The Signal-to-Noise Ratio when Communicating to Administration

As with many of these columns, this month’s edition is inspired by a recent experience. I hope that by reading and thinking about this story of a “teaser” subscription, you’ll learn some of the same lessons I’ve learned, but less painfully.

Administrators at Maimonides Medical Center commonly forward me copies of advertisements, newsletters and anything that mentions emergency medicine, “ED” or “ER”. Yes, I see solicitations for contract staffing groups that want to staff our ED, but that’s not what I want to talk about today. I want to tell you about what your hospital administration is reading, because it sure scared me to learn that my administrative colleagues were reading this junk.

I recently received a sample newsletter forwarded by the VP for Regulatory and Professional Affairs. The newsletter, produced by a subsidiary of a large, renowned medical newsletter publisher (that also operated a famed consulting organization subsidiary) was apparently one of a series devoted to credentialing standards for physicians in different specialties. This subsidiary of the publishing company publishes a monthly newsletter devoted to credentialing information for hospitals. Each “professionally produced” 16 page newsletter gives the appearance of rigor and credibility. The back list was impressive covering every specialty I’ve ever heard mentioned. Of course, the one in my hand was devoted to emergency medicine.

Discussion of the regulatory basis for credentialing and privileging generally were followed by detailed descriptions of two emergency medicine professional societies’ policy statements on credentialing of emergency physicians. The professional societies themselves were first briefly described. A one page boxed summary of recommended credentialing guidelines ended the document. At first glance, it seemed pretty well done. Then I examined it in detail; I was appalled. Did you know that you can be credentialed as an emergency physician if you see as few as 100 patients/year? When I wrote the publisher, seeking a source for the recommendation, I was told:

“In regard to the recommendation that an emergency medicine practitioner must be able to demonstrate that he or she has provided emergency medicine services to at least 100 patients in the past 12 months, we tried to come up with a number that hospitals could work with but which was not unduly restrictive for practitioners. As we talked to people in the emergency medicine field, it was considered that an average of two patients per week was not unreasonable. The number is not etched in stone, and hospitals can establish their own criteria according to their needs.”

In other words, let the hospital staff with anyone who is available so long as they have seen two patients weekly. Forget training, board certification, full-time practice in our field; your hospital administration is being told that 100 patients/year is sufficient for credentialing as an emergency physician.

As a clinician seeking to stay abreast of current clinical practice in emergency medicine, we’ve all selected a means of accomplishing that goal. We read journals, participate in CME programs on the web, attend conferences locally or with travel; but we’re familiar with the authorities in our field and we have the knowledge and the contacts to help us make an informed selection. Yet, we’re constantly receiving solicitations for all manner of publications beyond those we’ve already selected. It’s the American way of marketing and because we’re exposed to new publications, the “old ones” have to maintain a standard or we’ll switch.

The same thing pertains in hospital administration and your hospital’s administrators are equally inundated with publications. “Sample Issues” are a particularly potent form of marketing. Combine that marketing approach with the “quality” content I’ve described above and you could find yourself on the wrong side of an issue with your administration.

How might you avoid the problem or respond effectively in the event your administration raises an issue brought up in one of these sample newsletters from publishers or consultants?

Begin by reading the document yourself. Don’t attack the source. Express your reservations, “I’m not sure I consider this material authoritative. I’d like to have a day or two to find some other material that might be more on point.”

Then, go to our professional societies’ web-sites and search for material on the topic and read it. Do not anticipate that this content will solve your problem. Your administration is looking at the issue from the point of view of the hospital while you and the professional society are looking at it from the point of view of the physician. To you, your administration’s sample newsletter has lots of noise and very little signal; to administration, your professional society’s policy position also has more noise then signal.

After you feel informed on the topic, go to sources your hospital administration will value. Look at your regional or state hospital website—if your regional or state hospital website doesn’t have much content, look to other states or regions. Both California and New York have extensive web-sites as does the Greater New York Hospital Association. Obviously if you’re working at a small semi-rural hospital, there won’t be much on point at GNYHA, but then you can look to other more rural states’ hospital associations.

Another authoritative source used by more than 50% of the hospitals in the country is the Healthcare Advisory Board. If you’re on the medical staff of a hospital that’s a member, you can have access for free; the hospital has already paid for it. Look to authoritative sources beyond these free sources. It may cost you some money, but Joint Commission Resources, is widely viewed as an authoritative source. I’ve included the web-site URLs for all of these organizations below.

Disagreeing on an issue with your administration is a regular occurrence for emergency physician leaders. Establish your credibility and authority by referencing sources your administration considers credible. They are more likely to tune in and hear your message through the noise.
Greater New York Hospital Association
Hospital Association of New York
California Healthcare Association
California Healthcare Foundation
American Hospital Association
Joint Commission Resources
Healthcare Advisory Board

British hospitals’ cellphone ban really manages behavior

So the British are banning cellphones. Hospital cellphone ban under the stethoscope – Engadget – www.engadget.com. At Maimonides we just went the other way and removed the prohibition.

The data on close reading has become increasingly persuasive that we were merely managing behavior with the ban, not a true technical problem. A thoughtful nursing leader commented to me,

“Another myth that drove policy? I believe our challenge is one of enforcing civility; the myth that it may interfere with the patient’s electromechanical well-being was easier to convey than a request for good judgement and respect for a manageable environment. My nephew is a pilot and the manager of a private airport in DC, I asked him about the airline requirement; interesting response and he admits, it is more about managing the environment than the threat of real electromechanical interference! I guess the only good news for nursing is one less rule to enforce, as for the workplace, another example of who is really in charge.”

Since the radio frequency (RF) environment in hospitals is increasingly a challenge and will only become more so, you might want to review the current data and opinion before you act. For the primary sources view the FDA’s site which though it hasn’t been updated since October 2002 is still the place to start. The recent publication of the Mobile Healthcare Alliance updates the older information and helped us decide to allow cellphones throughout the hospital.