Author: John Weir

Ratings of every nonfederal hospital in the country on www.healthgrades.com

GOLDEN, Colo. (October 13, 2009) – The largest annual study of patient outcomes at each of the nation’s 5,000 nonfederal hospitals found a wide gap in quality between the nation’s best hospitals and all others. According to the study, issued today by HealthGrades, the leading independent healthcare ratings organization, patients at highly rated hospitals have a 52 percent lower chance of dying compared with the U.S. hospital average, a quality chasm that has persisted for the last decade even as mortality rates, in general, have declined.

The study also found that hospitals that have received the Stroke Certification from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) had an eight percent lower risk-adjusted mortality rate than hospitals that have not received this certification.

The twelfth annual HealthGrades Hospital Quality in America Study examined nearly 40 million Medicare hospitalization records from the years 2006, 2007 and 2008. The study looks at trends in mortality and complication rates and also provides the foundation for HealthGrades’ quality ratings of procedures and diagnoses at each individual hospital.

The new 2010 ratings for individual hospitals are available today at www.healthgrades.com, HealthGrades’ public Web site designed to help patients compare the quality of care at their local hospitals for 28 different procedures and treatments, from hip replacement to bypass surgery.

"The fact is, patients are twice as likely to die at low-rated hospitals than at highly rated hospitals for the same diagnoses and procedures," said Rick May, MD, an author of the HealthGrades study. "With Washington focused on rewarding high-quality hospitals and empowering patients to make more informed healthcare choices, this information comes at a turning point in the healthcare debate. For patients, sites like HealthGrades.com already provide the objective information needed to choose a high-quality hospital. And for hospitals themselves, HealthGrades’ hospital ratings provide the benchmarking data that can help them reach the benchmarks set by top performers."

The study also found the following: Mortality

• Overall, inhospital, risk-adjusted mortality at the nation’s hospitals improved, on average, 10.99% from 2006 through 2008.
• Across all 17 procedures and diagnoses in which mortality was studied, there was an approximate 71.64% lower chance of dying in a five-star rated hospital compared to a one-star rated hospital.
• Across all 17 procedures and diagnoses studied, there was an approximate 51.53% lower chance of dying in a five-star rated hospital compared to the national average.
• If all hospitals performed at the level of a five-star rated hospital across the 17 procedures and diagnoses studied, 224,537 Medicare lives could potentially have been saved from 2006 through 2008.
• Approximately 57% (127,488) of the potentially preventable deaths were associated with just four diagnoses: sepsis (44,622); pneumonia (29,251); heart failure (26,374) and respiratory failure (27,241).
• Over the last three studies, Ohio and Florida consistently have had the greatest percentage of hospitals in the top 15% for risk-adjusted mortality. Complications
• Across all procedures in which complications were studied, there was a 79.69% lower chance of experiencing one or more inhospital complications in a five-star rated hospital compared to a one-star rated hospital.
• Across all procedures studied, there was a 61.22% lower chance of experiencing one or more inhospital complications in a five-star rated hospital compared to the U.S. hospital average.
• If all hospitals performed at the level of a five-star rated hospital, 110,687 orthopedic inhospital complications may have been avoided among Medicare patients over the three years studied. Stroke
• Joint Commission stroke-certified hospitals were almost twice as likely to attain five-star status in stroke (30.1% of certified hospitals were five-star versus 15.7% of non-certified), and fewer of the stroke-certified hospitals fell into the one-star category (12.3% versus 19.6%).
• Joint Commission stroke-certified hospitals have an 8.06% lower risk-adjusted mortality rate compared to hospitals that were not stroke-certified.

HealthGrades’ Hospital Ratings

HealthGrades rates each of the nation’s 5,000 nonfederal hospitals in nearly 30 procedures and diagnoses, allowing individuals to compare their local hospitals online at www.healthgrades.com. The ratings are objective, created from data provided by the Centers for Medicare and Medicaid Services and 17 states that publish outcomes data. HealthGrades’ hospital ratings are independently created; no hospital can opt-in or opt-out of being rated. No hospital pays to be rated. Each hospital receives a one-, three- or five-star rating for each procedure or diagnosis, reflecting the mortality or complication rates at that hospital. Mortality and complication rates are risk-adjusted, which takes into account differing levels of severity of patient illness at different hospitals and allows for hospitals to be compared on equal footing.

