Wish List

Summer's great. Get's you outdoors, reminds you there's a life beyond work. Makes it harder to "blog" (...and I know that'll make some people happy! Cheers to them!)

There was a column last week in the Denver Post by Cal Thomas...not ususally a totally inspiring writer/thinker...but this piece deserves some attention. It was titled "Focus on the Patients"
and it was talking about a documentary on Public Television by Lloyd Dobyns about "Systems Thinking". When applied to hospital settings, systems thinking "..is not focused on reducing staff, reducing costs, or improving profits." Instead, everything is focused on the patients. "..as you focus on the patients, all the other things occur naturally. You want to help the hospital? Help the patients." Thomas says "In hospitals where systems thinking is used, health care costs have been reduced by as much as half.

I wish that our administration would at least make an attempt to really re-think the prevailing management "style" (process? method?), best characterized by "ignore it and it will go away"; perhaps they could use the PBS documentary to inspire them...perhaps we all could. I suggest the Director acquire a copy and play it at the next Director's Forum...start a good discussion...come up with some ideas for real change. Even I am beginning to get bored with just complaining...can't we actually improve something for once????!!!

Meanwhile, while I'm wishing, I wish Facilities Management would PLEASE turn on the sprinklers in the patient courtyard on T1, where what used to be grass is now dirt and straw. That would certainly be a patient centered thing to do. It is, after all, the only outside space many of these patients are allowed to inhabit for weeks on end. For years, it has been a pleasant, grassy area where volley-ball, or other outdoor activities could be held...for some reason, this year, there's been zero water applied and it's a really disgraceful excuse for a patient area.

And, oh what the heck, while I'm wishing: I wish that the hospital followed it's own grievance policy. The policy is spelled out prominently on every grievance form; it describes 4 steps, each to occur 7 days after the previous one. In actual practice, at least 3 grievances that I have personal knowledge of, got to step two and stopped....in spite of protests from the grievers, requesting that they proceed to the next step...it makes patients and staff feel that there is, in fact, no formal method for dealing with issues as they arrive. The grievance procedure, (written policy nothwithstanding) is just another exercise in frustration leading to cynicism and culminating in, among other dysfunctional gestures, the "blog" - where these matters become a public disgrace, instead of a private one.

Just to round out the wish list, I wish the State of Colorado would offer to take care of those whose personal identities were compromised in the same way the Office of Veterans Affairs has done. The VA is paying to have the victims credit info monitored...so far, our State Government has offered it's victims nothing at all...it's not clear to me that anybody's even said "sorry".

Now, who do I give this wish list to, I wonder...is there a Madhouse Fairy? A Santa?...Harold? Shinning Elmer?

.....Steve?
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Summer On, bloggers!!

There are new comments at least on the last post...have lost track a little...there was good one on an earlier post, too...egad. Dahlias are distracting.

Main Mental Health Worker Retires!!

Man Oh Man...I just hate to see our Main Mental Health Worker go!!

A guy who'd been here over 30 years retired last week. Well deserved. He couldn't, after all, just stay forever. But there's something so final about it; I can't imagine the place without him. It makes me feel kind of scared.

Which is funny, if you know him, since there was no one better at scaring you when he was here...under his tutelage I feared asteriod collisions, solar explosions, alien invasions and other catestrophic disasters on a fairly regular basis. But in the enchanted castle, I fear his absence more than any of those things.

Come back! Come back!!

No, of course, I don't really wish him back....I really wish him a peaceful, creative, engaged retirement...and I'm sure he'll have it. It's that "what goes around, comes around" principle...he's been very good to co-workers and patients here and the world will treat him right out there.

In the new world of psychiatric care, it's the nurses and doctors who run the show. It used to be different. There was a time when "multi-disciplinary team" actually meant that all the members of the team had equal importance in the treatment of patients. In those days, the mental health worker, as the professional who had spent the most time with the patient on a day-to-day basis, was consulted about the patient's response to treatment interventions, and asked for treatment suggestions; now not many of them even are told what medications the patient is on, never mind asked how the patient has responded to them, or what might be better. And medication is the only treatment most patients get.

Ah, but mental illness is a biological matter, right? No need for the mental health clinician, trained to understand the dynamics of personality. Irrelevant, time consuming, difficult to measure. And besides, they have degrees and are expensive.

Not as expensive as nurses, though.

More than psyc techs, however.

Anyhooo...we're all about to see what difference a good mental health clinician makes...as we experience the retirees absence. Thanks! Mr. Retiree...you've been great to work with. You made us all feel safe, you got us interested in things, you created an atmosphere of affection and caring, you knew what to do when nobody else did. Enjoy yourself and keep in touch....

How 'bout a little "blog" ?

News Reporters Evoke Response....Finally!!!

Holy Cow! How many of you were watching the television news last night? Finally, our identity theft issue has made its way to the surface, in spite of the "ignore it and it will go away" stance of our local administrators. It's in the Rocky Mountain News this morning, too...with a box headline on page One...haven't seen the Denver Post, but I imagine it's there, too.


Liz McDonough, spokesperson for the Department of Health and Human services says "patients were sent a letter Tuesday" June 6th....although the theft happened on April 21...anyone notice that its been way over a month...closer, I'm thinking, to six weeks since the theft occured???...and today, they're sending a letter to the victims....and only, apparently in response to the fact that the news reporters started asking about it. (Better late than never, I guess).

She said, "It's also a breach of trust with our staff, beacause there was personal information on our staff as well, and we take protecting that information very seriously." (This is a direct quote from the Channel 9 web site where the news is given TOP billing. The story was also, apparently, on Channel 7) Yet the staff, who've been asking for assistance repeatedly since the theft...have never been offered any help whatsoever, as I understand it...and, obviously, neither have the patients. Makes one wonder just how "seriously" the welfare of staff or patients was taken. If the news media had never reported it, would there have been a letter to patients Tuesday? I doubt it.

