to enhance care, telehealth now can be close the physical gap between providers and patients who may be nearby but cannot leave home.

    The National Emergency declaration provides some good news.

    HIPAA guidelines have been relaxed for this national emergency.  HHS has announced that it will exercise “enforcement discretion” and will not impose penalties for noncompliance with regulatory requirements during the “good faith provision of telehealth” services during the COVID-19 national emergency.

    Telehealth regulations around billing for Medicare for Medicare services to Medicare patients have been waived under Section 1135 of the Social Security Act, and the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 provided for $500 million in telehealth reimbursements.

    The challenge will be not just to stand up a telehealth service, but also explore how changed and relaxed rules affect service delivery — and who can provide services, another element of a changed credentialing and licensure landscape.

    “The telemedicine regulations are state specific,” says Todd Sagin, President and National Medical Director, Sagin HealthCare Consulting. “They vary a great deal. Common practice is a provider must be licensed in the state where that patient resides. CMS has waived this requirement for Medicare patients and many states have waived it for Medicaid patients and in numerous states this requirement has been waived for all patients.”

    “There is a definite need for a certain tolerance for uncertainty in this time,” he says, noting that all the issues and concerns are not being addressed at the same time as people struggle to quickly cope with this crisis. But to refer to an old adage, now’s the time to document, document, document.

    “If you're going to take latitude and liberties in this time of crisis, keep some documentation on what you are doing,” he advises “If you are authorizing someone to provide telemedicine services, make sure you capture the dates and the circumstances. If you're granting temporary privileges, make sure you document what you're doing as you would with any grant of temporary privileges. As long as you can indicate that you've taken a specific action with intent in order to accommodate the exigencies of this crisis, you'll be in a much better position afterward if anybody asks what the justification was for the actions you took.”

    Learn more about how VerityStream provides Credentialing, Privileging, Enrollment, and Evaluation for Health Systems and Health Plans.

  • New and Transformational Healthcare Technology Continues to Be Introduced

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 03, 2020

    As in recent years, technology promises to transform more areas of healthcare, in both the near and more distant future. A 2019 Forbes article offers multiple examples where great changes and advances are expected.

    Robotics

    A starting point is robotics, whose potential extends far beyond the application for surgery, which is already well-known. Tremendous growth is expected in the use of robotics for healthcare, from a telepresence in rural areas where doctors are scarce and for the transport of medical supplies within an organization to disinfecting hospital rooms, to helping patients with rehabilitation and micro-bots involving specific patient therapies.

    Wearables

    Another example, the wearable device, has potential uses that go far beyond the fitness tracking and counting steps that we all know. Wearables can be put into service to monitor heart rhythm, ECG, blood pressure, temperature, etc.

    Genomic Medicine

    Technology is driving the rise of genomic medicine, where a person’s genomic info is used to determine personalized treatment plans and clinical care. Computer analysis of genes and gene mutations will facilitate personalized medical treatment for such situations as organ transplant rejection, cystic fibrosis, and especially cancer.

    3D Printing

    Some of the uses that healthcare will find for 3D printing will include patient-specific practice organs to be used by surgeons, on-demand device and tool manufacturing, customized prostheses, and transplantable tissues and organs.

    VR/AR

    Look for enormous growth in virtual and augmented reality for healthcare—Forbes estimates its market will be $5.1 billion by 2025. Not only is this technology extremely beneficial for training and surgery simulation, but it’s also playing an important part in patient care and treatment, from treating patients with visual impairment, depression, cancer, and autism, to an augmented reality environment that supports healthcare practitioners during brain surgery and reconnecting blood vessels.

    Digital Medicine

    Two other developments with promise are the development of digital twins to enable doctors to explore outcomes, as well as the 5G wireless network that will allow better data transfer, telemedicine advances, and remote monitoring, among many other benefits (Marr, 2019).

    References

    Marr, B., “The 9 Biggest Technology Trends That Will Transform Medicine And Healthcare In 2020,” November 1, 2019, Forbes, Retrieved at https:// www.forbes.com/sites/bernardmarr/2019/11/01/the-9-biggest-technology-trends-that-will-transform-medicine-and-healthcare-in-2020/#38771a4d72cd.

     

    This blog post is an excerpt from the longer HealthStream article, Trends That Will Shape the Next Decade in Healthcare. Focused on the people providing healthcare, HealthStream is committed to helping customers address and solve big problems in our industry. From hospitals to long-term care and across the care continuum, there are challenges stemming from demographic changes, governmental mandates, and the need for higher care quality. Download the webinar, Ten Healthcare Trends for 2020, where Robin Rose, Vice President, Healthcare Resources Group, HealthStream discusses this information in detail. HealthStream is dedicated to improving patient outcomes through the development of healthcare organizations' greatest asset: their people. Learn more about our healthcare workforce development solutions.

  • New & Transformational Healthcare Tech Keeps Being Introduced

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 03, 2020

    As in recent years, technology promises to transform more areas of healthcare, in both the near and more distant future. A 2019 Forbes article offers multiple examples where great changes and advances are expected.

    Robotics

    A starting point is robotics, whose potential extends far beyond the application for surgery, which is already well-known. Tremendous growth is expected in the use of robotics for healthcare, from a telepresence in rural areas where doctors are scarce and for the transport of medical supplies within an organization to disinfecting hospital rooms, to helping patients with rehabilitation and micro-bots involving specific patient therapies.

    Wearables

    Another example, the wearable device, has potential uses that go far beyond the fitness tracking and counting steps that we all know. Wearables can be put into service to monitor heart rhythm, ECG, blood pressure, temperature, etc.

    Genomic Medicine

    Technology is driving the rise of genomic medicine, where a person’s genomic info is used to determine personalized treatment plans and clinical care. Computer analysis of genes and gene mutations will facilitate personalized medical treatment for such situations as organ transplant rejection, cystic fibrosis, and especially cancer.

    3D Printing

    Some of the uses that healthcare will find for 3D printing will include patient-specific practice organs to be used by surgeons, on-demand device and tool manufacturing, customized prostheses, and transplantable tissues and organs.

    VR/AR

    Look for enormous growth in virtual and augmented reality for healthcare—Forbes estimates its market will be $5.1 billion by 2025. Not only is this technology extremely beneficial for training and surgery simulation, but it’s also playing an important part in patient care and treatment, from treating patients with visual impairment, depression, cancer, and autism, to an augmented reality environment that supports healthcare practitioners during brain surgery and reconnecting blood vessels.

    Digital Medicine

    Two other developments with promise are the development of digital twins to enable doctors to explore outcomes, as well as the 5G wireless network that will allow better data transfer, telemedicine advances, and remote monitoring, among many other benefits (Marr, 2019).

    References

    Marr, B., “The 9 Biggest Technology Trends That Will Transform Medicine And Healthcare In 2020,” November 1, 2019, Forbes, Retrieved at https:// www.forbes.com/sites/bernardmarr/2019/11/01/the-9-biggest-technology-trends-that-will-transform-medicine-and-healthcare-in-2020/#38771a4d72cd.

     

    This blog post is an excerpt from the longer HealthStream article, Trends That Will Shape the Next Decade in Healthcare. Focused on the people providing healthcare, HealthStream is committed to helping customers address and solve big problems in our industry. From hospitals to long-term care and across the care continuum, there are challenges stemming from demographic changes, governmental mandates, and the need for higher care quality. Download the webinar, Ten Healthcare Trends for 2020, where Robin Rose, Vice President, Healthcare Resources Group, HealthStream discusses this information in detail. HealthStream is dedicated to improving patient outcomes through the development of healthcare organizations' greatest asset: their people. Learn more about our healthcare workforce development solutions.

  • The Economic & Emotional Cost of Hospital Readmissions

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 02, 2020

    Hospital readmissions can indicate a breakdown in caregiving, whether in the act of transferring a patient from one care environment to another, or between and facility and home. In the efforts of CMS to control expenditures for care, readmissions are a target, because they involve a patient’s return to the most costly care possible, inpatient hospital care.

    Important Things to Know About Readmissions

    An earlier HealthStream blog post about readmissions shared the CMS readmission definition as someone who has been readmitted to the same or another acute care facility within 30 days of an initial hospital stay. CMS has focused its efforts on reducing readmissions multiple common conditions linked to a large majority of preventable readmissions. The same post offered that in 2015 one in five elderly patients was readmitted to the hospital within 30 days of discharge, costing Medicare some $15 billion per year. Some of the things we know about readmissions include:

    • Hospitals that staff for manageable nurse workloads have lower levels of readmissions
    • Readmissions have a negative impact on revenue, due to penalties charged by CMS and other payers.
    • Hospitals in the highest quartile for quality typically have lower readmission rates.
    • HealthStream shared in an earlier post that hospitals caring for the neediest patients are likely to pay readmission penalties.
    • As mentioned in a previous HealthStream blog post, end of life planning has a tremendous impact on readmissions.

    How to Improve Readmissions

    There are definitely things hospitals can do to improve their readmissions. Here are some of things listed in a previous HealthStream post:

    • Focus on plans for discharge as soon as the patient is admitted and have everything in place before the patient leaves the hospital.
    • Practice effective good communication all around. The healthcare team must work together to address all patients’ post-discharge needs.
    • Ensure the pharmacy can provide any unusual medications needed upon discharge.
    • Facilitate prompt discharge follow-up with the primary care physician and other post-acute organizations involved.
    • Use data analysis to determine patients most at risk of readmissions, due to social determinants of health or their specific health conditions.
    • Optimize care transitions to prevent communication breakdowns that can occur during discharge planning and early recovery.
    • Improve patient engagement and education so that patients and families understand their responsibilities and role in the recovery process.

    The Financial Impact of Readmissions

    The cost of hospital readmissions is enormous, estimated to be in the vicinity of $26 billion annually (Wilson, 2019), so it’s no wonder Medicare is working to reduce this amount. According to the Advisory Board, “In FY 2019, 82% of hospitals in the program received readmissions penalties. While research shows national readmission rates have fallen since the program took effect, some experts note that HRRP does not count ED visits or observation stays as readmissions, and question whether readmissions actually decreased or if hospitals are avoiding admitting Medicare patients” (Advisory Board, 2019). The same article suggests that hospitals may have changed their tactics, leading to a sizeable increase in treat-and-discharge visits to the ED or observation stays, which do not count as readmissions. A study of more than three million hospital stays from 2012 to 2015 “found that the total number of 30-day return visits to the hospital—which included ED visits and observation stays—per 100,000 discharges increased by 23 visits per month” (Advisory Board, 2019), even as official readmissions decreased by 23 visits per month. This unintended consequence, of using ED visits and observation status stays, may be shifting more financial obligations to patients or at least preventing hospitals from being penalized to the same degree.

    The Emotional Cost of Hospital Readmissions

    When it comes to the emotional toll of readmissions, it is important to understand how rarely patients and direct caregivers have been asked about the process. One study showed that patients often felt that their readmissions were preventable and linked them to issues with “discharge timing, follow-up, home health and skilled services” (Smeraglio et al., 2019). It’s not hard to imagine the frustration that could be the result of this perceived failure. At the same time, the care providers involved failed to recognize their potential role in the readmission. The same article mentions that “review by a RN case manager found in 49% of readmissions the hospital system had some amount of opportunity to improve the discharge process. The RN case managers more often agreed with the patient’s perspective of readmission than the provider’s” (Smeraglio et al., 2019). Here again, the emotional toll of a care workplace with inadequate support and high patient volumes might cause some of the problems in discharge planning, care transitions, and patient education.

    References

    Advisory Board, “Hospitals are avoiding admitting Medicare patients to dodge financial penalties, study suggests,” advisory.com, September 5, 2019, Retrieved at https://www.advisory.com/daily-briefing/2019/09/05/readmissions.
    Smeraglio, A., Heidenreich, P. A., Krishnan, G., Hopkins, J., Chen, J., & Shieh, L. (2019). “Patient vs provider perspectives of 30-day hospital readmissions.” BMJ open quality, 8(1), e000264. https://doi.org/10.1136/bmjoq-2017-000264
    Wilson, L., “MA patients' readmission rates higher than traditional Medicare, study finds,” HealthcareDive, June 26, 2019, Retrieved at https://www.healthcaredive.com/news/ma-patients-readmission-rates-higher-than-traditional-medicare-study-find/557694/.

     

    Education can play a role in helping clinicians improve readmission rates for their organizations. There’s a good reason why HealthStream’s workforce education solutions are already trusted by more than 70 percent of healthcare organizations in the U.S. HealthStream’s comprehensive suite of learning and competency management tools empowers your people to deliver the best care more easily and effectively than ever before. Powered by the industry’s top content providers, HealthStream's Learning & Performance solutions connect you to healthcare’s largest learning community with a learning management system customized by you to meet your organization’s unique needs.

  • The Economic & Emotional Cost of Hospital Readmissions | HealthStream

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 02, 2020

    Hospital readmissions can indicate a breakdown in caregiving, whether in the act of transferring a patient from one care environment to another, or between and facility and home. In the efforts of CMS (Centers for Medicare & Medicaid Services) to control expenditures for care, readmissions are a target, because they involve a patient’s return to the most costly care possible, inpatient hospital care.

    Important Things to Know About Readmissions

    An earlier HealthStream blog post about readmissions shared the CMS readmission definition as someone who has been readmitted to the same or another acute care facility within 30 days of an initial hospital stay. CMS has focused its efforts on reducing readmissions multiple common conditions linked to a large majority of preventable readmissions. The same post offered that in 2015 one in five elderly patients was readmitted to the hospital within 30 days of discharge, costing Medicare some $15 billion per year. Some of the things we know about readmissions include:

    • Hospitals that staff for manageable nurse workloads have lower levels of readmissions
    • Readmissions have a negative impact on revenue, due to penalties charged by CMS and other payers.
    • Hospitals in the highest quartile for quality typically have lower readmission rates.
    • HealthStream shared in an earlier post that hospitals caring for the neediest patients are likely to pay readmission penalties.
    • As mentioned in a previous HealthStream blog post, end of life planning has a tremendous impact on readmissions.

    How to Improve Readmissions

    There are definitely things hospitals can do to improve their readmissions. Here are some of things listed in a previous HealthStream post:

    • Focus on plans for discharge as soon as the patient is admitted and have everything in place before the patient leaves the hospital.
    • Practice effective good communication all around. The healthcare team must work together to address all patients’ post-discharge needs.
    • Ensure the pharmacy can provide any unusual medications needed upon discharge.
    • Facilitate prompt discharge follow-up with the primary care physician and other post-acute organizations involved.
    • Use data analysis to determine patients most at risk of readmissions, due to social determinants of health or their specific health conditions.
    • Optimize care transitions to prevent communication breakdowns that can occur during discharge planning and early recovery.
    • Improve patient engagement and education so that patients and families understand their responsibilities and role in the recovery process.

    The Financial Impact of Readmissions

    The cost of hospital readmissions is enormous, estimated to be in the vicinity of $26 billion annually (Wilson, 2019), so it’s no wonder Medicare is working to reduce this amount. According to the Advisory Board, “In FY 2019, 82% of hospitals in the program received readmissions penalties. While research shows national readmission rates have fallen since the program took effect, some experts note that HRRP does not count ED visits or observation stays as readmissions, and question whether readmissions actually decreased or if hospitals are avoiding admitting Medicare patients” (Advisory Board, 2019). The same article suggests that hospitals may have changed their tactics, leading to a sizeable increase in treat-and-discharge visits to the ED or observation stays, which do not count as readmissions. A study of more than three million hospital stays from 2012 to 2015 “found that the total number of 30-day return visits to the hospital—which included ED visits and observation stays—per 100,000 discharges increased by 23 visits per month” (Advisory Board, 2019), even as official readmissions decreased by 23 visits per month. This unintended consequence, of using ED visits and observation status stays, may be shifting more financial obligations to patients or at least preventing hospitals from being penalized to the same degree.

    The Emotional Cost of Hospital Readmissions

    When it comes to the emotional toll of readmissions, it is important to understand how rarely patients and direct caregivers have been asked about the process. One study showed that patients often felt that their readmissions were preventable and linked them to issues with “discharge timing, follow-up, home health and skilled services” (Smeraglio et al., 2019). It’s not hard to imagine the frustration that could be the result of this perceived failure. At the same time, the care providers involved failed to recognize their potential role in the readmission. The same article mentions that “review by a RN case manager found in 49% of readmissions the hospital system had some amount of opportunity to improve the discharge process. The RN case managers more often agreed with the patient’s perspective of readmission than the provider’s” (Smeraglio et al., 2019). Here again, the emotional toll of a care workplace with inadequate support and high patient volumes might cause some of the problems in discharge planning, care transitions, and patient education.

    References

    Advisory Board, “Hospitals are avoiding admitting Medicare patients to dodge financial penalties, study suggests,” advisory.com, September 5, 2019, Retrieved at https://www.advisory.com/daily-briefing/2019/09/05/readmissions.
    Smeraglio, A., Heidenreich, P. A., Krishnan, G., Hopkins, J., Chen, J., & Shieh, L. (2019). “Patient vs provider perspectives of 30-day hospital readmissions.” BMJ open quality, 8(1), e000264. https://doi.org/10.1136/bmjoq-2017-000264
    Wilson, L., “MA patients' readmission rates higher than traditional Medicare, study finds,” HealthcareDive, June 26, 2019, Retrieved at https://www.healthcaredive.com/news/ma-patients-readmission-rates-higher-than-traditional-medicare-study-find/557694/.

     

    Education can play a role in helping clinicians improve readmission rates for their organizations. There’s a good reason why HealthStream’s workforce education solutions are already trusted by more than 70 percent of healthcare organizations in the U.S. HealthStream’s comprehensive suite of learning and competency management tools empowers your people to deliver the best care more easily and effectively than ever before. Powered by the industry’s top content providers, HealthStream's Learning & Performance solutions connect you to healthcare’s largest learning community with a learning management system customized by you to meet your organization’s unique needs.

  • The Value of Learning with Video - Experience HealthStream’s COVID-19 Channel

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Jun 01, 2020

    The COVID-19 pandemic has made it more obvious than ever that healthcare organizations need to adopt video as a learning option for employees. In response to this, we have created a free access Channel platform for video learning as a resource for healthcare workers. This Channel offers a collection of curated videos from HealthStream, partners, and several trusted sources on YouTube, such as the CDC and Mayo Clinic. The channel is best suited for healthcare facilities who want to get information to their employees quickly, without the necessity to create assignments and track completions. Users can simply browse and keyword search videos on a wide range of COVID-19 related topics. It’s available 24/7 on demand to anyone for free, and no login is required. 