On www.healthgrades.com, patients can compare the HealthGrades ratings of their local hospitals for the following procedures and diagnoses:

• Appendectomy
• Back and Neck Surgery (except Spinal Fusion)
• Back and Neck Surgery (Spinal Fusion)
• Bowel Obstruction
• Carotid Endarterectomy
• Cholecystectomy
• Chronic Obstructive Pulmonary Disease
• Pneumonia
• Coronary Bypass Surgery
• Coronary Interventional Procedures (Angioplasty/ Stent)
• Diabetic Acidosis & Coma
• Gastrointestinal Bleed
• Gastrointestinal Procedures & Surgeries
• Heart Attack
• Heart Failure
• Hip Fracture Repair
• Obstetrics
• Pancreatitis
• Peripheral Vascular Bypass
• Prostatectomy
• Pulmonary Embolism
• Resection/Replacement of Abdominal Aorta
• Respiratory Failure
• Sepsis
• Stroke
• Total Hip Replacement
• Total Knee Replacement
• Valve Replacement Surgery

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The study can be viewed at https://www.eurekalert.org/images/release_graphics/pdf/HealthGradesTwelfthAnnualHospitalQualityStudy2009.pdf.

HealthGrades

Health Grades, Inc. (Nasdaq: HGRD) is the leading independent healthcare ratings organization, providing quality ratings, profiles and cost information on the nation’s hospitals, physicians, nursing homes and prescription drugs. Millions of patients and many of the nation’s largest employers, health plans and hospitals rely on HealthGrades’ quality ratings, advisory services and decision-support resources. The HealthGrades Network of Web sites, including HealthGrades.com and WrongDiagnosis.com, is a top-ten health property according to comScore and is the Internet’s leading destination for patients choosing providers. More information on how HealthGrades guides America to better healthcare can be found at https://www.healthgrades.com.

Three Skills That Improve Conversation

By Brian Tracy

One key to becoming a great conversationalist is to pause before replying. A short pause, of three to five seconds, is a very classy thing to do in a conversation. When you pause, you accomplish three goals simultaneously.

The Benefits of Pausing
First, you avoid running the risk of interrupting if the other person is just catching his or her breath before continuing. Second, you show the other person that you are giving careful consideration to his or her words by not jumping in with your own comments at the earliest opportunity. The third benefit of pausing is that you will actually hear the other person better. His or her words will soak into a deeper level of your mind and you will understand what he or she is saying with greater clarity. By pausing, you mark yourself as a brilliant conversationalist.

Ask Questions
Another way to become a great conversationalist is to question for clarification. Never assume that you understand what the person is saying or trying to say. Instead, ask, "How do you mean, exactly?"

This is the most powerful question I’ve ever learned for controlling a conversation. It is almost impossible not to answer. When you ask, "How do you mean?" the other person cannot stop himself or herself from answering more extensively. You can then follow up with other open-ended questions and keep the conversation rolling along.

Paraphrase the Speaker’s Words
The third way to become a great conversationalist is to paraphrase the speaker’s words in your own words. After you’ve nodded and smiled, you can then say, "Let me see if I’ve got this right. What you’re saying is . . ."

Demonstrate Attentiveness
By paraphrasing the speaker’s words, you demonstrate in no uncertain terms that you are genuinely paying attention and making every effort to understand his or her thoughts or feelings. And the wonderful thing is, when you practice effective listening, other people will begin to find you fascinating. They will want to be around you. They will feel relaxed and happy in your presence.

Listening Builds Trust
The reason why listening is such a powerful tool in developing the art and skill of conversation is because listening builds trust. The more you listen to another person, the more he or she trusts you and believes in you.

Listening also builds self-esteem. When you listen attentively to another person, his or her self-esteem will naturally increase.

Listening Develops Discipline
Finally, listening builds self-discipline in the listener. Because your mind can process words at 500-600 words per minute, and we can only talk at about 150 words per minute, it takes a real effort to keep your attention focused on another person?s words. If you do not practice self-discipline in conversation, your mind will wander in a hundred different directions. The more you work at paying close attention to what the other person is saying, the more self-disciplined you will become. In other words, by learning to listen well, you actually develop your own character and your own personality.

Action Exercises
Here are two things you can do immediately to put these ideas into action.

First, make a habit of pausing before replying in any conversation or discussion. You will be amazed at how powerful this technique really is.

Second, continually ask, "How do you mean?" in response to anything that is not perfectly clear. This gives you even more time to listen well.

