The Challenges of Healthcare, Part III
By Charlie Melton
We were talking about the problems in health care. I pointed out that I believe nurses have to spend entirely too much time charting. They have less time to care for patients because of it. We all get less care and nurses can’t give all of the care they wish to give.
We were discussing why so much documentation is required of nurses. Some even have to chart that they washed their hands and put on gloves.
Nurses do acknowledge the need to document patient care that contributes to patient management and treatment. This communication between caregivers is essential. We’re not talking about the necessary charting. We’re talking about excessive charting.
We went through the belief that the threat of lawsuits is the driving factor for excessive charting. I said that malpractice suits are brought by people that feel they’ve been wronged or are looking for money, or both.
Why are people suing due to being wronged or looking for a payday?
The answer is that the state allows, and even encourages it. The state is complicit in excessive paperwork by nurses. In Illinois, the limits on malpractice suits are mostly non-existent. The caps enacted were ruled unconstitutional so there is really no limit on how much you can be awarded. This in itself is very enticing and very dangerous for nurses. It should be noted that states that have limits on malpractice awards have fewer lawsuits. I do not know if this equates to less charting by nurses.
Illinois also lets you sue in counties other than where the incidents occurred. Many cases end up in St. Clair, Madison, and Cook Counties because the counties give out more money.
Against my best efforts I ended up on a malpractice jury in St. Clair County when I lived in that county. The medical practice and the home of the injured party were in Monroe County. The attorney followed the money, and expected an enormous amount of it. After the longest 2 weeks of my life, we gave the person and his attorney absolutely nothing. That case, which should have been in the home county, was the exception. Most juries gave huge awards in that courthouse.
Lawyers are part of the cause of nurses being under fire. Greedy clients are part of the problem. The state itself is at fault as well. With all things being equal, I think the state limiting money available in malpractice suits will reduce a lot of the fear of lawsuits that causes excessive documentation by nurses.
I spoke to an attorney about my concerns. He doesn’t see a problem with nurses documenting so much information. His opinion is that as a professional you document. He relayed that he spends a lot of time documenting his actions. I thought it was funny that part of the reason is to protect himself from being sued by a client.
In my unqualified mind I think the medical establishment is to blame as well. Medical organizations are notoriously top-down. They give instructions and mandate actions often without input from any staff members affected by the mandates. Leaders make sweeping policies and have no patience with any dissenting opinions.
The issue of nurses’ reduced opportunities to care for patients is “standard practice” and taken for granted. It doesn’t have to be. Other industries have developed and embraced all sorts of process improvement techniques. Systems like “Lean”, “Six- Sigma”, and other methods have saved entire industries from oblivion. Some medical corporations have embraced process improvement, but not to the extent they’re needed. Leaders have to give up power to embrace the changes needed to free up nurses to do what they’re supposed to be doing. Leaders must learn that decisions need to be made at the lowest level possible.
We’ve talked a long time about excessive charting being required of nurses. We should be concerned because we want better care and more expedient care. Nurses are concerned because they want to care for people and heal. They know, and we know, that paperwork never healed anyone.
This is an opportunity for us to improve our lives. This is an issue to bring to legislators. This is an issue to bring to your medical providers.
I want to urge the state to enact limits on lawsuits. I want cases to be tried in the appropriate county. I want to get the care I need. I want to go home without waiting on a ton of paperwork. I hope you want the same thing and help achieve it.
Tuesday, June 16, 2015
Wednesday, June 10, 2015
The Challenges of Healthcare, Part 2
We were talking about the problems in health care. I pointed out that I believe nurses have to spend entirely too much time charting. They have less time to care for patients because of it. We all get less care and nurses can’t give all of the care they wish to.
The National Institutes of Health commissioned a time and motion study of 767 nurses at 36 hospitals. The study found that nurses spent the vast majority of their time (35.3%) in documentation, med pass (17.2%), and care coordination (20.6%) for a total of 73.1%. Only 19.3% of their time is spent on patient care and 7.2% of their time on patient assessment.
I brought this concern to nurses, and they believe they have to chart excessively because of the danger of lawsuits.
Is there a real threat of lawsuits against nurses?
Historically we think of malpractice lawsuits as being against doctors or institutions. That is no longer the case. Nurses are frequently named in malpractice suits. Multi-million dollar awards from malpractice suits aren’t unheard of. One source claims that Illinois malpractice case fees collected by attorneys exceed $200 million a year. This amount is only a portion of the total money awarded. Nurses are often part of those lawsuits.
The threat of lawsuits is a real danger to nurses. The professional nursing associations encourage nurses to carry malpractice insurance. The fear of lawsuits may influence how they have to perform their jobs. Because institutions fear lawsuits, they may demand an ever increasing amount of documentation to protect from lawsuits.
