Contextual errors and errors in the individualization of patient care: a multicenter

Contextual errors and errors in the individualization of patient care: a multicenter Video Clips. Duration : 7.02 Mins.

Tags:

Abusive Relationship - Subtle Communication Patterns of Abusive Relationships

People ask me what kind of domestic abuse assessment screen helps someone who is abused to see the light. In providing assessments for thousands of people, I'm convinced that a tool which reveals the subtle communication patterns of abusive relationships helps someone being abused to awaken to their circumstances. Further, identifying these subtle-and often unconscious-interaction patterns helps the abused partner recognize what keeps the abuse dynamic going and, from here, what stops it.

Many people say they know they are in an abusive relationship, but don't understand what maintains it. If that has been your experience, look at the subtle communication patterns of abusive relationships and you will gain insight into the mechanism that sustains this dynamic. Seeing this will give you what you need to stop the cycle and will insure your not engaging in another abusive relationship.

A Closer Look at the Subtle

For example, look at the interaction pattern and internal dialogue surrounding the subtle communication pattern of "when 'no' means maybe." When you feel your answers, from the core of your being, to domestic abuse screening questions addressing this communication pattern, you see the subtleties of the abuse dynamic unfold.

It's both subtle and significant. If s/he hears my "no" as a maybe and as a challenge to convert into a "yes," we see a lack of honoring the preferences of the partner saying "no" and an obsessive compulsion to control the outcome of the exchange.

Further, if I'm aware that my "no" sounds like "maybe," then I am cognizant of my hesitation in not fulfilling his/her request. As I look closer at that, I feel the basis for this hesitation. I see and feel the internal dialogue that supports the domestic abuse dynamic.

Your Personal Inquiry

Now we could go on from here; however if you're thinking of taking such a test, it would be best for your discovery to come from within. That will be more meaningful and more likely to move you forward, as you will resonate with it from your own personal experience.

Without that inward inquiry, the description could sound like a lot of psycho-babble. Trust me, it's not. Domestic abuse is quite real and is easiest to acknowledge, and to abort, in its most subtle manifestations.

Management of Heart Health at Home Using Portable Heart Monitor Device

The current century is an era of technological innovation. The burgeoning growth of technology has an impact on all aspects of our lives. In the health care industry, technologies have always played a significant role in patient health care and professional relationships. Innovations in technologies have significantly changed the way interactions between physicians and patients are performed and have greatly improved health care providers' services.

Health e-consumers are a growing breed. They are health conscious individuals who utilize online media, wireless communications and e-health for wellness maintenance. The popularity of the Internet and the trend for all consumers to be more health conscious mean that health-e-consumers will play a dominant role in the future health care industry.

Medical devices like Portable ECG/EKG Machines,Blood Glucose monitoring device and other devices like digital weighing scales and temperature measuring monitors have revolutionized the health care industry like never before.

In the past these devices were restricted to major hospitals and health care providers,and also they were very expensive,not all could afford them.Today with the growth of consumer electronic industries,the cost of these devices like portable ECG/EKG has been dramatically reduced.Every consumer who is concerned about their health can afford to get one of these devices either for themselves or for their loved ones.

In the case of heart disease and stroke getting an early diagnosis is vital to dealing with the disease and will greatly increase the chances for you to experience a speedy recovery.

The first thing that you can do to ensure help secure an early diagnosis of heart disease is to make frequent visits to your healthcare professional. You know your body better than anyone else, and if something isn't right you need to be checked out.

The media is littered with stories of people who could have been saved if they only had went to the doctor when the symptoms started to appear. If you hear a loved one or your spouse complaining of similar symptoms please urge them to go to the doctor, as you could literally be saving their life.

The second thing that you must do in order to remain on top of your heart health is monitor your heart beat through an portable ECG/EKG machine.

These machines are normally extremely complex and expensive and oftentimes only available at large doctor's offices and hospitals, but they are an absolute necessity if you're serious about monitoring the health of your heart on a daily basis.

Today, heart health issues are becoming more and more widespread. The simpler forms of heart disease in people are fast growing into serious life threatening complications. More awareness of your heart's condition is needed if you really want to protect yourself.

The ECG machine can help you monitor your heart's health closely and accurately. Moreover, this medical tool can also diagnose cases of early onsets and prevent heart diseases altogether.

Taking care of your health is no longer a option today,it is a necessity,with the increasing health care costs it is vital to be healthy prior to onset of any disease.Investing in simple technologies like a portable monitoring device which gives you analysis of your heart condition can help you in maintaining your health in the long term.

