February 16th, 2012
We all know that behind each cancer patient is a referring physician. But really, how well do you know each of these physicians? How effectively do you connect with them to secure steady streams of referrals? How often do you talk
to them?
A great deal of attention is being given these days to improving the quality and safety of cancer care, as well as improving the experience of the patient. These are indeed important and lofty goals. But they do ignore the importance of another customer who is critical to growing referrals in the face of intensifying competition between cancer programs.
Many cancer programs don’t really pay much attention to fostering long-term and mutually beneficial relationships with the physicians that refer patients to them. After all, “we built it so they’ll keep coming” – the referrals that is. By the way, the same is true for free-standing oncology practices as well, regardless of whether they are surgical, medical or radiation oncology or multi-specialty practices.
I have worked with numerous cancer programs, whose patient volumes are declining steadily. In addition to not being effective in promoting their cancer programs, many centers are also not paying much attention to a key source of their patients: referring physicians. When that happens, these physicians lose interest or worse, confidence and trust. Before you know it, they start sending patients elsewhere. In addition, many referring physicians are involved in cancer care themselves and may prefer treatment options that differ from the ones your center offers.
So let’s be honest, how many cancer program medical directors, administrators and oncologists are natural “sales” people, who are extroverts and instinctively know how to effectively connect with other physicians? How many really know how to effectively promote their cancer program and secure steady streams of referrals from these physicians?
Fortunately, you don’t have to be a natural marketer or sales person to build effective relationships with referring
physicians. There are a number of tools and methods available to help you effectively connect with referring physicians. Here are some ways to help you establish long-term relationships with loyal referring physicians.
- View and treat referring physicians as Very Important Customers. Your promotional and business development
initiatives should include an intense focus on building long-term relationships with loyal physicians to secure steady streams of referrals.
- Recognize that referring physicians are people too, so get to know them as individuals. This may sound obvious and trivial but it is not. Like you and I, referring physicians have hopes and dreams, face personal and business challenges, may have priorities different from yours and have probably become biased due to their profession, training and personal experiences. In addition, treating cancer is a people business. That means that referring physicians have to like and trust you as an individual, as well as the organization you represent, to feel comfortable referring patients to your cancer program. If the chemistry is not there, it will quickly become an uphill battle.
Consequently, you cannot assume that referring physicians are ready to do business with you right away after the first meeting. You are going to have earn their trust and respect by aligning your priorities with theirs to create a “win-win” relationship.
- Listen actively to referring physicians. Most representatives of cancer programs will have the natural urge to start “selling” themselves as soon as the meeting with the referring physician begins. However, it is very important to resist this urge and to get the referring physicians to tell you about their views, expectations and the challenges they may be facing. This will help you understand them effectively and it will enable you to tailor your relationship to better meet their needs. In addition, it will help you gain their trust in and respect for you as a person and the organization you represent.
In the pharmaceutical and medical technology industry, active listening is a critical and powerful part of consultative selling, whereby the seller and buyer try to find mutually beneficial reasons for working together.
- Make the relationship worthwhile for both parties. Relationships in which one partner benefits and the other gains little seldom last. While your goal is for them to send their cancer patients to your cancer program, you should also pay attention to what they hope to get out of the relationship. You are building a partnership around your shared customers – the patients. Most likely, their expectations will go beyond just taking good care of their patients. At a minimum, you need to treat them as partners of the team, keep them proactively and regularly informed about their patient’s progress, involve them as appropriate in their patient’s care, and be responsive to their requests. In addition, they will want to know that their patients will have timely access to your program’s services and that you will provide them with best possible care. Finally, their own practice may be struggling and there may be ways in which your organization can help them get back on track. Failure to do any of this will quickly lead to their referrals drying up.
- Establish trust and respect. Actions speak louder than words, so say what you do and do what you say. In the early stage of building a relationship with a new referring physician, provide them with meaningful facts about how you care for their patients. And request that other referring physicians share their experiences with your cancer program with the new physician. Later on, it is important to follow through on your commitments, even if some of the referring physicians turn out to be less than perfect partners. If they are important to you, find ways to improve the relationship.
- Keep in touch – often. Relationships with referring physicians are like any relationship: they require time, effort and the sincere desire to provide value to each other. Without these, partners will lose interest and cast their eyes elsewhere. Also, building and maintaining relationships with referring physicians cannot be based on a brief and one-time meeting. It will require regular meetings over time. Such encounters can be arranged through multiple venues, i.e., at their office, professional society meetings, country clubs, breakfasts, luncheons, dinners, etc. You get the picture.
So, how effective are you at building and maintaining a network of loyal physicians? Do you feel comfortable reaching out to them even when they show no interest? Please call or email us for a free discussion about how we can help. A few minutes of your time may just be what your cancer program needs to start growing again.
If you have any questions, contact primeASCENT by calling 410-444-6024 or click here today!
Check us out on Facebook, LinkedIn and Twitter as well!