What is the root cause of excessive charting? As I’ve stated, I lean towards lawyers causing this disruption. I approached one of my former professors from SIU. He’s the most analytical and methodical person I know. He never makes assumptions and always follows the data to its conclusion. He’s not convinced that this is the root cause of excessive documentation by nurses. When I announced to him that I’d identified the cause, he asked how I determined that the threat of lawsuits causes excessive documentation by nurses. He teaches to repeatedly ask why until you run out of “whys”. At that point you’ll be closer to the answer.
In this case, why is there a threat of lawsuits? There is a threat of lawsuits because people want to sue. Why do people want to sue? Because either they have been wronged or are looking for a payday, or both.
It should be noted that lawyers only do what the client allows them to do.
I know that some people sue to make money. There was just a story on the news about a policeman that was getting free coffee at a business and was burned by that free coffee. He sued. We all know similar stories. Some people sue because they can. It’s further verified by the fact that when the Illinois economy goes down, malpractice suits go up. It appears that you can supplement a lowered income with the proceeds of a lawsuit.
I’ve pointed out what I see as a problem. I’ve tried to start a discussion that someday may contribute to a solution.
How bad is it anyway? Is excessive time charting enough of an issue to even care about? Are there novel solutions to the problem?
Next week in my final installment I want to look at the results of all this paperwork. Has it really protected nurses? What is the impact on the patient? What can we do, and what can nurses do?
The National Institutes of Health commissioned a time and motion study of 767 nurses at 36 hospitals. The study found that nurses spent the vast majority of their time (35.3%) in documentation, med pass (17.2%), and care coordination (20.6%) for a total of 73.1%. Only 19.3% of their time is spent on patient care and 7.2% of their time on patient assessment.
I brought this concern to nurses, and they believe they have to chart excessively because of the danger of lawsuits.
Is there a real threat of lawsuits against nurses?
Historically we think of malpractice lawsuits as being against doctors or institutions. That is no longer the case. Nurses are frequently named in malpractice suits. Multi-million dollar awards from malpractice suits aren’t unheard of. One source claims that Illinois malpractice case fees collected by attorneys exceed $200 million a year. This amount is only a portion of the total money awarded. Nurses are often part of those lawsuits.
The threat of lawsuits is a real danger to nurses. The professional nursing associations encourage nurses to carry malpractice insurance. The fear of lawsuits may influence how they have to perform their jobs. Because institutions fear lawsuits, they may demand an ever increasing amount of documentation to protect from lawsuits.
What is the root cause of excessive charting? As I’ve stated, I lean towards lawyers causing this disruption. I approached one of my former professors from SIU. He’s the most analytical and methodical person I know. He never makes assumptions and always follows the data to its conclusion. He’s not convinced that this is the root cause of excessive documentation by nurses. When I announced to him that I’d identified the cause, he asked how I determined that the threat of lawsuits causes excessive documentation by nurses. He teaches to repeatedly ask why until you run out of “whys”. At that point you’ll be closer to the answer.
In this case, why is there a threat of lawsuits? There is a threat of lawsuits because people want to sue. Why do people want to sue? Because either they have been wronged or are looking for a payday, or both.
It should be noted that lawyers only do what the client allows them to do.
I know that some people sue to make money. There was just a story on the news about a policeman that was getting free coffee at a business and was burned by that free coffee. He sued. We all know similar stories. Some people sue because they can. It’s further verified by the fact that when the Illinois economy goes down, malpractice suits go up. It appears that you can supplement a lowered income with the proceeds of a lawsuit.
I’ve pointed out what I see as a problem. I’ve tried to start a discussion that someday may contribute to a solution.
How bad is it anyway? Is excessive time charting enough of an issue to even care about? Are there novel solutions to the problem?
Next week in my final installment I want to look at the results of all this paperwork. Has it really protected nurses? What is the impact on the patient? What can we do, and what can nurses do?
Sunday, June 7, 2015
Illinois Healthcare- Nursing part 1
The Challenges of Healthcare, Part 1
By Charlie Melton
Everybody talks about how healthcare is a mess. Too many of us have no insurance or insufficient insurance. Too many of us have to choose between food or rent or medicine.
I don’t understand all of the aspects of healthcare. I understand very little. What I do understand is that health resources often go to the wrong place for the wrong reason.
If you’ve ever been to an emergency room you know the drill. You appear, wait, get assessed, wait for the doctor, and wait some more. The nurse tells you that you can go home and then you wait more. You end up concerned, then irritated, then border on furious.
