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Reducing Health Disparities; Improving Patient Outcomes;. THROUGH PRACTICAL INITIATIVES. Introduction. Goal One: Build a team of health care professionals who understand their contribution to effective care giving

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Reducing health disparities improving patient outcomes

Reducing Health Disparities;Improving Patient Outcomes;




  • Goal One: Build a team of health care professionals who understand their contribution to effective care giving

  • Goal Two:Empower all clinical-based staff to help improve care through practical actions

Patient outcomes
Patient Outcomes

  • This is a way of measuring the how well a patient responded to the treatment provided

  • It is usually compared to averages compiled by organizations

  • Meeting or exceeding those averages is considered a way of gauging proper care

  • Why improve patient outcomes?

Why improve patient outcomes
Why improve patient outcomes?

  • Governments, health departments or insurance companies may

    • Measure your abilities on outcomes achieved

    • Base their reimbursements on outcomes

    • Decide on accreditation for facilities

  • But more importantly, improving patient outcomes means improving people’s lives

Health disparities
Health Disparities

  • Are differences in the quality of health and health care

  • Usually noticed among groups of people:

    • Minorities,

    • Rural populations

    • Non-citizens

Health disparities1
Health Disparities

  • Reducing health disparities means finding out

    • who in a patient population is receiving substandard care

    • And why they are receiving substandard care

Health disparities2
Health Disparities

  • Substandard care may be caused by:

    • Communication Problems

    • Discrimination

    • Lack of insurance coverage

    • Poor transportation

    • Shortage of care givers

    • Health literacy (patients have problems understanding health information)

Team building
Team Building

  • A health care team includes:

    • Doctors

    • Nurses

    • Schedulers

    • Billers

    • Receptionists

    • Security guards

    • Anyone who works in the clinical facility

Team building1
Team Building

  • Each member of the team can affect patient care through their actions,

  • So they must understand how they can maximize positive contributions to patient care

  • When all of the team members are attuned to the mission of improving care,

  • Positive health outcomes will follow

Empowering staff
Empowering Staff

  • Staff can be oriented about how their work affects patient care,

  • Through clarity of their job description

    • to understanding the mission of the organization

    • to practical skill building

Empowering staff1
Empowering Staff

  • Staff members can understand how their contributions matter when it comes to providing excellent care

Successful teams
Successful Teams

  • Understand that everyone has a role to play in helping patients get quality care

  • Know that quality care improves the lives of those people they serve

Successful teams1
Successful Teams

  • Understand that unnecessary visits are reduced because care is more effective

  • Know that the experience better for everyone involved

  • Recognize quality care is what we would expect for ourselves, so providing it to others is the Golden Rule

What are common challenges
What are common challenges

  • Medication non-adherence

  • Lost to follow-up

  • Patients with low health literacy

What are common challenges1
What are common challenges

  • Patients saying “yes” when they mean “no”

  • Difficult patients, e.g.

Common challenges cont
Common challenges, cont.

  • Difficult patients:

    • Substance users: alcohol, drugs

    • Angry patients

    • Drug seeking patients

    • Violent patients

    • Mentally challenged

    • Adolescents

    • Et cetera

Forging solutions
Forging Solutions

  • Solving these and other problems is not a one person job:

    • Everyone in a health care setting contributes to the solution;

      • From the receptionist,

      • To the schedulers,

      • To the accountants,

      • To the nurses,

      • To the doctors…

Forging solutions1
Forging Solutions

  • At its heart, health care is based on service

  • It is also a professional environment where:

    • Everyone understands their role within a team

    • Knows what they contribute to the team,

Forging solutions2
Forging Solutions

  • And how it can affect care giving,

  • For the better,

  • And for the worse…(African sickness mask)

Forging solutions3
Forging Solutions

  • Each person can affect patient outcomes:

    • The unfriendly intake person can drive up lost to follow-ups,

    • The unhappy scheduler candiscourage patients,

    • The resentful clinician can too

Forging solutions4
Forging Solutions

  • Patients need to feel comfortable at each step of their visit, encountering professionals committed to their care:

Forging solutions5
Forging Solutions

  • Employees will not intuitively know their specific responsibility to help patients understand their path through care,

Forging solutions6
Forging Solutions

  • They must learn the importance

  • And responsibilities of their role,

  • And how much it is valued by the management and those they serve

Forging solutions7
Forging Solutions

  • The Hippocratic Oath can apply to all in the health care setting:

Hippocratic oath
Hippocratic Oath

  • …Our responsibility includes not only the presenting illness, but also how the illness affects the person's family and economic stability.