Tags: Actions speak louder than words, active listening, build effective relationships with referring physicians, building a partnership, building a relationship, building and maintaining a network of loyal physicians, building and maintaining relationships, business challenges, Cancer care, Cancer patient, Cancer program, cancer program medical directors, cancer programs, competition between cancer programs, consultative selling, effectively connect with other physicians, effectively connect with referring physicians, establish long-term relationships with loyal referring physicians, extroverts, fostering long-term and mutually beneficial relationships with the physicians, free-standing oncology practices, improve the relationship, improving the experience of the patient, improving the quality and safety of cancer care, Listen actively, medical, medical technology industry, multi-specialty practices, new physician, new referring physician, Oncologists, Oncology, patient volumes, Patients, people business, personal experiences, pharmaceutical, physicians, PrimeASCENT, profession, promoting their cancer programs, promotional and business development initiatives, radiation oncolog, refer patients, referrals, referring patients, referring patients to your cancer program, referring physician, Relationships with referring physicians, representatives of cancer programs, sales people, secure steady streams of referrals, shared customers, surgical, The Forgotten Customer, training, treating cancer, Treatment Options, win-win relationship
Posted in Improving Referring Physician Relationships | No Comments »
December 12th, 2011
You are seeing your patient volumes staying flat or even declining. Maybe a competitor is moving in or some referring physicians are steering their patients elsewhere. Either way, you somehow lost connection with your customers and they are going somewhere else for treatment. So, now what do you do?
Most healthcare providers, including cancer programs, continue to make a number of mistakes that prevent them from effectively attracting new patients. The first mistake is that they pursue a simple marketing strategy that is based on two assumptions:
1. “Build it and they will come”; and
2. “One size fits all”
This strategy may have worked well in the past but not any more. Unless your center is located in a remote and rural center, and safe from distant competitors, you now have to actually work hard at attracting new patients. Just because your center treats cancer patients does not automatically mean that they will continue to come. There are plenty of competitors out there ready to take your business from you if you don’t pay attention. The “build it and they will come” strategy does not work any longer because it ignores the fact that new patients and their referring physicians need to be made aware and constantly reminded of your wonderful cancer program.
The “one size fits all” strategy, usually consisting of a few billboard and magazine advertisements, combined with an occasional visit to some of your referring physicians, no longer works either because of it assumes that you have only one customer: the patient. And it falsely assumes that all patients are pretty much the same and equally important to your cancer program.
Banks, retailers, manufacturers and other companies have long ago figured out that they provide services to multiple groups or segments of customers and that each customer segment has different needs. They also figured out that each customer segment needs to be approached differently. Some customer groups are best reached through advertising, direct mailings, social media, etc. Others may need a much more personal touch and require regular face-to-face interactions. Most customer segments will need a tailored blend of both strategies.
As the leader of a cancer program, you are already familiar with the sales reps of pharmaceutical or medical equipment companies stopping by regularly with doughnuts and bagels to keep in touch and to be ready to help you with purchasing decisions. You will need to do the same thing with your customers. In addition, patients and their relatives increasingly realize that they now have the tools to determine where to get the best treatment for their cancer. The internet, the social media, US News & World Report’s annual hospital ratings, the US government’s Hospitals Compare, etc. are providing patients and their relatives with enough information to be dangerous. Did you know that according to a recent AMA study, which also cites a study by the Pew Internet Research Group, in 2011, nearly 80% of Internet users, or 60% of all adults, have searched online for health information? In addition, 41% of patients look for medical content from social media sites.
So, the fundamental questions you need to answer are:
1. Who are my customers anyway?
2. Where are they coming from geographically?
3. What are they looking for?
4. How do I best reach them?
5. Are they all equally important?
Market or customer segmentation is, therefore, the first critical step in determining and understanding who your customers are.
Keep in mind that your customers are not only your patients but also many others who are involved, in some fashion, in the patient’s decision to come to your center for treatment, e.g., family members, primary care physicians, surgeons and other specialists, payers and employers. These are different groups of individuals or organizations, each with their own unique goals and needs.
Also, not all customers are equally important to your top line and bottom line. Some groups of patients may be more attractive than others because of your cancer center’s capabilities and expertise, or less attractive because the cost of caring for these patients in an appropriate and effective manner exceeds the reimbursement you collect from their payers.
Similarly, it is important to cultivate strong and long-term relationships with referring physicians in general and to take especially good care of those referring physicians who consistently send many patients to your cancer program for treatment. And that requires you to understand who these key referring physicians are.
Getting to know and understand your customers’ goals and needs is your first important step toward an effective marketing strategy. It will help you define how to reach out and connect with your customer segments and to build long-term relationships with them, just like they do in other industries. Your competitors aren’t sitting still either and are probably already going after the same customer segments you depend on for growth.
If you are experiencing a decline in patient volumes or plan to grow your cancer program and are not sure how to best proceed, please call me for a free consultation. I’ll be happy to help you avoid the 10 lethal mistakes in marketing your cancer program and help grow your cancer program profitably.
Yours in Oncology Excellence.
Paul Schilstra,
President
If you have any questions, contact primeASCENT by calling 410-444-6024 or click here today!
Check us out on Facebook, LinkedIn and Twitter as well!
