Excerpted from an article by Cheryl Clark, for Health Leaders Media, December 27, 2011
This year’s crop of healthcare buzzwords and catchphrases includes a handful of terms that are really oxymorons. An oxymoron is when one of the words or phrases in the expression contradicts the rest. However, lingo must adapt to where we are today. Here are eight of the most popular.
1. Palliative intensive care. Palliative care is generally perceived as comfort care with morphine or other diligent pain relief regimens to ease the dying process, along with more counseling for loved ones to understand what’s happening and accept it. But intensive or critical care means pulling out all the stops, doing everything possible, to keep patients alive. Now, providers are combining the two. It is said that 30% of all hospital in-patient deaths occur in the intensive care unit, so why not introduce palliative care systems much earlier? The idea increasingly being implemented within hospitals is to bring the patient and family together with palliative care professionals, when the patient’s condition is appropriate, in a much more concerted and structured way than has been the ICU routine.
2. Cultural DNA. Again the contradiction. DNA is something we’re born with, it can’t be changed with a shift in culture. But changing an organization’s cultural DNA is an expression that increasingly resonates among quality leaders. With this phrase, they’re trying to convey the idea that if leaders of a healthcare organization walk the walk and talk the talk, their behavior will gradually work its way into everyday practice.
3. Change fatigue. People get tired mainly when routines stay the same, day in and day out, right? Not necessarily. We’ve been hearing healthcare providers talk about a new kind of fatigue, one brought on by too much change too fast. There’s change in leadership, areas of responsibility, accelerated workload and expectations, and requirements for new skills and training in people who may not be prepared for it or want it. Now managers are trying to find productive ways to make transitions so there is enough stability and constancy mixed in to prevent change fatigue.
4. Positive deviance or disruptive innovation. In healthcare settings, these two phrases, which have different origins and meanings, can be used to express the same idea. They implies a strategy in which providers look at peers—be they controversial individuals or entire institutions—that function differently, but still achieve excellent results. One example of positive deviance comes from Michael Edmond, MD, chairman of infectious diseases at Virginia Commonwealth University, who eschews conventional wisdom that hospitals should perform active surveillance with testing to prevent hospital-acquired MRSA infections. Instead, he bucked that trend in favor of hand-washing and other universal precautions such as catheter insertion bundles. He got his infection rates down without using expensive testing and without having to put colonized patients into isolation. Disruptive innovation is a similar idea. A concept originally proffered by Harvard professor Clayton Christensen, disruptive innovation can mean advancing healthcare quality through a wide range of new ideas: the use of payment incentives, transparency, retail clinics, comparative effectiveness research, and the use of social networks.
5. Getting to genba (or gemba). Okay, not exactly a new phrase but we predict much more frequent use of this Lean-derived expression in virtually all aspects of healthcare. Genba is a Japanese word meaning the place where crucial work takes place. It may mean that a nurse will go to a patient’s home to see how preventive care is provided there. The idea is that by going to where the work (where the patient is) actually happens, patient care might very well improve.
6. Gamification. This is one possible way to ensure patient compliance and improve health literacy. ‘Gamification’ (a word to describe health-related web sites that have game-like interfaces and qualities) is a way to get people to learn about their health and use their healthcare data to improve it. Think of an iPhone app that lets one notify, or even compete with, friends on Twitter or Facebook how far and fast everyone ran today on the treadmill. There might be games in glucose checks for diabetics. Calorie counters may not just log in the day’s tally, but also show with a pinball machine interface whether those meals hit all the food groups. Game on!
7. Engagement. In essence, engagement means getting everyone on the team to understand the reasons for a policy or practice and incorporate those goals into everyday procedures. For patients, being engaged means that providers have tried to cultivate their trust, making sure on repeated occasions that they understand their diagnosis and the importance of adhering to the prescribed care regimen, and of course, doing adequate follow-up.
8. Getting to zero. Look for increased controversy in the use of this phrase to describe the goal to reduce adverse events, surgical errors, hospital-acquired infections, ventilator-associated pneumonia, and anything else bad that happens to patients in healthcare settings. There’s a sense among providers that the use of this phrase only provokes frustration, because realistically, zero can never be fully achieved forever. And some events are just not preventable. Simple as that. Another take in this controversy is that if an organization does achieve the elusive zero one day, it may provoke a subtle complacency.