You look out of the exam room you’re interred in and see nurses sitting at their station. They’re either peering into a computer monitor or writing on paper at length. If you stroll around and spy on the nurses they’re not writing a love letter or playing Angry Birds. The nurses are charting. They’re writing down every interaction with the patient, every observation, and every action taken or not taken.
While charting is an essential part of healthcare, to the uninitiated it seems to be excessive. With that concern I asked several professionals about charting.
I’m friends with several nurses on Facebook. I messaged them individually and asked each the same question. “My perception is that nurses spend most of their time on paperwork. What do you see as the biggest factor that makes this necessary?” About 10 nurses responded with almost identical observations.
Heather Tille is a self described “Ninja Nurse”. She works in a large hospital as an ICU nurse and she is a nursing instructor at a local college. She’s currently working on her master’s degree. She says that the amount of time charting varies according to the type of unit the nurse works in, but it ultimately takes away from direct patient care. Mrs. Tille says that nurses and their employers fear being sued and that influences the charting they do. She decries the fact that attorneys go for every conceivable person involved in patient care when suing for malpractice. She says this system makes fear and the quest for money the dominate factors in how a medical provider does business. Patient care suffers.
My good friend Brandie Walters is a RN. Brandie says, “If you’re involved in a lawsuit, if you didn’t write it down it didn’t happen. I even have to chart that I washed my hands and wore gloves. It’s a waste of time. I also have to chart the same information every time I see a particular patient. How about I spend that time taking care of someone? It’s the biggest thing I hate in my career. Charting is about money any way you put it.”
What I gleaned from nurses is that nurses, doctors, and companies fear lawsuits. Their perception is that they could do a better job for patients if the fear of attorneys wasn’t so pervasive.
Is that a rational fear? Do nurses really get named in malpractice suits? Does charting have a purpose other than to protect the individual care giver?
Am I naïve when I say that nurses are dedicated and caring professionals and the very idea of suing one is reprehensible?
Over the next couple of weeks I hope to explore what nurses do. Is the paperwork your nurse has to do excessive? Does it reduce the amount of care you receive? I’m not skilled enough to rewrite standard practices, but maybe we can start a discussion that will ultimately benefit us all. Please tell me what you think by emailing me at chasmelton@gmail.com or write me at P.O. Box 378, Norris City, Il 62869.
By Charlie Melton
Everybody talks about how healthcare is a mess. Too many of us have no insurance or insufficient insurance. Too many of us have to choose between food or rent or medicine.
I don’t understand all of the aspects of healthcare. I understand very little. What I do understand is that health resources often go to the wrong place for the wrong reason.
If you’ve ever been to an emergency room you know the drill. You appear, wait, get assessed, wait for the doctor, and wait some more. The nurse tells you that you can go home and then you wait more. You end up concerned, then irritated, then border on furious.
You look out of the exam room you’re interred in and see nurses sitting at their station. They’re either peering into a computer monitor or writing on paper at length. If you stroll around and spy on the nurses they’re not writing a love letter or playing Angry Birds. The nurses are charting. They’re writing down every interaction with the patient, every observation, and every action taken or not taken.
While charting is an essential part of healthcare, to the uninitiated it seems to be excessive. With that concern I asked several professionals about charting.
I’m friends with several nurses on Facebook. I messaged them individually and asked each the same question. “My perception is that nurses spend most of their time on paperwork. What do you see as the biggest factor that makes this necessary?” About 10 nurses responded with almost identical observations.
Heather Tille is a self described “Ninja Nurse”. She works in a large hospital as an ICU nurse and she is a nursing instructor at a local college. She’s currently working on her master’s degree. She says that the amount of time charting varies according to the type of unit the nurse works in, but it ultimately takes away from direct patient care. Mrs. Tille says that nurses and their employers fear being sued and that influences the charting they do. She decries the fact that attorneys go for every conceivable person involved in patient care when suing for malpractice. She says this system makes fear and the quest for money the dominate factors in how a medical provider does business. Patient care suffers.
My good friend Brandie Walters is a RN. Brandie says, “If you’re involved in a lawsuit, if you didn’t write it down it didn’t happen. I even have to chart that I washed my hands and wore gloves. It’s a waste of time. I also have to chart the same information every time I see a particular patient. How about I spend that time taking care of someone? It’s the biggest thing I hate in my career. Charting is about money any way you put it.”
What I gleaned from nurses is that nurses, doctors, and companies fear lawsuits. Their perception is that they could do a better job for patients if the fear of attorneys wasn’t so pervasive.
Is that a rational fear? Do nurses really get named in malpractice suits? Does charting have a purpose other than to protect the individual care giver?
Am I naïve when I say that nurses are dedicated and caring professionals and the very idea of suing one is reprehensible?