Tags: 10 lethal mistakes in marketing your cancer program, advertising, Are they all equally important, attracting new patients, Banks, Build it and they will come, cancer patients, cancer programs, customer groups, customer segmentation, customers, direct mailings, face-to-face interactions, family members, free consultation, healthcare providers, How do I best reach them, Internet users, manufacturers, Marketing Mistake #1: “Build It And They Will Come” And “One Size Fits all”, marketing strategy, medical content from social media sites, new patients, Oncology, One size fits all, online for health information, patient volumes, Paul Schilstra, personal touch, Pew Internet Research Group, pharmaceutical or medical equipment companies, primary care physicians, referring physicians, retailers, row your cancer program profitably, social media, surgeons, US government’s Hospitals Compare, US News & World Report’s annual hospital ratings, What are they looking for, Where are they coming from geographically, Who are my customers anyway
Posted in Marketing & Business Development | 1 Comment »
November 18th, 2011
In my previous blog, I announced a new series of blogs focused on promoting cancer programs. The world of cancer care is changing rapidly and competition among cancer centers is intensifying. The battle for attracting cancer patients is raging at full strength, even when few realize it.
There are two powerful forces that are shaping cancer care as we speak. First, supply and demand continue to grow out of balance because of a sustained surge in demand as the population grows and ages, revenues decline, treatments continue to cost more, regulation is increasing, shortages of physicians and nurses increase, and cancer drug shortages are growing.
Second, competition is intensifying due to the ongoing consolidation of cancer programs into large regional and national networks, an increasingly internet and social media-savvy population and, last but not least, a growing number of public ratings – e.g., the federal government’s Hospital Consumer Assessment of Healthcare Providers and Systems, US News & World Report, HealthGrades, etc. – that are available on the internet.
Instead of responding effectively to these profound developments, many cancer programs still promote themselves in very limited and conventional ways. To be perfectly blunt, the vast majority of cancer centers still erroneously assume that “since we built it, they will continue to come”. Those days are, unfortunately, over in this brave new world of cancer care.
The root causes of cancer programs not adjusting to the new realities are ten common and rather lethal mistakes that most cancer centers make in their promotional efforts, or lack thereof.
1. Not knowing your customers (who they are and what they are looking for)
2. Not creating value from your customers’ perspective
3. Taking the geographic position or reputation of your center for granted
4. Underestimating your competitors and overestimating your capabilities
5. Not being able to clearly differentiate yourself from your competitors
6. Being hard to find physically and on the internet
7. Not having clear goals and a game plan for growth (level of ambition)
8. Not knowing the difference between marketing and business development
9. Not leveraging the modern media, including the internet and other social media
10. Not tracking your Return on Investment in promotional efforts
I will discuss each of these common and deadly mistakes in blogs during the coming weeks.
But don’t wait for my next blog.If you are concerned about maintaining or increasing your patient volumes, please call me or email me to explore how I can help your cancer program effectively master this brave new world of cancer program marketing.
Yours in Oncology Excellence,
Paul Schilstra
President
If you have any questions, contact primeASCENT by calling 410-444-6024 or click here today!
Check us out on Facebook, LinkedIn and Twitter as well!
Tags: 10 Lethal Mistakes in Marketing Cancer Centers, Being hard to find physically and on the internet, Cancer care, cancer drug shortages, cancer patients, cancer programs, competition among cancer centers, consolidation of cancer programs, HealthGrades, Hospital Consumer Assessment of Healthcare Providers and Systems, including the internet and other social media, maintaining or increasing your patient volumes, new world of cancer care, Not being able to clearly differentiate yourself from your competitors, Not creating value from your customers’ perspective, Not having clear goals and a game plan for growth (level of ambition), Not knowing the difference between marketing and business development, Not knowing your customers, Not leveraging the modern media, Not tracking your Return on Investment in promotional efforts, Oncology, Paul Schilstra, population grows and ages, PrimeASCENT, promoting cancer programs, promotional efforts, public ratings, regulation is increasing, revenues decline, shortages of physicians and nurses increase, social media-savvy, supply and demand, Taking the geographic position or reputation of your center for granted, treatments continue to cost more, Underestimating your competitors and overestimating your capabilities, US News & World Report
Posted in Marketing & Business Development | No Comments »
November 1st, 2011
There is a war going on in the United States. A cold war, actually, very similar to the real Cold War during the second half of the 20th century. Most people don’t know or realize it, but it’s real. All you have to do is look at states such as California, Maryland, New Jersey, Pennsylvania, and Texas, where consolidations and affiliations of cancer programs are taking place at a rapid pace. Major health systems and cancer center networks are increasingly fighting for market share by using community-based hospitals and cancer centers as their proxies.
We all know that the demand for cancer care is increasing rapidly as the population grows and ages. At the same time, the number of surgical oncologists, medical oncologists, radiation oncologists and nurses is not increasing at the same rate – not even remotely, unfortunately. The result will be that this serious shortage will turn physicians into precious resources that are not to be shared with other, competing cancer programs.
In addition, reimbursement is also not keeping up with the demand and rising cost of treatment, and is actually expected to decline and to be linked to performance and value. Finally, the formation of Accountable Care Organizations (ACOs) is accelerating the consolidation of cancer programs across the country.
