Susan E. Mazer, Ph.D. Blog

Thoughts and ideas on healthcare

Hi, and welcome to my blog! I'm Susan E. Mazer -- a knowledge expert and thought leader on how the environment of care impacts the patient experience. Topics I write about include safety, satisfaction, hospital noise, nursing, care at the bedside, and much more.

Change, More Change, a Future, and Observations from Dallas

September 22, 2010

That change is in the air is hardly surprising. The whole country is in disarray with uncertainty being the state of the world and change seeming to be both imminent and equally risky.

Healthcare reform mandates begins today with annual caps on benefits being erased, with kids being able to stay on their parents insurance until the age of 26, and children not being excluded due to a pre-existing condition. Each of these are good and yet there are some who feel they should be repealed.

I personally don’t understand where or how these are detrimental to anyone’s concept of a healthy America. I also know that our healthcare system remains painfully imperfect.

Coming from the Health Facilities Symposium and Exposition in Chicago, it is clear that there is a hunger for more information, for evidence-based practices, and for healthier hospital environments. When we started this work, especially looking at hospital noise (an old problem devoid of miracle solutions), at the environment of care, and at the patient experience as human as well as medical, there were few discussions and fewer companies who addressed the issue.

Now, noise masking specific to the hospital setting and the broad and diverse range of issues, are making it to the forefront. The environment of care has become a benchmark with healing environments moving into the broad scope of viable research. Patient satisfaction, while still measured through surveys, has blanketed all of healthcare.

Furthermore, this year, speech privacy has demanded two different sessions at the HFSE.

David Sykes, co-chair ANSI S12 WG44, and I co-presented on the new HIPAA regulations for speech privacy and the lived-experience of patients and those that care for them. David has been on the frontlines of dealing with enforceable and measurable compliance standards for speech privacy that have been based on “reasonable efforts” until now.

And, in spite of these guidelines being published last January, David and I agreed that they provide a minimum effort but are hardly the full answer. Human beings interface and interact with their environments…and it is in this process that communications between individuals flow well beyond those directly involved. Thus, the speech privacy issue is far more complex.

At the same time I was involved with preparing for this presentation, my husband Dallas had accompanied me to this event and had a chance to attend a couple of most interesting sessions. He writes a travelogue of personal observations during all of his travels and this was no exception. I am including his thoughts as they capture so much of what was going on that is of great interest to most of us.

From Dallas: Healthcare Facilities Symposium

The Healthcare Facilities Symposium and Exposition is attended primarily by architects, hospital administrators, and designers. Susan and I received one of our biggest career boosts in healthcare in the early 1990s, when we were invited to speak and perform for a precursor conference, the National Symposium on Health Design.

This conference in 1992 was the one in which we first introduced the C.A.R.E. Channel, and at which we secured our very first hospital clients.

In the two years prior to this first conference, we had been working on providing music for healthcare facilities along with presenting workshops for nurses and physicians. For this first conference, we had made the decision to deliver music through the in-room television, the decision that led to my current on-going career as a video producer for Healing HealthCare Systems.

After not having attended the conference for a number of years, it was good to see people in the healthcare world that we had met in years past, some of whom remembered our initial musical performance and have remained strong advocates for our work. Unfortunately, there was no music at this year’s conference, meaning that there’s still work to be done.

The impetus to attend this year’s conference was for Susan to make a presentation on speech privacy and HIPAA at one of the many breakout sessions. The issue of patient privacy is the subject of Susan’s doctoral dissertation, currently in progress.

So it was gratifying that even prior to her publishing her dissertation and receiving her doctoral degree (projected for next July) that she is already recognized as an authority on the subject. She has spoken twice at Harvard’s annual Privacy Summit and has been published on the subject in several healthcare trade publications.

While Susan was preparing her presentation, I had the pleasure of being able to attend the conference’s opening keynote session. It is conferences such as this one that the future of healthcare will be determined. I’m pleased to report that I learned of many exciting and positive trends, in spite of the report in today’s newspaper that the number of Americans without healthcare insurance now is measured at more than fifty million.

So here’s some good news (for a change!):

1. Big hospitals are dinosaurs. New hospitals will be smaller dispersed neighborhood clinics, catering to the healthcare needs of their specific communities. Smaller clinics are more adaptable in terms of staffing and specialty medicine than larger hospitals with huge staffs on duty twenty-four hours a day.

2. Medicine will be delivered more and more offsite rather than in hospitals. This trend is driven in part by battlefield medicine in which medical staff go to the scene of the injuries and administer immediate care.

