Advanced Care Planning

Based on a recent article from HFMA, there is a lot of talk going on currently about Advanced Directives and Advanced Care Planning. As most know, this is essentially your instructions on how to be taken care of in the face of a terminal illness or unexpected trauma. This is how your next of kin and physicians know how to take care of you if you are unconscious or not of sound mind.

This article focuses on the monetary aspects of these directives. If we are given a set of instructions telling us to not waste our resources on this patient, why would we fight to prolong the inevitable? A study showed that using a new system, Advanced Illness Management (AIM), payers saved $8,000- $9,000. For families, this is great if they cannot pay for further treatment of their loved ones. For hospitals, we may never see that money if the patient cannot afford their bills. These are important reasons why current policy workers are trying to get coverage on Advanced Care Directives from insurances, such as Medicaid.

Most physicians fear following Advanced Directives, because they do not want to be sued for malpractice. But, if these are the patient's wishes, who are we to fight them on it? Currently, only 1/3 of the population has a directive and this is not readily available for the physician. In times of trauma, ER physicians must obtain the patient's records in order to know what they can and cannot do. Half the time, they may have already started emergency measures. In this case, they are now gone against patient wishes and fear repercussions from that.

In the article, it suggests having bracelets on patients that says their wishes. I think this would be effective for admitted patients, however no one would want to walk with a bracelet saying "do not resuscitate." I believe more access to people's medical history through EMR would be a great way to combat this issue. It would also be great to have insurances cover the costs of these directives, because many have wishes but cannot afford to have they written up on paper.

While this article focuses a lot on the monetary aspect of advocating for the importance of Advanced Directives, I think it is also important to bring up the idea of it being the patient's own choice. We do not have the right to tell someone in terminal condition they have to allow us to perform drastic medical measures that may not work! I have had two close family members use hospice for their end-of-life-care after battling cancer. Both were unable to have any other drastic chemo choices, and did not want to continue suffering in hospitals. My aunt had home-care while my grandma was brought to a hospice facility. This was important to them, and I think it is very important to respect other wishes for what they want to do with their body.

There are many advantages to investing in these directives, such as peace of mind that your clinician and family will understand your wishes. You can also potentially save your family and hospitals money by understanding the progression of your illness and what you want your next step to be. It is also important to sit and talk with family about your choices and why.

If you want to read this article:
http://www.hfma.org/Content.aspx?id=60367

Unfairness

In this Ted Talk, Marco Alvera discusses the importance of an unexpected "ingredient" to growing a successful team. This is the idea of fairness. What is fairness? To most of us, this is just the idea of everyone having an equal opportunity. In a sense, this is correct, but Alvera discusses this idea in terms of his own company.

In most businesses, we can expect to obtain positions based on our schooling and past experience in that area. Alvera was requested to internally hire someone for a supervisor position. This worker did not have a high school degree, but the company saw how well he was at his job and promoted him. Another worker proposed they build a cheese factory in Ecuador. The company said yes, because the saw the benefits of taking the risk. In Alvera's talk, fairness is more than everyone getting equal pay for the same job, but it is investing in your workers and their ideas, no matter their job title.

With this idea of fairness, everyone feels equally engaged in the company. No one feels unwanted or unappreciated. They have the motivation to strive to make the company better. There is no culture of competition, but instead working as a team to build their company. There is no worry of dishonesty, unappreciation, or other motivation-killers. There is the idea that if we contribute strong ideas that we can backup and defend, we will be given an equal opportunity to explore these ideas as a senior level executive would. The workers feel that they are just as necessary as the CEO.

Unfairness is a common feeling that we experience as humans. It is not a good feeling, and we tend to shut down when we feel we are being treated unfairly. How would not expecting a worker to be able to contribute to the growth of the company based solely on their job title contribute to the culture and dynamic? It wouldn't. Not listening to all of our workers can be detrimental to our companies.

Bad Meetings

As we get into the end part of the class, we are discussing topics about working in groups. With this in mind, I came across a Ted Talk about bad meetings, especially in big corporations. Meetings during work can be difficult for anyone. We would rather be at our desk doing our work and not listening to a supervisor lecturing at us. Many times we feel that we wasted the 45 minutes or so we spent in the meeting.

David Grady discusses how these meetings are plaguing our corporate world.

How can we avoid being subject to these "pointless" meetings? By being aware of what Grady refers to as MAS, or Mindless Accept Syndrome. Many of us receive notifications of meetings we are expected to attend, and click "accept." While we should be a part of the meetings in our workplace, it is more important that we know we are actually contributing to them. Feeling necessary in a meeting is the key to making yourself feel motivated to attend, because you know you are needed and your voice will be heard.

Grady recommends not just clicking "accept" every time a meeting notification pops up, but to investigate the meeting scenario prior. Reach out to your supervisor, or other colleagues who will be attending, and ask what the meeting will be about. How is your input going to be used after this meeting? How can you prepare prior to attending? What information will be discussed and how will it impact you? Knowing your purpose in these drab work meetings is key to being actively involved and not feeling that you wasted 45 minutes.

For our third presentation in the class, we will be discussing team engagement. This is the idea of how committed employees are to their company and its overall goals. Highly engaged employees are likely to be involved in meetings and contribute meaningful to the corporation as a whole. As employers, it is important to actively work to foster an environment of engagement, but employees must also be seeking the benefits of being engaged. When we are engaged, we are more noticed in the company, allowing for more chances for raises and promotions. Team engagement is a mutually beneficial asset to have in your company. It allows us to avoid these dreaded meetings that supervisors do not want to give and employees do not want to attend.

For those interested in watching David Grady's video on what a bad conference call is like:

https://www.youtube.com/watch?v=zbJAJEtNUX0