This cold war is sneaking up on many cancer centers around the United States as demand and supply are increasingly out of kilter. Large and academic medical center-based cancer centers are increasingly beginning to set up community-based cancer centers, or simply acquire them, in an effort to attract new patients and prevent competitors from getting those patients. After all, they made tremendous investments in research, new treatments, new technology and better facilities. Understandably, these investments have to be paid for. Simultaneously, smaller and community-based cancer programs need to differentiate themselves from nearby competitors in order to stay financially viable. By aligning themselves with premier cancer programs, they can offer their patients access to best practices and clinical trials.
While most of the large cancer programs do not challenge each other directly, they will challenge each other indirectly by using community-based cancer centers as their proxies. Like the Cold War during the second half of the 20th century, the fight won’t be on a battlefield, but through community-based cancer centers. This places many community-based cancer programs between a rock and a hard place. Many physician-owned practices and cancer programs at smaller community hospitals will increasingly get caught up in this quiet battle for market share.
A few weeks ago, I gave a presentation at the annual meeting of the Society of Radiation Oncology Managers (SROA) in Miami, titled “How To Avoid 10 Lethal Mistakes In Marketing Your Radiation Therapy Center”. Much to my surprise, I quickly learned that this cold war is a real issue for many cancer programs and that many are not sure who to turn to in order to deal with this. So, in response, I will start a series of blogs during the coming weeks about how to best promote cancer programs in this complex and highly competitive environment.
But don’t wait for my next blog! If you are faced with serious competitive challenges, just give me a call or email me, and I will help you find out what options are available to your cancer program to remain vibrant and viable. As the leading oncology management consulting firm, primeASCENT can help your cancer center business heat up during this cold war.
Yours in oncology excellence,
Paul Schilstra
President
If you have any questions, contact primeASCENT by calling 410-444-6024 or click here today!
Check us out on Facebook, LinkedIn and Twitter as well!
Tags: 20th century, academic medical center-based cancer centers, Accountable Care Organizations, ACOs, better facilities, California, Cancer care, cancer center business, cancer center networks, cancer centers, cancer centers around the United States, cancer programs, cancer programs across the country, clinical trials, cold war, community-based cancer centers, community-based cancer programs, community-based hospitals, competing cancer programs, esearch, How To Avoid 10 Lethal Mistakes In Marketing Your Radiation Therapy Center, large cancer programs, Major health systems, Maryland, medical oncologists, New Jersey, new technology, new treatments, Nurses, oncology management consulting firm, Patients, Paul Schilstra, Pennsylvania, physicians, premier cancer programs, Radiation Oncologists, rising cost of treatment, Society of Radiation Oncology Managers, SROA, surgical oncologists, Texas, The War of the Cancer Centers, war going on in the United States
Posted in Marketing & Business Development | No Comments »
October 18th, 2011
Getting a patient to hydrate himself/herself prior to arrival at clinic can save both time and money.
My daughter had countless outpatient visits for chemotherapy during her three-year leukemia treatment. Each time my teenage daughter went to the clinic for an outpatient chemotherapy appointment, her nurse told her to make sure she drank at least two bottles of water before she arrived so she would be hydrated enough to begin treatment right away. As a result, my daughter was very good at drinking two 8-ounce water bottles as we drove to the clinic. By the time we got to the clinic and her nurse took her blood, my daughter’s hydration level always met the criteria to begin chemo right away. We never had to wait for the nurse to give her IV fluids in order to start chemotherapy. My daughter’s nurse often commented on how many hours we saved because we did not have to wait for the fluid IV drip to complete, to hydrate her sufficiently, before we began her chemo hit. She noted that some patients needed up to four hours of IV fluids before their levels were high enough to begin treatment.
I used to think about all the poor parents who did not have such a conscientious child. I used to think about the number of hours they had to sit in clinic, all because their child would not drink two bottles of water before arriving to clinic.
The younger the child, the harder it is to help them understand why drinking water is important, and why drinking up to two bottles of water is required before treatment can begin. I am sure it can be difficult to help people of any age, young and old alike, understand why hydration is an integral part of their treatment process.
What if a cancer center handed out a special water bottle that represented the amount of water the patient needed to drink to be properly hydrated? Could the clinic or parent give a prize to the child if they drank it all before arriving at clinic? What other strategies could a clinic use to get a patient to hydrate his or herself prior to arriving at clinic?
How effective is your cancer center at educating patients on the importance of hydration? How many hours does your staff spend hydrating patients, something they can really do by themselves before they even get to clinic?
Please call primeASCENT today to help you evaluate the way your clinic views hydration and treatment preparation. Let us help you increase the speed and reduce the cost of patient treatment.
Yours in Oncology Excellence,
Christina Schilstra
Guest Blogger
If you have any questions, contact primeASCENT by calling 410-444-6024 or click here today!
Check us out on Facebook, LinkedIn and Twitter as well!
