Students Of Success

Healthcare managers are discovering that a “best practice” imported from another organization is not a panacea. First, one size never fits all. Second, managers charged with process improvement often think of the search for a best practice as a one-time effort. In truth, performance improvement is always ongoing. That’s why smart organizations are intensifying the search for best practices with “knowledge communities” – groups of people who share a common interest and are committed to exchange information and solve common problems together on a continuing basis. Here’s how knowledge communities can make a difference in patient care and the organization’s bottom line.

Why the Search for “Best Practices” Fails

There are five approaches to best practice “search and implement” missions that strangle management. They all begin with a vague project to find a best practice without any certainty on search parameters or desired outcome. What usually happens is one of the following:

Scenario 1:

The manager cannot find a better performer that is similar to his or her own organization in terms of size, scope, structure, environment, trauma level, profitability, etc. Therefore, there is no one from whom to learn.

Scenario 2:

Hospitals that are insufficiently diverse swap best practices, which then become inbred rigidities or sacred cows. No innovation occurs because there is no diversity in the learning pool.

Scenario 3:

The manager searches and searches for the “holy grail” or elusive best practice. The search continues with no end in sight, and nothing is accomplished. Or, the best practice is found, but never implemented. Searching doesn’t bring results. Doing does.

Scenario 4:

The manager at Hospital A succeeds in finding a best practice. Hospital B has standardized on a single vendor for artificial knee implants. The manager copies the practice by standardizing on a single vendor from Hospital A. The result? The physicians revolt because no one was consulted! Or, by signing a two-year exclusive agreement to get a lower price, Hospital B misses out on new advances in orthopedic implants and the high-volume, well-respected surgeon defects. The moral? Best practices are not commodities. Mindlessly mimicking a best practice is a recipe for disaster. Adapt, evolve, customize!

Scenario 5:

The manager finds that the best practice in pharmacies is computerized order entry, which is extremely costly and challenging to implement. He or she is overwhelmed by the grand plan, freezes and does nothing, instead of taking incremental steps to arrive at the goal. Best practice should be about motivation, not intimidation.

So, what’s a manager to do?: Join a Knowledge Community

No two organizations have the same clientele, physicians or environment. It follows that knowledge management processes must be as different as the organizations that practice them. The process has to meet the specific needs of the organization and provide managers with experience and knowledge they can use for improvement.

Knowledge communities offer a concrete starting point – a first place for managers to turn when they want to customize a successful practice to the organization and make it an ongoing part of their management style. In discussions with other members of the community, they gather ideas, test hypotheses, solve common problems, compare implementation strategies, and build courage to change and leverage shared knowledge. Available anywhere, anytime through the Web and technology such as teleconferencing, knowledge communities are the 21st century version of the professional society networking experience.

As part of a knowledge community, Baystate Medical Center in Springfield, Massachusetts participates in telephone conferences with eight to ten similar hospitals across the country. Sally Kaufmann, Manager of Rehabilitation Services, explains, “The members of our knowledge community share information on clinical topics that are of interest to us as rehabilitation managers in an acute care setting. As a benchmarking group, we compare data on the types and volume of services we provide and the cost of providing care. And, when clinical questions arise, any member of the community can generate a question and email it to the knowledge community facilitator, who then generates a survey that helps compare information on the topic. For example, we just completed a series of discussions on using whirlpools in the treatment of wounds. The therapy has become somewhat controversial recently, which raised some uncertainty about our current whirlpool practice. Hospitals participating in the discussion completed a pre-conference call survey to compare our programs, followed by a live discussion of specific issues. I then arranged a follow-up call with a member of the network who turned out to be particularly expert in this area. She gave me some solid advice, which helped me create a packet of information for physicians who are referring patients to our whirlpool service. It alerts them to alternatives and recommends a new referral process that may or may not include whirlpool.”

