I’ll be doing some promotions which you will hear about later, but for now here’s the description on Amazon:
Retaining Expert Knowledge: What to keep in an age of information overload covers two major topics central to capturing and transferring expertise in organizations:

• Methodology and best practices for interviewing subject matter experts (SMEs) to capture their knowledge
• Identifying the SMEs to interview

The more critical problem is identifying the SMEs and the knowledge that needs to be captured.

One reason identifying the right experts is now so important is that in the next 10 years, the largest recorded exit of talented and knowledgeable workers from organizations will occur as baby boomers retire. In their wake, they leave their former employers understaffed and, even scarier, under-informed. Identifying the right SMEs is also critical because of the rapid acquisition of new knowledge. Some estimates say knowledge now doubles every two years, so it is crucial each organization identifies its journey and catalogues it individually and collectively.

This book provides managers with answers to the following questions:

• Are we talking to the right subject matter experts?
• What knowledge should we capture?
• What knowledge needs to be captured immediately as opposed to eventually?
• If we have limited resources, which experts are most important to speak with first?

Every organization has a history, a culture, and knowledge that may have lost its current relevance but not its importance. It is that broader vision of capturing knowledge, which this book addresses. It guides readers on how to preserve corporate knowledge and provides tools to assess organizational circumstances and judge the value of the resources to capture.

Retaining Expert Knowledge is a training resource, but it is also a business resource. As knowledge proliferates and organizational culture rapidly changes, now is the time to step back and determine what has been important to your organization’s success, where the organization is today, and what it will take to stay in the game tomorrow.

Your company houses knowledge, skills, attitudes, intellectual property, trade secrets, company culture, and individuals who will never be replicated exactly as they are today. Because they have demonstrated value in the past and are demonstrating value today, these treasures are worth preserving. This book shows how to preserve these valuable assets today for tomorrow’s successes.
You can buy this wherever you normally purchase your books.

Here’s a link directly to Amazon. 

By Peggy Salvatore and Terry McGinn

Each company in a regulated industry is required to follow written procedures.  The written procedure describes how steps or tasks are to be followed to achieve the desired outcome or result.  Having these steps identified permits the distant or precise way to achieve the end of your process or practice. 

Knowing the critical nature of having written procedures, your standard operating procedures and best practices need to follow a few procedures of their own so you can replicate what you do across your organization.  In other words, your standard operating procedures need to be transparent and streamlined.

One of the many purposes of the SOP or best practice process is to ensure that the process flow can meet expectations. Done well, your standard process or procedure should result in a quality product or achieve the desired result every time.

Knowledgeable and trained  personnel must have the SOP available to follow because no matter how many years’ experience they may have, even experts get stuck for a variety of factors. In fact, some experts know their jobs so well that they think they can skip or modify steps, take shortcuts, or do it from memory. This is a red flag!

The SOP should be written in a logical process flow that will allow someone looking for the cause of a failure later can pinpoint where a difficulty arose. Reviewing the SOP with someone internally or externally who is checking or auditing your procedure should allow them to identify what and where things  went wrong.

When you have a point of failure, an examination of the SOP should indicate gaps or problems that can include one or more of a host of issues including materials, equipment, environment and much more. Often, a failure can point to the source of your complications by reading the SOP against practice.

A well-written procedure or best practice document will:

1. Be written to describe the flow clearly to anyone trained on it
2. Include every essential step without including extraneous steps or materials that can and should be accessed elsewhere
3. Always be followed by everyone from the new hire to the veteran employee using the current SOP

Expect you will have changes to your SOPs on occasion. Expect you will need to review your documents periodically according to your SOP. And expect that when you have a clean, clear, streamlined SOP process that your errors should be few and easily identifiable.

To summarize, standard operating procedures and best practices need to follow procedures of their own so you can replicate what you do across your organization.  In other words, they need to be transparent. If they are the opposite of transparent – opaque – they are hard to follow and may result  in errors.

If you would like to talk to us about your SOP process, give us a call for a no-obligation preliminary review of your procedures.

Terry McGinn has worked in regulated industry for many years and has experience in written procedures that will help pass scrutiny of a regulatory authority inspection. To have a conversation about writing your standard operating procedures, write to us at workingwithsmes@gmail.com to set up an appointment.  

Photo by Drew Hays on Unsplash

By Terry McGinn and Peggy Salvatore

We’ve been getting quite a bit of interest and feedback regarding our series on standard operating procedures, so we’ll continue writing about this topic this week.