Tags: cancer center, chemo, chemo hit, chemotherapy, Christina Schilstra, Clinic, educating patients, fluid IV drip, Getting a patient to hydrate, hydrating patients, hydration level, increase the speed and reduce the cost of patient treatment, IV fluids, leukemia treatment, Nurse, Oncology, outpatient chemotherapy appointment, outpatient visits, PrimeASCENT, properly hydrated, special water bottle, treatment preparation, Water Works
Posted in Improving the Patient Experience | No Comments »
September 21st, 2011
Everyone knows that chemo makes people feel nauseated and often leads to the terrible side-effect of vomiting. Fortunately, many drugs have been developed to help significantly reduce nausea during cancer treatment. We learned first-hand that palliative care can result in substantially reduced inpatient stays – a positive side-effect of this chemo side-effect.
When my daughter had leukemia the first time, she was only two and a half years old. Zofran and Benedryl were sufficient to help her through her bouts of nausea. When my daughter relapsed, at thirteen years old, the chemo cocktails were increased substantially. She also received chemo and steroids in her spinal column because of her CNS3 relapse in her spine. Her nausea and vomiting were intense. She lost twenty-five pounds during the first month of her treatment using only Zofran and Benedryl.
We then learned about Emend, a newer anti-nausea medicine that was FDA approved only for adults. Because my daughter was adult-sized, the doctors agreed to try it. During Induction 2, she had to endure four high-dose methotrexate treatments, one a week for four weeks. During our first inpatient stay, she was given Zofran and Benedryl to combat nausea. It was a hellish, five-day inpatient stay before her levels cleared enough to go home. Almost a whole week! For the remaining three high-dose methotrexate treatments, we used Emend, in addition to Zofran and Benedryl. The difference was miraculous. Because of Emend, she could eat during the chemo drip – unheard of in the previous high-dose treatment. Eating the food helped her clear the methotrexate so much faster. Using Emend literally cut our inpatient stay in half, from five days to two and a half days. As an added bonus, she could sit up and talk and watch TV throughout the treatment; she no longer curled up in the fetal position for days at a time.
I understand the risk I took to administer Emend to my child as a non-FDA-approved drug, but the benefits were unbelievable. First, the cost of the inpatient stay was cut almost in half. Second, we now had two and a half days more to be together at home as a family, instead of being split apart by the hospital visit. Third, and some would argue most important, the treatment was MUCH easier for my daughter. Throughout the remaining two and half year treatment, I used to wonder if her success would be compromised because the methotrexate passed through more quickly than the protocol was designed for – would it be too quickly? But she survived the protocol, so it turned out to be a good decision.
This demonstrates that palliative care not only increases the comfort level of patients but that it can reduce the length of stay during a hospital or clinic visit.
How integrated is palliative care in your cancer program? How much do you emphasize improvements in palliative care to improve the patient’s experience?
Please call primeASCENT today to help you use palliative care to improve the efficiency of your cancer center as well as the patient’s experience.
Yours in Oncology Excellence,
Christina Schilstra
Guest Blogger
If you have any questions, contact primeASCENT by calling 410-444-6024 or click here today!
Check us out on Facebook, LinkedIn and Twitter as well!
Tags: anti-nausea, anti-nausea medicine, Benedryl, Cancer, cancer center, Cancer program, cancer treatment, chemo, chemo cocktails, chemo drip, chemo side-effect, clinic visit, drugs, Emend, FDA approved, feel nauseated, high-dose treatment, Hospital, improvements in palliative care, Induction 2, inpatient, Leukemia, Medicine, methotrexate treatments, non-FDA-approved drug, palliative care, Patient's Experience, positive side-effect, reduce nausea, reduced inpatient stay, relapse, relapsed, Side Effect, side-effect of vomiting, steroids, The Side Effect of the Side Effect!, Treatment, vomiting, Zofran
Posted in Improving the Patient Experience | 1 Comment »
August 25th, 2011
When my daughter was treated for her leukemia relapse, she received a discharge summary after every outpatient visit and inpatient stay. This is very good medical practice at a cancer center. Throughout treatment, many things change. A patient’s illnesses may change. A patient’s protocol may change. A patient’s weight may change, sometimes substantially. All this change can lead to changes in drugs and doses administered, and the delivery of the drug to the patient during the following days and weeks. Additionally, if there is a mistake in the dosage, a review of the medicine at discharge can act as a final review of that medicine to ensure that its is taken correctly at home. Discharge summaries can help eliminate four types of medicine issues: unnecessary medicines, medicine changes, incorrect dosage and delivery mistakes.
For example, I spoke with the mother of a teen cancer patient and asked her what medicines her daughter was taking. She listed them all, including Claritin. I asked why the teen was taking Claritin. She was not sure. Was this prescribed for an allergy that the teen had experienced during the spring? Now that it was late summer, was that really still necessary? Why should the teen take this extra drug if it is no longer necessary? I suggested she check with her oncologist to review the need for this drug.
The second example is about changes in drugs to be taken. During cancer treatment, complications (e.g. neutropenia, infections, allergic reactions) may occur, or the cancer may no longer respond to a particular drug. A patient’s protocol may also change. These situations may trigger a reduction in dose, the use of the drug may need to be stopped, either temporarily or permanently, or new drugs may be introduced. After a while, a drug regimen may resume at the initial strength. All this represents numerous medicine changes and it is critical during this time that all members of the clinical team are well informed about any of these changes. Ensuring these changes are documented on the patient’s discharge summary enables the staff to carefully check that these changes are accurate and to review these changes with the patient.