Utah Valley Regional Medical Center in Provo, Utah, a division of Intermountain Healthcare, has been a member of a knowledge community for several years. Ron Liston, Director of Rehabilitation Services, reports, “Periodically, the knowledge community administrator runs a comparison of our hospital with some of our IHC sister hospitals, as well as hospitals throughout the U.S. For example, our inpatient rehabilitation program has been compared against similar units in terms of productivity, cost per unit per discharge and cost per patient day. If you’re the most expensive in the group, you can call the other hospitals and learn what they are doing to keep costs down. The procedure is simple. The knowledge community administrator schedules a time for a conference; you call in with a password, and you’re on the phone with ten of your peers all discussing your issue.”

Liston has participated in focused phone conferences concerning staffing mix and productivity. “Providing excellent outcomes while increasing staff productivity is always a challenge,” he says, “but when you share knowledge with ten other hospitals, someone always has a creative idea.” He in turn has shared IHC’s seven-on-seven-off staffing model which works well in a hospital that provides physical therapy seven days a week. IHC’s policy and procedure were posted on the knowledge community’s Web site, available for other members to learn from.

Small Steps to Big Goals

Incremental steps are the best way to improve, manage change and make a difference. Knowledge communities simplify the process of adapting and evolving a practice to fit the organization because managers can learn the incremental steps others took to arrive at the goal. Rather than searching for an elusive best practice or finding one too overwhelming to implement, managers can obtain practical information in digestible bite-size pieces. In Scenario 5, for example, a member of a knowledge community might learn that Pharmacy Manager X at Hospital A began by giving the physicians preprinted drug prescription forms. This approach worked well and eventually evolved into computerized order entry.

The healthcare industry has traditionally shied away from obtaining and utilizing external information from other healthcare systems and other industries. A knowledge community makes the process easy and comfortable because the member organizations are not competitors, but span the country. More importantly, a knowledge community expands the collective knowledge of the group and raises the bar for everyone.

“I highly recommend joining a knowledge community,” says Kaufmann. “Busy managers who do not have the time to research topics on the Internet or in the medical library can network with hospitals in different parts of the country. We learn what financial or clinical issues our peers are struggling with or have solved in creative ways. For newcomers, a knowledge community can seem a bit daunting, but once you get in the habit of sharing information, you realize that it’s a very valuable educational resource. It’s the perfect way to connect with peers on specific business and clinical issues. The time spent is well worth it in the long run.”

“Any organization that is small or lacks a solid peer group needs to belong to a formal or informal group to bounce ideas off each other, ask questions and get answers,” says Liston. “Sometimes we need to go beyond our own organization to learn how others are wrestling with problems that are similar across the industry. I can’t imagine being in a single hospital, or even a small group of hospitals, and not having instant access to peers to help deal with questions and concerns of daily operations. It’s not just for the benefit of hospital leadership. Department managers or senior physical therapists who are struggling with certain issues can get help from their counterparts in other organizations,” he added.

Solutions for Better Care

Knowledge communities are most successful when the sharing of information and experiences is accessible to the people (often department managers) who can effectively create change. Providing these people with readily accessible peer groups empowers them to learn from others to create solutions for themselves. This in turn expands the organization’s ability to change and improve. Everyone in the organization, not just a few executives, are now thinking about the kind of process improvement that will not only better the organization, but enhance the patients’ experience, which is what healthcare is all about.

Sidebar:

How to Advance or Doom Knowledge Management

Advance:

·Put knowledge where the action is, the front lines of the organization.

·Leverage internal and external peer-to-peer interactions to grow the collective knowledge of the group.

·Make historical knowledge available – easy to access, readily retrieved.

·Encourage a flexible, risk-taking culture to encourage positive change and growth.

·Maintain organizational curiosity for new ideas to germinate.

Doom:

·Focus on IT as the answer. IT may provide a shell to contain knowledge, but human intervention is necessary to actively manage knowledge exchange.