     

    Three Video Content Tabs

    Content on the COVID-19 Channel is divided into three tabs, allowing viewers to browse and watch what is most relevant to their needs. They are:

    1. COVID-19
    2. The COVID-19 tab is an area of curated videos specifically for healthcare workers. The sub-categories are sequenced in a general order of events for new and returning employees. Starting with on-boarding and resources, viewers can browse or search videos for common tasks and skills such as proper donning and doffing of PPE, and correct operation of common devices, such as monitors and ventilators. The last areas cover information about two determinations of patient disposition—Admit and Self-Quarantine. In these areas, you can browse or search videos ranging from patient care in acute settings to homebound patient education and telehealth.

    3. Health
    4. The Health tab contains videos ranging from the basics or essentials of COVID-19 to a deeper dive into various specific comorbidities associated with care. Under the Health tab, you’ll also find videos covering more general academic information related to pandemic epidemiology and public policy.

    5. New Normal
    6. The New Normal tab is for everyone. In this area, you can explore the basics of social distancing, making masks, coping with quarantine, and working virtually. It contains tips for preventing infection, staying well with a good diet, as well as mental and physical exercise.

    Video Is Important for Education and Learning

    In addition to the obvious benefits video presents for learning during a time like now, when in-person training is not possible, it has long-term advantages for organizations who regularly use and require employee education as a strategic necessity. HealthStream’s video partner Kaltura offers some key points about the benefits of learning by video:

    • Training can be delivered remotely, all over the world, to wherever employees are.
    • Learning visually allows for deeper understanding and retention of information.
    • Learners typically find video-based learning more engaging.
    • Video makes it easier for learners to connect the consequences of their training to possible results.
    • Advanced video tools offer even greater possibilities for learning in the future.

    The Value of Virtual Classrooms

    A virtual classroom has flexibility for training that goes beyond just playing a video or providing access to a talking presenter. It can contain multiple communication options, including chat, cloud-based video hosting, and multiple presenters. A virtual classroom is also amenable to content in multiple formats, from Word, Excel, and PowerPoint documents to a wide variety of graphics, all of which can be white boarded. In addition, you can draw, annotate, add text, and highlight as needed. The options for interactivity are powerful. Watch or read the case study about using a virtual classroom.

    HealthStream Video

    With powerful authoring, a deep library of searchable assets, feature-rich video tools, and centralized publishing with sharing and built-in tracking, HealthStream’s Content Authoring & Video Tools make designing rich learning experiences for your organization intuitive and easy. HealthStream Content Authoring & Video Tools unlock the power of fully customized online learning and video content to help develop the leaders of tomorrow.

  • How To Cut Emergency Room Wait Times

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 29, 2020

    Many organizations know that to improve patient experience, they need to work to reduce Emergency Room wait times. Average emergency room wait times are too long. Everyone has heard horror stories about showing up at an ER and being part of a large crowd waiting to be seen. Invariably, these events occur on a weekend, which certainly adds to the problem. According to KevinMD.com, “emergency department wait times reflect poor planning and weak leadership, not fluctuating patient demand. It’s no coincidence that ED delays and other ER wait time issues are most pronounced on nights and weekends. That’s when patient demand is at its highest and it is also the least desirable time for ED doctors to work” (Pearl, 2018).

    Guided by Triage Practices

    The traditional model of ED care involves triage, where a nurse assesses the severity of a patient problem and the patient is assigned a priority status for being seen. It emerged as a battlefield treatment strategy when “it was impossible to supply enough physicians to meet every soldier’s medical needs. Doctors, therefore, had to sort and prioritize patients by the severity of their injuries” (Pearl, 2018).

    It leaves patients with low priority care needs waiting until times when the volume of care decreases and all more emergent cases have been dealt with. Before the COVID-19 pandemic upended the normal functioning of many ED’s, “patients [would often] spend an average of two hours in the typical emergency department, according to the Centers for Disease Control and Prevention (CDC)” (Pearl, 2018). The reality is that negative ER experiences like this don’t have to happen, and we really know some of the solutions that can be put in place to improve most visits to the ER. Some of them include:

    Match Staff Numbers to Expected Demand – Higher demand occurs at night and on weekends, for multiple reasons. This is something that every healthcare organization expects. But, doctors and nurses don’t want to work nights and weekends, so the department is relatively understaffed at times when it needs the opposite.

    Ensure Nurses Are Providing Direct Patient Care – When nurses and doctors are all providing direct patient care, organizations can bolster the how may healthcare professionals are providing treatment. Shunting less emergent patients to lower-cost support staff is another way to free up RNs to handle greater acuity patients.

    Staff Physicians Differently – rather than just ED physicians, include “family medical practitioners and internists whose training adequately prepares them for the definitive treatment of non-life-threatening illnesses. This approach enables EDs to increase staffing without increasing budget, and it makes more physicians available to see patients as soon as they arrive” (Pearl, 2018).

    Tie Wait Times to Payments – Another way to inspire productive change is to link ER experiences to what is paid for them. According to the Harvard Business Review, “hospitals’ waiting times should be measured (as they are) and benchmarked against the national (risk-adjusted) average waiting time of patients with similar conditions. Hospitals that exhibit shorter waiting times than the average should be financially rewarded, while underperforming hospitals should be penalized” (Savva & Tezcan, 2019).

    Clearly, the ER experience in much of the U.S. leaves much to be desired for most people who encounter it. Eventually, we will have moved past the current pandemic situation that has changed going to the ER for everyone, afflicted with COVID-19 or not. This is a great time to rethink much of how we’ve grown accustomed to practicing and receiving healthcare. Too many people have settled for the emergency room wait time issues that are not automatic, nor a cost of providing good care. The ER experience has long been ripe for the restructure that needs to happen now.

    References

    Pearl, R., “3 ways to decrease emergency department wait times,” KevinMD.com, August 28, 2018, Retrieved at https://www.kevinmd.com/blog/2018/08/3-ways-to-decrease-emergency-department-wait-times.html.
    Savva, N., and Tezcan, T., “To Reduce Emergency Room Wait Times, Tie Them to Payments,” Harvard Business Review, February 6, 2019, Retrieved at https://hbr.org/2019/02/to-reduce-emergency-room-wait-times-tie-them-to-payments.

    Learning & Performance Exclusively for the Healthcare Workforce

    There’s a good reason why HealthStream’s workforce education solutions are already trusted by more than 70 percent of healthcare organizations in the U.S. HealthStream’s comprehensive suite of learning and competency management tools empowers your people to deliver the best care more easily and effectively than ever before. Powered by the industry’s top content providers, HealthStream's Learning & Performance solutions connect you to healthcare’s largest learning community with a learning management system customized by you to meet your organization’s unique needs. Learn more about our solutions focused on the Emergency Department.

  • COVID-19 and the Complexities of Telehealth Privileging (Part 1)

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 28, 2020

    This blog post is based off of an Industry Insight Webinar: Disaster and Telehealth Privileging During the COVID-19 National Emergency.

    The COVID-19 Pandemic Is Changing Everything

    When it comes to licensing and credentialing physicians and other healthcare professionals, there are clear guidelines, and most people involved like it that way. Now, however, the COVID-19 pandemic has upended everything in healthcare from basic services delivery to the credentialing and licensure process, says Vicki Searcy, Vice President, Consulting Services, at VerityStream.

    “It’s hard for people that work in the credentialing profession,” Searcy adds. “A lot of us don't like gray areas. We like things to be very defined and we are in a time right now where we are in some gray areas.”

    For instance, the very real issue of getting providers into the field, where their expertise is desperately needed to care for rising numbers of patients. Given the numbers needed, onboarding these providers quickly would be a heavy lift. It has been made somewhat easier by the ground-breaking changes that have come as result of the National Emergency declaration on March 13:

    Certain requirements with regards to background checks and other kinds of requirements to vet providers to enroll them in Medicare also were waived. There are two types of these “blanket” waivers:

    Provider Locations. CMS has waived requirements that out-of-state providers be licensed in the state where they are providing services when they are licensed in another state.

    Enrollment in Medicare. CMS is allowing new non-certified Part B suppliers, physicians, and non-physician providers to expeditiously obtain temporary Medicare billing privileges. CMS is also waiving certain application fees, criminal background checks, and site visits with respect to provider enrollment.

    Understanding new uses of existing terminology

    One result of the COVID-19 pandemic is that well-known healthcare terminology is being readapted:

    Licensure is someone's ability to be able to provide certain services, and the ability to grant that licensure is controlled by states.

    Emergency privileges are privileges that are commonly defined in medical staff bylaws and are granted to an institution. There may be additional policies related to emergency privileges, and often provisions for emergency privileges are on a privilege form so that when a provider requests privileges, there is an acknowledgement that in case of emergency he or she can do whatever is needed to save the patient.

    Disaster or temporary privileges are defined by the Joint Commission and are granted during some type of a declared disaster when an organization puts in place its emergency plans and can be granted to individuals.

    Telehealth and telemedicine privileging, which are in a state of change now because states and the government are trying to make it easier for telemedicine privileges to be exercised.

    “There are many concrete examples of what all this looks like, with more happening every day”, says Todd Sagin, President and National Medical Director, Sagin HealthCare Consulting.

    “In Texas, the medical board has said that retired physicians, if they have not been retired for more than two years, can return immediately to active status during this disaster,” Sagin says. “On their website, they list the requirements and exemptions that they're going to make available to facilitate the return of retired physicians. They address out of state physicians and indicate they'll be allowed to obtain a limited emergency license which will last no more than 30 days unless they extend the authority. They have set up fast-tracking mechanisms to facilitate this, and they outline a variety of tools that they are going to require to make sure that these out-of-state physicians actually come with a degree of competence.”

    Learn more about how VerityStream provides Credentialing, Privileging, Enrollment, and Evaluation for Health Systems and Health Plans.

  • What Does a Home Health Care Nurse Do?

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 27, 2020

    As the U.S. population ages and the proportion of older Americans increases in size, the demand for healthcare is expected to grow significantly. Not only are we going to see a need for clinicians in greater numbers, but we are especially going to see the demand increase in areas of healthcare that can have a positive impact on the overall cost of care. Home healthcare, when used in a coordinated effort to keep patients out of the hospital and compliant with treatment regimens, plays an important part in reducing hospital stays and costly readmissions. Home health care nurses play a vital role in the patient care continuum and in compliance with care regimens that ensure better outcomes.

    The Education and Licensure Requirements for Home Health Care Nursing

    Home health nursing is one of the many career options available within the nursing profession. It is a choice for registered nurses (RNs), licensed practical nurses (LPNs), and nurse assistants (NAs). The educational requirements for a home health nurse are dependent on the following nursing certifications:

    • RNs complete an accredited nursing program and obtain an associate’s degree in nursing (AND) or a Bachelor of Science in Nursing (BSN). They also must pass the NCLEX exam to get a license.
    • LPNs complete an accredited nursing program and test for licensure.
    • NAs are unlicensed but can obtain certification.

    Understanding What Home Health Care Nurses Do

    Home care nurses provide home-based care for patients, typically in the form of follow-up treatment post-discharge from a hospital or other medical care environment. By not being facility-based, home care nurses get to be self-directed and practice efficient time management. They often interact with patients’ families in the course of patient care, so that their clinical proficiency needs to be matched with strong communication skills and comfort with a breadth of cultures and lifestyles. Home health care can be physically demanding and require lifting, turning, or moving patients who need the assistance.

    The specific duties of a home health care nurse are largely linked to their credentials and the kinds of care their credentials allow them to provide. Here are some examples:

    • Registered nurses:
      • Medication administration, including intravenous infusions
      • Wound care/ dressing changes
      • Taking vital signs
      • Performing head-to-toe physical assessments
      • Drawing labs
      • Assisting with activities of daily living (ADLs) such as bathing, toileting, grooming
      • Assisting with mobility
      • Developing a plan of care with the physician
    • Licensed Vocational Nurses perform the following duties:
      • Medication administration, excluding intravenous infusions
      • Wound care/ dressing changes
      • Taking vital signs
      • Reporting to the supervising RN any concerns the patient may have
      • Assisting with ADLs
      • Assisting with mobility
    • Nurse Assistants perform the following duties:
      • Taking vital signs
      • Report to the supervising RN any concerns the patient may have
      • Assisting with ADLs
      • Assisting with mobility (registered nursing.org, n.d.)

    Why to Become a Home Health Care Nurse

    Many people want to become nurses without necessarily desirous of working in a hospital environment. Here are some of the reasons home healthcare might be the right career choice for them:

    • More Career Flexibility – Traditional hospital nursing, based on shifts and an often grueling pace, has a strict structure that does not work for everyone. Imagine instead a day of driving to patients’ homes in succession, lots of conversations and problem-solving with each visit. Nurses looking to leave a hospital setting may be especially attracted to this option.
    • Greater Independence – A non-traditional setting like home health care nursing involves more critical thinking and the potential for innovation. If there’s not a doctor nearby, a nurse is more on his or her own to assess the home environment and context.
    • Rewarding Patient Relationships – When a family allows a home health care nurse into the home, there’s a potential for stronger care relationships. These can last for a significant time duration and have a greater impact on patient well-being.
    • Greater Impact – Home health care nurses care for the whole person, in a home environment. This is becoming an even more important and transformative factor in patients’ quality of life, especially for vulnerable populations.

    references

    nursing.jnj.com, “Five Reasons to Consider a Career as a Home Health Nurse,” June 14, 2017, Retrieved at https://nursing.jnj.com/nursing-news-events/five-reasons-to-consider-a-career-as-a-home-health-nurse.
    registerednursing.org, “What Is a Home Health Nurse?,” n.d., Retrieved at https://www.registerednursing.org/specialty/home-health-nurse/.

    HealthStream’s jane™ is the World’s First Digital Mentor for Nurses. Jane harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, Jane was designed to power lifelong, professional growth of clinical professionals. Learn about HealthStream’s Suite of Clinical Development solutions for nurses.

  • What Does a Home Health Care Nurse Do?

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 27, 2020

    As the U.S. population ages and the proportion of older Americans increases in size, the demand for healthcare is expected to grow significantly. Not only are we going to see a need for clinicians in greater numbers, but we are especially going to see the demand increase in areas of healthcare that can have a positive impact on the overall cost of care. Home healthcare, when used in a coordinated effort to keep patients out of the hospital and compliant with treatment regimens, plays an important part in reducing hospital stays and costly readmissions. Home health care nurses play a vital role in the patient care continuum and in compliance with care regimens that ensure better outcomes.

    The Education and Licensure Requirements for Home Health Care Nursing

    Home health nursing is one of the many career options available within the nursing profession. It is a choice for registered nurses (RNs), licensed practical nurses (LPNs), and nurse assistants (NAs). The educational requirements for a home health nurse are dependent on the following nursing certifications:

    • RNs complete an accredited nursing program and obtain an associate’s degree in nursing (AND) or a Bachelor of Science in Nursing (BSN). They also must pass the NCLEX exam to get a license.
    • LPNs complete an accredited nursing program and test for licensure.
    • NAs are unlicensed but can obtain certification.

    Understanding What Home Health Care Nurses Do

    Home care nurses provide home-based care for patients, typically in the form of follow-up treatment post-discharge from a hospital or other medical care environment. By not being facility-based, home care nurses get to be self-directed and practice efficient time management. They often interact with patients’ families in the course of patient care, so that their clinical proficiency needs to be matched with strong communication skills and comfort with a breadth of cultures and lifestyles. Home health care can be physically demanding and require lifting, turning, or moving patients who need the assistance.

    The specific duties of a home health care nurse are largely linked to their credentials and the kinds of care their credentials allow them to provide. Here are some examples:

    • Registered nurses:
      • Medication administration, including intravenous infusions
      • Wound care/ dressing changes
      • Taking vital signs
      • Performing head-to-toe physical assessments
      • Drawing labs
      • Assisting with activities of daily living (ADLs) such as bathing, toileting, grooming
      • Assisting with mobility
      • Developing a plan of care with the physician
    • Licensed Vocational Nurses perform the following duties:
      • Medication administration, excluding intravenous infusions
      • Wound care/ dressing changes
      • Taking vital signs
      • Reporting to the supervising RN any concerns the patient may have
      • Assisting with ADLs
      • Assisting with mobility
    • Nurse Assistants perform the following duties:
      • Taking vital signs
      • Report to the supervising RN any concerns the patient may have
      • Assisting with ADLs
      • Assisting with mobility (registered nursing.org, n.d.)

    Why to Become a Home Health Care Nurse

    Many people want to become nurses without necessarily desirous of working in a hospital environment. Here are some of the reasons home healthcare might be the right career choice for them:

    • More Career Flexibility – Traditional hospital nursing, based on shifts and an often grueling pace, has a strict structure that does not work for everyone. Imagine instead a day of driving to patients’ homes in succession, lots of conversations and problem-solving with each visit. Nurses looking to leave a hospital setting may be especially attracted to this option.
    • Greater Independence – A non-traditional setting like home health care nursing involves more critical thinking and the potential for innovation. If there’s not a doctor nearby, a nurse is more on his or her own to assess the home environment and context.
    • Rewarding Patient Relationships – When a family allows a home health care nurse into the home, there’s a potential for stronger care relationships. These can last for a significant time duration and have a greater impact on patient well-being.
    • Greater Impact – Home health care nurses care for the whole person, in a home environment. This is becoming an even more important and transformative factor in patients’ quality of life, especially for vulnerable populations.

    references

    nursing.jnj.com, “Five Reasons to Consider a Career as a Home Health Nurse,” June 14, 2017, Retrieved at https://nursing.jnj.com/nursing-news-events/five-reasons-to-consider-a-career-as-a-home-health-nurse.
    registerednursing.org, “What Is a Home Health Nurse?,” n.d., Retrieved at https://www.registerednursing.org/specialty/home-health-nurse/.

    HealthStream’s jane™ is the World’s First Digital Mentor for Nurses. Jane harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, Jane was designed to power lifelong, professional growth of clinical professionals. Learn about HealthStream’s Suite of Clinical Development solutions for nurses.