The third example is about dosage mistakes. When my daughter was first admitted and put on the appropriate leukemia relapse protocol, we spent several weeks in the hospital. Upon her discharge, a nurse reviewed her discharge summary and noted that the Bactrim dosage was too low, half of what it should have been. This was corrected. My daughter remained on the correct dose for the remainder of the two and a half year protocol. The discharge summary offers a cancer center one more opportunity to check for accuracy before a patient goes home and fills all of his/her prescriptions.
The fourth, and final, example is about delivery mistakes. When my daughter had leukemia the first time, she was prescribed 6-Mercaptopurine. While an inpatient, the nurses gave it to her at dinner. When we got home, we gave it to her every night, right after dinner. After six months of treatment, a short discussion with the pharmacist revealed the need to give this drug on an empty stomach, preferably right before bedtime. This delivery mistake was not corrected during the first six months of her original protocol because a discharge summary was never given to us, listing this drug and the need to take this drug on an empty stomach.
What do you post on your discharge notices? Do you include drug AND dose AND delivery instructions? Do you include these items on both your inpatient and outpatient discharge summaries?
Be sure your discharge process does not lead to unnecessary setbacks in your patients’ progress. For a complete review of your discharge processes, please call primeASCENT today!
Yours in Oncology Excellence,
Christina Schilstra
Guest Blogger
If you have any questions, contact primeASCENT by calling 410-444-6024 or click here today!
Check us out on Facebook, LinkedIn and Twitter as well!
Tags: allergic reactions, allergy, Cancer, cancer center, Cancer patient, cancer treatment, Claritin, Complications, delivery mistakes, Discharge Summaries, Discharge Summaries: A Critical Tool For Reducing Medication Errors, discharge summary, dosage mistakes, doses, drug, drug regimen, drugs, Hospital, illness, incorrect dosage, infections, inpatient, Leukemia, leukemia relapse, medical practice, Medication, medication errors, Medicine, medicine changes, medicine issues, medicines, neutropenia, oncologist, outpatient, patient, pharmacist, prescribed, PrimeASCENT, Reducing Medication Errors, Treatment, unnecessary medicines
Posted in Improving the Patient Experience | No Comments »
August 5th, 2011
A cancer diagnosis rocks a patient’s world. One feels like one is thrown into a long dark tunnel and told to move forward. The future feels very uncertain. When my daughter was diagnosed with cancer the first time, the oncologist spent two hours with my husband and I reviewing the numerous drugs that my daughter would be given. He then handed us a summarized, five-page outline of her protocol, which listed when each drug would be administered to her. He called it her “roadmap”. This was our guide through the dark tunnel of cancer treatment, a 7 ½ year road we would follow through shots, pills, IVs and blood tests. This roadmap was like our lifeline because it defined our “road”, gave us direction and defined the duration of the leukemia treatment protocol. But we quickly learned that the road was not necessarily straight. We learned about the forks in the road, I call them Tangents. It is critically important that doctors become aware of these forks in the road and put procedures in place to recognize and address such Tangents from the original cancer treatment roadmap.
For example, during my daughter’s leukemia relapse treatment, she developed a spinal headache from her spinal tap. She lay for weeks, on her back, as the doctors worked through the standard protocol (roadmap) to get her into remission. Having put chemo in her spine during the spinal tap, it became clear that the spinal tap would not resolve itself (as they usually do). A multi-disciplinary approach was necessary. The doctors recognized the fork in the roadmap, the Tangent, and worked with the Pain Management Department in the hospital to give her an Epidural Blood Patch. Almost immediately, her head pain diminished and she was able to stay on track – on her roadmap.
Following the successful resolution of her spinal headache, the doctors found a blood clot in her Iliac Vein. The blood clot formed while she was lying still for so many weeks. Once again, we found ourselves on another fork in the road. We began the Deep Vein Thrombosis therapy, while simultaneously doing the leukemia protocol. With an ANC close to zero and a seriously reduced clotting factor in her blood, it became a balancing act to transfuse enough platelets to bring the clotting factor in her blood up high enough to give her the shots of Lovenox. In the end, the clot resolved and the extra platelets and medicines (Lovenox) were no longer necessary. We found ourselves back on the standard roadmap, actually happy to be following the normal course of treatment.
After talking with numerous other parents of children with cancer, I realized that it is rather common for Tangents to occur during a cancer treatment protocol (roadmap). We met patients who were experiencing severe chemo burns, secondary infections like RSV which made it difficult to breathe, relentless nausea resulting in dangerous weight loss, and many others.
The question is:
Are you prepared for the Tangents?
Whether it is a Tangent that can be addressed within the oncology department, like an anaphylactic reaction to a drug, or a Tangent that is more complex, like a chemo burn requiring burn unit support, how does your cancer center identify and address Tangents? What procedures are in place to provide solutions that require treatment support outside the oncology department? What steps do you take to identify Tangents, proactively address them, and thereby, maximize the ability for your patients to stay on their roadmaps?
