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The Quality Floor

When I first started working in quality, I found myself surprised by how many staff did not follow quality measures. "But they know what they are supposed to do," I would say. In response, I would be told that I needed to lower my expectations for people. Quality Floor At the very bottom of quality care is what I refer to as the quality floor. This is the very minimum staff need to do to achieve quality goals. They fill out the audit forms, complete the history and physical, check the box, and do what they think they are supposed to do. In this case, the quality bar is set so low that it is easy for any staff member to step over it. No outcomes are measured, no follow-through occurs, no patient followup occurs, no analysis of results occurs. Mediocrity There are other quality departments and organizations that set their quality goals at what "passing" is for a quality indicator.  The passing point maybe 50% patient satisfaction, 60% of audits completed, r

Cyberbullying and Cybersecurity in Healthcare

In many aspects, cyber-bullying and cyber-security are treated as separate and distinct issues in healthcare.  However, they are actually part of the same problem and are inclusive of one another rather than mutually exclusive of each other.  A culture that tolerates cyber-bullying creates an  atmosphere where cyber-security measures are taken lightly and not considered a serious threat. Cyber-bullying often occurs on a micro rather than a macro level.  That is, cyber-bullying is more often to occur at an individual level. An individual or small group of individuals targets another individual or small group of individuals. The target may also be a patient. Examples of micro level cyber-bullying include the following: Photo courtesy of *Accessing a coworker's  sent email messages and then bullying the employee over those messages. *Rifling through another employee's computer files or desk work from computer files and then bullying the employee in the physica

Acting Like Yourself

When I was in college, this acquaintance of mine would come up to me and say, "You aren't acting like yourself today." I would turn to him and ask, "Who am I acting like then?" He would say, "I don't know, but not yourself." As leaders, we have a lot of people pushing and pulling us in the direction that they want us to go. There are demands at work, at home, from coworkers, stakeholders, board members and family. Moreover, they all have opinions on what you should and should not be doing and how you should or should not go about achieving your goals. In addition to that, they have opinions about how you should act or what you should or should not say. They may even threaten to tell something you did to embarrass you or make you feel you must behave or make decisions in a certain way. The truth is, no one knows you as well as you know you. It seems like a simple concept to grasp, but so often we forget about ourselves.  We forget to act like ou

Creating Unhappiness is Ineffective

In finding the core of "creating unhappiness," the concept is essentially a form of top-down workplace bullying.  The manager institutes a bullying style to get an employee to leave.  It is easy to identify because anyone who has ever been on the outside of some clique or social group has experienced it. A group of girls refuses to let you sit at their table at lunch. Friends invite everyone to the party but one person, or they refuse to show up to her party. Work colleagues go through someone's desk, rummage through their purse, and file complaints to management. When examined in this manner, "creating unhappiness" is nothing more than petty, passive-aggressive, bullying behavior. At the root of this problem is that the department director was creating chaos within her division. For months, she encouraged and allowed other managers and staff members to be distracted from their work and their duties in order to bully this person out of the department. Imagine

How to Create Change in Policy

The past few elections it seems at least one candidate for each party has campaigned promising change . The two most recent U.S. presidents used the idea of change in their campaigns effectively, ultimately leading to their elections.  The candidates convinced the citizenry that change was necessary, and the citizens elected those candidates.  Now, the citizens want to see change. The citizens want to initiate change. However, they are unsure how to make sure change happens. Politicians, lobbyists, special interest groups, and even change-makers have a method for creating change and affecting policy in American society. Outlined below is a method that can be used for how one person, one group, one community, one citizenry, can affect change in policy in this country. 1. Center on One Issue . One thing lobbyists and special interest groups do really well is center, or focus, on one issue.  An environmental lobby is not going to spend its time discussing healthcare, just as a gun lobby

Kids, Guns, and Public Health

High school students across the country planned a protest. They weren't protesting school lunches, teachers, grades or even educational curriculum.  They were protesting for their rights to feel safe in their schools.  Their rights to know that if an "active shooter" arrived on their school grounds with a gun, then their likelihood of returning to their homes that evening would be high.  The kids stated that the reasons they were protesting is that no one seems to be doing anything.  The kids felt that they had to sit idly by and watch and wait and hope and fear.  These young people have declared gun violence in the United States a public health issue. The Centers for Disease Control and Prevention (CDC) has recently been given permission by Congress to study gun violence. The CDC's mission statement indicates that "The CDC protect America from health, safety and security threats, both foreign and in the U.S." Gun violence in schools is all t

Teach the Teacher: Mental Health

Another school shooting flashes across headlines.  In ways, the stories seem to repeat themselves. A mentally ill student or young adult attacks a school. Sometimes, it isn't a school. It's a movie theater or a political rally.  Then, the finger-pointing begins. Who is to blame? Where did we go wrong as a society? It's the school. No, it's the police officers who failed to follow up on complaints. No, it's the gun lobby that allows guns in America. No, it's the manufacturers of guns. No, it's bullying. No, it's society. The thing is, there is no single answer to this complex issue. There is no one person or one thing to blame.  There is one thing that is true. There is something wrong in American society that is causing these issues to occur.  In order to solve the problem as a whole, each problem must be addressed independently. One of those problems is understanding, funding, and appropriately treating mental health issues. In America, it's no se