After all, inherent in the word “expert” is the idea that something is done correctly. Correct procedures and best practices need to be captured and passed on. Sometimes, though, it seems the only people who care if the SOPs are followed are the experts who wrote them.

Truth is, everyone needs to care. Accountability right down to the last man or woman is absolutely the key essential ingredient in ensuring regulatory compliance.

Train for Accountability

Employees who are tasked with executing the many small, incremental steps are responsible only for their piece of the process. Sometimes in the laser-focus on one task, people may lose sight of the bigger picture. That bigger picture – a safe product going out the door – needs to be reinforced occasionally. Training usually steps in here for both reinforcement and correction. When that fails, the regulatory authorities will notice. Companies get slapped with government warnings and fines at a higher rate than the average person may realize. But if you are in a regulated industry, you know how often you are out of compliance.

Think about dialing the failure point back to its origin. The failure point is when the SOP is not correctly written, understood and applied.

Only then does the employee fail to perform to specifications.

Only then will training have to step in for often very expensive correction.

Only that will happen when an audit reveals you are out of compliance with your SOPs, and the Corrective and Preventative Actions (CAPAs) applied at that point of failure. That doesn’t need to happen.

In a perfect world, it should look like this:

If your current plant is not operating flawlessly as above, identify your points of failure:

1. How many people are asked to retrain personnel after a deviation or equipment issue?
2. How many SOPs do you have? Are they overwhelming or conflicting?
3. Are they easy to understand and do they follow a logical, stepwise process?
4. After a deviation, is the SOP reviewed?
5. Are people observing the CAPAs?

And, the big question…

Do your employees feel responsible and accountable for performing their jobs according to the SOPs in place?

Employees feel empowered when they are able to follow well-written SOPs, and when they are acknowledged for contributing to a well-run organization. Points of failure cannot be business as usual. Organizations that accept points of failure as the status quo have a company culture that unintentionally encourages non-compliance.

Maybe that is worth repeating:

Organizations that accept points of failure as the status quo have a company culture that unintentionally encourages non-compliance.

And the road to audit hell is paved with regulatory non-compliance.

The Solution

Dial back your points of process failure to the source.

Ask yourself:

• Are my SOPs well written?
• Do my employees feel a sense of responsibility for performing to specifications?

If your answer to either of those questions is, “No” or “I don’t know”, give us a call.

We would be happy to speak with you.

Unlike some problems in the universe, the problem of poorly-written and executed SOPs can be solved. Let’s do it.

Terry McGinn has worked in regulated industry for many years and has experience in written procedures that will help pass scrutiny of a regulatory authority inspection. To have a conversation, write to us at workingwithsmes@gmail.com to set up an appointment.  

Photo by Drew Hays on Unsplash

I’ve been hanging around the virtual water cooler in healthcare for two decades, and now the promise of technology as it affects and improves our lives is beginning to come to fruition. With that, here is a roundup and just a few developments and their significance to the future of healthcare from a medical, business and financial perspective.

Med-Tech: At the head of the futurist pack is Dr. Peter Diamandis, known for oh-so-many things including a founder of the X-PRIZE, Singularity University and the Human Longevity Institute. In his May 19 Abundance Insider, he looks  at a bionic hand developed in the UK “capable of grasping objects without the wearer’s focused thoughts.  The researchers created a convolutional neural network training the hand and its algorithm on the images of over 500 objects in various orientation and lighting conditions with four programmed grasps that you might use to pick up things.”  Go to the link to see the video. Under that entry, you can read the next story about an 18-year-old Mexican student who designed a bra that detects breast cancer.

Health Biz-Tech: The business of healthcare is all about how we pay for medical services and the structure of the business model. Our current system is focused on an insurance-based payment model. Already, insurance companies are toying with issuing insurance policies in real time based on your current medical history that involves instantaneous analysis of your condition, the company’s risk and what it will cost you to be covered by them. This could blow all the regulations out of the water. It could also call into question the current model of trying to cover everyone with insurance and could instigate a movement to have us begin to look at a different business model completely, especially in light of the kind of Med-Tech advances in the pipeline that will completely alter our outcomes and lifespan.

Health Fin-Tech: How and why certain goods and services get paid keep many an insurance agent, claims administrator and government regulator up at night., not to mention the security people who need to lock down our data to maintain patient privacy. The blockchain has the promise of changing the financial world, and healthcare payments and security will be part of this revolution. I am attending a Meetup of blockchain people in my area this Saturday and I’ll report back at some point.