Over the next couple of weeks I hope to explore what nurses do. Is the paperwork your nurse has to do excessive? Does it reduce the amount of care you receive? I’m not skilled enough to rewrite standard practices, but maybe we can start a discussion that will ultimately benefit us all. Please tell me what you think by emailing me at chasmelton@gmail.com or write me at P.O. Box 378, Norris City, Il 62869.
Wednesday, June 3, 2015
Road Rage
Sometimes things aren’t what they seem to be. Our experiences taint our perceptions. Our view of ourselves and others affects how we see things. I think this gives order to our world. It can also make us very wrong when we deal with circumstances.
Last week I was late to work because I had a certain view of the world. If I held a different view I would have been early enough for a cup of coffee and a few words with the girls before I clocked in. I had a good excuse for being late, but ultimately it was my view of the world that betrayed me and made me late.
I’m tooling to Enfield at my regular “look at the scenery” clip. I just achieve the speed limit North of Norris City when a car passes me and the driver starts tapping the brakes. I figure I must have taken his turn at the 4 way like a lot of us have the habit of doing. I salute in apology and slow way down to show I’m sorry.
He hits the brakes and slows down. I must have cut him off without realizing it because he really seems upset. I slow down even more to increase the distance between us and placate him. He speeds up and the situation seems over.
In a short time the other driver starts his antics again. Okay, this is getting ridiculous. I start mouthing oaths in his general direction. I find I still have all of the vocabulary I honed in my years in the military. Even though he can’t hear me, he senses my attitude. The situation just escalated.
My nemesis slows way down. I press the issue and get dangerously close to his bumper. He slows even more. I get a testosterone surge, and get ready for battle. He continues to slow.
The car’s turn signals come on and the driver points out of the window to a turn off. He turns in and so do I. He opens his door and I open mine. It’s time for battle.
“Something flew out of your truck back by Norris City”, he yells. “I thought you might need it.” I take a moment to process his words. “Thanks”, I respond. I continue to process the change in the circumstances. He gets back in the car and proceeds towards Enfield. I sit for a second and head back to Norris City to pick up my missing cargo. What just happened? How did I get this so wrong? Even if it was road rage, why would I get involved at my age?
I think my interpretation of the situation came from my experiences in life. I’ve lived in cities where a certain behavior facilitates survival. Some of my neighborhoods weren’t the best, and projecting a willingness to fight ensures continued breathing. Even my career rewarded aggressiveness and punished the timid. Experience may be the best teacher, but it’s still possible to get the lesson wrong like I did.
The point I’m trying to make is don’t make assumptions, and don’t jump to conclusion. A wise person I know says to think before speaking. I’d extend that to think before reacting. Something may have fallen off of your truck.
Last week I was late to work because I had a certain view of the world. If I held a different view I would have been early enough for a cup of coffee and a few words with the girls before I clocked in. I had a good excuse for being late, but ultimately it was my view of the world that betrayed me and made me late.
I’m tooling to Enfield at my regular “look at the scenery” clip. I just achieve the speed limit North of Norris City when a car passes me and the driver starts tapping the brakes. I figure I must have taken his turn at the 4 way like a lot of us have the habit of doing. I salute in apology and slow way down to show I’m sorry.
He hits the brakes and slows down. I must have cut him off without realizing it because he really seems upset. I slow down even more to increase the distance between us and placate him. He speeds up and the situation seems over.
In a short time the other driver starts his antics again. Okay, this is getting ridiculous. I start mouthing oaths in his general direction. I find I still have all of the vocabulary I honed in my years in the military. Even though he can’t hear me, he senses my attitude. The situation just escalated.
My nemesis slows way down. I press the issue and get dangerously close to his bumper. He slows even more. I get a testosterone surge, and get ready for battle. He continues to slow.
The car’s turn signals come on and the driver points out of the window to a turn off. He turns in and so do I. He opens his door and I open mine. It’s time for battle.
“Something flew out of your truck back by Norris City”, he yells. “I thought you might need it.” I take a moment to process his words. “Thanks”, I respond. I continue to process the change in the circumstances. He gets back in the car and proceeds towards Enfield. I sit for a second and head back to Norris City to pick up my missing cargo. What just happened? How did I get this so wrong? Even if it was road rage, why would I get involved at my age?
I think my interpretation of the situation came from my experiences in life. I’ve lived in cities where a certain behavior facilitates survival. Some of my neighborhoods weren’t the best, and projecting a willingness to fight ensures continued breathing. Even my career rewarded aggressiveness and punished the timid. Experience may be the best teacher, but it’s still possible to get the lesson wrong like I did.
The point I’m trying to make is don’t make assumptions, and don’t jump to conclusion. A wise person I know says to think before speaking. I’d extend that to think before reacting. Something may have fallen off of your truck.
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