Forging solutions professionalism
Forging Solutions: Professionalism

  • Staff orientation upon hire and annually thereafter can ensure that people understand their professional responsibilities

Forging solutions professionalism1
Forging Solutions: Professionalism

  • Understanding the organization’s mission

  • and how a staff member’s work contributes to the mission

  • helps diffuse frustration among patients and staff alike

Forging solutions professionalism2
Forging Solutions: Professionalism

  • To understand how one’s work contributes to the overall attainment of the organization’s mission

Forging solutions professionalism3
Forging Solutions: Professionalism

  • Ground’s a person in the importance of their work

  • Clarifies a person’s understanding of how they contribute to improving people’s lives

Forging solutions professionalism4
Forging Solutions: Professionalism

  • Job descriptions can be a tool to clarify staff members’ role in care-giving

  • They reduce ambiguity by clarifying expectations

Forging solutions professionalism5
Forging Solutions: Professionalism

  • Annual performance reviews based on job descriptions can provide valuable guidance about successes and opportunities for improvement

Forging solutions professionalism6
Forging Solutions: Professionalism

  • Performance reviews

    • Can actually reassure employees

      • If done with the intent of helping someone find solutions to challenges they face

        • And providing skill building methods to help

      • And praising the successes they have demonstrated since the last review

Forging solutions professionalism7
Forging Solutions: Professionalism

  • In short, every employee needs to understand that each patien--regardless of who they are--deserves respect and professional care

  • At the core, we must remember…

Forging solutions8
Forging Solutions

  • The Golden Rule:

  • "Do unto others as you would have them do unto you."

Forging solutions9
Forging Solutions

  • The Golden Rule is the cornerstone of human rights. Essentially, regardless of:

    • Their circumstances

    • Their station in life

    • Their appearance

    • The choices they have made

    • The time of day, the day of the week…

Forging solutions10
Forging Solutions

  • Each patient deserves equal and just treatment.

  • As caregivers, our role is

    • Not to judge people,

    • Not to impose our resentments on patients,

    • Not let our political views color our care

Forging solutions11
Forging Solutions

  • It is to set aside any ill will we may have before we encounter a patient

  • And treating all patients with the consideration and respect that your faith and/or professional code expects of you

Forging solutions12
Forging Solutions

  • Active incorporation of the Golden Rule into our professional lives can:

    • Reduce culturally-based differences

    • Reduce health disparities

    • Resolve underlying issues chronically and adversely affecting health outcomes

What does culture include
What does culture include: Asia/Pacific region?

  • Language

  • Traditions

  • Behavior

  • Beliefs

  • All of the above

  • None of the above

What is your culture
What is your culture? Asia/Pacific region?

  • I’m a health professional

  • I’m a Christian

  • I’m masculine

  • I’m feminine

  • I’m heterosexual

  • I’m gay

  • I’m wealthy

  • I’m educated

Cultural competency is the ability to
Cultural Competency is the ability to: Asia/Pacific region?

  • Interact effectively with people of different cultures

  • Appreciate differences and adapt for effectiveness

  • Implement system-wide practices to optimize care

  • All of the Above

Which of the following ways can improve your cultural fluency
Which of the following ways can improve your cultural fluency?

  • Ask and really listen

  • Minimize your assumptions

  • Empathize with your clients

  • All of the above

  • None of the above

Which of the following is true i am a deaf mute
Which of the following is True: fluency?I am a Deaf/Mute

  • Don’t worry, I can’t hear a thing

  • Ignore me because I can’t speak

  • I want to be treated with respect and dignity

A family member is an effective interpreter for patients seeking medical care
A family member is an effective interpreter for patients seeking medical care

  • True

  • False

  • Other

Which of the following is not true of a culturally competent organization
Which of the following is NOT true of a culturally competent organization: 

  • Provides professional interpreters

  • Information is in the languages of its patients

  • Staff reflects the cultural mix of its of its clients.