I'd like to know about accountability here....The Boss, i.e.The DIRECTOR...knew all about this...and, as I understand it, disciplined the offending employee by making him retake the HIPPA class. Now, I agree, retaking the HIPPA class (one hour long) certainly is punishment of a sort...yet, somehow doesn't seem to match the damage done here...and the boss of our boss, isn't that person accountable, too? Which adminstrators agreed on the "devil-may-care" stance taken regarding this theft until now....until, in fact, the public heard about it? Their actual response does not convey a sense that the Department of Health and Human Services takes this situation "seriously"...what they take "seriously" is the bad press.

I trust that now help will indeed be offered to the employees and patients who's information is out there floating around; I hope that the State is prepared to make damaged victims whole if the information is used; I hope that the Department of Health and Human Services will please review the performace of the the Director of this institution and make some changes...this is just the most public and egregious example of his management style...there's a whole lot more. Hey, Liz and Marva....check into why all the best experienced staff have left,..... or are about to....ask about the shredding of med variances, for example.

But the biggest news, I think, is that one or more employees actually took an action to defend themselves!! I assume that the news media found out about this story because someone...or several someones called them. Whoever you are, you are to be congratulated. The passive acceptance of this and other "victimizations" has troubled me a great deal. That passivity is, at least in part, to blame for our condition at the hospital. Each of us, as employees, has the responsibility to stand up for ourselves, our patients and for what is right...just as we do as citizens of our country. And someone among us has chosen to act! Thank you, thank you, thank you!! If I find out who you are, I'll give you a gold star - you're a hero. I'm sure you're sleeping well.

I'll bet the Director isn't.

Comments since last post on Privacy and Portability

Privacy and Portability

As regular readers of The Madhouse might know, I have issues with the implementation of HIPPA ( the Healthcare Insurance Privacy and Portability Act). Sometimes just blogging about it makes me feel better. So, sorry if you've heard this all before, but I have realized something new that might spice the discussion up. I've had the opportunity to talk with an attorney about HIPPA, and am told that there is, so far, very little case law on it...it's new, not many lawsuits have been filed. The courts haven't had the opportunity to clarify the issues yet. There are many ordinary people reading the massive new regulation, making interpretations about what must be done in response to it, and so forth. A few people will have to sue before we get a clear picture of what's required.

My blog-related issue is the feedback I've recieved that tends to take the position that we, in effect, aren't allowed to blog about patients at all, even if their identifying information is removed...the rub comes, near as I can tell, in the interpretation of "identifying information". My stance is that even if my co workers/readers can piece together the real identity of my subjects, no one else could...and who's to say that, after "piecing together the clues", even my co-workers are right when they "guess" an identity? I could assert that they're wrong, I was writing about an entirely other or imaginary person, couldn't I? And who would bring the complaint? and why? For a suit, doesn't someone need to be "harmed" in some way? ... blah blah blah, I could go on forever...

It would be extremely odd to suggest that we are prohibited from discussing our patients, their symptoms, the therapeutic interventions that we've tried...our reactions to it all....particularly in this field. What would happen to Freud under HIPPA? Are we not to learn from one another?

Here's an example of the interpretation of HIPPA as played out lately in our enchanted kingdom:

The evening program on the unit includes a community meeting. Formerly, a patient who had been elected by his/her peers to serve for one week as the leader of the group, would call roll from a clipboard, marking who was present, who was not. Now, for some reason, staff is required to perform the "leadership" role. I asked the reason for the change and was told that having a patient read the list of names of other patients is a HIPPA violation; further, running the meeting was "too much pressure" for the patients.

When pressed, staff agreed that the HIPPA issue was really a non-starter as the list was comprised of first names only...but, too late, I had already pictured the new world. Imagine a psyc unit where 24 psyc patients in crises live together, eat together, go to groups together, use the bathroom together...but are not allowed to know one another's names....interesting.

...and the next step is the staff are not allowed to know the patients names....and they can only talk about patients in supervised settings. Naturally, in order to manage the confusion, administration assigns numbers for each person which must be displayed prominently at all times...perhaps a tattoo....

The advertised "intent" of this regulation, was to insure that people moving from one job to another could continue their health insurance regardless of their pre-existing conditions. That's the "portability" part. The "privacy" part, I thought, was intended to make the "portability" part work.

But as it's been implemented in hospitals, it has resulted in very "unhealthy" situations where neither portability nor privacy are served. I remember taking my sister-in-law to the hospital where she was being treated for cancer. She was very sick, she came in at least every week for one thing or another...towards the end she was there repeatedly to have fluid drained from her chest so she could breathe...she would be panicky from lack of air by the time we arrived at the hospital. Each and every time, we were required to get into line and sign a bunch of paperwork...the same bunch of paperwork as the week before.....before being allowed to proceed. Each week we would hear the HIPPA apology from the frazzled clerk, as my sister-in-law - in such distress - had to repeat the "admission" process for what would be a 15 minute proceedure.

Now if she's had her number tattooed on her forehead, the clerk could've just scanned her and in she could go.

hmmm.

Forgive me for rambling, but this all somehow relates to Identity Theft....in both cases, people are seen to have digitized "identities" that require tending to...HIPPA creates a digital health care you. "Credit scores" create a digital financial you.... Social security numbers tie them all together. We're very busy trying to protect these digital identities...and we're finding such protection, as well as the identities themselves - have odd, burdensome consequences.

I just think we haven't thought this through. It's the electronic age, all right...and I love it...but, still....

Ah well. I'm going back to the Dahlia.



Comments since last post on Writers Block and Identity Theft