  • New Healthcare Roles Are Emerging to Meet Changing Care Needs

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 25, 2020

    As medicine evolves, new types of doctors and nurses are emerging to meet our system’s changing needs. In some cases, these clinicians are in new specialties that didn’t exist until recently, and demand for some of these physicians is already high. The Association of American Medical Colleges (2019) identified these five new physician specialties that match where healthcare is headed:

    • Cancer immunologist - This doctor will be adept at harnessing a patient’s individual immune system to fight cancer while avoiding or treating immune system overreactions and treatment-triggered diseases.
    • Nocturnist - Increasingly medically complex patients need the care continuity of doctors who practice hospital medicine primarily at night, a key addition to the level of safety and service offered.
    • Lifestyle medicine physician - 80% of healthcare costs are connected to care for chronic diseases, and 80% of chronic disease is related to lifestyle choice. A lifestyle medicine specialist oversees a patient’s food choices, exercise, sleep, stress levels, and ability to connect with others, whether in a primary care environment, lifestyle medicine clinic, or residential care facility. Demand to sit for this certification examis exploding.
    • Clinical informatics – This specialist collects and analyzes patients’ health information and applies those insights to improve patient health. Growth in this area is related to provisions of the Affordable Care Act (ACA) and the proliferation of electronic health records (EHRs). The goal is to use the volumes of medical data now being generated to make better clinical decisions and guide research efforts.
    • Medical Virtualist – This physician provides telehealth services, a sector of healthcare delivery that is expected to rise 30% each year between 2017 and 2022. Early uses include second-opinion consults, as well as telepsychiatry and telestroke services. Health systems are just beginning to add telehealth to their service mix, for primary care triage, specialty consults, and virtual rounding. The ability to create a successful telehealth experience for patients will be a key competency for this specialty (AAMC, 2019).

    In a complementary development, nursing roles that are emerging include care coordinators, virtual care nurses, legal nurse consultants, nurse researchers, forensic nurses, and a full array of nursing roles related to informatics and the outcome-focused use of healthcare data.

    References

    AAMC, “Five emerging medical specialties you’ve never heard of — until now,” Association of American Medical Colleges, N.D., Retrieved at https:// www.aamc.org/news-insights/five-emerging-medical-specialties-you-ve-never-heard-until-now.

    This blog post is an excerpt from the longer HealthStream article, Trends That Will Shape the Next Decade in Healthcare. Focused on the people providing healthcare, HealthStream is committed to helping customers address and solve big problems in our industry. From hospitals to long-term care and across the care continuum, there are challenges stemming from demographic changes, governmental mandates, and the need for higher care quality. Download the webinar, Ten Healthcare Trends for 2020, where Robin Rose, Vice President, Healthcare Resources Group, HealthStream discusses this information in detail. HealthStream is dedicated to improving patient outcomes through the development of healthcare organizations' greatest asset: their people. Learn more about our healthcare workforce development solutions.

  • How to Get and Give the Most from Hourly Rounding

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 22, 2020

    Hourly rounding is the process of intentionally checking on patients on a very regular basis, as a means of addressing patient needs, as well as improving their safety and overall care experience. The rationale for what has been relatively standard practice since the mid-1970s is “When patients are unable to comprehend nursing workflow and cannot predict when a nurse will be available for physical and emotional assistance, they worry that no one will be available to respond to immediate needs (i.e., they experience “help uncertainty”), anxiety levels rise, and inappropriate coping mechanisms may come into play (e.g., getting up to go to the bathroom alone shortly after receiving a pain medication). By taking the initiative to address basic needs such as use of the bathroom (“potty”), positioning, pain control, and proximity of personal items using a structured format, nurses can decrease patient anxiety and minimize help uncertainty” (Mitchell et al, 2014).

    Improving Hourly Rounding

    Whereas purposeful rounding was a mechanical process in its early days, typically relying on rigid requirements and a strict set of questions, nurses have recently become more practical and flexible in achieving it. A Cleveland Clinic article discusses efforts to improve the process, offering that “utilizing data and anecdotal evidence from caregivers, med-surg nurses began to consider what hourly rounding should look like and how to remove barriers. ‘No matter what, every single hour, 24 hours a day, someone should be rounding,’ says [Nurse Manager Katie] Galvan. ‘That doesn’t mean we’re going to use the same language, ask the same questions or wake people up. Nurses now are empowered to round using the ‘observe vs. ask’ guidelines’” (Cleveland Clinic, 2018). The process was able to incorporate patient circumstances more effectively and get past some of the barriers that had prevented effective rounding in the past.

    One Size of Hourly Rounding Does NOT Fit All

    Despite its intention, hourly rounding may not always achieve its goals. A King’s College London study found that hourly rounding may unintentionally “focus on completion of the rounding documentation rather than on the relational aspects of care delivery” (Townsend, 2019). Here are some situations where intentional rounding can be customized to the patient condition and preferences:

    1. Use digital notes with access to real-time information so that subsequent rounders can stay abreast of patient condition and concerns. Nothing destroys the patient experience faster than having to repeat what’s going on to a new clinician.
    2. Patients who are asleep should be allowed to continue resting. Sleep is very important for healing. A rounding nurse may simply observe the quality of the sleep with disturbing the patient.
    3. In some cases a patient may appreciate conversational banter during hourly rounding. The clinician should tailor interactions and engagement to what patients prefer. Even non-verbal interactions can occur in a way that expresses warmth and caring.

    Learn more from the HealthStream blog post, Five Guidelines for Purposeful Rounding in Healthcare.

    References

    Cleveland Clinic, “Finding the Way to Purposeful Hourly Rounding: Continuous Improvement project breaks down barriers,” clevelandclinic.org, May 25, 2018, Retrieved at https://consultqd.clevelandclinic.org/finding-the-way-to-purposeful-hourly-rounding/.
    Mitchell, M., et al, “Hourly Rounding to Improve Nursing Responsiveness: A Systematic Review (Abstract),” Journal of Nursing Administration, 2014 September 44 (9): 462-472. Retrieved at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547690/.
    Townsend, L., “Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients,” NursingNotes, 09/10/19, Retrieved at https://nursingnotes.co.uk/news/acute-care/hourly-rounding-may-nurses-deliver-carefinds-study/.
  • The Importance of Building Change Management Competence

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 21, 2020

    Naturally most of our focus on competency is on clinical and leadership competencies; however, given the rapid rate of change in healthcare, it also makes sense to ensure that your organization is competent in change itself. Prosci, an industry leader in change management, believes that all organizations need to be thoughtful about building and maintaining competency in change management. Prosci points to competitive advantages, a reduction in failed changes, the volume of upcoming changes, the value of consistent application, and building employees’ personal and professional competencies as benefits of change management competency. If your organization is struggling to keep up with change and has an uneven record of successful change implementation, perhaps it makes sense to evaluate organizational competence in change management itself.

    CONNECTING THE DOTS—CORE COMPETENCIES, TALENT DEVELOPMENT, AND PERFORMANCE APPRAISALS

    The Joint Commission establishes competency assessments and performance appraisals as two separate, but interrelated requirements. The standard defines the competency assessment as an evaluation of whether or not the clinical staff has the skills, knowledge, and ability to perform the assigned job duties. It also establishes that competency assessments are to be performed by staff who understand the skills and knowledge being assessed and recommends re-assessment at a minimum of once every two years after the initial assessment. Additionally, the performance evaluation looks at how well staff performs their job responsibilities and should also be performed at least once every two years.

    This blog post is the sixth in a series of excerpts from the HealthStream article, Maintaining Competency: Turning Concepts into Practice. Healthcare providers use the HealthStream Competency Center to Measure & Validate Competency. Doing so includes the ability to measure and benchmark behaviors or levels of competence in positions across the healthcare field through peer, preceptor, or manager appraisal, including methods of validation and evidence of achievement. Explore HealthStream clinical development solutions that ensure competency.

  • The ABCs of Credentialing & Life Support Certifications

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 20, 2020
    HealthStream regularly publishes guest blog posts like the one below from Kay Lynn Akers, CPCS; Advisor Consultant; VerityStream. This post is based on a webinar presented by Vicki Searcy, Vice President of Consulting Services, and Wendy Crimp, Senior Consultant.

    Credentialing professionals need to know about establishing and maintaining requirements for basic life support. It is an important patient safety concern that health care staff and physicians can recognize and immediately respond to an emergency.

    The Alphabet Soup of Credentialing Acronyms

    There’s a whole alphabet soup of certifications and sometimes a lack of clarity on which each represents. We’ve all heard of BLS, ACLS and PALS most likely but there is NRP, NALS, ATLS, CoSTR and PEARS. As Vicky Searcy pointed out “It really behooves us to understand what they mean so we can use them appropriately in our policies, procedures and other requirements.”

    Traditionally organizations required all clinical and medical staff be certified in BLS and then targeted providers for certifications in ACLS, PALS or NPR and ATLS. This provided a level of comfort that providers were appropriately certified.

    Even though a provider has certification, proficiency is a concern if they don’t have the opportunity to practice their skills.

    The emergence of Code Blue Teams that responded to housewide codes 24/7, team members did have the opportunity to perform ACLS functions on a daily basis. According to Wendy Crimp “a new paradigm… emerged with the code blue team having the ACLS or PALS certification … the general clinical and medical staff are BLS certified and then you have ACLS requirements or advanced life support credentials of some sort for specific privileges.”

    The field of resuscitation science has definitive evidence-based protocols. ILCOR (International Liaison Committee on Resuscitation) is the international group that issues the guidelines. Two certifying bodies that follow these are the American Red Cross and the American Heart Association. Searcy stated “If you choose either one of those or both of those, you can be assured that your people in your organization are going to have appropriate certification.”

    American Red Cross offers many types of basic life support, not only for medical professionals but also for the community. In the hospital setting, the three most relevant certifications are basic life support, advanced life support and pediatric advanced life support.

    American Heart Association also offers options for both the community and health care providers. In addition to the three listed for American Red Cross they offer the PEARS (Pediatric Emergency Assessment, Recognition and Stabilization) course.

    Verifying Life Support Certifications

    If you require life support certifications either as a privilege criteria, policy or bylaws, it’s important to verify the impacted providers attain and maintain it. Per Crimp consider the benefits and downside when selecting the options for verification timeframes. Is it important to target all your management systems to enforcing expiration or is it more important that the certificants review skills and recertify every two years?

    In summary, key recommendations are to:

    1. Don’t unnecessarily limit the organizations from which providers can obtain certification.
    2. Determine what providers must be certified and the type of certification they must hold.
    3. Determine timeframes for validation of certification.
    4. Determine the method of validation (submission of a card or confirmation via integration with the certifying organization.

    Learn more about how VerityStream provides Credentialing, Privileging, Enrollment, and Evaluation for Health Systems and Health Plans.

  • What Is Cultural Competence in Healthcare?

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 19, 2020

    Now more than ever, healthcare professionals and everyone supporting them in the industry need to work to break down any barriers to care.  No one should receive substandard care due to conditions or situation beyond their control that can be addressed to ensure better outcomes. One way many organizations are making an effort to meet more patients’ needs is to focus on cultural competence.

    According to Health Affairs, “Cultural competence in health care is not merely a box to check. Rather, it is a foundational element of providing high-quality health care and a bedrock for meeting the needs of an increasingly diverse population of patients. Cultural competence becomes effective when those working for health care providers and health systems—from the sanitation staff to the chief medical officer—systematically consider how to integrate it into their approach in delivering care and their interactions with patients” (Chiu, 2019).

    What Is Cultural Competence in Healthcare?

    To understand cultural competence, a healthcare provider needs to pay attention to how culture can have an impact on experiences with the healthcare system. For example, cultural details varying among patients “can include a range of factors such as ethnicity, language, religion, gender identity, sexual orientation, age or peer group, geography, and other sociological characteristics. Cultural competence involves being conscious of one’s own biases and how that may affect how you interact with or provide care to others and understanding where differences may arise in the health care system related to culture so that those can be addressed during the provision of care for better patient experiences and health outcomes” (George Mason University [GMU] School of Nursing, 2019).

    Cultural competence needs to start at the beginning of any encounter with healthcare. For example, a realistic solution is “to prepare registration personnel with a script or form to help identify those patients who may need additional explanation of how the process works or how many bills they can expect to receive” (GMU, 2019).

    National Standards for Culturally Competent Care

    To demonstrate the national importance of encouraging a culturally competent approach in healthcare, “THE U.S. Department of Health and Human Services had developed guidelines for providing culturally competent care. The National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (The National CLAS Standards) aim to improve health care quality and advance health equity by establishing a framework for organizations to serve the nation's increasingly diverse communities” (HHS, 2018). Learn about implementing them.

    The Benefits of Cultural Competence for Healthcare

    A MedCity News article from 2019 discusses a Health Research & Educational Trust study showing that “Culturally competent care benefits the organization, patients, and the community, according to Health Research & Educational Trust. ‘Organizations that are culturally competent have improved health outcomes, increased respect and mutual understanding from patients, and increased participation from the local community,’ the report said (MedCity News, 2019).

    The article goes on to outline three significant benefits of becoming a culturally competent healthcare organization. They are:

    Business benefits that include “enhancing the efficiency of care services, increasing the market share of the organization, decreasing barriers that slow progress, helping to meet legal and regulatory guidelines, and incorporating different perspectives, ideas, and strategies into the decision-making progress.”

    Health benefits that include reducing care disparities in patient population, enhancing preventive care, improving collection of patient data, and reducing the number of medical errors, treatments, and medical visits.”

    Social benefits that “include increasing trust, promoting community member inclusion, involving the community in health issues, assisting patients and families in their care, promoting patient and family health responsibility, and increasing mutual respect and understanding for patients and the organization” (MedCity News, 2019).

    References

    Chiu, H., “Cultural Competence Is Key To Meeting Patients' Needs: One Perspective From New York City,” Health Affairs, September 19, 2019, Retrieved at https://www.healthaffairs.org/do/10.1377/hblog20190917.271436/full/.

    George Mason University School of Nursing, “’Tell Me Your Story’: How to Provide Health Care in a Culturally Diverse Environment,” November 18, 2019, Retrieved at https://nursing.gmu.edu/news/581596.

    HHS, “The National CLAS Standards,” 10/2/2018, Retrieved at https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53.

    MedCity News, “The Need for Cultural Competence in Healthcare,” September 4, 2019, Retrieved at https://medcitynews.com/?sponsored_content=the-need-for-cultural-competence-in-healthcare
  • Nurse Retention: Where Are We Now & Strategies for Moving Forward

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 18, 2020

    If you work in healthcare now you probably cannot remember a time when nurse retention was not an issue. Nurse retention statistics identifying the problem can be found as early as the mid-1930s; reports re-emerged in the 1960s and persist today. So, where are we now and what are the strategies that might improve nurse retention statistics, drive nurse recruitment, and lead to long-term solutions?

    By the Numbers

    While historically nursing shortages have been driven by a variety of factors, the current shortage actually resembles earlier ones in that it is partially driven by an increase in demand. An aging population and their increasing healthcare needs has led to an increase in demand that has well exceeded the nursing workforce. In addition, the historically female profession has had retention issues now that women have a greater variety of career options. Nurse-led efforts to improve opportunities, pay, and working conditions have led to improvements in retention and work-life balance; yet, demand for nurses continues to exceed supply resulting in an increased focus on retention.

    The Bureau of Labor Statistics Occupational Handbook provides some insight into the current situation and makes some estimates about what the future of the profession might look like. Their most recent report estimates that in 2018 there were approximately three million nursing jobs in the US. They also projected a growth rate of 12% in the expected number of jobs between 2018 and 2028. This projection means that nursing is growing at a much faster rate than the national average. The Bureau also predicts an additional 203,700 nurses will be needed each year through the year 2028 in order to fully staff newly-created nursing positions and those created by a very high number of retiring nurses. Some reports estimate that as many as 1 million nurses will retire by 2030 creating an even larger gap between supply and demand. To see the full report, click here: https://www.bls.gov/ooh/healthcare/registered-nurses.htm

    We Need More Nurses Than Ever

    If the Bureau’s prediction that an additional 203,700 nurses will be needed for each of the next 7 years is accurate, where will those nurses come from? Nursing school enrollment was slightly up in 2018 (3.7%), but according to a recent study conducted by the American Association of Colleges of Nursing, more than 75,000 qualified applicants were turned away from nursing programs. Nursing programs are also impacted by nurse retention issues and have cited insufficient faculty, a lack of clinical sites, classroom space and preceptors as contributing factors to their limitations.

    Nationwide nursing turnover is at about 15.9%, however; there are some nursing specialties that exceed that number. Nurses in behavioral health, step-down units, emergency departments, critical care and med-surg units all exceed the national average making these

    areas particularly vulnerable to shortages. It is encouraging to note that nurse practitioners and allied health professionals have turnover rates that are somewhat lower than that of hospital nurses.

    Strategies to Close the Gap on Nurse Retention

    So what nurse retention strategies might work to help improve retention and alleviate shortages? Universities and healthcare providers are getting creative in their attempts to manage these issues.

    • Stay connected to what matters to nurses to improve retention.
      • Culture matters – So, create a culture where nurses can provide the kind of care that they want to deliver. Nurses want to work in an environment that supports goals of safety and quality.
      • Self-governance matters -- It is an essential piece of obtaining Magnet status and a real model of self-governance can make a substantial contribution to the kind of culture that can make positive contributions to retention.
      • o Professional development matters -- Ensure that development programs help nurses take steps toward fulfilling their professional goals.
    • Creative, New Strategic Partnerships – The University of Minnesota and the Minnesota VA Healthcare System formed a partnership which will enable the university to expand enrollment in their BSN program while also expanding the number of clinical slots in the healthcare system. The program is a win for aspiring nurses, patients and the two healthcare organizations.
    • Remove Financial Barriers to Entry to Nursing School – the University of Wisconsin’s, Nurses for Wisconsin initiative provides fellowships and loan forgiveness for future nurse faculty provided that they agree to teach after graduation.
    • Be Proactive in Eliminating Nurse Burnout – The University of Iowa’s nurse residency program provides a structured learning environment where nurses learn strategies to help them cope with death and dying along with self-care strategies that are taught alongside their clinical skills.

    Career development is one important way to encourage nurse retention. HealthStream’s jane™ is the World’s First Digital Mentor for Nurses. Jane harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, Jane was designed to power lifelong, professional growth of clinical professionals. Learn about HealthStream’s Suite of Clinical Development solutions for nurses.

  • Artificial Intelligence Will Transform Healthcare

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 15, 2020

    Artificial intelligence (AI) research and application within medicine is growing rapidly. In 2016, healthcare AI projects attracted more investment than AI projects within any other sector of the global economy. According to the British Journal of General Practice (2018), investment banking giant Morgan Stanley estimates that the global market for AI in healthcare could surge from $1.3 billion today to $10 billion by 2024, growing at an annual compound rate of 40% (Buch et al, 2018).

    Harvard University tells us why—advances in computational power paired with massive amounts of data generated in healthcare systems make many clinical problems ripe for AI applications. In Forbes, Accenture reports that the ten most promising AI applications for healthcare, led by robot-assisted surgery, virtual nursing assistants, and administrative workflow assistance, could create up to $150 billion in annual savings for U.S. healthcare by 2026.

