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Reducing Power Distance and Increasing Collaboration Can Reduce Errors and Improve Patient Care

Posted on Mon, Mar 13, 2017
Reducing Power Distance and Increasing Collaboration Can Reduce Errors and Improve Patient Care

By Adam Corley, MD, FACEP, FAAEM

Error reduction, quality improvement, patient safety and staff satisfaction are all impacted by a little-discussed concept known as power distance.

Traditionally in medicine, physicians were thought of as the “captains of the ship,” whose wisdom was unquestioned and whose instructions were to simply be followed. Doctors gave orders to nurses, allied health professionals and patients. Most members of the healthcare team went by their first names, but doctors still required a formal title.

This traditional hierarchy can be called a high power distance environment. Power distance is a term coined by Geert Hofstede, a Dutch social psychologist. In such systems, power relationships are autocratic, paternalistic and draconian. There is little premium put on collaboration, and subordinates are expected accept their lower positions. Authority and authorities (doctors, in this example) are rarely questioned, and their instructions are regarded as certain and inflexible.

In low power distance cultures, power is more evenly distributed, and there is a relatively small emotional distance between those in charge and others. Leaders and their teams are less concerned with status or title and more concerned with collaboration, communication, partnership and teamwork.

Luckily, medicine has begun transitioning from a high to low power distance environment, but we still have a long way to go. We have begun to shed titles between co-workers. We are encouraging all members of the healthcare team to share ideas and strategies with their colleagues. Nurses and allied healthcare workers are encouraged and empowered to challenge physicians if they notice errors or have concerns about the prescribed treatment plan. Physicians have begun to not only accept but to appreciate suggestions from their co-workers.

Medical specialists in fields like emergency medicine, anesthesia and surgery are developing team-based approaches to medicine. While the doctor is most often still at the helm, these highly functional team of RNs, advanced practice providers and other clinicians work collaboratively to deliver care. In most cases, these teams function in a very low power distance environment.

There still are elements of higher power distance that make sense in medicine and should remain. For example, emergent surgeries, CPR, code blue situations and trauma resuscitations still require a more rigid element of hierarchy, given the shortened timeframe for success and critical nature of the work.

Although it makes sense in medicine, a low power distance culture is not right for every field. The military is a classic example of an environment that works well with high power distance relationships. The features of a low power distance culture that make that hierarchy favorable in fields like medicine and aviation would not necessarily work well when fighting a war or keeping the peace.

A 2013 study published in the Journal of Patient Safety estimated that approximately 400,000 people die from preventable harm in medicine each year. We must continue to flatten our medical hierarchies, reduce our power distance and empower and encourage all members of the healthcare team to identify and report errors. Not only do patient’s benefit from the collaborative environment allowed for in a low power distance culture, but doctors and their nursing and allied health colleagues will be much happier practicing medicine this way.

Adam Corley, MD, FACEP, FAAEM, is an emergency physician with more than 10 years of clinical and leadership experience. Dr. Corley serves as Executive Vice President for EmCare’s West Division. He also serves as the medical director for several EMS services and the Anderson County Texas Sheriff’s Department. Dr. Corley lectures and writes on a variety of topics, including decision science and behavioral economics, management of disruptive behavior in healthcare, conflict resolution and healthcare leadership.

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Get to Know our January Clinician of the Month: Dr. Pawan Dhawan!

Posted on Thu, Jan 29, 2015
Get to Know our January Clinician of the Month: Dr. Pawan Dhawan!

EmCare has more than 10,000 clinicians serving communities across the country and we want to share their stories with you. Get to know these hard-working, difference-makers right here with our monthly “Clinician of the Month” blog post. Do you know a clinician who should be featured? Email socialmedia@emcare.com!

Dr. Dhawan is the medical director for the hospitalist program at Trident and Summerville Medical Centers in Summerville, S.C.

He attended medical school at JJM Medical College, Davangere, Karnatka, India. At his hospital, he is vice chair of the department of medicine and serves on the clinical excellence committee, medical executive committee, critical care committee, utilization management committee, clinical review committee and PDoc Review Committee. He is referred to as a “scheduling savant” by his EmCare colleagues.

FEATURED JOB: Hospitalist in Myrtle Beach, S.C.

Dr. Phawan was recently honored at EmCare South Division’s 2014 Hospital Medicine  Site Medical Director of the Year.

His leadership of the Summerville Medical Center program has caused it to evolve from an inpatient program that just manages the care of those patients assigned to its service, to a program that focuses on team development, clinical initiatives, and collaboration with the medical staff to meet the needs and ongoing challenges of patient care within the facility.

FEATURED JOB: Nurse Practitioner/Physician Assistant in Summerville, S.C.

His innovative approach has transformed Summerville Medical Center into a model for the South Division.
 

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Watch highlights from the Inaugural Emergency Medicine Quality Summit and Register for the 2015 Event!

Posted on Thu, Jan 22, 2015
Watch highlights from the Inaugural Emergency Medicine Quality Summit and Register for the 2015 Event!

Have you registered for the 2nd Annual Quality Summit?

The 2nd Annual Quality Summit for Emergency Medicine is presented by the Baylor, JPS, & Parkland Division of EmCare. In 2014, its inaugural year, the Quality Summit was an exclusive event for EmCare-affiliated clinicians; however, after much success, the division decided to make the event annual and extend an invitation for non-affiliated clinicians to take advantage of the CME credits, networking and fun the event offers.

“It started with a little journal club at local restaurants and went into more of a clinical integration forum, which went on for about a year and a half, and now this is a summit that we felt would allow us to showcase all of the quality improvement and examples of integrated leadership in the [Dallas/Fort Worth] metroplex,” said Dr. Nick Zenarosa, EmCare’s system medical director for the Baylor/JPS division.

Last year, the summit’s topics included: “Treatment of Headache and Chronic Pain,” “Lactate in Sepsis,” “Low-Risk Chest Pain” and “End Tidal CO2 Patterns and Usage.”

War time trauma, population health and HIV screening in the ED are a few of the topics that will be covered at this year’s event that’s expected to draw more than 300 emergency medicine clinicians to the day-long event at the Omni Hotel in downtown Dallas on January 30, 2015.

“We had between 150 and 200 people attend,” said Crystal Stanley, project manager for EmCare’s Baylor/JPS Division. “The summit is something the Baylor Quality Committee put together for the division for continued education, to bring everybody in the division together, to get some CME credit, get some vendors here so everyone can learn about some new products and technologies. It’s been a really great success!”

To learn more and register for the 2nd Annual Quality Summit, visit the event website.

And, watch the video below to see highlights from last year’s Quality Summit.


To see who else is attending and ask questions about the event, visit the event’s Facebook page here.

Not an EmCare-affiliated clinician? Search nationwide jobs now!

 

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AMA Reports on How Docs Use Their Free Time

Posted on Sun, Jan 18, 2015
AMA Reports on How Docs Use Their Free Time

Doctors of all ages report being physically active, with many running or jogging, walking for health

FRIDAY, Jan. 9, 2015 (HealthDay News) -- The American Medical Association recently surveyed physicians to find what activities they pursue when not in the exam room.

According to the results of the survey, physicians of all ages report being physically active, with the most-enjoyed activity for physicians under age 40 being running or jogging (about one-half of physicians of this age run or jog). Physicians aged 40 to 59 report that they most enjoy running or jogging (36 percent), bicycling (35 percent), and camping or hiking (24 percent). About 50 percent of physicians older than 60 reported walking to stay healthy. Other interests include golf, aerobics and cardio, skiing, tennis, and fishing.

Other leisure activities reported include reading, with many physicians describing themselves as avid readers; regular reading was reported by more than half of physicians under 40, 58 percent of those aged 40 to 59, and more than 64 percent of those aged 60 and older. Gardening, do-it-yourself home improvement and decorating, and playing musical instruments were also reported as top hobbies, while nearly half of all physicians are interested in gourmet cooking. More than one-quarter of physicians are interested in new technology, and a similar percentage own a Kindle e-book reader.

"Free time isn't something most doctors have in abundance," according to the report. "But when they're not working, physicians of all ages engage in a variety of extracurricular activities."

More Information

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DIY Healthcare System: What is Population Health, Anyway?

Posted on Wed, Dec 17, 2014
DIY Healthcare System: What is Population Health, Anyway?

BY: TOM PECK

“You all are in the cat bird’s seat. Because you are in the hospital most of the time and in the ED particularly, the common pathway for entry into the hospital, you know what’s going on better than anyone else. You are in the best position to implement change. You are in the right spot at the right time. Our country needs your help.” With those words, David Nash, MD, MBA, dean of the Jefferson School of Population Health at Thomas Jefferson University in Philadelphia, opened EmCare’s 2014 annual conference with his presentation entitled, “Population Health & Quality in the New World of Health Reform.”

Dr. Nash, an accomplished educator and author, was instrumental in founding the country’s first school of population health. A board certified internist, Dr. Nash is passionate about the need to reform America’s healthcare system.

He divided his presentation into five parts:

  • How did we get into this jam?
  • What is quality in healthcare?
  • What’s population health, anyway?
  • What is health reform and what’s its special connection to quality, safety and accountability?
  • What’s in the future?

Over the next few weeks, we’ll post key takeaways from Dr. Nash’s presentation.

What is Population Health, Anyway?

In an effort to address the challenges outlined in the IOM report, one approach has emerged as promising – population health management. What is population health and is it the answer? Dr. Nash said the concept is attributed to David Kindig, who espoused it 35 years ago. The concept looks at health outcomes (morbidity, mortality and quality of life) and their distribution within a population, health determinants (medical care, socioeconomic status, genetics) that influence the distribution and policies and intervention (social, environmental and individual) that impact these determinants.

"The take home message," said Dr. Nash, "is that medical care is 15 percent of the story the other 85 percent are the messy social determinants of health. Four determinants– smoking, unhealthy diet, physical inactivity and alcohol use -- account for 40 percent of all deaths in the US."

A study by the Bipartisan Policy Center examined what makes us healthy. The results showed that individual behaviors such as diet, exercise and education determine 50 percent of an individual’s overall health status while genetics comprise 20 percent and access to care makes up the remaining 10 percent. The ironic fact is that as a country, the US spends 88 percent on medical services, eight percent on other activities and only four percent on healthy behaviors.

While population health seems to be the magic pill to cure the healthcare system of its ills the facts are that most healthcare organizations don’t have the resources or scope to build a comprehensive population health management program. Doing more of what we are already doing won’t address the many factors that affect the health of a population that extend beyond the realm of traditional medicine. Successful population health management initiatives will cover between 250,000 and 500,000 lives so healthcare organizations will be required to add new components to their care delivery infrastructure, recruit new talent and develop a culture of innovation.

Dr. Nash’s organization, Thomas Jefferson School of Population Health, published the first textbook on the subject, Population Health, Creating A Culture of Wellness. The school also publishes a population health management journal. Dr. Nash also cited the Trust for America’s Health Report, A Healthier America 2013: Strategies to Move from Sick Car to Health Care in the Next Four Years, as an important addition to the library of knowledge on the subject.

Consider this fact: the US spends under two percent of its health dollars on population health and there is no dedicated federal funding stream to address chronic diseases that comprise 80 percent of the total disease burden in America. It’s sad but true that only three percent of the US population exercises for at least 20 minutes three times a week, doesn’t smoke, eats fruit and vegetables regularly, wears seat belts regularly and is at its appropriate body mass index.

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