Patient Care Technician Training

Image : http://www.flickr.com

Patient care technician training programs combine classroom course studies with practical skills mastered in the laboratory. Main duties of patient care technicians are to assist in nursing care and provide patient transportation, as from a hospital room to an x-ray unit. Candidates graduating from patient care technician schools may also be required to maintain rooms, stock supplies, and keep areas and rooms clean. Patient care technicians may work directly under the supervision of nursing staff.

Patient care technician training will include clinical skills, such as blood collection, performing EKGs, taking and recording vital signs, and other tasks relating to the care and comfort of patients and the smooth operation of a health care facility. Students will learn good communication skills, and will develop physical ability and strength, ability to follow instructions, and ability to perform basic technical skills and procedures are required of patient care technicians (PCTs).

A patient care technician may choose an advanced specialty, requiring advanced patient care technician studies. Specialized PCTs may find it necessary to continue their medical education throughout their career to keep abreast of new developments.

Those who have completed patient care technician training will find employment in hospitals, rehabilitation centers, nursing homes, and clinics. Prior to employment, examinations for certification in phlebotomy, administration of EKGs, CPR, First Aid, and Automatic Electronic Defibrillation (AED), and good patient care may be required.

Current trends in the medical field are to hire multi-skilled support staff with excellent Patient care technician education and other associated vocational courses, giving PCTs the opportunity to choose flexible job descriptions and flexible schedules, informal or professional environments, and to find situations that satisfy personal preferences.

You can find patient care technician training that suits you on our website.

DISCLAIMER: Above is a GENERAL OVERVIEW and may or may not reflect specific practices, courses and/or services associated with ANY ONE particular school(s) that is or is not advertised on SchoolsGalore.com.

Copyright 2007 - All rights reserved by Media Positive Communications, Inc.

Notice: Publishers are free to use this article on an ezine or website, provided the article is reprinted in its entirety, including copyright and disclaimer, and ALL links remain intact and active.

Medical Waiting Rooms Are No Joke

Emailing your doctor may not be as bad as you think. Which scenario causes a patient less stress? The awkwardness of the waiting room verses sending a question to your doctor over email, the latter choice may be much easier to your psyche. Take for example the joke below I've been getting in my email inbox for ages:

- - - - - - - - - -

An 86-year-old man walked into a crowded doctor's waiting room. As he approached the desk, the receptionist said, "Yes sir, what are you seeing the doctor for today?"

"There's something wrong with my dick," he replied. The receptionist became irritated and said, "You shouldn't come into a crowded doctor's waiting room and say things like that."

"Why not, you asked me what was wrong and I told you," he said.

The receptionist replied, "You've obviously caused some embarrassment in this room full of people. You should have said there is something wrong with your ear or something and then discussed the problem further with the doctor in private."

The man replied, "You shouldn't ask people things in a room full of others, if the answer could embarrass anyone." The man walked out, waited several minutes and then re-entered.

The receptionist smiled smugly and asked, "Yes?"

"There's something wrong with my ear," he stated.

The receptionist nodded approvingly and smiled, knowing he had taken her advice. "And what is wrong with your ear, Sir?"

"I can't piss out of it," the man replied. The waiting room erupted in laughter.



- - - - - - - - - -

Funny as this email joke about the elderly man's "ear-ache," may be, it mirrors the uncomfortable reality of most medical waiting rooms, pharmacies, and treatment clinics. Accessibility to one's healthcare provider online can be less stressful and a more practical means of contact for many patients. "People are often more comfortable talking to a computer than they are to a doctor," says Dr. Delbanco, a professor of medicine at the Harvard Medical School and the lead author of an article on doctors and e-mail in the current New England Journal of Medicine.(1) However, the convenience of emailing your doctor or clinic to ask your provider questions brings up a myriad of risks. As medicine and the internet have converged, concerns about protecting a patient's PHI (personal heath information) and EMRs (electronic medical records) have come to the fold.

HIPAA, the Health Insurance Portability & Accountability Act requires health care institutions to protect patient information. The Act outlines how this should happen, but does not make any firm recommendations about how to go about it. At the same time, strides are being made to make the electronic medical office a reality. "Office visits between patients and their doctors increasingly will take place not in person but over the Internet, through e-mail or even a video conference," Dr. Thomas Delbanco and Dr. Daniel Sands of Beth Israel Deaconess Medical Center stated in the April 2004 New England Journal of Medicine.(2) This means that seeking information online is now as common as dialing 411 a decade ago. From Drugstore.com to WebMD, the internet is where patients seek information on maladies to drug and herbal supplement information.