·Rely on written documents to transfer knowledge. Interactive sharing is to effective knowledge exchange.

·Breed a culture that inhibits action.

·Restrict or convolute access to knowledge.

·Decline to resource knowledge. Knowledge distribution, archival, use, interactions and access will not be valuable unless they are thoughtfully managed and facilitated with appropriate manpower.

·Refuse to participate. Asking for information from others without sharing ideas and information in return creates an unsatisfactory relationship.

Shelley Burns is Director of Knowledge Management and Michelle Gray-Bernhardt is a Healthcare Knowledge Consultant with The Healthcare Management Council, Inc., located in Needham, Massachusetts. HMC is a dynamic benchmarking, knowledge management and consulting company that helps its healthcare clients create goals and execute plans for ongoing performance improvement. For further information, call (781) 449-5287 or visit the company Web site at http://www.HMC-benchmarks.com

Naomi Jo Rush new book of poetry, I Kissed a Frog and My
Prince Forgave Me, is a well-crafted poetic journey through
infidelity.

Naomi reveals the most vulnerable time in her married life.
Her poetry teaches us that married couples tend to forget
about each other’s needs and become absorbed in habitual
day-to-day behavior. While she strained for the attention that
her husband would not or could not provide Naomi put on a
performance of a happily content wife, when she was really
screaming with frustration inside.

Her confusion ripens with the prospect of temptation. The
thrill of spontaneity coupled with feeling of being desired
draws Naomi to her lover like a drowning person would
desperately clutch at a lifeline.

Craving for her husband to notice the change and
discovering she never wanted the marriage to end prompts
Naomi to confess her wrong doings. When it is all revealed,
Naomi endures the torturous guilt while watching her
husband writhe in the pain she inflicted upon him.

In the end, I think Naomi provides hope for us all in showing
us the reasons and effects of infidelity by walking us through
the steps of recovering a marriage. I felt encouraged that
marriages have a chance of thwarting this common mistake
if we show one another love and open the channels of
communication .We can thrive in a world of strife and
temptation.

~ Book Reviewer: Lillian Brummet - Co-author of the book
Trash Talk, a guide for anyone concerned about his or her
impact on the environment – Author of Towards
Understanding, a collection of poetry.
(http://www.sunshinecable.com/~drumit)

What technology tools do successful websites use? Remember that
a website is a store front; it’s your customer service rep and
your marketing department rolled up into one.

“We are open” People don’t enter stores that have a closed sign
at the door. (Well some do, but… you know, we talking about
the law abiding kind here.) Nothing says ‘Closed” louder on a
website than old content: old date references and postings. So
one of the best things you can do is to get a script that keeps
the current date front and center for your visitors. You don’t
have to update it everyday - it does it all by itself.

Now that people think you are home, and open for business, they
may inquire about your product. You must have a customer service
desk. This can take the form of a form where they fill out their
name and email. It can be to simply subscribe to your newsletter
or they may have a specific question. If you want to have a
’stress-free’ site, try post an FAQ section - Frequently Asked
Questions. Then one of the important things you will want to
have is an autoresponder.

An autoresponder will keep your site in the mind space of your
potential clients who have signed up for your newsletter or
requested more information. It will send out preformatted emails
at defined intervals automatically. Did you know that after 5
emails, the likelihood of making a sale increases steadily? It
may seem like you are being intrusive, but they will be able to
unsubscribe if they wish.

Urgency Sells: When you offer limited time offers, you cause
people to make decisions. You need a script that keeps a
deadline up to date on your website. It would generate a line
that looks like this: This offer expires on XX/XX/XX, so act
quick!

The Popup Generator - Pop up windows that appear on your web
site when a visitor enters or leaves your web site have been
shown to dynamically boost subscriber rates and sales. Even if
you don’t have any programming knowledge, you’ll be able to add
a popup to your site with a single click

Tell A Friend Generator - No matter what promotional tools you
use on your site, no tool is a match for the power of viral
marketing. Use this generator to create a quick, one-step button
that you can add to your web site that will let your visitors
tell their friends about your site with just one click! Add this
to your site and watch a whole new flood of targeted traffic
come in!