    Just a few examples show that AI-informed healthcare can significantly improve outcomes, from outperforming physicians’ ability to detect cancer (Harvard, 2019) and increasing the time that doctors can spend with patients to screening medications for effectiveness against the Ebola virus (Amisha, 2019).

    References

    Amisha et al, “Overview of artificial intelligence in medicine,” Journal of Family Medicine and Primary Care, 2019 Jul; 8(7): 2328–2331, Retrieved at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691444/.

    Buch, V., Ahmed, I., and Maruthappu, M., “Artificial intelligence in medicine: current trends and future possibilities,” British Journal of General Practice 2018; 68 (668): 143-144, Retrieved at https://bjgp.org/content/68/668/143.

    This blog post is an excerpt from the longer HealthStream article, Trends That Will Shape the Next Decade in Healthcare. Focused on the people providing healthcare, HealthStream is committed to helping customers address and solve big problems in our industry. From hospitals to long-term care and across the care continuum, there are challenges stemming from demographic changes, governmental mandates, and the need for higher care quality. Download the webinar, Ten Healthcare Trends for 2020, where Robin Rose, Vice President, Healthcare Resources Group, HealthStream discusses this information in detail. HealthStream is dedicated to improving patient outcomes through the development of healthcare organizations' greatest asset: their people. Learn more about our healthcare workforce development solutions.

  • New Tools for Achieving High Quality CPR | HealthStream

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 14, 2020

    Balancing the education and certification requirements for CPR against the need for education that is compliant, includes the latest science, and is streamlined and efficient can be a challenge for healthcare educators. The American Red Cross’s new curriculum may help educators meet this challenge.

    What is New?

    In 2015 the American Heart Association (AHA) issued major new guidelines for CPR and CPR training that was aimed at increasing survival rates for sudden cardiac events and changed how providers are trained, specifically the frequency of that training. In 2015, new evidence that showed relatively rapid deterioration of the skills associated with CPR (within 6-12 months) caused the AHA to issue recommendations for more frequent, continuous training.

    In 2019 additional guidance was given by the AHA. The 2019 updates addressed training recommendations aimed at including the best equipment for training. The new recommendation is for training equipment that provides student feedback that is:

    • Provided in real-time
    • Audible, voice-directed
    • Specific to the student and training exercise

    The AHAs research showed that the feedback provided by training devices with these features helps students better understand what is meant by high-quality CPR.

    What Is High-Quality CPR?

    High-quality CPR includes the following components.

    • Chest compression fraction (CCF) ˃80%
    • Compression rate of 100-120 compressions per minute
    • Compression depth of 2 inches in adults and a minimum of one-third of the anterior-posterior chest dimension in infants and children
    • No excessive ventilation
    • Minimizing interruptions to CCF
    • Full chest recoil – no residual leaning

    How Do Organizations Prepare Staff to Deliver High-Quality CPR?

    Healthcare and emergency medical services providers need to be ready to provide high-quality CPR, so what can healthcare organizations do to help them remain in a state of readiness? The American Red Cross has developed a Resuscitation Education Suite that can help organizations satisfy CPR certification and licensing requirements. The program provides:

    • An online, adaptive learning component that allows the student to customize and possibly shorten their path to certification.
    • Videos and simulations featuring real physicians and nurses in hospital settings demonstrating the kinds of critical thinking and decision-making important to successful outcomes.
    • Content that can accessed from any device at any time allowing flexibility for busy providers.

    In addition, these materials are now ADA-compliant.

    The suite also provides increased training efficiency with its “Review and Challenge” option which allows students three training options. Students can:

    • Take the full course
    • Use the Review Option which allows providers who are renewing their certification to do a brief skills review before testing on those skills and proceeding to the in-person skills assessment
    • Lastly, for experienced providers, the Challenge Option allows an expedited path to certification by giving the student the option to proceed directly to testing. However, if the student does not pass the test, they must then take the full course.

    In addition, the suite helps focus learners on real-life situations, critical decision-making and team work to help further integrate this education into the real life practice of CPR.

    While guidance on what constitutes high-quality CPR may be regularly updated, there are practical and efficient options to help healthcare organizations to stay abreast of updated guidance and support staff with training that is efficient and current.

    Deliver Resuscitation Quality and Compliance within Budget

    When lives are at stake, can everyone on your staff respond quickly and competently to a resuscitation event? Many healthcare leaders are concerned that despite rising costs of training, resuscitation rates have not improved in the last decade.

    The American Red Cross Resuscitation Suite ™ for BLS, ALS and PALS empowers healthcare organizations to be in control of a customizable adaptive program, saving the organization money while participating in the next wave of resuscitation advancement.

  • Addressing Challenges in Medical Billing

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 13, 2020

    Whether it is a bill from a medical office practice, a freestanding surgery center, or a regular acute care hospital, there are some common medical billing issues that can impact revenue as well as patient perceptions of their experience. What are those issues and what is the best way to address them?

    Know the Most Common Medical Billing Issues

    There are four issues that have consistently remained problematic in medical billing. They are:

    1. Patient education -- Many of a patient’s medical expenses remain “invisible” to them. Healthcare pricing is typically a bit less than transparent, and patients (particularly those that are newly-insured) might assume that having insurance is all they need to completely cover costs associated with office and hospital visits. When Obamacare resulted in coverage for millions of people, many of them had high-deductible plans and did not understand that a significant medical event could leave them with up to $10,000 in medical bills for which they were responsible. A communication plan to help patients understand their financial responsibilities is an essential element in healthcare finance.

    2. Coding errors – These mistakes remain a significant issue even as hospitals have become more experienced in applying ICD-10 codes. Incorrect coding of a medical service will usually result in a denial of a claim. Frequent communication between clinicians and billing staff, along with regular medical billing training and education to update staff on coding requirements, are essential to eliminating these errors.

    Whether it is a bill from a medical office practice, a freestanding surgery center, or a regular acute care hospital, there are some common medical billing issues that can impact revenue as well as patient perceptions of their experience. What are those issues and what is the best way to address them?

    3. Incomplete Patient Information– Failing to capture relevant patient information is still a very common barrier to full and timely reimbursement. Scheduling and registration staff are essential to this effort. Medical billing training and education to help staff understand the information that they need to collect along with the importance of this information is essential.

    4. Manual Claims Processes – While many claims processes are now automated, there are still practices that rely on cumbersome and error-ridden manual processes and suffer the reimbursement consequences.

    Efficient Medical Billing Processes May or May Not Result in Improved Revenue Cycles

    Even if our processes to educate patients and bill them correctly work well, medical debt remains a significant issue for consumers. In fact, it is medical debt and not poor or

    irresponsible spending habits, which is the number one contributing factor in personal bankruptcies. So what is behind an increasing load of consumer medical debt?

    A higher number of insured patients may not necessarily result in an improved accounts receivable sheet. Some patients may be unaware that their insurance plan requires them to be responsible for up to 20% of their medical expenses and carries a deductible of up to $10,000 in some cases.

    Patients are delaying medical care. Financial concerns may play a part in a patient’s initial decision to delay medical care, but often does little to improve their financial situation as those delays can sometimes result in lengthier and costlier treatment. That more costly treatment can result in increasing medical debt for some consumers. Snowballing medical debt has far-reaching effects—bankruptcies and drained savings accounts can be the result of large or unexpected medical bills.

    Making Strides Towards Patient-Friendly Financial Communication

    The Healthcare Financial Management Association’s (HFMA) Patient Friendly Billing Project has the tools to help healthcare organizations work with patients towards a less-punishing process. The initiative is based on HFMA’s research showing that patients want financial information that is clear, concise, correct, and patient-friendly.

    In addition to establishing these parameters for patient financial communication, HFMA also has published best practices in patient financial communication with unique strategies to address financial communication for each healthcare setting. Medical billing training is essential for staff connecting with patients about financial matters.

    Because deductibles are likely to remain relatively large and insurance and healthcare expenses will also remain significant line-items in many household budgets, it will be important to embrace best practices in patient financial communication to keep patients informed, comfortable with their understanding of their financial responsibilities and to protect revenue cycles. It is also important to provide staff with regular training to address the need for accurate coding and full and accurate patient billing information.

    All staff with patient access must perform effectively to ensure the success of the revenue cycle in its entirety. With the shift toward high-deductible health plans and the growth in newly insured individuals, Patient Access is faced with communicating and collecting increasingly larger amounts for which patients are financially responsible. In addition to patient communications, these employees must fully understand insurance plans, coordination of benefits, medical necessity and ABNS, and the importance of the demographic and insurance information they collect and record. Learn about HealthStream solutions for training general Revenue Cycle and specific Patient Access staff.

  • Addressing Challenges in Medical Billing

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 13, 2020

    Whether it is a bill from a medical office practice, a freestanding surgery center, or a regular acute care hospital, there are some common medical billing issues that can impact revenue as well as patient perceptions of their experience. What are those issues and what is the best way to address them?

    Know the Most Common Medical Billing Issues

    There are four issues that have consistently remained problematic in medical billing. They are:

    1. Patient education -- Many of a patient’s medical expenses remain “invisible” to them. Healthcare pricing is typically a bit less than transparent, and patients (particularly those that are newly-insured) might assume that having insurance is all they need to completely cover costs associated with office and hospital visits. When Obamacare resulted in coverage for millions of people, many of them had high-deductible plans and did not understand that a significant medical event could leave them with up to $10,000 in medical bills for which they were responsible. A communication plan to help patients understand their financial responsibilities is an essential element in healthcare finance.

    2. Coding errors – These mistakes remain a significant issue even as hospitals have become more experienced in applying ICD-10 codes. Incorrect coding of a medical service will usually result in a denial of a claim. Frequent communication between clinicians and billing staff, along with regular medical billing training and education to update staff on coding requirements, are essential to eliminating these errors.

    Whether it is a bill from a medical office practice, a freestanding surgery center, or a regular acute care hospital, there are some common medical billing issues that can impact revenue as well as patient perceptions of their experience. What are those issues and what is the best way to address them?

    3. Incomplete Patient Information– Failing to capture relevant patient information is still a very common barrier to full and timely reimbursement. Scheduling and registration staff are essential to this effort. Medical billing training and education to help staff understand the information that they need to collect along with the importance of this information is essential.

    4. Manual Claims Processes – While many claims processes are now automated, there are still practices that rely on cumbersome and error-ridden manual processes and suffer the reimbursement consequences.

    Efficient Medical Billing Processes May or May Not Result in Improved Revenue Cycles

    Even if our processes to educate patients and bill them correctly work well, medical debt remains a significant issue for consumers. In fact, it is medical debt and not poor or

    irresponsible spending habits, which is the number one contributing factor in personal bankruptcies. So what is behind an increasing load of consumer medical debt?

    A higher number of insured patients may not necessarily result in an improved accounts receivable sheet. Some patients may be unaware that their insurance plan requires them to be responsible for up to 20% of their medical expenses and carries a deductible of up to $10,000 in some cases.

    Patients are delaying medical care. Financial concerns may play a part in a patient’s initial decision to delay medical care, but often does little to improve their financial situation as those delays can sometimes result in lengthier and costlier treatment. That more costly treatment can result in increasing medical debt for some consumers. Snowballing medical debt has far-reaching effects—bankruptcies and drained savings accounts can be the result of large or unexpected medical bills.

    Making Strides Towards Patient-Friendly Financial Communication

    The Healthcare Financial Management Association’s (HFMA) Patient Friendly Billing Project has the tools to help healthcare organizations work with patients towards a less-punishing process. The initiative is based on HFMA’s research showing that patients want financial information that is clear, concise, correct, and patient-friendly.

    In addition to establishing these parameters for patient financial communication, HFMA also has published best practices in patient financial communication with unique strategies to address financial communication for each healthcare setting. Medical billing training is essential for staff connecting with patients about financial matters.

    Because deductibles are likely to remain relatively large and insurance and healthcare expenses will also remain significant line-items in many household budgets, it will be important to embrace best practices in patient financial communication to keep patients informed, comfortable with their understanding of their financial responsibilities and to protect revenue cycles. It is also important to provide staff with regular training to address the need for accurate coding and full and accurate patient billing information.

    All staff with patient access must perform effectively to ensure the success of the revenue cycle in its entirety. With the shift toward high-deductible health plans and the growth in newly insured individuals, Patient Access is faced with communicating and collecting increasingly larger amounts for which patients are financially responsible. In addition to patient communications, these employees must fully understand insurance plans, coordination of benefits, medical necessity and ABNS, and the importance of the demographic and insurance information they collect and record. Learn about HealthStream solutions for training general Revenue Cycle and specific Patient Access staff.

  • Improving Communication in the Emergency Room

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 12, 2020

    While communication is extremely important in every healthcare environment, the Emergency Room stands out as one where communication success is critical, especially when saving lives can be a matter of quick decisions and responses within minutes or hours. An article in The Journal of Emergency Medicine observes that “Patient safety incidents are commonly observed in critical and high demanding care settings, including the emergency department. There is a need to understand what causes patient safety incidents in emergency departments and determine the implications for excellence in practice” (Amaniyan, 2019).

    Poor ED Communication Is a Problem for Providers and Patients

    When researching literature about patient safety incidents, the authors above found that poor ED communication played a significant role in unfortunate patient outcomes. Communication lapses on the part of healthcare providers were an identified problem. According to Amaniyan, “Inadequate and poor staff communication were stated as a well-recognized safety challenge that was even more evident in EDs. Problems with the transfer of medical information and orders were considered an important communication-based factor that impacted patient safety. For example, failing to communicate changes in vital signs to the attending physician was an important factor for staff-related communication incidents in EDs” (Amaniyan et al, 2019). In some case , treatment for patients was delayed due to communication failure at the time of handoff between shifts. Additionally, medication management issues such as wrong doses, incorrect medicines, delayed or missing doses, and miscalculations were also attributable to communication problems. Further challenges included lack of compliance with patient safety protocols, such as infection control, clerical or laboratory processes, and incomplete discharge instructions were emphasized in the literature (Amaniyan, 2019).

    ED Communication Improvement Strategies

    An article about improving ED outcomes focused significantly on the noise problem in emergency departments (Welch et al, 2015) and how it can inhibit successful communication. Some strategies to overcome it include:

    1. Reducing Ambient Noise – Successful ERs have used noise monitors to gauge their noise levels and then pursued strategies to reduce it, from changing out garbage can lids to lowering the decibel level of equipment alarms. When possible, some EDs use single person rooms, which have been found to be quieter. Extra sound absorbing materials may be used, and other noise sources are addressed as necessary.
    2. Use a Communication Scheme – Deliberate communication plans involve a hierarchy of communication. Limiting overhead paging is one option. An urgency-based communication plan can also be effective. Automated paging for consults also can contribute to better and more efficient communication.
    3. Understand Different Approaches to Communication based on roles -- Acknowledge the respective differing communication needs of physicians, nurses, and staff and tailor communication to them.
    4. Reduce the impact of fractured attention spans -- Limit interruptions wherever possible.

    Focus on ED Teambuilding to Promote Communication

    An article about improving ED Outcomes offers that “Provider organizations with great teams are more effective in improving quality and reducing costs. According to the Joint Commission, communication failure is one of the most-frequently identified root causes of reported sentinel events.” An important strategy to strengthen the ED team is to emphasize “teamwork and communication to create better experiences for patients and staff” (Sharma et al, 2017). In addition, it is a good idea to employ communication tools and methods to share important departmental information, as well as gather feedback from frontline staff. Consider implementing a daily interdisciplinary ED huddle, a worthwhile message of the week, and even creating a virtual suggestion box.

    References

    Amaniyan, S., et al, “Learning from Patient Safety Incidents in the Emergency Department: A Systematic Review,” The Journal of Emergency Medicine, 13 December 2019, Retrieved at https://www.sciencedirect.com/science/article/pii/S0736467919310121.

    Sharma, R., et al, “How One Urban Emergency Department Is Making Care Better,” American Association for Physician Leadership News, October 30, 2017, Retrieved at https://www.physicianleaders.org/news/field-report-how-an-urban-emergency-department-is-making-care-better.

    Welch, S., et al, “Strategies for Improving Communication in the Emergency Department: Mediums and Messages in a Noisy Environment,” The Joint Commission Journal on Quality and Patient Safety, June 2013, Retrieved at https://www.edbenchmarking.org/assets/docs/hottopics/welch%20communication%20and%20noise%20in%20%20%20%20the%20ed.pdf.

    HealthStream’s workforce education solutions are already trusted by more than 70 percent of healthcare organizations in the U.S. Our comprehensive suite of learning and competency management tools empowers your people to deliver the best care more easily and effectively than ever before. Powered by the industry’s top content providers, HealthStream's Learning & Performance solutions connect you to healthcare’s largest learning community with a learning management system customized by you to meet your organization’s unique needs.

  • How Nursing Informatics Benefits Quality Outcomes

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 11, 2020

    A recent HealthStream blog post, “What Is Nursing Informatics?,” includes the ANA definition that "Nursing informatics (NI) is the specialty that integrates nursing science with multiple information management and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice. NI supports nurses, consumers, patients, the interprofessional healthcare team, and other stakeholders in their decision-making in all roles and settings to achieve desired outcomes. This support, which ensures the benefits of nursing informatics are realized, is accomplished through the use of information structures, information processes, and information technology” (ANA, 2015).

    Connecting Nursing Informatics and Artificial Intelligence

    According to an article in The Online Journal of Nursing Informatics, “Artificial intelligence (AI) is a relatively new concept in healthcare, particularly in nursing practice.” (Carroll, 2018). An important area of AI for nursing is predictive analytics, which “allows nurses to discover previously unknown patterns in multiple sources of clinical and operational data that can guide better decision making. Through the use of predictive data, nurses can gain actionable insights that enable greater accuracy, timely, and appropriate interventions in a prescriptive way for both patient and nurses” (Carroll, 2018). Furthermore, “The difference is that AI, particularly predictive analytics, adds breadth and precision to decision making for healthier care experiences for those giving and receiving care” (Carroll, 2018).

    HealthStream’s JaneTM Uses AI to Ensure Competency in Nursing

    HealthStream has established the JaneTM system as a highly reliable, effective, and evidence-based method for the AI-based assessment and validation of clinical competency—with the ultimate goal of a more targeted orientation, personalized developmental training and on-going maintenance of competency. In addition to competency validation, Jane is a comprehensive system whose approach to ensuring the readiness and ability of your nursing staff can provide multiple benefits to healthcare organizations.