Patients aren't the only ones flocking to the net. Online use shows many within the medical field want to take accessing medical information a step further. Medical providers and patients alike wish to use the internet as a tool in their personal healthcare communications. According to Dr. Daniel Z. Sands, a primary care internist and Assistant Professor of Medicine at Harvard Medical School, "The internet will increasingly change patients' expectations of the clinicians, so that physicians will routinely need to offer services like e-messaging, instant messaging, video conferencing and other online services."(3)

Now is the opportune time for both patient and doctor to lay the ground work and find a balance in both patient's concerns over PHI and the immediacy of emailing their doctor. Looking towards the future of online healthcare means measures need to be put into place to protect a patient's privacy in order to securely implement the digital medical office.

- - - - - - - - - -

End Notes:

1.) Anahad O'Connor, "Take Two Aspirin, E-Mail Me Tomorrow," The New York Times, Section F; Column 5; Health & Fitness; LexisNexis 30 September 2005. 7.

2.) Liz Kowlaczyk, "Is Email The Future of Doctor-Patient Relations?," D2, The Boston Globe, LexisNexis, 27 April 2004.

3.) Dr. Daniel Z. Sands quoted in: Susannah Fox, Janna Quinney, Lee Rainie, "The Future of the Internet," Pew Internet and American Life Project, Published 4 January, 2005. 4.

Medical Technology Training

There are a lot of choices when it comes to health care education, and one of the most interesting would have to be medical technology training. The best medical technology schools across the US and Canada will be approved by national accrediting agencies. Only accredited schools are fully qualified to help you learn to be a certified medical technologist.

Medical technology schools can teach you all of the skills and professional methods used in the laboratory by professionals. You will gain much experience using modern laboratory equipment such as microscopes, cell counters and other lab equipment and learn to identify abnormal cells in tissue samples and blood specimens. You will learn to recognize cancerous cells and to relate your findings to pathologists or other medical professionals. Of course, there is much more to it, and you can request course curriculums from your choice of schools to see what is involved.

Training in medical technology is readily available in hospitals and medical schools, or you can earn an Associate degree (AS) at a community college, vocational or trade school. The AS degree will be the first step that will qualify you to enter a bachelor degree program (BS) to complete your training. To be employed as a medical technologist almost always requires a minimum of a bachelor degree with a major in medical technology or one of the life sciences, as well as certification from a nationally accredited agency, such as American Medical Technologists (AMT).

In short, a community college, hospital or trade school will be a great place to start your education and obtain your AS or even your BS degree in medical technology. You will find trade schools, vocational schools and even some online schools offering good undergraduate programs and excellent entry-level health care training.

If you would like to learn more about gaining an education in medical technology, select a few schools from our website today and request more information to help you decide.

DISCLAIMER: Above is a GENERAL OVERVIEW and may or may not reflect specific practices, courses and/or services associated with ANY ONE particular school(s) that is or is not advertised on SchoolsGalore.com.

Copyright 2007 - All rights reserved by Media Positive Communications, Inc.

Notice: Publishers are free to use this article on an ezine or website, provided the article is reprinted in its entirety, including copyright and disclaimer, and ALL links remain intact and active.

Implications of NIMS Integration Plan For Hospitals and Healthcare

The Homeland Security Act of 2002 provided the authority for the creation of the Department of Homeland Security (DHS). It also directed the Director of DHS to create a National Incident Management System (NIMS). Published in 2004, NIMS formed the framework for detection, mitigation, response and recovery from manmade and natural occurring disasters, events and incidents of national significance within the United States, its territories, protectorates and Indian Tribal nations. NIMS provided the framework for the creation of the National Response Plan (NRP), also published in 2004.

The National Response Plan is an all-hazards, all-agencies approach to the detection, mitigation, response and recovery from disasters, whether natural or manmade events and incidents of national significance. A little known provision of NIMS created a classification system for all disaster-related resources. This classification system, the National Resource Typing System (NRTS) provides a unified cross-agency, cross-jurisdictional means of classifying all resources that are or could be used in response to a NRP/NIMS event, whether these resources are equipment or personnel.

Responsibilities of a Signatory:

All federal agencies, all 50 states, all U.S. protectorates and territories and all Tribal Nations within the scope and authority of the federal government have now become signatories to NRP/NIMS. Among these signatories are the Health Resource and Services Administration (HRSA) and the Department of Health and Human Services (DHHS), the parent agency for Medicare, Medicaid and Veteran Healthcare funding. This signatory status places certain responsibilities upon these agencies and governments, as well as providing them certain rights and privileges. These rights and responsibilities are incumbent upon all agencies that derive their funding or authority from a signatory to NRP/NIMS.

In addition to an irrevocable agreement to participate fully in any disaster, whether manmade or natural, event or incident of national significance within the region of that signatory or the authority of that signatory's office, department or agency, all signatories to the NIMS/NRP have pre-agreed to all changes, classifications, modifications and regulations that may be promulgated by the director of DHS or the NIMS Integration Center or the NRP Implementation Center. Such changes, classifications, modifications and regulations must be implemented without modification.

NIMS Requirements Upon DHS of Significance:

Within NIMS, there are several clauses that are of significance to establishing a new industry in the area of Disaster Preparedness, Planning, Training and Evaluation within the United States. Recurrent through the document is the phrase "establish qualifications, credentials and certification for hospitals and healthcare facilities in cooperation with ... and national professional organizations". This phrase appears in every reference to hospitals and healthcare facilities in all levels of the response - administrative, financial, logistical and most notably operational. When hospitals are specifically noted, this phrase occurs with increased regularity. To date, there has been no classification, credentialing or certification system implemented by the DHS, NIMS, or NRP.

The NRTS provides no guidance, as of the writing of this report, for the qualification, certification, credentialing, or typing of medical providers and, more specifically, physicians. However, the NIMS Integration Center, on September 12, 2006, quietly published a Hospital and Healthcare Facility NIMS Implementation Plan.

NIMS Responsibility Upon DHHS of Significance:

In addition to an irrevocable agreement to participate fully in any disaster, whether manmade or natural, event or incident of national significance within the region of that signatory or the authority of that signatory's office, department or agency, all signatories to the NIMS/NRP have pre-agreed to all changes, classifications, modifications and regulations that may be promulgated by the director of DHS or the NIMS Integration Center or the NRP Implementation Center. Such changes, classifications, modifications and regulations must be implemented without modification.

The Center for Medical Services (CMS) is the DHHS agency specifically empowered and charged with the responsibility of overseeing all operations for Medicare, Medicaid and Tricare. These responsibilities include the certification of participating Hospitals and Healthcare facilities whether directly through a network of Regional Offices (RO's) and State Agencies (SA's) or through approved private organizations including the Joint Commission for Accreditation of Healthcare Organizations (JCAHO) and the Healthcare Facility Accreditation Program (HFAP) of the American Osteopathic Association (AOA). CMS draws its authority directly from the secretary of DHHS and is responsible for performing all the duties and responsibilities of the secretary of DHHS as applied to Medicare, Medicaid and Tricare, including but not limited to promulgating regulations and regulatory guidance towards this end.

NIMS Implementation Center Hospital and Healthcare Facility Plan:

The NIMS Implementation Center Hospital and Healthcare Facility Plan provides a new landscape for those providing Disaster Planning, Preparedness, Training and Evaluation services as well as for national organizations involved in the certification or accreditation of healthcare facilities, healthcare professionals, planning professionals and emergency management professionals.

JCAHO Accreditation Standards and Disaster Preparedness:

The Joint Commission for Accreditation of Healthcare Organizations (JCAHO) has become the de facto standard for hospital and healthcare facility accreditation. The American Osteopathic Association (AOA) has a parallel Healthcare Facility Accreditation Program (HFAP). For the purposes of this discussion, there is no practical difference in the standards set forth by JCAHO and AOA. As JCAHO is the more common accreditation, the discussion will center on the JCAHO standards.

Participating hospitals and healthcare facilities renounce "self-certification" in favor of external accreditation by JCAHO. The DHHS through CMS uses JCAHO accreditation in lieu of CMS certification for the purposes of CMS provider eligibility. Loss of JCAHO accreditation is synonymous with loss of CMS provider eligibility. JCAHO published a special compliance manual entitled Standing Together which outlines the JCAHO standards for disaster preparedness in the post-9/11 era and provides guidance on meeting these standards.

The JCAHO standards have specifically adopted the START/JumpSTART Disaster Triage System (aka Integrated Triage). JCAHO guidance also specifically addresses Disaster Preparedness and Training through Immersion Simulation Drills, referred to as "community wide" and "influx drills." The JCAHO guidance allows tabletop exercises, but this type of drill does not fulfill the need for influx drills. JCAHO specifies that an accredited hospital must conduct at least one community wide drill every year and at least two influx drills every two years.