All these types of scripts are available for free or for a small
fee online. I suggest that in addition to these sites, that you
visit lots of sites you would like to emulate and see what they
do well, what strategies are particularly effective and find
ways to incorporate them. I know even just the little bit above
seems overwhelming. Well perhaps a mentor, someone who has done
all the above and more would be of interest to you.

Implants:

the reason that I choose to start talking about implants is very simple, in my point of view they are the beginners in EBM, or using a better choice of words, they are the least invasive of the 3 base techniques.
I found so many types of implants and all of them are very interesting, So I decided to write about:

Eye ball jewellery

Magnetic Implants

3d implants

Eye ball jewellery is probably one of the newest techniques of the all EBM. It was developed by ophthalmologic experts, it is an ocular Surgery that adds a decorative platinum implant inserted under a thin membrane in the eye, which holds the implant in place. Since the membrane is clear, the implant can be seen clearly against the white of the eye. There are not many shapes of ornaments offered yet, and it is a very new procedure that for now can only be done officially in Holland, the cost is around U$ 1200.So far the doctors could not find a side effect to it, what does not mean that there aren’t any. In the U.S. some States committees already approved a bill to ban it; the procedure goes more or less like the following:

• The eye is anesthetized with routine eye-drop anaesthesia medication.

• The eye is decontaminated and draped with routine techniques used in ocular surgery.

• An intra conjunctival bleb is created by injection of BSS in the most superficial conjunctive layer. The bleb may be positioned adjacent to the temporal limbus.

• With conjunctive scissors, the bleb is opened and a superficial intra conjunctival tunnel is made.

• The tunnel is checked to determine if it is wide enough to accommodate the implant.

• The device is inserted into the tunnel up to the desired final position of the implant.

• With a sponge, all excess BSS is removed from the implantation area.

• At the end of the procedure, antibiotic drops are applied onto the eye.

• Postoperative management includes antibiotic eye drops for 1-2 week(s).

• The procedure takes about 15 minutes.

So far Doctors could not find any side effect or complications caused by the implant, and hopefully they won’t find any. So keep in mind, there are very few people authorized to do this procedure, and so far it can only be realised in Holland, and even so only 2 clinics are fully authorized to do so.

Magnetic Implants:

What are they? They are small magnet implanted under your skin with the purpose to enhance your senses as if it was the acquisition of the so famous sixth sense, how it happens, by moving in response to an electromagnetic field and transferring this as sensation to the surrounding nerves.

We can divide the magnetic implants into 4 types:

Sensory: The one that supposed to give you the sixth sense

Sexual: Where the magnets are placed inside the most sensitive area or the genitalia of a couple, male and female have to get the implant, it supposed to enhance the feeling of the body parts while in movement against each other, they can also be placed in the lips.

Symbolic: is implanted but a couple to create a magnetic bond as the two people hold hands, as there are not real proves that a couple can really exchange energy thru this technique, we can take it as more discrete kind of wedding rings.

Functional: Probably not a very comfortable matter, but if you get larger magnets you would be able to pick up things such as screws and some other items, with the magnets commonly used you can’t pick up more than a paper clips, the up side of having such small magnets is that they wont affect your credit cards, hard drives, monitors, and so on.

To get the implant is also quite simple:

Small incision in the tip of the finger and opening a pocket

Create a tinny pocket to add the magnetic pellet (the magnets are about a third the size of a grain of rice)

Do the suture and bandage the finger tips (the procedure takes about half an hour to do 5 fingers)

The first few days the sensation is not very pleasant but after a week and the stitches taken off the pain goes away and in the period between 1 to 4 weeks you can start to enjoy the magnetic field moving feeling, and the benefit of this EBM is that the scars are almost invisible and if what I read is true, the feeling is quite interesting.

Because this procedure is bran new the side effects are not known yet, but the biocompatibility of neodymium, but it is considered a generally toxic irritant and moderately poisonous with documented adverse effects. In order to keep the magnet from coming in contact with the skin, it has to be coated with a sheath of biocompatible silicone, there is always the risk of “peeled” the silicone off of the magnet, if it happens the compromised magnet should be replaced by removed and replaced by a new one.

This procedure is so very new that not even all the BM specialists are doing it; some are waiting for it to get a bit safer and better developed. Because so far risks are unknown, but once that the coating of the magnet problem is solved it will probably turn into a huge trend among people. But if you are one of those that want to get all of it first, please wait until it is proved safe.

3d implants: It is the act of placing an object under the skin to create a design on the skin’s surface, it is actually a very simple technique, an incision is made, and the implant that can be made out of many materials (titanium, soft or solid silicon, Teflon and steel, the steel variety sometimes can cause an infection, there is also the option of natural bone tissue) is inserted, you are stitched up and ready to go. Simple….the after care apparently is simpler than the after care of a piercing. To get a 3D implant you can choose many areas of the body, forehead (the intern horns, third eye and the external horns), you can place spikes on your head, beads on your arms, legs, chest and many but many more, if you are a guy you can get your penis beaded (pearling), in many different ways.

Some of the risks of the implants are:

-Tissue Resorption: erosion of the tissue by rubbing or pressure applied against the body. Implant can bury itself into the muscles wearing down the body’s natural defences; this risk can happen especially with hard materials such as Teflon and stain less steel so if you want to get it done try to use softer materials such as silicone and choose safer places to add the implants.

-Implant Rejection: Is when the implants put enough pressure on the skin above them, that it actually manage to do enough damage to surrounding tissue that the skin above the implant dies and the implant becomes exposed ,once this process begins there’s not lot that can be done about it other than removing the implant.

-Pressure on Nerve and Muscle: When an implant is placed on top of muscle, nerves, or blood vessels, it has the potential to interfere with their functioning. To minimize the risk you have to be sure to tell the 3D artist if you are experiencing anything that can be related to it, this way the artist can change the positioning or the placement of the implant without harm you, in some cases the procedure has to be postponed or aborted. You should also strongly consider research about the kind of implant that you will get and the location of it so you can do it safely.
There are also many other possible risks that can be associated with implants such as:

Keloids, Implant surface contamination, Implant Biocompatibility, Implant Finishing, Lidocaine Toxicity, Anaesthetic allergy, Sub dermal Shifting, Mod before Client, Needle allergy, Adrenalin Excitement, Impact damage, Hypertrophy scarring, Abscess, Boils, Cancer, Blood loss, Shock, Bloodborne Pathogens

Ok that is all for now guys, next week I will be writing about Surgical modification……And I can promise to you all that it will be a very, but a very interesting article….Until them, go have fun and enjoy life…
Yes, I’m really trying to fix my karma thing……we never know what can happen tomorrow…..

My name is Adriana and I’m the creator and developer of Wirlyhome label.
I’m jewellery and clothing designer, I’ve been working in the fashion industry for the last 9 years of my life, I went to fashion school in Canada, where I lived for 10 years, and 8 of those long years I worked as a fashion designer, illustrator and forecaster.
I came back to Brazil last year to open my label Wirlyhome, and now after almost 1 year of hard work the label is finally picking up and we are getting some recognition.

if you want to know more go to
http://www.wirlyhome.com/

Credit card is a type of debt instrument where a card is being issued to the person who applies for it. When a card holder uses a credit card, he is borrowing from the credit company to whom he is obliged to repay the loan amount at a specific point of time. Usually, a high rate of interest is charged on credit card balances. So it affects your financial life when you carry too many credit cards.