  • Staff does not need to be reminded to treat all patients with respect.

Case one
Case One organization: 


  • 45 Filipino male who works on a fishing boat.

  • Married to a local woman with 3 young children

  • He is very religious.

  • Has sex with other men but does not consider himself homosexual.

  • Very upset with positive HIV test and accuses you of malpractice

    How would you address his concerns?

Case two
Case Two organization: 


  • 35-year old local male seeing you off and on for 5-years.

  • HIV+ and doesn’t work.

  • He is an alcoholic, angry, and wants pain medications immediately

  • Non-adherent to HAART because of the diarrhea and nausea

    How should the receptionist be taught to deal with this patient?

    How can the physician help this patient?

Forging solutions13
Forging Solutions organization: 

  • While this is all well and good, the question ultimately becomes how do we handle situations that challenge our attempts to live by the Golden Rule?

Reducing lost to follow up
Reducing Lost to Follow-up organization: 

What can we do?

Standardize information gathering

  • Document, Document, Document…

  • Confirm contact information at every visit.

  • Ask patients for the best way to reach them

  • Ask if patient expects to move within the next six months.

Reducing lost to follow up cont
Reducing Lost to Follow-up, cont. organization: 

  • Obtain/Confirm emergency contact information for the patient at each visit.

  • Obtain employer information

  • Reminder calls

  • Smiles and friendliness go a long way

Reducing lost to follow up cont1
Reducing Lost to Follow-up, cont. organization: 

  • When suggesting follow-up appointments, you might ask:

    • How will you get here?

    • Will you have transportation?

    • Would 4:30 be better for you?

Reducing lost to follow up cont2
Reducing Lost to Follow-up, cont. organization: 

  • Could you call us if you can’t come so we can schedule other patients?

  • Make it clear that “No” is OK. “It’s okay if that time doesn’t work for you. Tell me whattime is better.”

Improving patient satisfaction
Improving patient satisfaction organization: 

  • Active listening to improve outcomes

    • People often are not listening attentively to one another.

    • They may be distracted, thinking about other things, or thinking about what they are going to say next

Improving patient satisfaction1
Improving patient satisfaction organization: 

  • You can help by:

    • Tuning in, ignoring distractions

    • Acknowledging key points, and confirm w/patient,

    • Expressing yourself clearly and succinctly

Enhanced listening
Enhanced Listening organization: 

  • Active listening structures listening and responding to others.

Enhanced listening1
Enhanced Listening organization: 

  • It focuses attention on the speaker.

  • Suspending judgments is important in order to fully attend to the speaker.

Enhanced listening2
Enhanced Listening organization: 

  • Modifying listening skills:

    • Summarize the patient's chief concerns.

    • Interrupt less.

Enhanced listening3
Enhanced Listening organization: 

  • Modifying listening skills:

    • Offer regular, brief summaries of what you are hearing from the patient.

    • Reconcile conflicting views of the conversation.

Enhanced listening4
Enhanced Listening organization: 

  • To improve understanding between patient and care-giver, you could ask:

    • "What I hear from you is ….Did I get that right?“

    • This affirms the patient’s perspective,

    • And reduces misunderstandings

Enhanced listening5
Enhanced Listening organization: 

  • To illustrate empathy; ensure understanding of patient's emotional responses to condition and care:

    • "You seem quite upset. Could you help me understand what you are going through right now?"

Enhanced listening6
Enhanced Listening organization: 

  • To improve adherence:

    • "What's your understanding of what I am recommending?“

    • “How does this treatment fit with your ideas about how to cure your illness?“

Enhanced listening7
Enhanced Listening organization: 

  • These questions can confirm your instructions and reveal challenges to treatment the plan

Universal skill clear communication
Universal Skill: Clear Communication organization: 


  • Use medical jargon

  • Prescribe w/o explanation

  • Provide too many recommendations

  • Assume the patient understands

  • Expect patients to recall your medical advice

Universal skill clear communication1
Universal Skill: Clear Communication organization: 