    Improved Quality Outcomes Resulting from Nurse Informatics

    The importance of nursing informatics is tied to the primacy of data in healthcare. Using the various electronic medical record systems that are now ubiquitous in healthcare for collecting health information across an organization, nurse informaticists are managing, interpreting, and communicating data with a primary purpose to improve the quality and outcomes of patient care. Here are some examples of the benefits of nursing informatics shared by Electronic Health Reporter:

    1. Better Documentation

    “Modern nursing care is driven by individual patient needs and history — information that is collected and organized in electronic patient records. By documenting a patient’s condition, and sharing that information electronically, nurses are able to more effectively manage care, and by extension, improve the quality of that care.”

    1. Fewer Medical Errors

    “Nurses are often on the front lines of ensuring that their patients are kept safe and preventing medication errors, misdiagnoses, falls, and other problems. Health informatics provides important data that can prevent these errors; for example, an electronic record can provide information about a possible dangerous medication interaction or allergy that might not otherwise be immediately apparent. Armed with data, nurses can make quick decisions that keep their patients safe.”

    1. Cost Savings

    “Medical errors cost nearly $40 billion every year, and many of those errors are preventable with informatics. Not only does information provide nurses with alerts to avoid errors, it also helps to automate certain tasks, both improving nurse productivity and preventing some of the costs associated with health care.”

    1. Improved Care Coordination

    “Nurses are often called upon to help coordinate the care of their patients. This often means relaying information from physicians, therapists, pharmacy, billing, and more, both during care and at discharge. Without all of the necessary information, patient care could suffer. Informatics improves the coordination of this information, allowing nurses to give their patients all of the information they need, improving both outcomes and the satisfaction with care” (Electronic Health Reporter, November 14, 2016).

    References

    ANA, “Nursing Informatics: Scope and Standards of Practice,” 2nd Edition, ANA 2015 as quoted at https://www.himss.org/what-nursing-informatics.

    Carroll, W. (July, 2018). Artificial Intelligence, Nurses and the Quadruple Aim. Online Journal of Nursing Informatics (OJNI), 22(2). Available at http://www.himss.org/ojni

    Electronic Health Reporter, “How Nurses Are Using Health Informatics to Improve Patient Care,” November 14, 2016, Retrieved at https://electronichealthreporter.com/nurses-using-health-informatics-improve-patient-care/.

    HealthStream’s jane™ is the World’s First Digital Mentor for Nurses. Jane harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, Jane was designed to power lifelong, professional growth of clinical professionals. Learn about HealthStream’s Suite of Clinical Development solutions for nurses.

  • Developing Leading Edge Knowledge Assessments for Healthcare Requires a Rigorous Process

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 08, 2020

    HealthStream offers current, clinically relevant, valid, and reliable knowledge assessments for healthcare employees. HealthStream’s assessments are based on best practices for test development, including meeting psychometric standards as well as federal directives outlined in the US Equal Employment Opportunity Commission’s Uniform Guidelines on Employee Selection Procedures.

    In brief, the Process involves:

    1. Conduct the Job Analysis

    HealthStream’s six-step process begins with a careful analysis of the most recent nationwide studies of the critical tasks, skills, and abilities required for a given health care specialty.

    1. Create the Test Blueprint

    HealthStream convenes a clinical team to create the Test Blueprint for our assessment. Using the role delineation study and data from the US Department of Labor, the team develops the test blueprint, which identifies the knowledge, skills, and abilities that are necessary for successful job performance in the clinical area that the test will assess.

    1. Develop the Items

    Using the role delineation study and data from the US Department of Labor, the team develops the test blueprint, which identifies the knowledge, skills, and abilities that are necessary for successful job performance in the clinical area that the test will assess.

    1. Review the Items

    HealthStream’s critical review ensures that each item measures a critical element of successful job performance and documents why the test taker’s knowledge of the correct answer is essential for successful job performance, all of which ensures compliance with EEOC UGESP guidelines.

    Example

    Which of the following is a symptom of severe preeclampsia?

    a. Edema of the feet and ankles

    b. Epigastric pain and/or impaired liver function

    c. Weight gain of one pound per week

    d. Early morning headache

    Validation analysis:

    a. The knowledge measured by this question is the recognition of symptoms of severe preeclampsia.

    b. This knowledge is important, because a Labor & Delivery nurse should recognize that epigastric pain in addition to hypertension and other specific symptoms indicate severe preeclampsia. This symptom indicates liver swelling and capsular stretch and may be considered as rationale for delivery of the baby. This symptom may also be accompanied by the elevation of serum liver enzymes.

    1. Test the Test Items

    To gather statistics on each test item, HealthStream deploys newly created (or updated) tests on the platforms of our validation partners and collects data from test takers nationwide over a 30-60 day period.

    1. Evaluate and Adjust

    HealthStream then conducts extensive statistical analyses to ensure that each item meets or exceeds psychometric standards.

    HealthStream's knowledge assessments help to show how to improve and measure healthcare staff competency across an entire healthcare organization. This blog post is taken from the HealthStream article, HealthStream Uses Rigorous Six-Step Process to Develop Leading Edge Knowledge Assessments.

  • How to Handle Employees When Improving Outcomes Requires New and Changing Duties for Staff

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 07, 2020

    Healthcare organizations are perpetually seeking out best practices for every aspect of clinical care and for management issues. Harvesting those best practices is a relatively simple process, but operationalizing those practices typically proves more elusive. While addressing new recommendations for the prevention of pressure ulcers, the Agency for Healthcare Research and Quality (AHRQ) identified some steps that can help organizations adapt to new and changing processes and build competency in those processes.

    Managing Change Requires a Strategic Focus

    AHRQ recommends developing strategies that will address how to manage change at the front line. Start by ensuring that staff understand their new roles and have the necessary tools and equipment to implement the change. Be sure that the educational efforts are clear on the reasons for the change to reduce staff resistance. Help employees connect the dots between the new and changing duties and the benefits for patients.

    AHRQ also recommends regular assessments to help the organization understand the issues associated with the new or changing practice and develop strategies that will better support competency.

    Structuring an Implementation Team

    When it is time to get started, be sure that your implementation team includes unit-level champions. They will have the most informed feedback for the implementation team and can serve as subject matter experts for front line staff. Also, do not overlook physicians. Hospitalists in particular may play a key role in the success of the implementation of new and changing processes and will bring a perspective to the implementation that may be difficult to get from any other source.

    Focus on Results

    Maintain your focus. Leadership support and an ongoing focus on results are important to long-term success. Standing agenda items should be used to ensure that performance on new initiatives remains on the leadership team’s radar screen. Focused leaders can also be ready to authorize resources for and remove barriers to competency.

    This blog post is the fifth in a series of excerpts from the HealthStream article, Maintaining Competency: Turning Concepts into Practice. Healthcare providers use the HealthStream Competency Center to Measure & Validate Competency. Doing so includes the ability to measure and benchmark behaviors or levels of competence in positions across the healthcare field through peer, preceptor, or manager appraisal, including methods of validation and evidence of achievement. Explore HealthStream clinical development solutions that ensure competency.

  • 11 Clinical Privileging Best Practices

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 06, 2020

    HealthStream regularly publishes guest blog posts like the one below from Vicki Searcy; Vice President, Consulting Services, VerityStream

    It is a great time to review best practices related to defining and formatting clinical privileges. Do you identify any gaps in how your organization handles privileging? If you do identify gaps, you should put a plan in place to address them!

    Privileges should be organized by specialty – not by medical staff organization departments.

    If privileges are organized by departments, it is likely it will lead to confusion about criteria, qualifications to apply for privileges, etc. An example is a privilege form that lists the specialties within a department of medicine. The form could include internal medicine and its subspecialties, but might also include dermatology, PM&R, and psychiatry. The last three mentioned specialties might be included in the medicine department, but the training required for each of these specialties is different from internal medicine and its subspecialties. Additionally, organizing privilege forms by departments often leads to voluminous forms, and providers who request privileges outside of their specialty.

    Privilege criteria should be objective so that it can be consistently and uniformly applied.

    Example: Applicant must have performed 6 " " procedures during the past 12 months. NOT: Applicant must have performed " " procedures during the recent past that is acceptable to the Credentials Committee.

    Criteria should address required education/training as well as clinical activity and outcomes when appropriate.

    To determine competency, the first question is: Did you do it? The second question is: How well did you do it?

    Privileges within a grouping should have the same criteria and require similar education/training, knowledge, skills and/or technique. A grouping should represent what the majority of the specialty in your organization actually does.

    Don’t include “breast procedures” in the general surgery core/primary privileges if, in your organization, there are general surgeons who ONLY perform breast procedures OR there are a number of general surgeons WHO DO NOT perform any breast procedures. Another example would be including spine surgery within the general orthopedic core privileges if there are orthopedic surgeons with advanced spine surgery training and they are the only ones who provide spine surgery services.

    Procedures that are included in a group should be listed like a laundry list, rather than in a large paragraph so that applicants as well as the organization can modify the group of privileges to the specific expertise of the applicant.

    CMS (Center for Medicare and Medicaid Services)—as well as The Joint Commission requires that core privileges are able to be modified. Traditionally, providers have been instructed to “cross out” privileges they don’t wish to request from a paragraph. That process does not work electronically.

    The organization should have well-defined policies and procedures in place that allows providers to request that new procedures/privileges/technology be added to privilege delineations.

    The old way was to allow a provider to write in a request for something new on his/her privilege form. Privileges should not be allowed to be requested until the organization determines that the privilege in question should be added to the scope of services for the organization and have developed criteria for what providers will be eligible to apply for the new privilege.

    Privileges should be defined in sufficient detail to allow monitoring of the exercise of privileges to assure that providers do not exceed the scope of privileges granted.

    Again, monitoring to assure that providers stay within the scope of what they have been granted is a CMS and accreditation requirement. Don’t list: Stomach procedures (not enough details).

    A plan for confirmation of competency of the full scope of privileges granted (i.e., FPPE – focused professional practice evaluation) should be implemented as soon as new privileges are granted to a provider.

    This means that the plan should be formulated as part of the granting of privileges. It also means that the organization can’t determine that “the first six cases” will be proctored – as the first six cases probably will not cover the full scope of privileges granted.

    Multi-facility or enterprise privilege delineations should be used when there are several hospitals in an immediate geographic area that report to the same board.

    This will reduce duplication of effort for physicians and assure that the same criteria are used for privileges. This should eliminate the possibility that a provider could be granted a privilege by one hospital and denied the same privilege by another hospital, both hospitals reporting to the same board.

    Have a plan for regular review and update of all privilege delineations in order to keep privilege forms current and relevant.

    Some privileges will require annual review – others that do not change much might be on a two-year schedule.

    Whenever possible, incorporate provision of telehealth services on the applicable specialty privilege forms instead of creating separate privilege forms for telehealth services.

    This will eliminate the proliferation of privilege forms for telehealth services and will make more sense to your providers.

    Learn more about how VerityStream provides Credentialing, Privileging, Enrollment, and Evaluation for Health Systems and Health Plans.

  • Provider Credentialing Is Going to Change Significantly

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 05, 2020

    With their constant attention on patient safety, Medical Services Professionals (MSPs) are taking on more complex roles as the healthcare industry continues to shift to value-based care from the traditional volume-based model. As the healthcare industry and its payers embrace the use of telehealth, especially for rural patients and small clinics, credentialing will play an important role in making this service finally viable.

    The National Association Medical Staff Services (NAMSS) says in its 2018 State of the Medical Services Profession Report that standardization, consolidation, and the increasing importance of quality metrics will redefine the role MSPs play in organizations in the coming years (Barajas, 2018). Electronic and software solutions for credentialing and related services are growing rapidly as the industry moves to digitize records and operations to support automation. The volume for credentialing functions is predicted to increase as more nurse practitioners (NPs) and physician assistants (PAs) begin working in a hospital environment

    This blog post is an excerpt from the longer HealthStream article, Trends That Will Shape the Next Decade in Healthcare. Focused on the people providing healthcare, HealthStream is committed to helping customers address and solve big problems in our industry. From hospitals to long-term care and across the care continuum, there are challenges stemming from demographic changes, governmental mandates, and the need for higher care quality. Download the webinar, Ten Healthcare Trends for 2020, where Robin Rose, Vice President, Healthcare Resources Group, HealthStream discusses this information in detail. HealthStream is dedicated to improving patient outcomes through the development of healthcare organizations' greatest asset: their people. Learn more about our healthcare workforce development solutions.

  • Balancing Workforce Efficiency in Healthcare with Patient Needs and Care

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 04, 2020

    There is tremendous room for improvement in how healthcare operates. Not only is the lack of workforce efficiency in healthcare a waste of resources that could be devoted to better care and helping more people, but sometimes it may even contribute to poor outcomes. According to Health Affairs, “approximately 30 percent [of what we spend on healthcare] can be attributed to wasteful or excess spending, including spending associated with unnecessary or inefficiently delivered services, excess administrative costs, prices that are too high, missed prevention opportunities, and fraud. Health care costs continue to increase faster than the GDP, impacting the budgets of federal, state, and city governments; employers; and individuals" (Pronovost et al, 2019).

    The same article examines other industries’ efforts to reduce costs, splitting their measures into one of two options—using fewer services or increasing productivity. Healthcare has “largely focused on using fewer services. On the one hand, this is appropriate because the industry overuses many services, and some are harmful. On the other hand, no other industry solved its cost problems by simply consuming less; they also improved productivity" (Pronovost et al, 2019).

    Addressing Productivity in Healthcare

    It is alarming that some technology adoptions in healthcare have actually led to declines in productivity. When they have occurred, small productivity gains may require care providers to work at a pace that is not sustainable. No healthcare organizations can afford an increased level of burnout among doctors and nurses, which is already something that is out of hand. Importantly, however, “Economic models suggest that if health care productivity could grow by 4 percent, we would solve the health care cost problem” (Pronovost et al, 2019).

    Suggestions for Making Healthcare Practices More Efficient

    Here are a few suggestions for making healthcare professionals and processes more efficient:

    • Manage the Last 10 Feet of the Supply Chain

    Hunting for supplies may take up to 20% of a nurse’s time. IT is time we came up with a solution for these activities that “add up to wasted time and unnecessary costs, induce safety risks to patients, and are disrespectful of nurses’ professionalism, contributing to dissatisfaction, burnout, and turnover” (Pronovost et al, 2019).

    • Convert Human Double Check of Medications to Electronic

    It is very important to verify dosage and administration involved with high-risk medications like narcotics or insulin. When done as recommended, a manual double check can take up an inordinate amount of nursing time. The solution is to adopt an “electronic double check [that] would be more effective and efficient than a human double check; it would reduce medication errors, avoid distraction errors in the second nurse, and result in labor savings” (Pronovost et al, 2019).

    • Eliminate False Alarms

    It is estimated that “On average, nurses answer a false alarm every 45 seconds from multiple devices used in support of patient care” (Pronovost et al, 2019). Devices need to be integrated into a single notification system so that time spent turning off an alarm doesn’t prevent responses when they need to occur.

    • Minimize Human Documentation

    Here’s where documentation requirements and EMRs have created more problems than they solve—"Clinicians spend up to half their time and several hours after work documenting in the EMR, contributing to physician burnout and its associated safety, productivity, and personal risks” (Pronovost et al, 2019). Automated documentation is needed badly.

    • Eliminate Human Labor Costs for Submitting and Processing a Claim

    The business side of healthcare, from all sides, is a significant source of extra, unnecessary cost. By some estimates, “Hospitals’ administrative costs—including costs for submitting and processing claims—account for 25 percent of total spending on hospital care. Insurers and employers also incur significant costs for processing claims” (Pronovost et al, 2019). Electronic submission, uniform data guidelines, and a shared platform are a way to support efficiency in healthcare to reduce costs and frustration while advancing quality.

    Every effort that improves efficiency in healthcare will create an opportunity to provide more and better care. Workforce efficiency in healthcare is a goal to which every organization in the industry must commit. In a world where costs continue to rise and the need for healthcare for an aging population continues to grow, we have no choice but to find ways to do things better, cheaper, and with more attention to quality.

  • Healthcare Employee Recognition Ideas and Benefits

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 01, 2020

    Everyone working in healthcare human resources knows that compensation and recognition are both extremely important contributors to employee satisfaction. We have to be certain that healthcare staff are paid fairly for their work and that underpayment is not a reason for anyone to feel underappreciated or unvalued. Recognition is also very important for everyone working in healthcare. In the HealthStream blog post, Six Reasons to Prioritize Employee Recognition Over Rewards in Healthcare, we wrote about how effective recognition can be defined as receiving trusted, authentic feedback, whether from a colleague or superior, about how the staffer’s efforts had an impact on team goals and organizational success. The blog goes on to state “When employers use rewards to motivate, they are attaching performance to the physical—a tangible object. Effective recognition, on the other hand, impacts employees on a psychological level. It connects performance to intrinsic motivators—why they perform—and sends a message that the behaviors they exhibited are in alignment with how the employer defines success.

    Benefits of Effective Healthcare Employee Recognition Programs

    Four benefits of effective recognition are:

    • Recognition Changes Behavior for a More Sustained Duration.

    Effective recognition will have a longer-lasting impact as it better connects to ongoing performance.

    • Rewards Can Have a Negative Effect on Performance.

    Recognition engages top performers and has an impact on the performance of the less engaged workforce, by exemplifying how the employee is contributing to the organization’s goals and vision.

    • Recognition Has a Positive Impact on Work Relationships.

    Acknowledgment of employee performance by a peer or manager creates an environment of camaraderie.

    • Recognition Creates Better Outcomes with No Costs Attached.

    Effective recognition programs and processes will get the same or most likely better outcomes without the costs of a rewards-based program.

    Healthcare Employee Recognition Program Ideas

    Here are three creative ideas for healthcare employee recognition:

    1. Establish an employee-driven Reward & Recognition Team.

    2. This team should be tasked with planning and implementing a variety of programs, from special contests and regular service awards banquets to performance-based awards and recurring programs. The breadth of activities should be wide and varied, because employees differ greatly in what they find to be meaningful. Some are impressed by formal recognition ceremonies and newsletter announcements, while others like impromptu, surprise events. Encourage the team to incorporate variety into the recognition program.

    3. Establish Departmental Recognition Programs.
    4. Sometimes performance is encouraged more strongly when it involves teamwork. Establish a program where departments work against one another for a regular prize. For some organizations, this kind of program has proved to be an exciting way to keep employees engaged about cultural improvements and promote friendly competition among departments.

    5. Have Employees Recognize One Another for Great Performance.
    6. Start a customer/patient-focused initiative to reinforce extraordinary customer service behaviors through peer recognition. Ask employees to recognize and document acts of extraordinary customer service—it can have a twofold effect: increased attention to the contributions of co-workers, along with enhanced collaboration and teamwork.