You can easily reduce your credit card debt to a great extent if you follow these steps:

1. You should not borrow from your credit cards from tomorrow what you want to have today. This means if you are already buried into too many debts, you should stop spending more through your credit cards as this will make your situation worse.

2. Once you are accessing credit cards and spending lavishly it might be not easy for you to set up a budget but it would be much fruitful if you do so. Therefore, you will come to know how much money is being properly utilized and what part is actually wasted while you make credit purchases.

3. When possible, use cash instead of credit card for making purchases. This is because people usually don’t give the same importance to non cash substitutes as compared to cash and spend more freely.

4. Thus, you can apply your new found cash flow to your retiring debt. If you live within your debt, make a cash budget, making purchases with cash rather than credit card will help you save thousands which you can apply later to consolidate your credit card debt.

5. One of the most effective ways to eliminate credit card debt is going for a credit card debt consolidation where you can merge all the high interest credit debts into a single credit card debt with lesser interest rates. It would really be worth and improve your credit rating too.

For further information visit our recommended website credit-card-debt-consolidation-guide.info

Olivia Andrews, writer of credit-card-debt-consolidation-guide.info is a freelance journalist and has written many reviews on subjects such as finance, education, health, entertainment, music, apparels and mobile phones.

Choosing a baby shower theme is an important part of the baby shower planning process. A theme will tie the entire shower together and make it more organized.

When you have chosen a theme, you can easily think about what decoration you are going to use for your desired theme. Without a theme, you are likely to pick several items that you feel will look good, combine these, and get an unorganized look.

Selecting and preparing a baby shower theme is not a difficult task. Here are some suggestions to give you an idea on how to create a theme for your baby shower.

Teddy Bears

Since the teddy bear is one of the first toys the child will own, it is nice to have a teddy bear theme. You can use medium-sized teddy bears to design the baby shower party area. It is not necessary to buy the teddy bears; you can borrow these from friends and family members. Also, you can purchase small teddy bears as party favors to give to your guests.

Stars

Stars symbolize dreams. “A star is born,” they say. You can decorate the place with stars hanging from thin strings. You can also design the walls and the ceiling with stars and heavenly bodies. The program may also include wishes for the baby on how he or she will be a bright star.

Diapers

This is the basic need of the newborn baby. The baby shower organizer can decorate the area with diapers, especially those with cute colors and designs. You can even prepare a diaper cake by neatly stacking the diapers together.

The organizer can also ask the guests to bring diapers as gifts. A better idea would be to have a raffle for a special prize in which the raffle entry will be a diaper. This will help the guests since they wouldn’t have to think on what gift to buy. It also helps the parents a lot, since they will have a supply of diapers for several months.

Books

Baby and kid books are good gifts for the baby. With a collection of baby books, the parents can have a small library for the baby.

The decorations can be anything related to books. You can place books on the table, or design the walls with books. You can even have a book-shaped cake and cookies.

Noah’s Ark

This is a good idea if the parents are expecting twins. The guests will be requested to bring a pair of gifts for the babies. Pairs of stuffed animals may be used to decorate the place.

Prince/Princess

Everyone wants the new baby to feel like a prince or a princess. You can adorn the place with fairy tale concepts pertaining to royalty. You can create miniature towers and castles, a garden and shining stuff fit for a royalty.

Fairy

This is a good option if you will be having the baby shower in the garden. You can enhance the garden surroundings to make it look like the home of fairies. You can include vines, arches, bees and butterflies, as well as small fairy-like decorations to create a fairy garden.

Characters

You can choose a storybook or cartoon character as a theme. How about a superhero? There are lots of options, and once you have selected one, you can think about what items the character is associated with that you can use for the party.

With these simple ideas, you can conceptualize a special baby shower theme that will be remembered by the parents and the guests.

Visit www.babyshowerguidebook.com/ today and download your free report on baby shower games and other fun baby shower ideas.