Sunday, February 28, 2010

Enhancing the Patient Experience of Care - The Difference Between Good and Great

What makes a really great physician? Is it their vast medical knowledge, technical skill, reputation or years of experience? Is it the medical school or residency program, the number of certifications received or the number of patients cared for?

Although these tangible things are important and help patients define basic standards for choosing a physician, they are only partial ingredients in determining what makes a physician great.

Both the beauty and the challenge for physicians in perfecting the art of medicine lies in learning how to combine our tangible medical assets and accomplishments with the intangible. That intangible part of care revolves around creating a relationship and environment where a patient feels a true sense of being cared for.

It is clear why this intangible component is so important. A patient’s recovery depends on both the medical skill of the physician-led medical team, as well as the role the patient plays in recovery. If patients are not compliant and motivated to be on the same team as caregivers, the outcome of care will certainly be suboptimal. What motivates patients to be a compliant part of their care team depends heavily on how well they relate to their physician, and how well their physician communicates an understandable game plan.

Certain factors are essential for establishing the kind of critical collaboration key to ensuring a patient feels well cared for. Physicians must make the time to stop, to listen and to hear their patients’ concerns. Studies and surveys show that physicians are most effective when they sit down at the bedside to answer questions, express their own concerns for the best outcome and convey how they will facilitate a clear coordinated plan. These simple actions will greatly enhance patient compliance and magnify, 6the physician’s healing power. In addition, these actions derail any adversarial tendencies and lead to a decrease in litigation, instead, increasing patient satisfaction, retention and referrals.

Many times patients convey a sense of relief and gratitude to their physician that promotes a healing environment more satisfying for all, including the physician. Physicians who foster these types of relationships with their patients report feeling a heightened sense of connection, recognition and purpose, which helps soften the harsh realities of healthcare today.

One of a medical staff leaderships' goals is often to improve patient satisfaction with physicians during the hospital stay. This is measured through the HCAPS (Health Care Consumer Assessment of Providers and System) survey reported to CMS that asks patients to rate their relationship with doctors in the following four areas:
Communication with doctors
•Doctors treat with courtesy and respect
•Doctors listen carefully to you
•Doctors explain in a way you understand
The desired answer is a positive answer of “Always” to all questions.

These questions may seem simple but getting an "Always" answer when multiple physicians are involved can be difficult. Regardless of this, when we truly treat patients from our hearts and remember that we went into medicine to have a genuine impact on our patient's health and well being we will get much closer to our ultimate success. Regards, Barb Loeb

Monday, December 21, 2009


We all have a corner of the world that we can transform. Every day, as physicians, we have the opportunity to have a significant impact on the lives of our patients. This has been my focus for the last 26 years in medical practice. Four years ago when I told my husband that I wanted to run for Medical Staff President he asked me, “Why?” I told him beyond my usual work, I wanted to have the opportunity to do something new and creative that would inspire me. I wanted to serve in a role that could help make the hospital a better place for our physicians and their patients. I realized that this also included creating great relationships with nurses, staff and administration, where we all would be a collaborative team. With the partnership of our medical staff, nursing staff and proactive administration we have been able to do exactly that. Advocate Good Samaritan Hospital has not only won numerous awards but it has become an increasingly
physician-centric environment. This is my final letter for the Physician Forum and I will miss the opportunity to write about health care and the world today. What I leave you with is a celebration of all the wonderful things we do every day here at Good Samaritan Hospital. I encourage every member of the Medical Staff to step forward and get more involved with the hospital and your departments. Attend meetings and educational events. Volunteer for committees and projects. Run for office to give your valuable input into areas that improve the quality of our work environment and care we give to our patients. It is an opportunity to grow as a physician and leader. I have benefited and grown in numerous ways by participating.
In your clinical practices, concentrate on being present and attentive to your patients. You will find that whatever you do in life, it is more rewarding and inspiring when you are fully immersed in it.It has been a true honor and pleasure to serve you. The people I owe thanks to are too numerous to list but my gratitude to all of you is infinite. As I transition into the role of past president, I will continue to support our excellent journey.

I would like to take the liberty of sharing a quote that
Dave Fox shared with me from Jim Collins’ book,
“Good to Great:”
“When all these pieces come together, not only does your work move towards greatness, but so does your life. For, in the end, it is impossible to have a great life unless it is a meaningful one. And it is very difficult to have a meaningful life without meaningful work. Perhaps, then, you might gain that rare tranquility
that comes from knowing that you’ve had a hand in creating something of intrinsic excellence that makes a contribution. Indeed, you might even gain that deepest
of all satisfactions: knowing that your short time here on this earth has been well spent, and that it mattered.”
In Gratitude,
Barbara Loeb, M.D.

Wednesday, November 11, 2009

Safety does not improve by chance

It was 2 am on a fall morning. My husband, Dan, and I were traveling in our new car on the newly repaved Wisconsin Highway 42 toward our trailer in Egg Harbor, Door County. Dan was at the wheel. We were both concentrating to keep each other alert for the last leg of the trip. Sarah, my 15-year-old daughter, was sleeping in the back seat. Out of nowhere, a pair of bright headlights appeared speeding rapidly toward us in our lane.

Out of the corner of my eye I saw Dan calmly make a quarter turn of the steering wheel directing the car smoothly into the shoulder as the car—“swish”—passed by, barely missing us. Then he turned the wheel back and the car went right back into the proper lane just as smoothly. We continued on our way. My daughter woke up and asked what happened. “Dan just saved our lives.”

This was a true near miss that could have been a hit. Maybe it was a stroke of luck or divine providence but I believe there was more than that behind this narrow escape. A number of factors saved us. Skill, attentiveness, experience, judgment, good conditions and proper equipment all played major roles. We were both alert in spite of the late hour. Dan was a skilled operator, an experienced driver with excellent judgment. We had made a conscious decision to have him drive instead of me in this very late and tiring journey. Our new car was an excellent piece of equipment. (An older, less-reliable car may have failed to respond properly.) The road was newly repaved and well maintained. All these factors helped to ensure our ultimate safety.

In health care it is the same as it was for us in that early morning journey. It takes skill, education, training, judgment, optimal conditions and proper equipment to avoid safety events. It is no accident that some hospitals are safer than others. Organizations that pride themselves on being prepared for unexpected circumstances to avoid harm to patients do the best in creating the safest environment. In addition, they have systems in place to learn from the incidences where there was a break in the safety net.

We have worked hard at Advocate Good Samaritan Hospital to create a culture where safeguards are in place to prevent errors. Timeouts for procedures, reporting of safety events and near misses as well as cultivating improved communication between health care providers/workers are some of the ways we have done this. However, what will it take to continue to get better?

It will take continuously looking at what we can do every day to reinforce these systems. It will take us looking at the breakdowns as they occur and proactively reporting them so that they can be prevented in the future. Our goal is no less than to be the safest hospital in the country.
I want to remind you that if you see a breakdown in patient safety, whether it has caused a poor outcome or not, there is still value in capturing it to prevent future injuries. Please report near misses in you institution. Your feedback is essential to saving lives from lessons learned.

Kind Regards,
Barbara Loeb, MD

Monday, October 5, 2009

Internet impacts patient’s choices

On a recent visit to a hospital outside of Atlanta, I had the opportunity to round with a long time physician practicing there. One of his patients asked me if I wanted to know how he chose this internist to be his primary doctor. Curious, I answered yes.
“When I moved here, I knew I would need a doctor at this hospital,” he said. “I called the referral service and they gave me four names. I closed my eyes and prayed really hard. The Lord answered my prayers and told me to put the names in alphabetical order and choose the last name on the list. That was Dr. W.”
This is an uncommon way for patients to choose their physicians. Word of mouth is still the usual means patients use for finding a doctor, but today’s electronic age is beginning to change things. The internet provides technology which expands people’s ability to gather information. With BlackBerries in hand, the data is at their fingertips.
The extent to which this affects health care was discussed at a recent Health 2.0 Summit in San Francisco. It is believed that 80 percent of people surfing the web are looking for health information and somewhere between 60 - 80 percent begin their search with Google. Patients are not only searching for answers about their symptoms and diagnosis, they are researching physicians. Our past, present and potential future patients are investigating us. What they find has the power not only to influence their choice of physician, but may also affect the perception of the care given by their existing doctors. Sometimes it is for the better, sometimes not.
I did an experiment and entered “Barbara B. Loeb, MD” into the Google search box. In addition to some expected results, a dozen websites like and appeared. These are unsubstantiated consumer web sites where patients comment publicly on physicians. Although these sites have unique URLs, the information contained on them often seems to be metastatic with exactly the same information appearing on multiple sites. I suspect the information is sold from one to another. In this long list, I was hoping that the MD directory from the Advocate web site would be among the selections. Unfortunately it wasn’t.
What should be our reaction to this unsolicited publicity? First, it is important to realize it exists. Secondly, we must provide the best care we can to our patients which automatically promotes the best reviews. Some sites allow you to comment and correct inaccuracy. More important than this is to realize, like it or not, we all have an internet presence and we all can develop strategies to manage its content. One option is to create our own individual web sites or online profiles, which can work well to counteract these unwanted sites.
But as part of Advocate, we can work toward making the Advocate web site more robust with easily searchable information on all of the physicians. We can facilitate this by first providing current and accurate information to be posted. Secondly, we can work as a Medical Staff to urge Advocate to invest more resources to heighten the visibility of the MD component of Advocate Online. By promoting our high quality physicians, Advocate promotes the hospitals and the organization overall. Using the right technology in the right way will in the end benefit the patients by providing them with accurate information and giving them the sense that they are being cared for by the best clinical team.
Kind Regards,
Barbara Loeb, M.D.

Tuesday, August 18, 2009

What Holds Us Up ?

Daily, in our professional and personal lives, we are met with an array of both
positive and negative forces. Professionally we have the opportunity to see patients get better, procedures succeed and experience the gratitude of those we have helped. Personally we see our families grow, celebrate birthdays, weddings and graduations and travel to far off places. On the flip side, professionally we face the patients that can’t be healed, some that litigate rather than thank and the ever growing demands placed on physicians from limitless directions. Personally we experience the loss of friends and family, the troubled economy and our hopes of retirement ever fading. We are consistently met with new duties to fulfill and struggles to endure. The challenge for many physicians is finding ways to cope with thisconglomeration of influences rushing at us. What methods can we use to keep us from becoming unglued as we move forward?
What ultimately hold us up are our values and beliefs and the people that care about and support us. There are six things that I find keep us on track, focused and strong in spite of challengesand adversity:

Faith: we, regardless of our religious background or personal
beliefs, acknowledge a greater power exists that keeps life moving and all of us breathing. This is a well, from which we can draw strength particularly when we are exhausted and weary.

Gratitude and kindness: we all have the ability to give and
receive gratitude and kindness. As we express more of these acts, we receive more in return. These positive forces fill us up.

Commitment: we are dedicated to fulfilling our responsibilities,
not only to the medical profession but to our families and friends, as well as to our dreams and aspirations. We get satisfaction and energy through a job well done.

Belonging: we acknowledge that we are part of a community, profession, family and a universe. Connection creates a sense of belonging which will
always support us.

Loving our work: we must find joy in our work, as it will give us infinite power. We spend endless hours at work and if this time feels worthless, the days will seem pointless. As physicians we are fortunate to have a meaningful occupation. Our ability to make a difference in the lives of our patients is limitless. Realizing it, celebrating it and using it to make a difference makes
us stronger and happier.

Cherishing our loved ones: we should never
underestimate the importance of our “home team.” Our families and close friends fill our lives with love and caring, which we can share not only with them but with the rest of the world.

Remembering these things as you face your
day will reenergize you, and I hope, bring you
renewed happiness.

Sunday, May 24, 2009

Nurses Making a Difference

I felt totally helpless. My breathing was labored, my body jarred by shaking chills. I was afraid to close my eyes—maybe they wouldn’t open again. Any rational thinking was gone. Then my nurse, Karen, came in and sat by my side. Her words soothed me. She held my hand and somehow I knew everything would be alright. She made all the difference.

This was my experience in 1994 when I suffered a postpartum hemorrhage. My exceptional nurse, Karen, brought me through those frightening hours until my blood volume was restored. When a patient is as ill as I was, that patient completely loses their identity, power and control over their own destiny. They are no longer a doctor, a nurse or a teacher. As health care professionals we are no different from the patient in the next bed, totally reliant on the hospital system to care for us. The sicker we are the truer this becomes. We have to wait for the call light to be answered and for our pain medicine to be brought, just like everyone else. It was a very humbling experience for me to have to call someone to use the bathroom or to get a cup of water. What is amazing is that amid all of this helplessness, it is the nurse who has the ability to turn the entire experience around. She has the opportunity to make a patient feel safe and well cared for. Karen did this for me 15 years ago.

The nursing profession has a critical role to play in the hospital. Nurses are responsible for the hour-to-hour patient assessment, as well as assure the proper delivery of prescribed treatment while maintaining a nurturing environment. They must be the Florence Nightingales for each and every one of their patients.

Although I began to understand this in 1994, it has become increasingly clear to me as I continued practicing medicine during the last 26 years. Nurses are our patients’ keepers. They are the physicians’ eyes and ears. They must execute a physician’s instructions in an accurate and timely fashion while maintaining the atmosphere of genuine caring.

As I round at Advocate Good Samaritan Hospital, I make it a regular practice to introduce myself to new physicians. I always ask them how things are going and how they like the facility. Inevitably they say they like this hospital better than all the other hospitals. It’s not because of the vaulted ceilings, mahogany furniture or the VIP doctor’s lounge. We don’t have any of those things. The number one reason they like Good Samaritan Hospital is because of our nurses and the excellent job they do, keeping all the pieces of care together.
We celebrate Nurses Week in May, but beyond that, we want to thank our nurses and recognize them every week for the great work they do all year round. Physicians, please share your appreciation with our outstanding nursing staff.

Sunday, May 3, 2009

"We Love Our Nurses"

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