Call primeASCENT today to help you identify and proactively address the Tangents that occur during cancer treatment in your cancer center.
Yours in Oncology Excellence,
Christina Schilstra
Guest Blogger
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Posted in Improving the Patient Experience | 2 Comments »
July 15th, 2011
On June 20, Kaiser Health News published an article jointly with The Washington Post, in which it reported the lack of progress in reducing wrong-side and wrong-site surgeries since 2004, when Dr. Dennis O’Leary (then president of the Joint Commission) commented on this critical issue. According to this article, wrong-side and wrong-site surgeries may have actually increased rather than decreased. According to Kaiser Health News, 93 cases were reported to the Joint Commission as compared to 49 cases in 2004. Reporting such incidents to the Joint Commission is voluntary and the article did not specify whether this incidence increase was due to a true increase in wrong-side and wrong-site surgeries, or whether it was also caused by a steady increase in voluntary reports by physicians and hospitals.
On June 28, the Robert Wood Johnson Foundation announced the launch of yet another website to help patients find information about the cost and quality of local healthcare. While the number of websites aimed at helping patients decide where to go for their care continues to increase, it does signify the increasing thirst for good information about where to go for the best care.
What both articles, in addition to many others, indicate is that we still know so little about the quality and safety of healthcare in general and cancer care in particular. I have commented on the lack of transparency a number of times in previous blogs, so I hope that you will indulge me once again as I share my thoughts on the importance of transparency for cancer centers from a different point of view.
While reading the two articles and viewing the Volkswagen example of transparency once more, I was reminded of an important insight a professor shared with us during a graduate course in production, as I pursued my Master’s degree in Industrial Engineering and Management Science. During the course, the professor showed us these pictures.
Figure 1. Rocks and Boulders
Figure 1 shows a cross section of a river with rocks and a boulder that prevent ships from passing through. This is metaphor for a process in which the water level represents resources and inventory, the ship represents products, services or patients, and the rocks and boulder represent bottlenecks and waste.
Figure 2. Traditional Approach: More is Better
Figure 2 shows the same cross section of the river with the water level well above that rock, allowing ships to easily pass through. This picture served as a metaphor for how many organizations in the US, Canada and Western Europe tried to improve throughput. They simply increase the “water level” (i.e., increase resources and inventory) to overcome any obstacle. The problem is that the bottlenecks and waste still remain and could pose problems in the future, when resources become limited or demand increases. This strategy is no longer an option for cancer programs in the current economic climate in addition to a rising demand for care and an increasing shortage of oncologists and radiation oncologists.
Figure 3. Toyota’s Approach: Reducing Resources
Figure 3 shows the same cross section of the same river, but this time, the water level is well below the tip of the boulder and more rocks become visible. This is a metaphor for of how Toyota continues to approach its supply chain processes. Toyota continuously “lowers the water level” (i.e., by simplifying, streamlining and standardizing processes) to identify where the rocks and boulders are (i.e., where process bottlenecks are or waste occurs) so they can remove them.
Figure 4. The Result of Toyota’s Approach
Figure 4 finally shows that by removing rocks and boulders (bottlenecks and waste), the ship (products, services or patients) can still sail easily on the river without needing a high water level (resources and inventory).
Western companies, having had access to ample capital, land, raw materials and labor, simply eliminated any obstacles to production (flow and quality) by “flooding” the supply chain process with capacity and inventory. Toyota, on the other hand, had only limited access to capital, land and raw materials so it made a virtue out of necessity. By tightly managing its resources, it forced obstacles (a.k.a. process bottlenecks and waste) to become obvious and, thus, make it much easier to identify and eliminate them. That is how Toyota became known as the “Machine That Changed The World” and the creator of “Lean”.
So what does this have to do with transparency in cancer care? Well, creating transparency is like lowering the water level in the river to uncover the rocks and boulders. If we continue to ignore quality, safety and inefficiency issues or simply cover them up, we’ll continue to perpetuate the current problems. And we will never learn about our own processes, improve them and grow as a successful learning and adaptive organization should.
I am personally somewhat skeptical of requiring cancer programs to report each and every error to the government or an accreditation agency. It often leads to reporting a minimal and politically acceptable set of indicators. There is still little proof that such reporting requirements actually improve the quality and safety of health care in a significant way. The aforementioned articles suggest that significant improvements have not materialized.
Rather than viewing transparency as a necessary evil to satisfy some external agency, cancer programs should embrace transparency as a powerful tool to transform their care programs and to differentiate themselves in a compelling manner from competing programs in their region. Cancer programs that successfully transform and become safe, lean and agile should proudly share their successes with the general public. By proudly sharing the results of improvement efforts with the general public, cancer programs stand out for their excellence in caring for cancer patients.
Organizations that continue to transform their care delivery systems by increasing internal and external transparency, e.g., Geisinger Health System, Johns Hopkins Medicine, the Mayo Clinic, ThedaCare, the Virginia Mason Medical Center, etc., have demonstrated that internal drive, rather than external pressure, leads to impressive results. Toyota learned to do this over half a century ago.
So, how much do you really know about the quality, safety and efficiency of your cancer program? Do you know where all the “rocks and boulders” are in your cancer program?