    7. Ask Patients and Families to Identify Exemplary Caregivers.
    8. Encourage patients and their families to nominate employees for phenomenal performance in the service of care. Give everyone who interacts with the healthcare organization an easy way to honor professionalism and service. Draw names from those that are submitted or make everyone nominated a member of a special cohort within your employee base. Honor these people with big ceremonies, written certificates, photos, press releases, etc.

    Enhancing healthcare employee recognition is a core function served by HealthStream partner AMPT, whose social recognition platform allows organizations to easily and effectively recognize employees in their moments of greatness. AMPT enables employees to connect, engage, and grow by allowing them to recognize, share and celebrate moments of greatness. The AMPT platform allows companies to connect their core values to recognition accomplishments, which ultimately drives employee performance and retention rates. When an employee receives praise for their efforts, their job satisfaction increases, motivation improves, and positive actions are reinforced. Learn more about HealthStream solutions for

  • Healthcare Employee Recognition Ideas and Benefits

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | May 01, 2020

    Everyone working in healthcare human resources knows that compensation and recognition are both extremely important contributors to employee satisfaction. We have to be certain that healthcare staff are paid fairly for their work and that underpayment is not a reason for anyone to feel underappreciated or unvalued. Recognition is also very important for everyone working in healthcare. In the HealthStream blog post, Six Reasons to Prioritize Employee Recognition Over Rewards in Healthcare, we wrote about how effective recognition can be defined as receiving trusted, authentic feedback, whether from a colleague or superior, about how the staffer’s efforts had an impact on team goals and organizational success. The blog goes on to state “When employers use rewards to motivate, they are attaching performance to the physical—a tangible object. Effective recognition, on the other hand, impacts employees on a psychological level. It connects performance to intrinsic motivators—why they perform—and sends a message that the behaviors they exhibited are in alignment with how the employer defines success.

    Benefits of Effective Healthcare Employee Recognition Programs

    Four benefits of effective recognition are:

    • Recognition Changes Behavior for a More Sustained Duration.

    Effective recognition will have a longer-lasting impact as it better connects to ongoing performance.

    • Rewards Can Have a Negative Effect on Performance.

    Recognition engages top performers and has an impact on the performance of the less engaged workforce, by exemplifying how the employee is contributing to the organization’s goals and vision.

    • Recognition Has a Positive Impact on Work Relationships.

    Acknowledgment of employee performance by a peer or manager creates an environment of camaraderie.

    • Recognition Creates Better Outcomes with No Costs Attached.

    Effective recognition programs and processes will get the same or most likely better outcomes without the costs of a rewards-based program.

    Healthcare Employee Recognition Program Ideas

    Here are three creative ideas for healthcare employee recognition:

    1. Establish an employee-driven Reward & Recognition Team.

    This team should be tasked with planning and implementing a variety of programs, from special contests and regular service awards banquets to performance-based awards and recurring programs. The breadth of activities should be wide and varied, because employees differ greatly in what they find to be meaningful. Some are impressed by formal recognition ceremonies and newsletter announcements, while others like impromptu, surprise events. Encourage the team to incorporate variety into the recognition program.

    1. Establish Departmental Recognition Programs.

    Sometimes performance is encouraged more strongly when it involves teamwork. Establish a program where departments work against one another for a regular prize. For some organizations, this kind of program has proved to be an exciting way to keep employees engaged about cultural improvements and promote friendly competition among departments.

    1. Have Employees Recognize One Another for Great Performance.

    Start a customer/patient-focused initiative to reinforce extraordinary customer service behaviors through peer recognition. Ask employees to recognize and document acts of extraordinary customer service—it can have a twofold effect: increased attention to the contributions of co-workers, along with enhanced collaboration and teamwork.

    1. Ask Patients and Families to Identify Exemplary Caregivers.

    Encourage patients and their families to nominate employees for phenomenal performance in the service of care. Give everyone who interacts with the healthcare organization an easy way to honor professionalism and service. Draw names from those that are submitted or make everyone nominated a member of a special cohort within your employee base. Honor these people with big ceremonies, written certificates, photos, press releases, etc.

    Enhancing healthcare employee recognition is a core function served by HealthStream partner AMPT, whose social recognition platform allows organizations to easily and effectively recognize employees in their moments of greatness. AMPT enables employees to connect, engage, and grow by allowing them to recognize, share and celebrate moments of greatness. The AMPT platform allows companies to connect their core values to recognition accomplishments, which ultimately drives employee performance. When an employee receives praise for their efforts, their job satisfaction increases, motivation improves, and positive actions are reinforced. Learn more about HealthStream solutions for healthcare employee engagement and retention.

  • Credentialing Issues in Healthcare

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Apr 30, 2020

    Credentialing is the process by which organizations obtain and evaluate documentation regarding a medical provider's education, training, work history, licensure, regulatory compliance record, and malpractice history before allowing that provider to participate in a network. Provider credentialing is foundational to healthcare and is clinically and financially essential. Credentialing mistakes can result in increased legal liability and delayed or lost revenue.

    Issues and Challenges to Successful Credentialing Programs

    1. Evolving Requirements - An evolving business environment, such as healthcare, means changing requirements in how healthcare organizations manage their credentialing processes. Public reporting and increasing levels of scrutiny led the National Committee for Quality Assurance (NCQA) to develop a set of standards that now drive the provider credentialing process. Their requirements have added some rigor to the process by requiring that the organization verify with the primary source when verifying degrees, diplomas, or certificates. Copies are no longer sufficient to satisfy the requirement. Having people and processes that are committed to addressing the evolving nature of credentialing along with the increasingly rigorous requirements is essential to the accuracy and efficiency of the process.

    2. Resource Requirements – Payers and other organizations that supply the information that is critical to the credentialing process have their own standards for processing requests. Because these timelines are different from one another, and in some cases, longer than what we might anticipate, it is difficult to estimate completion dates for credentialing. This can make tracking provider progress through the process somewhat difficult.

    Even if the information required for credentialing is made readily available, the process is still fairly laborious and requires real attention to detail and a great deal of work, disciplined processes and meticulous record-keeping. Having software and processes dedicated to credentialing can help minimize errors and shorten timelines.

    3. Managing Additional Requirements – Your organization may be in a state that has additional credentialing requirements. Make sure that credentialing staff understand the unique requirements of your location and that any additional steps that might be necessary are built into your processes. Credentialing software should also address the unique requirements of your state.

    4. Failure to Address Requirements for Updates – Providers need to update their licenses and other credentials regularly according to the requirements of the state in which they are practicing. In addition, processes to capture interim changes in information like phone numbers and other contact information must be in place. Processes that are systematic in

    tracking required updates and people who are attentive to detail in their management of these processes are critical to the success of a credentialing program.

    5. Incomplete Provider Applications – The credentialing process can be daunting for the provider as well. The applications can require enormous amounts of information and incomplete information may cause an application to be rejected. Software and processes that verify full and complete applications can make the process faster and more efficient.

    In the midst of continual healthcare change some things stay the same, like the need for comprehensive provider credentialing, privileging, and enrollment processes. In today’s value-based environment, operational efficiency is critical. Conducting manual verifications, completing paper forms by hand or taking time to deliver files to various locations across the hospital or the system is not cost-effective. Learn about making VerityStream your comprehensive provider solutions partner.

  • Recognizing Religious Beliefs in Healthcare

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Apr 29, 2020

    Given the wide range of religion practices across our national population, it is no wonder that healthcare providers and systems are often challenged by delivering care that meets the religious needs of patients and their families. One way providers and the industry as a whole can overcome this problem and honor healthcare religious freedom is to provide training for staff and develop policies and procedures that encourage culturally competent care that incorporates sensitivity to religious beliefs in healthcare.

    Why Religion Matters in Healthcare

    According to Cultural Religious Competence in Clinical Practice, “Religion and spirituality are important factors in a majority of the patients seeking care. Unfortunately, health providers may not take religious beliefs into account when they are dealing with difficult medical decisions for patients and their families” (Swihart & Martin, 2020). Here are some reasons shared by Swihart & Martin about how overlooking religious beliefs in healthcare can have an impact on outcomes:

    • Patients often turn to their religious and spiritual beliefs when making medical decisions.
    • Religion and spirituality can impact decisions regarding diet, medicines based on animal products, modesty, and the preferred gender of their health providers.
    • Some religions have strict prayer times that may interfere with medical treatment.

    These authors go on to share that “Many patients’ anxieties are reduced when they turn to their faith during healthcare challenges. Because many patients turn to their beliefs when difficult healthcare decisions are made, it is vital for healthcare professionals to recognize and accommodate patient religious and spiritual needs. Health professionals should provide an opportunity for patients to discuss their religious and spiritual beliefs and tailor their evaluation and treatment to meet their specific needs” (Swihart & Martin, 2020).

    Here are a few ways that religious adherence may restrict the care a patient may receive:

    Jehovah’s Witnesses – Several Old and New Testament scriptures are “used by Jehovah's Witnesses to explain why their religion refuses to accept blood transfusions. ‘This is a religious issue rather than a personal one,’ explains JW.org, the official website for the religion. ‘We avoid taking blood not only in obedience to God but also out of respect for him as the Giver of life.’ Followers are quick to point out that other than accepting blood, Jehovah's Witnesses are told to seek and receive the best medical care available” (Lamotte, 2018).

    The Amish – “The Amish will not allow heart transplants and, in some cases, heart surgery because they view the heart as ‘the soul of the body.’ Children who have not been baptized are exempt from that restriction. Though the religion does not forbid its members from seeking medical attention, many Amish are reluctant to do so unless absolutely necessary. They believe that God is the ultimate healer, and they are likely to turn to folk remedies, herbal teas and other more "natural" antidotes. They do not practice birth control, often lack prenatal care and avoid preventative screenings” (Lamotte, 2018).

    Hindus – “Vaishnavism, the major branch of the Hindu faith, considers the killing of animals, especially cows, to be sinful. Therefore, the religion does not condone the use of any drugs, implants, skin grafts or medical dressings that contain parts of pigs or bovines” (Lamotte, 2018).

    Muslims – “Both Sunni and Shiite Muslims also do not approve of any drugs, medical dressings or implants that contain porcine ingredients. But they too allow exceptions for emergencies and when no alternative drugs or materials are available” (Lamotte, 2018).

    The examples above demonstrate just how important an understanding of individual spiritual belief can be to successful healthcare outcomes. We live in a world where healthcare religious freedom must be taken into account when care is being provided. When providers take the time to understand the faith of a patient, as well as how religion may affect the ability to receive care, everyone benefits.

    Reference

    Lamotte, S., “'Inoculate yourself with the word of God': How religion can limit medical treatment,” CNN Health, February 7, 2018, https://www.cnn.com/2018/02/07/health/religion-medical-treatment/index.html.
    Swihart, D., and Martin, R., Cultural Religious Competence In Clinical Practice, February 17, 2020, Retrieved at https://www.ncbi.nlm.nih.gov/books/NBK493216/.

     

    HealthStream’s healthcare workforce education solutions are used by more than 70 percent of healthcare organizations in the U.S. Our comprehensive suite of learning and competency management tools, which includes cultural competency training, empowers your people to deliver the best care more easily and effectively than ever before. Powered by the industry’s top content providers, HealthStream's Learning & Performance solutions connect you to healthcare’s largest learning community with a learning management system customized by you to meet your organization’s unique needs.

  • The Millennials Have Arrived, Especially in Healthcare!

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Apr 28, 2020

    Much has been made of the growing impact of the millennial generation on healthcare and especially the healthcare workforce. The 73 million millennials in the U.S are part of a larger group that now makes up a quarter of the global population. This cohort, born between 1981 and 1996, already became the largest generation in the workforce in 2016. They will make up a dominant 75% of the workforce by 2030. As members of a digitally focused generation that is the most urbanized in history, these employees are already inspiring new efforts among healthcare providers to attract and retain them. Organizations are making people-focused investments in better communications, competitive salaries, more advanced technology and programs for mentoring, work flexibility, and career development to be more attractive as employers. There are lots of opportunities for healthcare learning and workforce development to innovate to meet the needs of these staffers.  

    Common negative stereotypes about millennials in the workforce have proliferated, but a 2013 PWC study revealed the extent to which these are inaccurate or should be examined more closely (Finn et al, 2013). A better way to look at the situation is that millennials feel much the same about their work environment as other generations, desiring more flexibility, greater work/life balance, and especially meaning. It’s just that they may be more likely to act on the need for a better situation, leaving “if their needs for support, appreciation and flexibility are not met, while non-Millennials are more likely to leave if they feel they are not being paid competitively, or due to a perceived lack of development opportunities” (Finn et al, 2013). 

     

    Reference

     

    Finn, D. and Donovan, A., “PwC’s NextGen: A global generational study,” PwC, 2013, Retrieved at https://www.pwc.com/gx/en/hr-management-services/pdf/pwc-nextgen-study-2013.pdf. 

    This blog post is an excerpt from the longer HealthStream article, Trends That Will Shape the Next Decade in Healthcare. Focused on the people providing healthcare, HealthStream is committed to helping customers address and solve big problems in our industry. From hospitals to long-term care and across the care continuum, there are challenges stemming from demographic changes, governmental mandates, and the need for higher care quality. Download the webinar, Ten Healthcare Trends for 2020, where Robin Rose, Vice President, Healthcare Resources Group, HealthStream discusses this information in detail. HealthStream is dedicated to improving patient outcomes through the development of healthcare organizations' greatest asset: their people. Learn more about our healthcare workforce development solutions

  • Best Practices of HLC Administration

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Apr 27, 2020

    HLC Administrators are at the heart of every successful learning program. HealthStream offers Virtual Administrator Services to reduce administrative burdens, optimize performance, and drive maximum customer value from the HealthStream Learning Center. We chatted with several HLC administrators who are current HealthStream employees, and asked them their best practices for HLC administration. These 7 practices will elevate your learning management experience and provide the best outcomes for your entire organization.

  • Nursing on the Frontlines: How the Covid-19 Crisis Is Changing Standard Hospital Procedures

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Apr 27, 2020

    By Nicole Kraut RN

    Working as an infection preventionist (IP), there is always a running joke that the IP’s job is to go around and yell at people for not washing their hands. While there may be some truth to that joke, as we often do remind people to wash their hands, the job of an IP is much more involved.

    Essentially, IPs are professionals who work to ensure healthcare institutions and healthcare workers are doing everything possible to prevent infections. We work hard to prevent and control the spread of infectious diseases among patients, as well as among staff.

    Rounding to Ensure Compliance with Infection Prevention Practices

    Prior to COVID-19, my duties as an IP included hospital rounding to ensure infection prevention practices were being followed, surveillance for hospital acquired infections, surveillance for and identification of potential infectious disease clusters, staff education and training to infection prevention policies and procedures, reporting of state health reportable diseases, as well addressing any other infection prevention and control related concerns that may occur.

    Unfortunately, IPs are not always everyone’s favorite health care worker because we are a constant reminder of unknown dangers. For example, we really do spend a lot of our time reminding staff to wash their hands, because hand washing truly is one of the best ways to prevent the spread of infections to their patients as well as themselves.

    Infection Prevention Is More Important than Ever

    However, when the unknown danger is no longer unknown and has infiltrated every aspect of our lives, that is when the IP is needed the most.

    Since the onset of the COVID-19 crisis, my duties as an IP have inherently remained the same. My fellow IPs and I have still been rounding the hospital, observing infection control practices, and providing education; however, the degree to which we are performing these tasks has expanded greatly.

    Even before the crisis became evident in the United States, we were remaining up to date on the latest COVID-19 developments and looking at ways to best prepare the hospital and its staff.

    Education Was Key to Instilling Confidence

    We began our preparations with ensuring front line staff were educated and confident with the CDC’s recommendations for personal protective equipment by providing one on one education and training.

    While we have always been involved in educating staff, one on one education is not our typical means of disseminating education to the majority of staff.

    A 24-Hour Responsibility

    Another familiar duty to IPs is rounding; however, rounding the hospital, to include patient care areas as well as non-patient care departments, has been an almost 24-hour duty. Our guidance has been necessary during all shifts and throughout all departments, as we need to ensure all staff feel safe, comfortable, and supported. Adapting our schedules to ensure staff were supported was another change in our normal operations.

    Understandably so, there have been a lot of changes, as well as fear and anxiety surrounding COVID-19 and common workflow practices. The essential duties of the IP have remained the same since the onset of the COVID-19 crisis. What has changed; however, is the necessity of an increased availability of the IP for education, rounding, and overall support for hospital staff. As we continue to navigate the crisis, and especially when we begin to return to normal operations, the IP will continue to be a resource for healthcare institutions, ensuring patients and staff alike are prepared and protected from unknown dangers.

    About the Author

    Nicole Kraut is a nurse working in Chicago, Illinois, who writes for us regularly about her experiences as an early-to-mid career nurse. She has been a RN for over five years.

    Nicole graduated with her Bachelor of Science in Nursing from Loyola University Chicago and recently obtained a Master of Science in Nursing with an Emphasis in Nursing Education from Grand Canyon University. She “was inspired to become a nurse because I wanted to work in a career field in which I could make a difference in people’s lives on a daily basis.” She adds, “I feel nursing is my vocation and am passionate about sharing my knowledge and experience in order to positively influence others.”

    HealthStream’s jane™ is the World’s First Digital Mentor for Nurses. Jane harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, Jane was designed to power lifelong, professional growth of clinical professionals. Learn about HealthStream’s Suite of Clinical Development solutions for nurses.

    PLEASE NOTE: The information in this blog post was considered current at the time of its publishing, 04/27/20. However, the COVID-19 pandemic is an ever-evolving disaster due to new findings, data, and availability of resources. Please refer to the CDC website for the latest detailed information when you need it.

  • 5 Guidelines for Creating Healthcare Management Competencies

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Apr 23, 2020

    There are some principles and some essential competencies that are just too important to be left out of the equation and can be useful to us in establishing organizational thresholds for competency.

    As early as 2003, the Institute of Medicine had identified five competencies designed to help organizations thrive in the current healthcare environment. They remain very relevant today.

    1. Embrace patient-centered care. While no longer a new concept, its importance is actually growing as organizations try to find means to keep up with ways to respect and treat an increasingly diverse patient population in an environment where patient perceptions of their experience can impact bottom-line and brand.
    2. Work within inter-disciplinary teams. As our population ages and the acuity level of acute care hospital patients increases, it will be more important to evaluate behavioral aspects such as collaboration, communication, and integration to ensure the best care across the continuum. These behaviors will also impact our performance on Transitions of Care measures.
    3. Employ evidence-based best practices. Ensure that care reflects current research, as well as provider expertise and patient values.
    4. Apply quality improvement. In order to move from incompetence to competency, we need to ensure that staff has the ability to identify errors as well as measure and understand metrics around the quality of care.
    5. Utilize informatics. Increasingly these tools should be able to help staff avoid errors and support real-time decision making. Are these essential competencies the foundation for your organizations competency measurement?