Brian Tracy is the most listened to audio author on personal and business success in the world today.  His fast-moving talks and seminars on leadership, sales, managerial effectiveness and business strategy are loaded with powerful, proven ideas and strategies that people can immediately apply to get better results in every area.  For more information, please go to www.briantracy.com

We are living in a bacterial world. For decades now we have been waging chemical warfare against the bacteria and viruses that are in our environment. We have been lobbing hand grenades at them in the form of disinfectants, antibiotics and antiseptic soaps. The bacteria have been throwing hand grenades back at us in the form of acquired resistance and the ability to make us sicker faster (increased virulence). In the Housekeeping Department we have loved our disinfectants, particularly quaternary ammonium chlorides – quats. Experts believe that the bacteria in our environment have been learning to resist quats because of the residual chemical smear that remains after the cleaning is complete, and in doing so they have gained an increased resistance to antibiotics as well. Also, we’ve known for years that gram-negative bacteria like Pseudomonas and E.coli can actually thrive in a mop pail or spray bottle of diluted quats – they are thriving, not being killed. In our effort to sterilize our environment by cleaning everything with a disinfectant we have succeeded in providing a competition-free zone for the harmful strains of common bacteria to grow wildly and cause worse infectious outbreaks. We are living in a bacterial world!! They were here long before we were, and they will be here long after we’re gone. Bacteria surround us and live in us, and on us. There are more bacterial cells in the human body than there are human cells, and they are absolutely necessary to our survival. Disinfectants are necessary in the operating room, Intensive Care Units, Burn Units, on the surface of dialysis machines, and in other areas specified by AHA and the Centers for Disease Control. For most surface cleaning we use germicidal detergent solutions at the Medical Center and Medical Office buildings for a healthy healthcare environment, clean well and love your bugs.

Questions often asked at facilities are” “Is this a waste?” and “Is the waste a hazardous waste?”

The answer depends on the issue of point of generation (POG). A material becomes a waste when the owner or operator decides that it cannot be used for its original intended purpose. A good example would be a can of paint. As long as there is a legitimate use for the paint and the paint is still usable as a paint, it is not a waste. So if you can find some one to use the paint in a legitmate manner, you won’t have to worry about it.  But if you decide that you want to dispose of it, it becomes a waste. Another example would be a jar of pure chemical on your laboratory shelf. If the shell life of that chemical has been exceeded (it cannot be used for its original intended purpose), it becomes a waste.

Another example: You may have a hazardous chemical in a machine that is operating on your site. You do not have a waste as long as that hazardous chemical stays inside the machine. But once you take that hazardous chemical out of the machine and you have no further use for it, you will have generated a waste at that point. That’s you POG.

Once you have a waste, then you have to determine if it is hazardous. Does it exhibit any of the four hazardous waste characteristics (ignitability, corrosivity, reactivity and toxicity)? Has the waste been listed by EPA?

A critical member of the staff at Scripps Green Hospital in La Jolla California talks about her job and the rewards it offers.

Here Betco Corporation offers a video overview of how and why we clean critical areas. This is a good video for regular review.

Paul Tarrant, Site Coordinator at Community Hospital North gives an overview explaining how Environmental Services cleans at this Indiana hospital.

Senator Jim DeMint states the following on his web site –

In many ways, our health care system is broken. Even people satisfied with their own care are nervous about losing it, concerned about rising costs, and frustrated by the failure of government to bring about genuine reform. But the reason Congress has so far been unable to fix our health care problems is that Congress is too busy creating the problems in the first place. That’s why the current proposals emanating from the White House and congressional Democrats won’t work either. Those proposals would hand over the most personal, private undertaking of our lives — health care — to the most impersonal, inefficient, and broken system in our society — the federal bureaucracy.

I for one, am glad to hear there won’t be a vote right away. Something this big, and far reaching, should not be rushed. I know there is so much talk about government lead health care not costing the billions we know it will, but the proof is clear in history. There has been not been any government program that has saved money, and I believe the proof has been they cost significantly more then initially stated.

Customer Relationship Management or CRM means developing a comprehensive picture of customer needs, expectations and behaviors. In the Environmental Services (ES) world, CRM means looking at the ES function as a customer intensive business function instead of a facility services cost center. And the management part implies an active rather than passive role in influencing the customer’s perception of service success.

The gaps between customer expectations and service delivery typically occur in the area of the 3 R’s; Resources, Response and Respect.

We need to continually balance our resources to response with the proper respect to the customer’s expectations, not our own limitations.