Call us if you wish to learn more about those “rocks and boulders” in your cancer program.
Yours in oncology excellence,
Paul Schilstra
President
If you have any questions, contact primeASCENT by calling 410-444-6024 or click here today!
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Posted in Improving Patient Services | 1 Comment »
July 1st, 2011
Last Tuesday, the Department of Health & Human Services (“HHS”) canceled its plans for deploying “mystery shoppers”. The goal of this planned initiative was to determine the impact of the growing shortage of primary care physicians, as well as the type of insurance coverage, on the timely access to primary care. The recent announcement by HHS to introduce “mystery shoppers” was met with a great concern on the part of the primary care physician community, as was described in the New York Times article “U.S. Plans Stealth Survey on Access to Doctors” last Sunday. But it was the critical letter from Illinois Senator Mark Kirk to HHS Secretary Kathleen Sebelius that prompted the cancellation of the “mystery shoppers” project. In his letter, Senator Kirk asked a series of challenging questions about the need for and execution of this plan. Shortly after he shared his letter on the Senate floor, HHS announced the cancelation of its plans.
While the use of “mystery shoppers” by government agencies may or may not be questionable, the use of “mystery shoppers” can be a very effective tool for cancer programs to identify issues with timely and easy access to care. As many providers strive to be more patient-centric and improve the patient’s experience, timely and easy access to cancer care can be among the key factors that help a cancer program differentiate itself from competing programs.
Let us consider the results of the recent study published at the Annual Meeting of the American Society of Clinical Oncology by Drs. Keerthi Gogineni and Katrina Armstrong, from the University of Pennsylvania. In this study, volunteers posed as patients with a new diagnosis of inoperable hepatocellular carcinoma. Only 23% of the “patients” were able to get a new patient appointment out of 432 attempts. These results should serve as a wake-up call to cancer programs about potentially avoidable barriers to timely access to cancer care.
According to the study, callers posed as “patients” with varying types of cancer and insurance coverage. The most frequent reason (39%) that the “patients” couldn’t get a first appointment was that both oncology practices and hospitals required that patients have all of their medical records in their possession when they scheduled their first appointment. This, of course, is likely to be an extremely challenging and stressful experience for patients who are already anxious and, perhaps, suffering from pain. Do patients even know how to track down images, lab results and other key parts of their records from different providers at different locations, and furthermore which records are even necessary? In many instances, patients may not understand or fully appreciate what the oncologist(s) need to finalize the diagnosis and determine the best course of treatment.
In addition, other reasons why the “patients” were unable to schedule an appointment included the inability to reach the scheduler (24%), the need to obtain a referral first (18%), the requirement to go through a new-patient coordinator first (3%), or the need to talk to a financial counselor.
This does not exactly paint a patient-friendly picture and may actually hurt a cancer program’s reputation. Having a complete medical picture is critical to the clinical decision-making process, but delaying anxious patients’ access to timely care until they have all of their clinical documentation gathered poses an undue burden on them and will likely tarnish a cancer program’s reputation. There are better and easier ways to address this issue. Such improvements would also ensure that the clinical team has all the critical facts needed to make an informed decision about the best treatment course for the patient.
Let’s also not forget that first impressions matter a great deal, in healthcare as well as in other industries. Schedulers, registration clerks, patient navigators, financial counselors and the folks staffing the parking garage are all part of the team that patients will be interacting with during initial consultations, treatment and follow-up. Their behavior, as well as policies and procedures that guide their behavior, and the layout of the reception and waiting areas, shape a patient’s perception of a cancer program’s level of customer service in a significant way.
So, assessing he accessibility of your cancer program is critical for improving access to your cancer program and improving its efficiency and reputation. By having hospital managers or others pose as “patients”, you will quickly learn about the impact of policies and procedures, the patient’s physical experience, operational inefficiencies and the attitudes and behavior of front-end staff and their impact on the initial patient experience with your cancer program. By creating easy and timely access to your program’s cancer care, you create one more compelling reason for patients to come to your cancer center.
How easy is it for new cancer patients to schedule appointments at your cancer center? When was the last time you reviewed how patients experience the start and end of their interactions with your cancer program? Call us for a free consultation on how primeASCENT can best assist you with improving the overall patient experience.
Yours in Oncology Excellence,
Paul Schilstra
President
If you have any questions, contact primeASCENT by calling 410-444-6024 or click here today!
Check us out on Facebook, LinkedIn and Twitter as well!
Tags: American Society of Clinical Oncology, Appointment, Cancer, Cancer care, cancer center, Cancer program, Care, Department of Health & Human Services, diagnosis, Effective Tool, Efficiency, egistration clerks, financial counselors, Government Agencies, Healthcare, HHS, How Accessible Is Your Cancer Program, Identify Issues, inoperable hepatocellular carcinoma, Insurance Coverage, mystery shoppers, New York Times, Oncology, patient navigators, Patient's Experience, Patient-centric, Patients, Primary Care, primary care physicians, PrimeASCENT, Providers, Senate, Timely Care, U.S. Plans Stealth Survey on Access to Doctors, Wake-up Call
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