    This blog post is the fourth in a series of excerpts from the HealthStream article, Maintaining Competency: Turning Concepts into Practice. Healthcare providers use the HealthStream Competency Center to Measure & Validate Competency. Doing so includes the ability to measure and benchmark behaviors or levels of competence in positions across the healthcare field through peer, preceptor, or manager appraisal, including methods of validation and evidence of achievement. Explore HealthStream clinical development solutions that ensure competency.

  • How to Ensure Healthcare Data Security

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Apr 22, 2020

    Everyone leading healthcare organizations in the United States is aware that healthcare data is at risk for hacking attacks. Greater awareness and the institution of tighter healthcare security measures has not done much to discourage the efforts of criminals to gain access to private information. Security breaches in healthcare continue to be common headaches for organizations across the map. If anything, hacking techniques have become more sophisticated and complex as a result. Healthcare security needs to take note and respond. 

    Why Is Data Security Becoming Even More Important in Healthcare? 

    We’ve spent a decade moving patient information to electronic medical records, so that providers at different organizations can easily connect. Some experts believe that “the next 10 years will be about ensuring the data that has been collected and stored in the cloud is being used in a secure and meaningful way” (Wilking, 2018). The upshot as even more sensitive data and information is stored digitally will be increased regulation and oversight to ensure that security and privacy is protected across healthcare. 

    Some of the ways stolen healthcare information can be used involve identity theft, insurance fraud, extortion, and even market fraud. One example is that public figures could be blackmailed about private life details. Another is where corporate leaders could have a healthcare condition that might affect company performance if a leadership succession plan isn’t already in place. Healthcare organizations are hiring more and more cybersecurity professionals to oversee their efforts, especially from industries like the military and financial services, where security has long been something to safeguard. 

    Data security is also connected to risk. When a privacy breach occurs, a healthcare organization has also violated HIPAA, which often requires a fine or settlement with the U.S. Government. Private lawsuits can also occur, as can Corporate Integrity Agreements (CIAs) involvement extensive training programs to prevent repeat violations. 

    Five Ways to Keep Networks and Data Safe from Hackers 

    Health IT Security just released the following five ways that healthcare organizations can safeguard protected health information (PHI) by instituting up-to-date cybersecurity measures. Specifically, the article recommends efforts to bring patient portal security up-to-date and keep networks safe from unauthorized access. Healthcare data security and preventing security breaches in healthcare has never been more important. 

    These healthcare data security measures include: 

    1. Automated the Portal sign-up process  

    Protect the initial sign-up process to stop false enrollments into a patient portal. Patients should only need to enter a few pieces of information, just enough to confirm the user’s identity on the back end. 

    2. Update all anti-virus and malware software 

    HIMSS Analytics has stated that 78% of providers had ransomware and malware attacks in 2017. If email is the likely route for deploying malware, conventional security measures must consistently evolve. Outdated anti-virus software can make organizations vulnerable to every new iteration of malware. Institute automatic opt-ins so updates are downloaded and installed as soon as they’re made available. 

    3. Use Multifactor verification 

    After a sign-up, use multifactor verification to ensure all future portal sessions are equally secure. Two-factor authentication adds additional protection on top of conventional login credentials. Require a password or PIN, plus something personal such as a cell phone number, fingerprint, iris scan, or more. For compromised devices or accounts, multi-factor authentication can ensure a network remains safe. Consumers are already used to these measures. 

    4. Employ identity solutions to protect patient identities. 

    HIPAA requires providers to ensure you’re giving access to the right patient. Use measures that can help you confirm a person is who they say they are. Identity proofing questions can be triggered to provide an extra check, when something doesn’t seem right. Biometrics are beginning to supplement existing identity-proving solutions. Communicate the steps your organization is taking to secure patient information, so patients feel about your commitment to data security.   

    5. Continue to focus on interoperability standards 

    Interoperability ensures disparate systems can share medical histories and data in ways that support outcomes improvement across the continuum of care. Without it, we’ll still be forced to use email, with all its capacity for phishing attempts causing security breaches in healthcare and lapses in protection. 

    References 

    Davis, J., “Best Practice Cybersecurity Methods for Remote Care, Patient Portals, Health IT Security, March 20, 2020, Retrieved at https://healthitsecurity.com/news/best-practice-cybersecurity-methods-for-remote-care-patient-portals 

    Wilking, M., “5 Ways healthcare organizations can improve data security,” Becker’s Health IT, July 10, 2018, Retrieved at https://www.beckershospitalreview.com/healthcare-information-technology/5-ways-healthcare-organizations-can-improve-data-security.html

    HealthStream’s compliance training solutions help healthcare organizations across the care continuum comply with government regulations and accrediting body requirements while developing and engaging staff.  In addition to providing essential tools and training to help you remain compliant, we help analyze your training data and provide insight into your training initiatives—enabling you to measure compliance progress, identify outstanding challenges, and determine where to make compliance program improvements.  Our innovative educational content, data solutions, and tools are recognized throughout healthcare as the industry standard for comprehensive and engaging compliance training. 

  • AI Advances Aggressive Healthcare & Helps Meet Providers Goals

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Apr 21, 2020

    The concept of artificial intelligence, or AI, has moved from the stuff of science fiction to everyday application with remarkable speed. Consumer-oriented applications have led the way, and many industries have been quick to adapt AI to their operations in order to maximize efficiency and spur growth.

    Healthcare, which can sometimes lag behind the curve when it comes to implementing new technology, has been quick to see the value of AI as well. Providers have grasped that Artificial Intelligence can allow them to use the copious data sets they collect to create actionable insights. And in so doing they are able to advance many operational goals while also increasing the quality and efficiency of patient care and satisfaction.

    While AI’s capabilities are seemingly endless, here are some concrete ways it is already making a difference in healthcare when it comes to setting and achieving operational goals:

    Improved Performance and Efficiency

    AI is allowing clinicians to utilize a “big data” model to take volumes of information and quickly distill them into treatment plans that can be more predictive around patient needs and outcomes. On the staffing side, AI can also use staffing patterns and trends to optimize workflows. AI programs, such as HealthStream’s Jane™, also can provide valuable insights and support around such vital staffing concerns as nurse onboarding, training, and continuing operations.

    Predictive Population Health Management

    AI also allows healthcare providers to go beyond the four walls of their facilities and be more aggressive in community outreach and support. When they can have information on illness vectors and other trends, they can move to take preventive action. That can be anything from public-relations outreach around seasonal issues such as flu vaccines to more urgent issues, such as health and wellness information in the face of a rapidly moving concern, such as the COVID-19 pandemic. AI allows for a more targeted approach to outreach, so resources aren’t wasted on providing information or services that don’t have value for the community or the provider.

    Better, Faster and More Integrated Decision Making

    When information is being analyzed from a broad perspective, rather than utilized in silos, it can do more to achieve enterprise-wide goals. That’s a huge plus with AI; it can drill down, or pull back, what it’s doing in terms of data analysis to meet specific needs. That means if there’s an issue around clinical support in one area of a facility or enterprise, the data can be explored to see what solutions would solve the problem. If it’s a larger issue, such as an outbreak of a specific illness, AI can present data around the groups affected, and then the provider can ramp up specific care models and staff to handle the expected rise in patients.

    Improving Patient Satisfaction

    More people than ever before have access to their healthcare records through patient portals. They also have apps literally at their fingertips to study their own health information, from calorie counters to heartrate monitors. That’s AI at work in the consumer sector. Consumers don’t understand why their healthcare provider isn’t similarly “plugged in,” and so the onus is on providers to keep up. The good news is, AI is being rapidly deployed all across healthcare, allowing provides to meet patients where they are on the technological front while also solving their most pressing needs around care, operational efficiency and planning for future growth.

    HealthStream’s Jane™ is the World’s First Digital Mentor for Nurses. Jane harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, Jane was designed to power lifelong, professional growth of clinical professionals. Jane is part of HealthStream’s Clinical Development Solution for Nurses.

  • Caring for Maternal Addicts Without Using a Withdrawal Program

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Apr 20, 2020

    Breaking free from opioid addiction is a difficult and multifaceted challenge. For many women who are addicted, the process is made even more complex by pregnancy. Often these women are unable to tap into any kind of healthcare, whether for substance abuse treatment or prenatal treatment. The result is that they pursue neither, endangering two lives. That’s where the Giving Respect and Compassion to Expecting Moms, or G.R.A.C.E., program steps in. Created by the team at Lovelace Women’s Hospital in Albuquerque, NM, G.R.A.C.E. has been ground-breaking for a highly under-served population, says Dr. Abraham Lichtmacher, Chief of Women’s Services, who developed the program’s clinical protocols and support systems.

    Caring for Addicts Without a Withdrawal Program

    A layer of complexity the program must address is that the professional literature from the American College of Obstetricans and Gynecologists (ACOG) does not recommend pregnant mothers weaning off opioids during pregnancy. The G.R.A.C.E. solution was to require its participating physicians to obtain special licensure to prescribe Subutex (buprenorphine), a medication used to treat opioid addiction, which women can use while pregnant. According to MedPage Today, only about 46,500, or 5 percent, of U.S. doctors have this waiver (George, 2018).

    Assessing Outcomes Key to Driving Forward Progress

    Now that G.R.A.C.E. is up and running, the focus is on continually assessing its offerings so that changes can be made around efficiency and quality. This means everything is always under review, a process that can be complicated due to the relative scarcity of similar programs to use for benchmarking.

    “There is little national, or even local data for comparison,” Dr. Lichtmacher says. “Data is key, but when you lump this whole group of patients into one big bucket, you don’t get the whole picture. Remember, our program is geared towards general addiction—not just opioids. There are differences in our patient population. To assess those differences, we ultimately developed a method of designating what the addiction is: for instance, patients who are addicted to opioids vs. those who are addicted to methamphetamines or barbiturates and things of that nature.”

    Even so, the G.R.A.C.E. team is encouraged by patients who often are eager and willing to make changes in their lives and have a motivation to do so in the form of a newborn child.

    “One thing that’s working for us is that within the world of addiction, women who are pregnant have a very high level of motivation,” Waschler says. “If you take a woman who is addicted to an opioid like heroin, or using meth on the street, and compare her to a pregnant woman doing the same thing, the pregnant woman has more motivation to make a change in her life. Our hope is that we can come along beside her and make sure that she has the right support and resources. We connect her to behavioral health services and to medication-assisted therapy, and really try giving her every opportunity to succeed.”

    The whole goal of our program is to help keep the mother as stable as possible during her pregnancy so that the baby will be stable as well, “Dr. Lichtmacher adds. “We’re not going to cure them, most likely, but we’re going to give them an opportunity. We certainly have had women who have done quite well and been able to stay clean.”

    This blog post is an excerpt from the HealthStream article, SAVING G.R.A.C.E. - Program engages with at-risk mothers through prenatal care, delivery, and beyond. The article also includes:

    • A Multifaceted Program with One Overarching Goal
    • Building a Training Program from the Ground Up

    Clinical development training, like that necessary for treating those affected by opioid addiction, is just one of the healthcare workforce development solutions offered by HealthStream for providers and employees. Explore HealthStream Clinical Development Solutions.

  • The Healthcare Impacts of Anticipated U.S. Demographic Shifts

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Apr 17, 2020

    The entire healthcare industry is going to feel the growing impact of a demographic change unlike any the United States has ever seen. The aging of our population, which some have called a “silver tsunami,” will only keep accelerating. We are not that far away from 2034, the date when older adults are first expected to outnumber children in the population. Even before then, all baby boomers will be older than 65 by 2030, such that the older adult population will comprise 21% of the population, up from 15% today.  

    Rising Expenditures and Caregiver Shortages 

    One result of these changes is the anticipated rise in national health expenditures—the $4 trillion estimated for 2020 will increase to $5 trillion by 2025. In 2019, CMS projected that the national health expenditure growth is expected to average 5.5 percent annually from 2018-2027, reaching nearly $6.0 trillion by 2027 (CMS, 2019). In addition to the staggering growth in aggregated cost, the workforce needed to treat the growth in healthcare demand will be astounding. Beyond the shortage of clinicians, Mercer Consulting predicts that by 2025 U.S. providers also will face a collective shortage of about 500,000 home health aides, 100,000 nursing assistants, and 29,000 nurse practitioners (Mercer, 2019).  

    Acute Shortages of Much-Needed Geriatricians 

    Specific areas of the physician shortage also will be related to this shift in need. The current need for geriatricians far outstrips our supply of them, especially when you realize that about 30% of the population 65 and older requires some type of geriatric care. That equates to more than 15 million people in need. Since each certified geriatrician can effectively treat up to 700 patients, we would need about 21,500 certified geriatricians to care for the Silver Tsunami—four times the current supply! Dishearteningly, there was a 21% decrease in the number of first-year geriatric residents from 2010 to 2015. This means that the pool of certified doctors is now shrinking at the same rate the need for them is growing. Future issues surrounding geriatric care are alarming, from the increasing population with chronic conditions and decline in family caregiving options to the very sustainability and structure of federal healthcare programs. 

    This blog post is an excerpt from the longer HealthStream article, Trends That Will Shape the Next Decade in Healthcare. Focused on the people providing healthcare, HealthStream is committed to helping customers address and solve big problems in our industry. From hospitals to long-term care and across the care continuum, there are challenges stemming from demographic changes, governmental mandates, and the need for higher care quality. Download the webinar, Ten Healthcare Trends for 2020, where Robin Rose, Vice President, Healthcare Resources Group, HealthStream discusses this information in detail. HealthStream is dedicated to improving patient outcomes through the development of healthcare organizations' greatest asset: their people. Learn more about our healthcare workforce development solutions

  • Importance of Anticipated U.S. Demographic Shifts in Healthcare

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Apr 17, 2020

    The entire healthcare industry is going to feel the growing impact of a demographic change unlike any the United States has ever seen. The aging of our population, which some have called a “silver tsunami,” will only keep accelerating. We are not that far away from 2034, the date when older adults are first expected to outnumber children in the population. Even before then, all baby boomers will be older than 65 by 2030, such that the older adult population will comprise 21% of the population, up from 15% today.

    Rising Expenditures and Caregiver Shortages

    One result of these changes is the anticipated rise in national health expenditures—the $4 trillion estimated for 2020 will increase to $5 trillion by 2025. In 2019, CMS projected that the national health expenditure growth is expected to average 5.5 percent annually from 2018-2027, reaching nearly $6.0 trillion by 2027 (CMS, 2019). In addition to the staggering growth in aggregated cost, the workforce needed to treat the growth in healthcare demand will be astounding. Beyond the shortage of clinicians, Mercer Consulting predicts that by 2025 U.S. providers also will face a collective shortage of about 500,000 home health aides, 100,000 nursing assistants, and 29,000 nurse practitioners (Mercer, 2019).

    Acute Shortages of Much-Needed Geriatricians

    Specific areas of the physician shortage also will be related to this shift in need. The current need for geriatricians far outstrips our supply of them, especially when you realize that about 30% of the population 65 and older requires some type of geriatric care. That equates to more than 15 million people in need. Since each certified geriatrician can effectively treat up to 700 patients, we would need about 21,500 certified geriatricians to care for the Silver Tsunami—four times the current supply! Dishearteningly, there was a 21% decrease in the number of first-year geriatric residents from 2010 to 2015. This means that the pool of certified doctors is now shrinking at the same rate the need for them is growing. Future issues surrounding geriatric care are alarming, from the increasing population with chronic conditions and decline in family caregiving options to the very sustainability and structure of federal healthcare programs.

    This blog post is an excerpt from the longer HealthStream article, Ten Healthcare Trends for 2020, where Robin Rose, Vice President, Healthcare Resources Group, HealthStream discusses this information in detail. HealthStream is dedicated to improving patient outcomes through the development of healthcare organizations' greatest asset: their people. Learn more about our

  • The S.T.A.B.L.E. Program

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Apr 14, 2020
     
  • Does Your Competency Program Have the Whole Staff Comfortable with Expectations?

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Apr 14, 2020

    As long-term care facilities implement the Centers for Medicare and Medicaid (CMS) Final Rule—Medicare and Medicaid Programs: Reform of Requirements for Long-Term Care Facilities, they should be taking a closer look at their competency programs for some potential traps that could prevent success: 

     

    • First, does the whole staff understand that a competency program is not the same as a training program?  

    • And even more importantly, is the program set up to differentiate between roles, or is it a “one size fits all” assessment of skill sets and goals? 

     

    If it’s the latter, that’s a problem for the simple reason that various staff members have very different jobs, and they cannot be expected to achieve the same levels of success across all duties and functions within a facility. 

     

    Role-Specific Competencies 

     

    “Each job role has unique responsibilities,” points out Tracey Cooley, RN, BSN, a master trainer and surveyor and Vice President of Training at HealthStream. “We definitely have to tailor training and competency programs so that staff can be successful in those roles. Not only does a competency affect the quality of care and services delivered to residents, it also has a huge role in staff satisfaction. Make training engaging, capture staff's attention. Make it more interactive, make it more effective and more dynamic, and the key to that is defining the competencies by the roles of our staff members.” 

     

    As an example, consider emergency preparedness. Through this program, a facility is supposed to assess the types of emergencies it is vulnerable to. Every department, each staff member, has different responsibilities when responding to a crisis situation, and they need to be confident and competent in their job roles during that high-stress period. Yet their roles will be different and complementary to each other vs. each person trying to do the same one or two things. So, competency around emergency duties is very different for each team member. 

     

    Tailor Competency Plan to Assess Individual and Team Roles 

     

    “Take a look at the roles that folks have and customize the plan,” explains Patrick Campbell, a master trainer and surveyor, and Senior National Account Services Director with HealthStream. “Don’t assess competency in things they're not responsible for, but make sure [the plan] is comprehensive so that you don't miss anything.” 
     

    “Assessing through observation of staff members in action is one of the strongest verification methods for determining competency,” Cooley says. “Observe people when they request it, and also observe them in action to make sure they are competent.” 

     

    And, she adds, “For some staff members, training and competency is not just limited to technical skills. For example, when you look at the job description of a director of nursing, you see they wear many, many hats. There's definitely more to consider than just the technical skills of the nurse. There are the regulations in addition to many administrative duties. Competencies need to be tailored to the director of nursing's specific responsibilities.” 

     

    Team Competency Plans Benefit from a Multi-Tier Approach 

     

    For a team or overall facility competency plan, including philosophies can also help establish benchmarks. For instance, if employee feedback is part of the overall culture, it can be woven into a competency verification strategy. Other types of documentation can include observation of daily work, says Campbell. 