3. One example is the hand-held battery-operated ultrasound module. At a car accident scene, the technician can scan a person’s body (a la Star Trek) to discover injuries. If, for example, internal hemorrhaging is discovered, the technician can change attachments on his hand-held module and cauterize the torn blood vessel immediately through converging radiation beams (the “cyber-knife”) with no surgical incision required, all this before transporting the patient to the nearby emergency clinic.

4. Currently, the standard practice is: patient makes appointment with doctor; doctor prescribes a CAT scan; patient makes appointment for CAT scan; patient makes a new appointment with original doctor to interpret CAT scan from lab. Why not: Have a CAT scanner at the entrance of the hospital; give everyone entering a CAT scan; (It takes only thirty seconds each.); Give each patient their CAT scan result for their IPhone/Blackberry; The CAT scan becomes a baseline measure which can be used to compare with subsequent scans to discover/track any changes in one’s bodily condition; This becomes each person’s personal health profile. All cheaper, more efficient, and more effective than our current system!

5. Hospital operating rooms that currently have those large lamp lights that must be pulled into position and regularly sterilized will be replaced by an array of high intensity lights built into the ceiling which can be turned on and off by voice activation.

6. Currently, a surgical assistant goes to school for five years in order to work in the operating room, handing the surgeon his tools upon request. Instead, a voice activated robot could hand the same surgical instruments upon request while sterilizing the used instruments in between their being used. That surgical nurse has better work to do with his/her years of training.

7. Another surgical improvement inspired by Star Trek: automatic sliding doors. The sterilized staff doesn’t have to push the door open. Also, sliding doors don’t create the same drafts that can transfer bacteria from one room to the other, thus contaminating the sterile field.

8. Hospital-born infections are a big problem. Every patient room should have a hand-washing station immediately beside the patient for consistent use by any caregiver who needs to touch the patient. Also, infrared bacteria-killing lights should be standard in every room.

9. Surgery will regularly take place through the alimentary track, i.e. through small instruments inserted down the throat, and then penetrating the stomach wall to perform any abdominal procedures. This new technique avoids surgical incisions and reduces potential infection sites. Patient recovery time is reduced as well.

10. In general, radiology will supplant surgical procedures. Radiology avoids the trauma of incisions and infection danger.

11. Chronic disease treatment will more and more be determined through genetic analysis, with early detection and prevention based on genetic analysis of potential disease conditions before they develop.

12. Harvesting of personal stem cells will provide the possibility of creating “spare” organs as well as the regeneration of diseased tissues. New tissue transplanted from stem cells does not create the need for anti-rejection drugs which must be taken by current transplant patients. Such drugs impair the patient’s immune system.

Many of the futuristic improvements and trends listed above are already being tested and implemented in pilot projects. Others will take more time. Some of them, such as stem cell research, are hindered by politics. (However, stem cell research will continue in other countries.

It’s just a question of whether the U.S. will be a leader in this research or not.) Some of the measures listed above will require a re-structuring of the current ways in which healthcare is financed in the US. Certainly, most healthcare professionals agree that the U.S .system of employer-financed healthcare is breaking down. Consider how many workers lost their insurance during the current round of layoffs under the global recession. It’s just that we don’t have agreement on what system should replace the current one.

Our current healthcare system is stuck in the”industrial age”, trying to fix decades-old systems, while the rest of the world has moved in the “information age.” Information technologies make it possible for every individual to carry his/her digital health profile at all times all over the world, facilitating the delivery of care by doctors anywhere in the world the patient might have a medical emergency.

We have an emerging global healthcare system, linked by the easy exchange of information and the latest technologies.

One final point made in this incredible conference session is that there is a need for coordinated “transition planning.” Planning for how to restructure healthcare to implement the improvements that are so drastically needed.

The speaker expressed that the healthcare industry can’t wait for the politicians to reform healthcare. They must take the lead and create care-delivery models that work, and the politicians will follow.

I left this conference with the feeling that, if enough of the fantastic futuristic proposals can be realized, that there’s the chance that the U.S. can move back to the forefront in the delivery of state-of-the-art healthcare. Currently, the U.S. does not rank anywhere near the top compared with other nations in standard measures such as life expectancy, infant mortality rates, accessibility, etc.

Ultimately, the healthcare system will move more to promoting healthy lifestyles and disease prevention, as opposed to the current fee-for-service reactive sick-care treatment system. I look forward to it. The general health of the American people will be much better when this transition is realized.