They say those in a movement need to either lead, follow or get out of the way.

At some point in the history of the evolution of healthcare, government was in a position to lead. In the past few years, it has been in the unfortunate position of having to follow as technical advances outpaced the ability of government to legislate and regulate at the pace of change. Now it is time for government to get out of the way. At some point, we’ll need to regulate for safety and security reasons. But this is not that time.

Health Wonk Review for February 9, 2017

#alternative_facts Edition

And now, for your dancing and listening pleasure, Health Wonk Review, the musical…

David Harlow of HealthBlawg’s Health Wonk Review is Bustin’ Out All Over. Hat tip to Rogers and Hammerstein. Listen here.

For more Harlowfun, tune in every other Tuesday to Health Wonk Review On Air with David Harlow. Click here to listen or participate on Blab.

In the spirit of innovation, the entries this week are organized according to the order in which they arrived in my inbox. This relieves me, as the host, of the awesome responsibility of finding a compelling theme. First in, Dr. Bradley Flansbaum.

The Early Bird

 Dr. Bradley Flansbaum offers a birds-eye view of the physician relationship with the pharmaceutical industry at The Hospital Leader: the Official blog of the Society of Hospital Medicine. Dr. Flansbaum details his interactions with the pharmaceutical industry – from a young hospitalist receiving speaker’s honoraria to a pharma-sponsored researcher. If you want to know about the relationship between the pharmaceutical industry and the medical profession, this is a good primer. Dr. Flansbaum has chosen to opt out of all relationships with pharma, and he is eloquent in explaining his professional position. At the risk of taking the suspense out of his story, in part, here is his conclusion:

“Remember why we call industry, industry. It’s a business. They sell, and we buy. That’s my message so do with it what you will.”

Healthcare Economist Asks “Is P4P doomed to fail?”

 The way pay-for-performance and quality incentive programs are currently structured, the conclusion one draws from Jason Shafrin’s question is, “Yes, P4P is doomed to fail.”  Jason bases his discussion on a referenced article in Health Economics that calls out a “fundamental design flaw in P4P design” which is, simply, a provider chasing too many quality metrics that result in rewarding competing measures. For providers and health care organizations looking to be reimbursed based on this model, the ensuing confusion can be hazardous to your patients’ health and the health of your bonus payment. Read the detail at Healthcare Economist.

Tracking ACA Enrollments: Figuring Out How Many Grandfathered/Grandmothered Plan Are Still Around

In this week’s entry, Charles Gaba of ACASignups.net gives us a breakdown of a tally of Grandfathered and Grandmothered plans in the individual market. He did, in his own words, a “back of the envelope” calculation and, with input from Louise Norris of healthinsurance.org, came up with an estimate of those old plans still hanging around. Charles says, “My Conclusion? There should be roughly 1 million people still enrolled in Grandfathered policies and perhaps 1.5 million in Transitional/Grandmothered plans today.” If you want to know the difference between Grandfathered and Grandmothered health care plans and the detail, click here.

Dare Roy Poses Suggest: Healthcare Leaders Should Come From Healthcare

Roy discusses a New England Journal of Medicine article describing “Immersion Day” during which members of the board of a non-profit hospital system who had no healthcare background were given a one-day exposure to life in the hospital. Roy Poses poses (sorry, I couldn’t help myself) an interesting hypothesis: “True health care reform would put more health care professionals back in control of health care, or failing that, would at least promote leadership by people with some knowledge of health care who would support health care values and would be willing to be accountable for doing so.” Read the detail about the NEJM article here.

 ObamaCare Wear: Gasoline Pants

Hank Stern’s InsureBlog is on top of the dish on ObamaCare. Blogger Mike Feehan writes this week that we have more bad news about the ACA. ObamaCare Co-ops are going the way of the dodo bird, according to Mike. In fact, I can’t improve on Mike’s description of the status quo, so here it is, in his own words: “As Nipsy Russell might have observed, the Obama administration’s health policy is running thru Hell in gasoline pants.” Read More Bad News About ObamaCare Co-Ops – Part CCIX – at InsureBlog.

 Health Plans Need to Consider the UX

Just as Apple figured out that computer users needed an intuitive interface to finally integrate computing into their daily lives, Joe Paduda of Health Strategy Associates says that the health plans that figure out how to give their members a good user experience will be winners. “Members do NOT want to wade thru fine print stuffed with SAT-test words and jargon that’s murky at best. Blaming the consumer for misunderstanding a benefit plan is just nuts; write the plan so it’s understandable for everyone” Read more at JoePaduda.com.

California Is the Harbinger of Things to Come

California often leads the way in trends that work their way across the country. Anthony Wright at Health Access Blog writes out of the state capitol in Sacramento from Health Access California where he and co-blogger Bethany Snyder tell us “Covered California produced a report about potential 1332 waivers, and gave a greenlight to one proposal to allow undocumented Californians to buy into the exchange with their own money.” Yes, insurance is governed at the state level, but keep your eye on California’s move to allow undocumented people to buy into the healthcare system and the implications it could have for the future of health insurance. Read Opening Up Covered California here.

The CMS Innovation Center and Next Generation ACOs

Writing for Health Affairs, Chris Dawe, Nico Lewine and Mike Miesen discuss the recent CMS Innovation Center announcement saying ACOs can share in 100 percent of the savings they create for the payer’s largest book of business, theNext Generation ACO. In Today’s Most Attractive National ACO Model is Offered By…CMS, the authors write, “Would-be Next Gen ACO participants must grapple with two primary hurdles: risk exposure and a closing decision window.” Read more about the tension created by being exposed for full risk for spending in excess of targets and opportunities to enjoy capturing savings at the Health Affairs blog.

Another Medicare Pilot: Medicare Comprehensive Primary Care

If you’ve read this far, you know that Dr. Jaan Sidorov is not the only HWR contributor this week who wonders if government should get out of the way and let healthcare do its job of caring for patients. In this entry at Disease Management Care Blog , Dr. Sidorov explains that Medicare has just launched a multi-year primary care initiative aimed at improving care, but that might not be as good as it sounds. Dr. Sidorov tells us that it is based on a two-year-old pilot that hasn’t shown improvement in costs or quality. He asks, “Should CMS get out of the care management game and let others handle the work of caring for populations with chronic conditions?”

Lack of Transparency or Just Plain Greed?

David Williams at Health Business Blog writes about healthcare’s version of the military’s $10,000 toilet seat: in this case, a $427 hospital charge is reimbursed at $22. He wonders what could be wrong. Is the hospital overbilling to begin with? Is the health insurance company underpaying? Or both? In Urgent Care Billing: Eyebrows Raised , David discusses the implications of this type of billing/reimbursement discrepancy.

And Finally, A Little Education from Worker’s Comp Insider

Julie Ferguson takes time to educate about occupational medicine and its unique place in healthcare. At Workers’ Comp Insider, Julie writes about how occupational medicine differs from other specialties, and she offers an informative video, “Introduction to Occupational and Environmental Medicine (OEM)”. Check out this training at Workers’ Comp Insider here.

Blabbin’ with the Wonkers at Health Wonk Review On Air with David Harlow

If our biweekly dose of health policy leaves you wanting even more detail about things like QALYs and risk corridors, please join us live, online, every other Tuesday for Health Wonk Review On Air with David Harlow. David is joined by other HWR contributors to discuss details of the most recent edition and whatever else is on their minds health policy-wise.

Blab is interactive, so it is a good place to ask questions and join the discussion. If you miss the session, you will be able to view the recording later. David posts the link at HealthBlawg.com.

 The next edition of Health Wonk Review On Air Blab is Tuesday, April 26 from 1 to 1:30 p.m. Eastern.  

This is the eighth entry in a series of blogs for ePharma Summit 2016 to explore ways the pharmaceutical industry can maximize the promise of digital health.

A report put out by the California Health Care Foundation  last week chronicled the promise of digital health holding the key to holding down costs for low-income patients with chronic conditions. After all, it is the poor, those with poor literacy and health literacy, who are often the ones with the highest rate of chronic disease – and the highest cost – to the healthcare system.

Who pays? For patients who fit this description, it is often the states and federal government who end up footing the bill for medications, emergency department care (because they sometimes don’t have a home at all, let alone a medical home) and inpatient stays. The study states:

Some 90 million Americans have multiple chronic conditions (MCCs), with the prevalence of MCCs highest among people with the lowest incomes. Each additional chronic disease increases a person’s risk of adverse drug events, higher out-of-pocket expenses, impaired functional status, hospitalization, and mortality. Two-thirds of health spending is associated with patients managing MCCs. (p.3)

A series of pilot programs have shown that even the poorest of the poor in unstable living situations often have a cell phone or even a smart phone, and Internet access at a computer. With just those tools, a few low-cost, high-touch digital outreach programs have moved the needle with medication compliance, attending appointments and maintaining health regimens recommended by their providers.