     

    “How do you know how a staff member relates to residents outside of a classroom setting? Well, we should be looking at what they're doing every day,” he says. “That's one way to determine competency or identify problems quietly. Case studies also are always good. Those will tell you things that work and didn't work and may help formulate a plan as far as what a competency is, how to tell when someone is competent, and what kind of training methods do or don't work.” 

     

    Lastly, it’s key to engage employees in the competency and facility assessment plans, both from a macro and micro perspective. They will have thoughts on how the entire enterprise should perform, as well as their individual roles in achieving facility-wide goals and expectations. 

     

    “Sometimes they might not be good test takers and that's OK,” says Ellen Kuebrich, a Senior Director of Business Development at HealthStream. “You can find other ways to verify competencies. Definitely make sure you're identifying what a pass is ahead of time. If it's using a skills checklist when you're observing or grading a test. If they're at a certain percentage, make sure all of those criteria are identified ahead of time. Make this process dynamic. Understand that this is a feedback loop—your facility assessment should inform your competency program, and vice versa, on an ongoing basis.” 

     

    Nursing homes and skilled care facilities that continue to excel are those that treat residents as people worthy of respect, regardless of medical condition or funding source—and regardless of the pressures felt by staff. HealthStream works with skilled nursing and LTC facilities to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream for workforce development solutions, long-term care organizations and others across the care continuum are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care. 

  • Using AI to Assess and Build Competency in New and Existing Clinicians

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Apr 13, 2020

    Acute and post-acute care organizations are confronted with many challenges in today’s current economic and healthcare environment. One of many challenges involves standardized clinical orientation and assessment programs, including validation of bedside competencies, which can be lengthy and costly with no promise of success.

    Download this article to learn how you can identify your nursing staff's individual competence gaps, remediate gaps with personalized learning paths, and improve the delivery of care.

  • HealthStream Uses Rigorous Six-Step Process to Develop Leading Edge Knowledge Assessments

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Apr 13, 2020
    HealthStream is dedicated to offering current, clinically relevant, valid, and reliable knowledge assessments for healthcare employees. HealthStream’s assessments are based on best practices for test development, including meeting psychometric standards as well as federal directives outlined in the US Equal Employment Opportunity Commission’s Uniform Guidelines on Employee Selection Procedures. Download this article to learn how HealthStream developed their leading edge, evidence-based knowledge exams using a rigorous six-step process.
  • Preventing Nurse Burnout – Five Strategies

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Apr 13, 2020

    Nurse burnout is a much-studied phenomenon that can result in both physical and emotional symptoms. It is characterized by a lack of motivation, frustration and a loss of efficiency. The ongoing nursing shortage and the relatively low numbers of nursing school openings has made addressing nurse burnout even more of a priority.

    Strategies to Reduce Nurse Burnout

    1. Be aware of the symptoms of burnout. This may sound simplistic, but knowledge about nurse burnout and nurse practitioner burnout is important. As with many health problems, a more advanced case of burnout is more difficult to treat than a nascent one. Recognizing the symptoms of burnout and responding early with help and treatment early is key. The professional stresses that lead to burnout in the nursing profession may be somewhat difficult to minimize, but early intervention is possible. Watch for these signs:

    a. A nurse who is struggling with a loss of his or her sense of personal accomplishment, regularly wondering if they are really making a difference.

    b. A nurse who is becoming so emotionally exhausted that the work itself, colleagues, and patients are depersonalized, and the nurse is simply numbed to the greater nursing experience.

    c. A nurse who is doubting his or her competence.

    d. A nurse who is feeling irritable and short-tempered—at work and outside of work.

    e. A nurse who is experiencing physical symptoms, which may include feelings of anxiety, physical illness and dreading the thought of work

    2. Be proactive and persistent in encouraging nurses to adopt work life balance practices to ensure that the stresses of work stay at work. The advice to make sure that nurses are investing in self-care is oft repeated, but it is still good advice. Healthy eating habits, exercise and hobbies that can promote relaxation are good ways to help avoid or minimize burnout.

    3. Connect nurses to resources. Many healthcare organizations have excellent Employee Assistance Programs (EAPs). This may sound obvious, but a nurse that is suffering burnout may be desensitized to the help that is around them. Be redundant with messages to nursing staff regarding available resources. Consider adding some of these tools to your campaign to reduce nurse burnout and nurse practitioner burnout.

    a. Provide stress-reduction classes – either live or online to provide practical tools and stress-relieving techniques.

    b. Enact reward and recognition programs – use programs that recognize real contributions made by nurses, connect behaviors with the mission of your nursing organization to help struggling nurses re-connect with the value of their work.

    c. Create Buddy programs – they may be a staple in the workplace, but when well-executed, they can provide nurses with a valuable means of support and a means for venting while also providing alternate points of view on nursing and work life issues.

    4. Wherever possible, address the factors that contribute to nurse burnout. The University of Iowa Hospitals and Clinics has a nurse residency program that could serve as a model for how to introduce new nurses to the realities of the profession—without introducing burnout at the same time. Participants come together for about four hours each month to learn from one another and from nurse leaders. In addition to the clinical and leadership skills nurtured by the residency program, nurses will also learn strategies to help them cope with death and dying and to care for themselves, personally and professionally. The program provides an early intervention to help prevent burnout and provide nurses with tools to deal with burnout should it occur. To learn more about this program, click here: https://uihc.org/nurse-residency-program

    5. Re-evaluate. Help nurses make career changes but stay connected to their passion for nursing. This may mean helping them to re-evaluate their current situation. Is it time for another specialty? Is it time for a different setting? Passion and satisfaction can go hand-in-hand and a bout of burnout might mean that it is time to re-evaluate.

    Combatting nurse burnout is one of the many strategies that healthcare organizations can work to improve nurse retention. The growing nurse shortage in some parts of the country requires that we make every possible effort to re-connect nurses to the passion that inspired their career choice. Contact HealthStream to speak to a solutions expert to learn more about our courses related to nurse burnout prevention in the healthcare industry.

  • Does Your Competency Program Have the Whole Staff Comfortable with Expectations?

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Apr 10, 2020

    As long-term care facilities implement the Centers for Medicare and Medicaid (CMS) Final Rule - Medicare and Medicaid Programs: Reform of Requirements for Long-Term Care Facilities, they should be taking a closer look at their competency programs for some potential traps that could prevent success:

    • First, does the whole staff understand that a competency program is not the same as a training program?
    • And even more importantly, is the program set up to differentiate between roles, or is it a one size fits all assessment of skill sets and goals?

    If it's the latter, that's a problem for the simple reason that various staff members have very different jobs, and they cannot be expected to achieve the same levels of success across all duties and functions within a facility.

    Role-Specific Competencies

    Each job role has unique responsibilities, points out Tracey Cooley, RN, BSN, a master trainer and surveyor and Vice President of Training at HealthStream. We definitely have to tailor training and competency programs so that staff can be successful in those roles. Not only does a competency affect the quality of care and services delivered to residents, it also has a huge role in staff satisfaction. Make training engaging, capture staff's attention. Make it more interactive, make it more effective and more dynamic, and the key to that is defining the competencies by the roles of our staff members.

    As an example, consider emergency preparedness. Through this program, a facility is supposed to assess the types of emergencies it is vulnerable to. Every department, each staff member, has different responsibilities when responding to a crisis situation, and they need to be confident and competent in their job roles during that high-stress period. Yet their roles will be different and complementary to each other vs. each person trying to do the same one or two things. So, competency around emergency duties is very different for each team member.

    Tailor Competency Plan to Assess Individual and Team Roles

    "Take a look at the roles that folks have and customize the plan," explains Patrick Campbell, a master trainer and surveyor, and Senior National Account Services Director with HealthStream. Don't assess competency in things they're not responsible for, but make sure [the plan] is comprehensive so that you don't miss anything.

    “Assessing through observation of staff members in action is one of the strongest verification methods for determining competency,” Cooley says. “Observe people when they request it, and also observe them in action to make sure they are competent.”

    And, she adds, “For some staff members, training and competency is not just limited to technical skills. For example, when you look at the job description of a director of nursing, you see they wear many, many hats. There's definitely more to consider than just the technical skills of the nurse. There are the regulations in addition to many administrative duties. Competencies need to be tailored to the director of nursing's specific responsibilities.”

    Team Competency Plans Benefit from a Multi-Tier Approach

    For a team or overall facility competency plan, including philosophies can also help establish benchmarks. For instance, if employee feedback is part of the overall culture, it can be woven into a competency verification strategy. Other types of documentation can include observation of daily work, says Campbell.

    “How do you know how a staff member relates to residents outside of a classroom setting? Well, we should be looking at what they're doing every day,” he says. “That's one way to determine competency or identify problems quietly. Case studies also are always good. Those will tell you things that work and didn't work and may help formulate a plan as far as what a competency is, how to tell when someone is competent, and what kind of training methods do or don't work.”

    Lastly, it's key to engage employees in the competency and facility assessment plans, both from a macro and micro perspective. They will have thoughts on how the entire enterprise should perform, as well as their individual roles in achieving facility-wide goals and expectations.

    “Sometimes they might not be good test takers and that's OK,” says Ellen Kuebrich, a Senior Director of Business Development at HealthStream. “You can find other ways to verify competencies. Definitely make sure you're identifying what a pass is ahead of time. If it's using a skills checklist when you're observing or grading a test. If they're at a certain percentage, make sure all of those criteria are identified ahead of time. Make this process dynamic. Understand that this is a feedback loop—your facility assessment should inform your competency program, and vice versa, on an ongoing basis.”

    Nursing homes and skilled care facilities that continue to excel are those that treat residents as people worthy of respect, regardless of medical condition or funding source—and regardless of the pressures felt by staff. HealthStream works with skilled nursing and LTC facilities to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream for workforce development solutions, long-term care organizations and others across the care continuum are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care.

  • Clinician Shortages Will Be a Growing Problem in Healthcare

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Apr 10, 2020

    The start of a new year and a new decade is an appropriate time to assess the state of affairs in terms of U.S. healthcare and think about major trends that are changing our industry. Sometimes healthcare begins to change direction due to factors that are largely beyond anyones control, like the demographic shifts and increase in longevity that will impact every area of the care continuum.

    Over the next decade, doctors and nurses will be in short supply.

    The existing shortage of nurses and physicians will continue and become an even larger problem across many areas of healthcare. According to the Association of American Medical Colleges (AAMC), the United States will see a shortage of up to nearly 122,000 physicians by 2032 as demand for physicians continues to grow faster than supply. The high end of the number of doctors we could lack includes more than 55,000 primary care physicians, nearly 66,000 specialists, and more than 23,000 surgical specialists. Two factors are contributing to this problem—the U.S. "population is estimated to grow by more than 10% by 2032, with those over age 65 increasing by 48%. Additionally, the aging population will similarly affect the physician supply, since one-third of all currently active doctors will be older than 65 at some time during the next decade. When these physicians decide to retire could have the greatest impact on supply" (AAMC, 2019). Rural and inner-city areas will feel the shortage most acutely, as those are places physicians are less likely to want to practice. It is probable that the industry will see states and hospitals going to great lengths to retain the doctors they have trained and hired. There are already examples of financial incentives, such as loan forgiveness and bonuses, being used in some areas to hold on to physicians.

    The Situation for Nurses Mirrors That for Doctors

    A similar problem looms within the nursing profession. By 2025, according to the Georgetown University School of Nursing & Health Studies, “states on the east and west coasts will likely have nursing shortages, while states in the middle of the country will have a surplus of nurses” (Becker’s, 2017). Retaining new nurses is going to become even more important; the turnover rate for new nurses is 25% to as high as 60% during the first year and replacement costs can run as high as $60,000 per nurse. Even if more of them choose to stay, a workforce with lots of novice nurses has its own challenges—treating high-acuity patients requires confidence that may be in short supply and practice errors are more common during a nurse’s first six months on the floor.

    This blog post is an excerpt from the longer HealthStream article, Trends That Will Shape the Next Decade in Healthcare. Focused on the people providing healthcare, HealthStream is committed to helping customers address and solve big problems in our industry. From hospitals to long-term care and across the care continuum, there are challenges stemming from demographic changes, governmental mandates, and the need for higher care quality. Download the webinar, Ten Healthcare Trends for 2020, where Robin Rose, Vice President, Healthcare Resources Group, HealthStream discusses this information in detail. HealthStream is dedicated to improving patient outcomes through the development of healthcare organizations' greatest asset: their people. Learn more about our healthcare workforce development solutions.

  • Embrace an Overarching Set of Five Competencies for All Clinicians

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Apr 09, 2020

    There are some principles and some essential competencies that are just too important to be left out of the equation and can be useful to us in establishing organizational thresholds for competency. As early as 2003, the Institute of Medicine had identified five competencies designed to help organizations thrive in the current healthcare environment. They remain very relevant today.

    These Five Competencies are:

    • Embrace patient-centered care. While no longer a new concept, its importance is actually growing as organizations try to find means to keep up with ways to respect and treat an increasingly diverse patient population in an environment where patient perceptions of their experience can impact bottom-line and brand.
    • Work within inter-disciplinary teams. As our population ages and the acuity level of acute care hospital patients increases, it will be more important to evaluate behavioral aspects such as collaboration, communication, and integration to ensure the best care across the continuum. These behaviors will also impact our performance on Transitions of Care measures.
    • Employ evidence-based best practices. Ensure that care reflects current research, as well as provider expertise and patient values.
    • Apply quality improvement. In order to move from incompetence to competency, we need to ensure that staff has the ability to identify errors as well as measure and understand metrics around the quality of care.
    • Utilize informatics. Increasingly these tools should be able to help staff avoid errors and support real-time decision making.

    Are these essential competencies the foundation for your organization’s competency measurement?

    This blog post is the fourth in a series of excerpts from the HealthStream article, Maintaining Competency: Turning Concepts into Practice. Healthcare providers use the HealthStream Competency Center to Measure & Validate Competency. Doing so includes the ability to measure and benchmark behaviors or levels of competence in positions across the healthcare field through peer, preceptor, or manager appraisal, including methods of validation and evidence of achievement. Explore HealthStream clinical development solutions that ensure competency.

  • Customer Spotlight: CHRISTUS St. Michael Health System

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Apr 08, 2020
     
  • How to Make Scheduling Work Better for Nurse Managers

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Apr 08, 2020

    In addition to requiring a great deal of time and attention from nurse managers, scheduling processes that fail to work efficiently can seriously impact nurses work environment and satisfaction. Healthcare organizations can also experience a significant financial impact when too much nurse overtime occurs in the process of filling empty shifts. Most importantly, patient outcomes and experience can suffer when a nursing unit is understaffed and overworked.

    Many nurse managers use precious time for scheduling when they could be working more productively on the unit. These are hours spent trying to fill up shifts, trying to flex off nurses when the unit is overstaffed, and struggling to get nurses to work when they are needed at the last minute. All too often that comes with the cost of incremental overtime or through traditional overtime, contradicting the basic goal to staff the right nurses at the right time and at the lowest cost.

    Well Designed Nurse Scheduling Solutions Benefit Nurse Managers

    It is possible for healthcare organizations to adopt solutions that make the scheduling process work better for nurse managers. Ideally, the most effective scheduling tools contain a majority of the following features:

    Enterprise Schedule Management

    A best practice is for entire nursing departments, staffing offices, and health systems to connect and communicate with staff through a mobile app that streamlines all day-to-day communication and schedule management across the board. That way it s easier to distribute the schedule directly to everyone s devices and then deal with all the inevitable adjustments that come up throughout that period.

    App-Based Scheduling That Automatically Feeds Back into the Master Schedule

    A real time communication tool can deal with all the changes that come up, post and fill open shifts, approve shift swaps, etc., and then ensure all of those changes are automatically fed back into your internal systems of truth to ensure that there is always parity.

    Easily Pinpoint Potential Candidates for Open Shifts

    Nurse managers benefit when they can efficiently hone in on eligible candidates when looking to fill any open shifts they only want to fill shifts with the most qualified individuals, based on competencies, and mitigating unnecessary overtime hours.

    Savings in Terms of Time and Budget

    Automated operations can reduce the time spent filling open shifts and limit the dollars associated with a managers time spent scheduling and registering shift swaps. That doesn't even include the time saved on the nurses side to identify and initiate a swap request amongst themselves.

    Improved Nurse Satisfaction and Engagement

    Improving processes and making the scheduling process more flexible for staff has implications of improving staff satisfaction and engagement and the dollars associated with retaining staff.

    This blog post concludes a series based on the HealthStream Webinar, Fill Open Shifts Faster with Nurse-Centric Technology, which features leaders from HealthStream partner NurseGrid, an organization whose widely adopted nurse scheduling platform was inspired by the core belief that health care systems and providers must have the best tools in order to provide the most efficient and effective patient and nursing experience. Presenter Joe Novello, the Founder of NurseGrid, is a nurse who has worked in and around hospitals for more than 20 years as a clinician and a clinical operational leader. He was joined by Connor Whan, a healthcare entrepreneur who has been with NurseGrid for much of the organization s existence, who has led conversations with thousands of nurses and nurse leaders across the country, to ensure NurseGrid remains at the forefront of supporting nurses personally and professionally.

    Learn about using NurseGrid to improve the nurse scheduling process.

  • How Are Millennials Experiencing Healthcare and Affecting Its Future?

    by System.Collections.Generic.List`1[Telerik.Sitefinity.Model.IDataItem] | Apr 08, 2020

    Whether they want to or not, Millennials are always making the news. They are the largest, most educated and most connected  group the world has ever known. Endless articles and hot takes pore over their choices in music and food, not to mention how they are disrupting and revolutionizing everything from how we get around to where we stay. And with good reason — they became the workforce majority at the end of 2015, and by 2025 are expected to make up 75 percent of the workforce. Whether we, or they, like it or not, they are trendsetters.

     And that certainly applies to Millennials and their relation to personal health, and healthcare. They value health and wellness highly, and that manifests itself in everything from a plethora of diet and exercise apps to more physical fitness and less smoking than previous generations. More than any group before them, they have mastered the pairing of technology and lifestyle to keep tabs on their own heath.

     

    Coupling Health Awareness with Health Issues

    But is that paying off? For those born between 1981 and 1996, a surface examination would appear to say yes. They seem to have taken control of their health-related destiny, but there are outside forces that provide strong headwinds.

    According to a study by Moodys Analytics and Information, Millennials are projected to experience slower economic growth and pay more in healthcare costs, which could result in economic damage as well as negatively affect their financial well-being. For example a BCBSA survey reports that: