Blog Posts


Communication Series: Going ‘Old School’ to Reduce Confusion

Posted on Mon, Nov 07, 2016
Communication Series: Going ‘Old School’ to Reduce Confusion

Part 1 of a two-part series.

By Ginger Wirth, RN

Communication. That word is used in every aspect of life and considered one of the most powerful tools we have as human beings. It’s also considered one of the biggest challenges we have. Whether it’s in our professional or personal relationships, when there is the perception of poor, failed or the lack of communication, there is a breakdown of the relationship. There aren’t nearly as many complaints related to the actual work we perform or the acts we do than there are regarding the way we speak (or don’t) speak to each other.

One definition of communication is: A positive, ceaseless, and challenging leadership responsibility of creating and maintaining understanding and trust between people.

It’s important to realize that when conversations happen, the intended purpose is to create a clear understanding to whom the message is being conveyed. The message is not simply made up of words; it includes all of the other important aspects of communication:

  • Words
  • Actions
  • Facial expressions
  • Tone of voice
  • Gestures
  • Silence

All of these make up pieces of the message and play a large part in how the message is received. It’s the responsibility of the sender to ensure that the receiver understands the message. It behooves the sender to be acutely aware of the receiver’s nonverbal cues to ensure that they are getting the information the way it is intended.

The reliance on electronics, such as email, text messages and other nonverbal modes of communication, has created somewhat of a breakdown due to the lack of the essential verbal component as well as the ability to see the other person during the interaction. Care must be taken when relying on these methods as the sole ways of communicating with one another. Consider the potential degradation of communication when we changed from using the telephone as an extension of the verbal to one that puts nonverbal communication “on demand.” Perhaps we should rely more on “old school” communication and go back to actually calling to speak with a colleague.

Communication Miscue: It Happened to Me

I found myself in somewhat of a sticky situation that was directly related to a breakdown in communication related to the use of email rather than traditional face-to-face or phone communication.

The situation was this: A meeting was requested by one of the team members to the administrative assistant. The assistant (Jane) spoke with the Team Leader (Joe) and sent out an invite for a conference call. When the Outlook invite was emailed to the team, I noticed that one of the key members wasn’t listed.

I sent this email to Jane: “Do we need to have Sarah on this call? Just me thinking out loud…”

Innocent request, I thought. Quickly, I receive this email back: “Hi Ginger. As Sarah is a vice president, she attends our meetings and is a vital part of all we do. The topics you requested to be discussed on the call would be beneficial for Sarah to be a part of. If you feel that Sarah should not be a part of this Team call, please address with her directly. Thank you, Jane.”

Clearly after reading the response from Jane, I replied back and told her simply that I had not seen Sarah on the invite and want to make sure that she was included. My intention was the opposite of what she interpreted from my initial email.

This illustrates how easily email and text communication can be taken out of context or completely misinterpreted. It’s the responsibility of the sender to ensure that the recipient understands the message. This may be very difficult when using email or text messages.

In the end, Sarah picked up the phone, we discussed the misunderstanding “old school” and it was cleared up in seconds. And then we laughed!

An additional pitfall with electronic communication is the use of specialty fonts, bolded text and colored texts. When you type in ALL CAPS, it gives the impression that you are shouting at the recipient. The same can be said for BOLDED or Red text in email or texts. One should use care when selecting enhancements to the normal font or typeset. I offer this suggestion: If there is a message that’s so important that you feel it needs to be in bold, italic, ALL CAPS, underlined or colored, consider picking up the phone or walking down the hall to deliver that message. You run less risk of having the communication misinterpreted that way.


Ginger Wirth, RN, joined EmCare in 2013 as a Divisional Director of Clinical Services for the Alliance Group. Her goal is to make positive changes in healthcare by helping others focus on quality, excellence, and the overall patient experience. Wirth regards her role as Director of Clinical Services as the ideal opportunity to partner with nursing, physician and facility leaders to make positive changes to the entire patient care experience. Her 20-plus year nursing career has been dedicated to quality and excellence, promoting overall positive outcomes and safety for patients.


Leadership Lessons: Turn to the 3 Cs

Posted on Mon, Sep 19, 2016
Leadership Lessons: Turn to the 3 Cs

By Ginger Wirth, RN

Leadership often can be linked to the great military minds of our country. Generals Patton, MacArthur and even as far back as George Washington are considered some of the greatest leaders.

Being a strong leader has so many implications, especially when leading teams. Think about it: Almost everything that you do involves some sort of team, unless you’re performing a solo task. Most often there is one person who emerges as the leader of these teams. That leadership carries a responsibility to get the identified task completed and help the team meet its ultimate goal.

Strong leadership skills can be attained by focusing in three areas – the three Cs of leadership:

  1. Commitment: This is where leading by example comes into play. A great leader demonstrates his or her commitment to the cause often by being right there in the middle of it all, showing the team that they are willing to get right down and dirty with those in the trenches. When a leader works alongside the team, a very strong sense of teamwork develops. It also shows the team that you can evaluate how things are going when you are able to do the work.

  2. Confidence: Believing in yourself and your ability to lead a team will take you a long way! Make sure that you are self-aware, know your limitations, triggers and strengths. Use this knowledge to your advantage, and believe that you can get to the end point successfully. Oftentimes we need to take time to look in the mirror and know what traits within us may be a barrier to the team’s success.

  3. Communication: Be the kind of leader who makes sure that the team clearly understands the who, what, when, where and why of any project. It’s imperative that objectives are shared openly and honestly. A great leader demonstrates his or her trustworthiness, honesty and integrity in how they communicate to the team. A successful leader needs to “talk the talk” and be able to “walk the walk.”

There are many other traits and qualities that define a great leader and they’re certainly not limited to those listed above. But, whether you are leading the U.S. Military, a Fortune 500 company or your neighborhood watch group, these three areas are a fantastic starting point on your road to success.

Ginger Wirth

Ginger Wirth, RN, joined EmCare in 2013 as a Divisional Director of Clinical Services for the Alliance Group. Her goal is to make positive changes in healthcare by helping others focus on quality, excellence, and the overall patient experience. Wirth regards her role as Director of Clinical Services as the ideal opportunity to partner with nursing, physician and facility leaders to make positive changes to the entire patient care experience. Her 20-plus year nursing career has been dedicated to quality and excellence, promoting overall positive outcomes and safety for patients.


10 Tips for Emergency Medicine-Hospital Medicine Collaboration

Posted on Wed, Jan 13, 2016
10 Tips for Emergency Medicine-Hospital Medicine Collaboration

By Ginger Wirth, RN

According to Merriam-Webster, the full definition of collaborate is:

  1. To work jointly with others or together, especially in an intellectual endeavor
  2. To cooperate with or willingly assist an enemy of one's country and especially an occupying force
  3. To cooperate with an agency or instrumentality with which one is not immediately connected

I know that collaboration in healthcare can sometimes seem like assisting another country. The relationships between departments, disciplines, practices and partners have both rewards and challenges. Collaboration is key on so many levels to achieving the best outcomes and delivering the overall best care for patients. This is essential between nursing and providers in the emergency department when planning and executing care. Effective communication and collaboration plays into the safety, clinical quality and satisfaction of each patient’s visit.

Another important collaborative relationship is the emergency physician and the hospitalist. Continuity of care and the handoff of the admitted patient are essential to those same aspects of the patient’s overall experience: safety, satisfaction and clinical quality. This collaboration should happen not only when directly dealing with a patient, but also when processes, order sets or clinical pathways are being developed and reviewed. Healthcare is unique in the fact that we have governing and regulatory bodies that have standards, guidelines and measures that set basic expectations for outcomes. However, ultimately it is the provider-to-provider relationship and collaboration where the “magic happens.” Strong relationships among emergency medicine and hospital medicine teams have proven not only to meet standards but exceed them. Best practice is to have regular team meetings between these specialties to discuss opportunities and share the wins and outcomes of cases. Again, strong collaboration is a “win-win” for all – especially for the patients to which we provide care.

10 Lessons in Collaboration

Regardless of your industry, collaboration is so important. Here are some tips from Deborah B. Gardner PhD, RN, CS:
  • Lesson #1: Know thyself. Many realities exist simultaneously. Each person's reality is based on self-developed perceptions. Requisite to trusting yourself and others is in knowing your own mental model (biases, values, and goals).

  • Lesson #2: Learn to value and manage diversity. Differences are essential assets for effective collaborative processes and outcomes.

  • Lesson #3: Develop constructive conflict resolution skills. In the collaborative paradigm, conflict is viewed as natural and as an opportunity to deepen understanding and agreement.

  • Lesson #4: Use your power to create win-win situations. The sharing of power and the recognition of one's own power base is part of effective collaboration.

  • Lesson #5: Master interpersonal and process skills. Clinical competence, cooperation and flexibility are the most frequently identified attributes important to effective collaborative practice.

  • Lesson #6: Recognize that collaboration is a journey. The skill and knowledge needed for effective collaboration takes time and practice. Conflict resolution, clinical excellence, appreciative inquiry and knowledge of group process are all life-long learning skills.

  • Lesson #7: Leverage all multidisciplinary forums. Being present both physically and mentally in team forums can provide an opportunity to assess how and when to offer collaborative communications for partnership building.

  • Lesson #8: Appreciate that collaboration can occur spontaneously. Collaboration is a mutually established condition that can happen spontaneously if the right factors are in place.

  • Lesson #9: Balance autonomy and unity in collaborative relationships. Learn from your collaborative successes and failures. Becoming part of an exclusive team can be as bad as working in isolation. Be willing to seek feedback and admit mistakes. Be reflective, willing to seek feedback, and admit mistakes for dynamic balance.

  • Lesson #10: Remember that collaboration is not required for all decisions. Collaboration is not a panacea, nor is it needed in all situations.

To read more about emergency medicine-hospital medicine integration and collaboration, read our recent white paper, “Integration Changes Everything.”

Ginger Wirth

Ginger Wirth, RN, joined EmCare in 2013 as a Divisional Director of Clinical Services for the Alliance Group. Her goal is to make positive changes in healthcare by helping others focus on quality, excellence, and the overall patient experience. Wirth regards her role as Director of Clinical Services as the ideal opportunity to partner with nursing, physician and facility leaders to make positive changes to the entire patient care experience. Her 20-plus year nursing career has been dedicated to quality and excellence, promoting overall positive outcomes and safety for patients.


How We’re Improving ED-Inpatient Hand-Offs

Posted on Tue, Aug 18, 2015
How We’re Improving ED-Inpatient Hand-Offs

By Nathan Goldfein, M.D.

A recent study published in the Journal of Hospital Medicine found that challenges still exist in the patient hand-off process from ED to inpatient unit. Researchers concluded that communication needs to improve between EM physicians and hospitalists to ensure quick transfer and optimal patient safety.

It’s true – communication errors do exist, and sometimes the hand-off is sloppy and the baton gets dropped. These issues are precisely the reason I looked for a better way to pass that baton; an electronic, fool-proof way to ensure accountability and accuracy.

We’ve developed Rapid Admission Process and Gap Orders™ (RAP&GO™), a digital integration mechanism between the emergency department and the inpatient units. The software collects and distributes all of the data needed by both specialists. It delivers concise information and timely notifications to all who are involved in arranging and expediting an admission from the ED, truly “hardwiring” Lean principles into the process. The automated notification system effectively manages many of the inefficiencies involved in calling, tracking and following-up. System protocols can help reduce the errors, delays and distractions that naturally occur in a fast-paced, complex environment.

Through agreed-upon protocols, both emergency and hospital medicine physicians have a better understanding of the process and requirements of each specialty. Also, by automating the steps that are unrelated to patient care, physicians can focus on what matters most - physician-to-physician communication, high-quality patient care, patient satisfaction and financial impact. 

The Benefits of Automating Hand-Offs

The benefits of this technology in an integrated emergency medicine-hospital medicine model include:

  • Allowing emergency physicians to quickly provide needed information to hospitalists, which expedites decision-making
  • Decreasing administrative tasks for physicians and nurses
  • Providing a shared tool to measure and manage time intervals to identify opportunities for improvement
  • Automating timely notifications to case managers to keep patient flow on track
  • Eliminating the need for time-consuming back-and-forth conversations, arguments and debates about admission criteria
  • Streamlining processes that can bolster patient care and improve the patient experienceHow it Works

The RAP&GO software, now available as a smartphone app, provides relevant patient information in a format that is useful to both the hospitalist and the emergency physician.  If the patient meets the agreed-upon criteria for admission, the emergency physician creates a gap order, and the patient can be sent straight to the inpatient unit. This reduces the time that the patient spends boarding in the ED and decreases the likelihood of a bottleneck.

The system uses telephonic technology to page, text or call each person in the chain of events and delivers an automated message about actions needed (i.e., call the ED, assign a bed, move the patient to the inpatient floor). If someone in that chain fails to respond in the predetermined time, the software will escalate the activity by contacting the next person in the chain of command. Everyone in the communication loop is held accountable to respond quickly and move the patient to the inpatient floor.

Yes, healthcare is inefficient. Yes, there are pieces of the process that are broken. But as physicians and as leaders, we’ve got to keep exploring ways to fix these problems in ways that are easily adaptable and pro-patient. There’s always a better way.

Nathan Goldfein

Nathan Goldfein, M.D., is Vice President of Operations with EmCare Hospital Medicine and the director of the Hospital Medicine program at Gerald Champion Regional Medical Center in Alamogordo, N.M. Dr. Goldfein graduated from the University of Arizona College of Medicine and finished his residency in internal / hospital medicine at the University of New Mexico in 2008. His undergraduate degree is in mechanical engineering and manufacturing. Prior to pursuing medical school, Dr. Goldfein worked in manufacturing. He holds more than eight patents and is the inventor of more than 100 additional products and programs.



Posted on Wed, Feb 11, 2015

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on Each month, one of Studer Group's insightful articles will be made available to blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit 

By: Dave Brown     Posted: November 03, 2014

High quality healthcare delivery depends on great access to care and information. We know that promoting access into our care and services is requisite to both attaining and retaining patients in a practice.  Consumers want to know that they can get care when and where they need it.

Spurred by increased demand resulting from healthcare reform measures, looming workforce shortages, and concerns about access and barriers to care, many leaders are focused on transforming the delivery of healthcare.

New measures evaluating patient access are included in the Clinician and Groups Consumer Assessment of Health Providers and Systems (CG CAHPS) and Patient Centered Medical Home certification process (shown in Table 1) and continue to push for improved access to care, often focusing efforts on same day or timely access.

Element A: Patient-Centered Appointment Access (MUST-PASS)

The practice has a written process and defined standards for providing access to appointments, and regularly assesses its performance on:

   1. Providing same-day appointments for routine and urgent care. (CRITICAL FACTOR)
   2. Providing routine and urgent-care appointments outside regular business hours.
   3. Providing alternative types of clinical encounters.
   4. Availability of appointments.
   5. Monitoring no-show rates.
   6. Acting on identified opportunities to improve access.

Table 1. NCQA Patient Centered Medical Home Access during office hour’s requirements 

Questions from the CG CAHPS survey relating to access include:

“When you phoned this provider's office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed”
“When you made an appointment for a check-up or routine care with this provider, how often did you get an appointment as soon as you needed?”

To meet the challenges of patient access while maintaining high quality, patient-centered care, here are a few tips that can make a big impact:

Set objective and targeted goals that measure your strategy of success

Many healthcare organizations have learned an important lesson from other service industries and are re-adopting the premise that access and service must be designed from the customer’s perspective. For example, an emerging definition of excellent access is: “The ability of a patient to seek and receive care with the provider of choice at the time the patient chooses.” Coupled with this definition must be metrics that measure and monitor ongoing progress related to patient access. Determine which measures will be used followed by setting targets.

Communicate the strategy of access to providers and staff

Access-related strategies are not likely to be successful if they are not effectively communicated to those who must implement them: the providers and staff. To accomplish this goal, many venues are available to you to ensure the message is heard loud and clear. Utilize employee forums, Leader Development Institutes (LDIs), monthly supervisory meetings, individual rounding on providers and employees, staff meetings, daily huddles, and communication boards to name a few.

When communicating the strategy of access, start with the why. Simon Sinek, author of the book “Start with the Why,” comments that “People don't buy what you do; they buy why you do it. And what you do simply proves what you believe”. When communicating the why supporting your strategy for improved access, clearly articulate that easier access leads to better outcomes.

Train staff to communicate your strategy of access to patients

Begin offering every appointment on the day a patient calls, regardless of the reason for the visit. Consistent with the concept of doing today’s work today, a posture that seeks to provide same day access to patients is not only perceived positively, but it has been found to improve the efficiency of the office. Remember also, if patients do not want to be seen on the day they call, schedule an appointment of their choosing.

Develop Key Words for schedulers to further probe the symptoms and potential urgency of patient complaints. Simply asking the patient if they “would like to be seen today” positions scheduling as a patient centered process and one of great satisfaction to patients.

Subsequent to developing Key Words, maximize validation techniques including real time coaching to support, recognize and continuously improve the skill and competence of scheduling team members. Utilize the framework of AIDET® with specific key words or phrases that comprise the full scheduling script, including the statement, “would you like to be seen today?” When validating, listen to and observe scheduling team members using these key words and capture notes on a standardized validation form allowing for skill assessment and feedback.

The significance of this challenge and more importantly, the impact on quality of care cannot be overstated. Just this week as I was working with a healthcare organization, we learned from a patient the difficulties he is having accessing care. Having recently moved back to his home town, he called to schedule an appointment with a primary care provider and was told it would be several months before he could be seen. Within the same week, he made 2 visits to the local Emergency Department with the second visit resulting in his admission for antibiotics to treat an infection.

While healthcare organizations focus on improving access to care, creating a strategy with inclusion of goals, communication of the why supporting the strategy and communicating to patients the attitude we’ve adopted, “would you like to be seen today?” will lead to better access and health for those we serve.


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