  • Use simple explanations

  • Be specific

  • Prioritize, and focus on a few critical recommendations

Universal skill clear communication2
Universal Skill: Clear Communication organization: 


  • Ask the patient to describe the treatment plan

  • Give your patient written, simple instructions

Universal skill building
Universal Skill Building organization: 


  • Assume knowledge/skill

  • Teach too much at one time

  • Assume one-session learning

  • Assume skills will remain accurate over time

Universal skill building1
Universal Skill Building organization: 


  • Observe behavior

  • Prioritize, teach one skill at a time

  • Repeat instructions

  • Make skill assessment and instruction part of standard care

Foundations for success
Foundations for Success organization: 


  • Be judgmental

  • Criticize and threaten

  • Expect too much

  • Ignore good behavior

Foundations for success1
Foundations for Success organization: 


  • Accept less than perfect behavior

  • Do problem solve

  • Set realistic goals

  • Praise even small positive behavior change

Difficult patients types
Difficult Patients: Types organization: 

  • Substance users: alcohol, drugs

  • Angry patients

  • Drug seeking patients

  • Emotionally Needy

  • Violent patient

  • Mentally challenged

Difficult patients types cont
Difficult Patients: Types, cont. organization: 

  • Adolescents

  • Demanding/Complaining

  • Emotionally Needy

  • Re-scheduler

  • Seductive

  • Non-paying

  • Others?

Difficult patients
Difficult Patients organization: 

May have difficulty understanding common social boundaries

  • The patient/care-giver encounter is like any interpersonal relationship

  • Boundaries must be established and maintained to encourage positive outcomes and maintain professional standards

Difficult patients the how s
Difficult Patients: The How’s organization: 

  • A “demanding patient” may be a person who challenges the customary professional or personal boundaries between the patient and the care-giver.  

Difficult patients the how s1
Difficult Patients: The How’s organization: 

  • They may challenge boundaries because:

    • They don’t understand/recognize them 

    • Psychological impairments

      • Neediness

      • Et cetera

Difficult patients the how s2
Difficult Patients: The How’s organization: 

  • It is the care-giver’s responsibility to maintain professional and personal boundaries.

Difficult patients boundaries
Difficult Patients: Boundaries organization: 

Basic boundaries

  • Adhering to the law.

  • Maintaining standards.

  • Keeping appropriate emotional distance.

  • Precluding inappropriate physical contact.

Difficult patients boundaries1
Difficult Patients: Boundaries organization: 

  • Maintaining standards (rules).

    • Rules are relative to a social setting.

    • Rules promote efficiency because everyone abides by them.

    • If rules are bent, then systems can be compromised (Change the rules if they are failing to meet needs)

Difficult patients1
Difficult Patients organization: 

  • Challenging boundaries can;

    • Engender feelings of frustration,

    • Ambiguity,

    • Anger

    • And create a feeling of being manipulated

Difficult patients the whys
Difficult Patients: The Whys organization: 

  • They may feel mistreated, cheated or ignored

  • Have personality problems

  • Be experiencing social/financial problems

  • Lack trust, information or have communication difficulties

  • Cultural differences

Difficult patients the how s3
Difficult Patients: The How’s organization: 

  • Set limits

  • Restate common goals

  • Schedule regular visits…

Difficult patients the how s4
Difficult Patients: The How’s organization: 

  • Keep visits short and focused

    • Prioritize the patient’s needs

    • Deal with the most pressing issue first

Difficult patients the how s5
Difficult Patients: The How’s organization: 

  • Schedule follow-up w/understanding given to the patient that her/his concerns are valid;

  • They will be addressed fully in future visits;

  • But it is important to focus on one issue at a time to ensure thorough care

Strategies complaining patient
Strategies : Complaining Patient  organization: 

  • Evaluate the physiologic basis for each symptom

  • Conduct a thorough medical evaluation

  • Refer for consultation with a mental health professional if needed

Strategies complaining patient1
Strategies : Complaining Patient  organization: 

  • Some patients who complain no matter how well they are doing;

    • Need to be evaluated for a physiologic basis for each symptom;

Strategies complaining patient2
Strategies : Complaining Patient organization: 

  • Care-givers need to understand a patient’s emotional patterns without labeling the symptoms as real or psychosomatic;

  • Diagnosis of symptoms should be based on objective clinical and lab findings.

Strategies complaining patient3
Strategies : Complaining Patient organization: 

  • If a care-giver exhausts tests and cannot find the cause, the patient should be assured that there were no serious findings.  

  • And consider referring the patient to another physician for a second opinion. 

Strategies complaining patient4
Strategies : Complaining Patient organization: 

  • In either case, it is imperative to document complaints in the medical chart. 

  • Documentation may preclude future misunderstandings

Re scheduler non compliant patient
Re-Scheduler/ organization: Non-Compliant Patient

  • Provide patient with written notification of the potential consequences of failing to follow medical advice

  • Inform the patient, in writing, of the need for ongoing care

Strategies re scheduler
Strategies: Re-Scheduler organization: 

  • Care-givers are responsible for maintaining regular follow-up on patients who are prescribed medication on a regular basis since medical conditions change, progress, and get complicated over time. 

  • If changes are unidentified, Care-givers may miss something important.

Strategies re scheduler1
Strategies: Re-Scheduler organization: 

  • Patient education is necessary to reinforce the value of regular follow-ups.

  • Rules should exist so that all patients are seen at set intervals of time.  

  • Missed appointments should generate a letter or conversation explaining the need for regular patient care. 

Strategies re scheduler2
Strategies: Re-Scheduler organization: 

  • Repeated missed appointments may have an adverse outcome on the patient’s long term health. 

  • This information needs to be communicated to the patient, with documentation made in the patient’s medical record.

Strategies angry patient
Strategies: Angry Patient organization: 

  • Politely isolate patient into private space

    • Assure him/her that privacy will aide your complete attention

    • Leave the door slightly ajar to facilitate your escape, if necessary;

Strategies angry patient1
Strategies: Angry Patient organization: 

  • Maintain your composure

    • As the professional, your task is to control the situation through careful attention to your emotions

    • Anger, fear, visible displeasure are unhelpful at this time,

Strategies angry patient2
Strategies: Angry Patient organization: 

  • Visible concern and empathy can help to de-escalate a situation

  • If you feel unsafe, excuse yourself politely and seek assistance

  • Otherwise…

Strategies angry patient3
Strategies: Angry Patient organization: 

  • Listen to the patient

    • Don’t escalate the discussion by;

      • Raising your voice;

      • Vehemently contradicting the patient;

      • Vigorously denying the patient;

Strategies angry patient4
Strategies: Angry Patient organization: 

  • Confirm what the patient is saying by succinctly restating the problem in a calm manner at natural break points in the conversation;

  • e.g., “I understand you’re upset that we did not provide your test results as promised; that must have been very frustrating to not know your prognosis.”

Strategies angry patient5
Strategies: Angry Patient organization: 

  • If feasible, offer a solution or solutions to the patient within your capabilities;

  • If accepted, re-state your understanding of the frustration the patient experienced;

Strategies angry patient6
Strategies: Angry Patient organization: 

  • Confirm your plan to resolve the matter, and

  • Obtain a clear sign that the patient accepts and is satisfied with the solution.

Strategies violent patients
Strategies: Violent Patients organization: 

  • Maintain a calm demeanor as a means of being a neutral factor in the exchange

  • Suggest the conversation be moved outside

Strategies violent patients1
Strategies: Violent Patients organization: 

  • Never let the patient get between you and the door,

  • If the door is closed, get it ajar in a non-threatening manner;

  • Keep your back to the door at all times

Strategies violent patients2
Strategies: Violent Patients organization: 

  • When in doubt, politely excuse yourself, and get help;

  • If there appears to be no means of de-escalating the situation, recommend an opportunity to collect more facts, and promise a follow-up phone call or meeting

Concluding thoughts
Concluding thoughts organization: 

  • All of us in the health care field contribute to the well-being of our patients

Concluding thoughts1
Concluding thoughts organization: 

  • We each can make a positive difference in someone’s life through our actions

Concluding thoughts2
Concluding thoughts organization: 

  • By treating all patients with the consideration and respect that your faith and/or professional code expects of you

Questions? organization: