Revisiting Teams

HSA 6385--Health Care Quality Management

I have had many wonderful experiences in Health Care Quality Management during the summer semester of 2012. To start, I have enjoyed participating in the classroom discussions relating to the different aspects of healthcare quality management.  Viewing the Power Point presentations and actively discussing the topics of the week allowed me to obtain a wide range of perspectives from my classmates, as well as the professor. One of the most relatable topics was the Case Study in Team Building and Interdisciplinary Collaboration by Bernard J. Horak, Joyce Pauig, Ben Keidan and Jennifer Kerns. Discussing the challenges of the dynamics of a team allowed me to reflect on some of the triumphs I have experienced in a few athletic and professional aspects my life.

As a first-year student at Rutgers University, I became a part of a team of very talented sprinters, middle distance runners, hurdlers, long jumpers and high jumpers. It was very intimidating to be the outsider of an elite team which had been together for many years. I was quickly selected to run the third leg of the mile relay. The third runner’s main purpose was to place the baton into the hands of the fourth runner; the anchor leg. There was a lot of pressure on the third leg in that they had to position the anchor in the best possible way to win the race. I felt neither worthy nor capable of living up to the standards of the anchor, a senior sprinter who was the team favorite. She ran her race with the greatest of ease and made it clear she would expect no less from her teammates; especially me. As a new runner with very little knowledge of track and field on a collegiate level, I studied her intensely. It was my goal to never let her down. I mirrored her techniques in practice and prepared for the meets the way she did, by walking around the track and visualizing the race prior to running it.  

During that year, I learned the dynamics of teamwork from the perspectives of seasoned athletes. They had proven themselves to be valuable members of a cohesive team. I understood that becoming a member of that team required individual preparedness and commitment to excellence. I also discovered that hard work, dedication and excellent coaching would allow me to rise to the expectations I had set for myself. During a very intense track meet at Boston University, I was made to run the Distance Medley Relay. The DMR, as we fondly referred to it, was a grueling indoor race consisting of 1200 meter, 400 meter, 1600 meter and 800 meter legs. I was the only first-year runner on a team of senior runners. Prior to the race, they made it very clear to me that I was expected to run the best 800 meter race of my life.  Needless to say, I did. We were able to secure a school record in the DMR that year. The record stood for almost twelve years until it was broken several years ago. My position as a reliable member of the team was solidified that day; there was a clear understanding of my level of commitment to the team’s success.

On a professional level, my desire to remain a part of a successful team allowed me to grow as a claims examiner for many years. My team consisted of very powerful players: a business-savvy supervisor, a senior level adjuster with extensive litigation experience, an efficient clerical assistant, a knowledgeable nurse case manager and myself; a new adjuster. Thanks in part to my team; I was promoted to a senior level adjuster within three years. As mentioned previously, being a contributing member of a successful team motivates me to success. I look forward to using the knowledge gained through reading and discussions regarding teams in Health Care Quality Management, along with my athletic and professional experiences, to guide me into becoming a successful health care manager.

Adverse Effects and The Patient's Perspective

When adverse effects, particulary those associated with medical errors, are reported to the public, shock and disbelief echo throughout the nation through media outlets. Despite the explanation for the perceived adverse effect, public outcry drives the outcome of the fate of those involved. When things go awry, public pressure is on to  find the responsible party, assign the appropriate blame, reprimand the individuals and take great measures to ensure the situation never happens again. The precursor to this could have merely been the patient's believe that an adverse effect has happened without one actually having occurred. This type of media attention based on the patient's perspective may prove to be detrimental to the reputation of all parties involved.

In the case of clinical trials of phamaceuticals, one of the main objectives is to perform a series of tests to determine the efficacy of the drug in comparison to a variety of possible side effects. Participants are asked to take the medications under certain conditions and their responses are documented and presented to the public using satistical data. In this controlled environment the patient's perspective as to whether an adverse event has occurred is most important to the ultimate outcome of the testing.
The fact that a drug has a mild adverse effect may not necessarily cause the drug to be rejected, there are some acceptable side effects that, when documented, allows the user to understand the risk associated with its consumption. There is no drug advertised on television devoid of mild adverse effects. Individuals understand the risks and make their determination for use based on the perpectives of clinical trial participants.

Sometimes the perspective of the patient that an adverse effect has happened can bring about changes in medications which are currently in widespread use. The firestorm surrounding the outcry proves the patient's perspective to be the most important determinant in creating a need for adjustments to keep consumer confidence intact. In the case of the Measles, Mumps and Rubella inoculations, mothers were adamant that there was a correlation between this vaccination and the increase in autism. Despite clinical tests showing otherwise, the mercury that was used in the shots were removed in an attempt to ensure that inoculations were received at the appropriate times thereby decreasing the possibility of an outbreak of these diseases. Pressure was applied on the drug companies based on a perception that an adverse event had happened.

In conclusion, a patient's perspective as to whether an adverse event has happened can be welcomed in controlled environments but cause mayhem when it takes on a life of its own. In these scenarios, the patient's perspective as to whether an adverse effect had occurred was the most important factor in the way careers were handled, drugs were marketed and perceived harmful ingredients were removed from a required inoculations. The patient's perception was the most important driving force behind the subsequent actions causing harm or perceived good in various situations.

Nicole Thomas-Tate

"Use of this medication may cause drowsiness, headaches, foot drop, hallucinations and temporary blindness lasting 1-4 years--"see" your doctor if symptoms persist."

I suffer from seasonal allergies. Every year around December, those pesky oak trees decide to do their thing and aggravate my allergies. My discomfort lasts until February (sometimes March or April if  we receive little rain) of the following year. So, essentially, my Christmas is not very merry, my New Year is not so happy and I am not feeling the love on Valentine's Day. I am not one to go to the doctor unless I am unable to relieve my symptoms with home remedies (facial steaming, nettie pot, or good old fashioned Vicks).

As I progress in years and have adopted a busier lifestyle, the home remedies are less effective and I have less patience waiting for them to "kick in".  This leads me to my current complaint. Now that I am visiting my health care provider with more frequency, I am realizing several things: 1) I have seen an actual physician 2 times in the 10 years I have been going to the doctor and everytime I go, 2) I am given a myriad of prescription, samples of medicine and told to "try this and see how it works" then told to come back in 1 week and 3) given antibiotics?

My issue? Why do I feel like a lab rat? Why am I given different medications that have contraindications? Why do you want me to "try" a medicine and then come back?
I love my Physician Assistant, we have become friends. She "gets" me as the person I am who just wants to have these meds in case the weekend gets rough or worse-I can't breathe. She knows, for the most part I won't fill the prescription and I won't use the free samples unless I have no other choice.  I feel the quality of medicines is questionable. I don't feel the medicines work and If I am suffering so badly that I throw caution to the wind and take them--I feel worse! Then it starts a vicious cycle of additional symptoms and complaints.

It has been said that "perception is reality". My perception is that the quality of healthcare as it relates to the testing of prescription medications, the push to get them approved and the relative freedom with how they are dispensed is poorly handled. So, unless and until things change drastically in this arena, I will be coughing my way through opening my Christmas presents, sneezing to the tune of Auld Lang Syne and rubbing my itchy eyes while Cupid tries to shoot me with his arrow.

What does quality mean to you?

Prior to my acceptance in the MS-HSA program, I had the privilege of interning at a highly-regarded hospital in Central Florida well-known for its dedication to providing high quality healthcare to its patrons. This hospital prides itself on well- trained physicians, a top-notch nursing staff and a reputation for professionalism. My role as an intern included a myriad of duties including fielding phone calls, maintaining supplies, preparing required forms (Do Not Resuscitate, Advanced Directives, Health Insurance Portability and Accountability Act release) and directing the foot traffic in Labor and Delivery. With guidance from my preceptor, I was also responsible for scheduling important lab work to assist physicians in mapping out their initial plan of care. This position; albeit an entry level one, came with huge responsibilities which could adversely affect the quality of healthcare being delivered.

On the second day of my internship, my preceptor was unable to work and, due to limited staffing, I was thrust into an environment I was not fully qualified to handle. Baffled that a facility that prides itself on having an excellent reputation in healthcare quality would allow an intern to assume such a crucial role in such a short period of time, I had to make some critical decisions. At that time, I asked myself the very question posed by Dr. Oetjen for this blog assignment: “What does quality mean to you (me)?” Although just an intern on a temporary unpaid assignment, I realized that the position I held on that particular day came with huge responsibilities, I asked myself more specifically:  “What can I do to maintain the high quality of care that each individual has come to expect?”

In response to these questions, I set out to handle every situation to the very best of my abilities and to seek out knowledgeable staff when posed with challenges. On this particular day providing quality healthcare meant: answering phone calls by the second ring, maintaining open communication with family members in the waiting room, contacting physicians immediately when requests were made, returning phone calls within minutes of receipt, quickly responding to call lights and fostering open communications with nurses to keep them fully informed of situations which may have arisen in their absence. At the end of the day, I realized that providing quality healthcare meant taking an active role in the delivery process and owning every detail inherent to it (as it relates to my position) while attempting to add value to the hospital’s reputation; or at the very least, not diminish it.

Although no longer an intern, I have used my experiences that day to guide me in making quality decisions for customers in my current position. I realize that quality means taking personal ownership and accepting that no matter how small the task (and regardless if compensated), one should apply integrity, professionalism and a full working knowledge of the bigger picture to guide their decision in providing a better outcome.