Here are a few highlights from this February 2016 CHCF study which surveyed global healthcare leaders:

• Digital solutions use texting, customize language and communication style to the audience, uses portals, kiosks, video, telephone and cable, combines medical and social services, leverages a trusted human and collects data passively.
• One-half of low-income adults own a smartphone and 84% own a cell phone. Customized text messaging bolstered appointment adherence by 40% and medication adherence by 12%. One successful test program has been expanded to Medicaid care management programs in New York.
• Text4baby is a program in both English and Spanish that messages labor signs and symptoms, birth-defect prevention, prenatal care, urgent alerts, developmental milestones, immunizations, nutrition, safety and more. It also connects users to Medicaid and the CHIP program.
• Meducation targets community health centers and translates medication and discharge instructions into 18 languages as well as provides visual instructions.
• Kaiser Permanente implemented KP HealthConnect by mining retrospective data in the EHR and using HEDIS data sets to use electronic messaging to bolster outcomes for black patients managing diabetes and heart disease.
• In a North Philadelphia grocery store in a low-income area of the city, one kiosk with behavioral health information encourages people to get “a check-up from the neck up”.

Some programs leverage relationships with faith-based initiatives, federally qualified health centers and university programs. The promise of digital health to help, diagnose, treat and manage diseases and common conditions (like pregnancy!) are only limited to our imagination.

With the desire to serve those who cannot afford and do not have regular access to healthcare, and the limitations of state and federal budgets to do so, digital health solutions can bridge the gap between poor health outcomes and managing high-risk populations.

I am hoping to tap into a network of health IT people within organizations who are interested in this idea or who need a project writer to pull together work your team is already doing.

I am available to attend HIMSS15 for an organization that would like a writer onsite for their company. I have a lot of experience in healthcare and years of interest in health IT. I write books, white papers, articles. blogs, training programs, presentations, and more. I attended HIMSS10 and worked on the original change management task force. I think this year is a turning point in health IT and would love to be there but can’t justify going for my own curiosity and enrichment. Besides, I think it would be much more valuable for me to attend with a specific end goal or research question in mind to stay focused because the options are almost endless.

I can attend the event and work on a project basis, especially if a company or organization is interested in pursuing a particular topic at length beyond the event.

I have done year-long projects and other book length papers and presentations, and view this is an opportunity for an organization to explore an issue at this turning point in health IT and using the HIMSS event as bookends.

Your project would focus on your area of interest from your point of view.

I can be reached at peggysalvatore@healthsystemed.com

For readers who are training people, you know that KSAs are Knowledge, Skills and Atttitude. You can teach KSAs.

Here are some examples of teaching KSAs in Health IT:

• Knowledge training includes compliance training. Health IT learners need to know the laws that govern the use of electronic health information such as HIPAA regulations regarding the use of personal health information. Some trainers I’ve worked with call this “head knowledge”.
• Skills training includes the actual, hands-on software training. Learners experience how to sign on to an application, which fields must be filled in, and how to access, save and send information. Providers learn how to use a laptop or tablet in patient interactions so the device does not interfere with the relationship.
• Attitude training includes what are known as “soft skills” in the parlance of human resources. Soft skills include things like leadership, empathy, management of self/others/projects. In health IT, attitude training includes change management techniques such as finding champions of an IT implementation and sending them out on the floor to make sure people are on board with the implementation. Soft skills health IT training includes managing the people, timelines and workflow, making sure there is a smooth transition.

You can lead an HCP to health IT, but can you make them think? Think what? This is where attitude training enters:

• Think about the value of gathering the correct patient information for high-quality care
• Think about the overall efficiency of gathering information to be disseminated to other caregivers who might be outside your immediate care team – say the dentist and the ophthalmologist
• Think about the value of patient data to researchers in the fields of cardiology, oncology and neurology (just as examples) based on the accurate information you have entered about the patient in front of you
• Think about the correct clinical protocol returned to you when you enter patient information into the system

Question: Are you employees trained in essential soft skills related to health IT? Would it help?

The Borg in Start Trek said, “Resistance is futile.” In health IT, resistance is probably futile in the long run. But in the short and medium run, resistance has probably slowed progress.

I would appreciate your feedback on whether you are doing soft skills training for your health IT implementation.

Please leave a comment or email me at peggysalvatore@healthsystemed.com. I am very interested to hear your thoughts on this issue.