Center for Medical Services (CMS):

The Department of Health and Human Services (DHHS), a signatory to NRP/NIMS is the supervisory agency for Medicare, Medicaid and Tricare (Veteran's Administration) funding through the Center for Medical Services (CMS). The regulatory agency provides certification for hospitals and other healthcare facilities either through JCAHO/HFAP or directly though its own system of state inspection offices/teams. CMS regulations carry the force of federal law under various aspects of the Social Security Act Title XVIII and XIV. The specific Federal Register sections applicable to this discussion include 42CFR482.1 and its applicable regulatory guidance. The CMS State Operations Manual provides the clearest guidance on the current interpretation of 42CFR482.1 and CMS regulations. CMS provides for both enforcement of these safety and preparedness regulations.

As an office of a NRP/NIMS signatory agency, it is incumbent on CMS to comply with the full implementation of NRP/NIMS. This compliance includes requiring NRP/NIMS compliance of all vendors (Hospitals and Healthcare Facilities) receiving funding through CMS. CMS regulations create a regulatory requirement for full NRP/NIMS compliance by all Medicare, Medicaid and Tricare certified Hospitals and Healthcare facilities. As an office of a NRP/NIMS signatory (DHHS) these requirements are no more than a restatement of NIMS and the NIMS Implementation Center Hospital and Healthcare Facility Plan. Further, CMS has elevated non-compliance with safety and preparedness to the level of an "immediate jeopardy" and thus immediate suspension of a hospital or healthcare facility's status as a CMS (Medicare, Medicaid & Tricare) participating provider.

Correlation of the NIMS-IC Plan, CMS Regulations & JCAHO Standards:

Correlation 1:

The NRP/NIMS signatory agreement signed by DHHS and thus incumbent upon CMS to implement combined with the applicable policies, regulations and accreditation requirements of CMS, HRSA and JCAHO create a mandate for full and unmodified compliance with NRP/NIMS/NRTS and the NIMS Implementation Center Hospital and Healthcare Facility Plan is incumbent upon all hospitals and healthcare facilities.

Correlation 2:

CMS regulations and JCAHO standards both call for the use of an Incident Command structure and attention to the four phases of disaster. This paraphrases the NIMS Implementation Center Hospital and Healthcare Facility Plan requirements for the use of the Incident Command System structure and ICS education.

Correlation 3:

CMS regulations and JCAHO standards require hospitals and healthcare facilities cooperate with community based multi-agency responses to disaster as well as participating in community wide multi-agency drills. This parallels the NIMS Implementation Center Hospital and Healthcare Facility Plan and effectively implements this portion of this plan.

Correlation 4:

The combination of the CMS use of JCAHO accreditation as CMS certification and the deferment of certification by hospitals to JCAHO makes JCAHO accreditation the de facto certification to fulfill the NIMS Implementation Center mandate for "self-certification." Thus JCAHO accreditation also has become the de facto certification of compliance with the NIMS Implementation Center Hospital and Healthcare Facility Plan for each individual Hospital or Healthcare Facility.

Correlation 5:

CMS regulations and JCAHO standards prescribe that an accredited hospital or healthcare facility must develop and publish for CMS/JCAHO review an operational budget including the provision of capital for all aspects of business operation. This echoes the NIMS Implementation Center Hospital and Healthcare Facility Plan provisions regarding Preparedness Funding.

Correlation 6:

CMS regulations and JCAHO standards require revision of existing plans as well as regular updating of plans in light of both pre-event Vulnerability Analysis and Post Event Review (After Action Review). These clauses validate the NRP/NIMS and NIMS Implementation Center Hospital and Healthcare Facility Plan requirements for plan revision and regular reevaluation.

Correlation 7:

CMS regulations and JCAHO standards detail requirements for both Community Wide and Surge (Influx) disaster drills. Further, both organizations discourage Tabletop Exercises in favor of Live Patient and Simulator Environment Drills. The detailed and recurrent reference to these drills emphasizes the weight and importance placed on this phase by these regulatory and accrediting agencies. This emphasis reflects the same importance given to disaster drills by NRP/NIMS and NIMS Implementation Center Hospital and Healthcare Facility Plan.

Correlation 8:

CMS regulations and JCAHO standards specify that hospitals and healthcare facilities must maintain sufficient supplies and resources including generators, potable water, medications and oxygen to ensure the safety of all staff, patients and residents. These requirements are included in multiple key sections of the regulations including Life Safety, Facility Operations, Patient Safety and Human Resources/Personnel. The JCAHO and CMS sections are actually more stringent and specific than the comparable NIMS Implementation Center Hospital and Healthcare Facility Plan portions.

Correlation 9:

CMS regulations and JCAHO standards specify the use of plain English and a common nomenclature in all communications without allowance for a different language or nomenclature in event of disaster. This common language requirement is far more stringently worded than the associated NIMS Implementation Center Hospital and Healthcare Facility Plan sections in large part owing to the high priority placed by both CMS and JCAHO on the 1999 To Err is Human report published by the Institute of Medicine.

Implication of the NIMS-IC Plan, CMS Regulations & JCAHO Standards:

Implication 1:

Whether by design or serendipity, recently published CMS regulatory changes and progressive refinement of JCAHO standards have resulted in accreditation criteria that now closely approximate those put forth in NRP/NIMS and the NIMS Implementation Center Hospital and Healthcare Facility Plan. This has the effect of creating a regulatory mandate for hospitals and healthcare facilities to fully implement NRP/NIMS and the NIMS Implementation Center Hospital and Healthcare Facility Plan. It is the position of High Alert that this creates a new market for Disaster Planning Services and Disaster Preparedness, Response & Recovery Education.

Implication 2:

Owing largely to the Nationals Patient Safety Program initiated by JCAHO and CMS in response to the Institutes of Medicine To Err is Human report, recently published CMS regulatory changes and progressive refinement of JCAHO standards have resulted in accreditation criteria for resource acquisition/inventory and common communication nomenclature that exceed those put forth in NRP/NIMS and the NIMS Implementation Center Hospital and Healthcare Facility Plan. Further, both agencies have tied these criteria to the facility safety/Life Safety criteria for accreditation.

Implication 3:

Following the catastrophic events of the 2004 and 2005 hurricane season and the recent National Academies of Science reports regarding Hospital and Community Disaster Preparedness, recently published CMS regulatory changes and progressive refinement of JCAHO standards have resulted in accreditation criteria for disaster planning, education and drills that exceed those put forth in NRP/NIMS and the NIMS Implementation Center Hospital and Healthcare Facility Plan. Further, both agencies have tied these criteria to the facility safety/Life Safety criteria for accreditation.

Implication 4:

Because certification by CMS and indirectly JCAHO accreditation are required for Medicare, Medicaid and Tricare insurance participation and because CMS and JCAHO have tied much of their disaster preparedness criteria to the facility safety and Life Safety certification criteria, violation of these criteria would immediately suspend CMS certification and thus immediately suspend Medicare, Medicaid and Tricare insurance participation by the violating hospital or healthcare facility. Further, all private insurance suspends program participation in the event o a CMS suspension. Thus violation of the CMS and/or JCAHO disaster preparedness criteria and by extension the NIMS Implementation Center Hospital and Healthcare Facility Plan holds significant financial penalties for any hospital or healthcare facility.

Conclusion:

Based on the comprehensive review of CMS regulations, JCAHO standards, NRP/NIMS and the NIMS Implementation Center Hospital and Healthcare Facility Plan, it is the position of High Alert that this creates a market pressure towards Comprehensive Immersion Simulation Training that includes a "Crawl - Walk - Run" Disaster Exercise program for staff and ICS training for administration. This program can be delivered in 5 to 6 days and provide all required education and drills to meet all patient safety, disaster preparedness/response and community/multi-agency drills required under CMS regulations, JCAHO standards, NRP/NIMS and the NIMS Implementation Center Hospital and Healthcare Facility Plan. Such a program provide client hospitals and healthcare facilities with comprehensive disaster planning, preparation and response training, significant patient safety improvement through the use of simulation based training and demonstrable cost savings compared to the present market approach to these processes while protecting these clients from potential financial harm.

The fortuitous conflagration of CMS regulations, JCAHO standards, NRP/NIMS/NIMS Implementation Center Hospital and Healthcare Facility Plan revisions, National Academies of Sciences Reports on Hospital and Community Preparedness and the Institutes of Medicine To Err is Human report create an unexpected environment that yields de facto mandates for full and unmodified implementation of the NIMS Implementation Center Hospital and Healthcare Facility Plan. Further the market is ripe for the introduction of the next evolution disaster preparedness training.

Immersion Simulation Training will extend the disaster training to the inpatient bedside environment and include high fidelity human patient simulators to train not only disaster and terrorism response/treatment, but also patient safety and other issues raised in the Institute of Medicine report To Err is Human. This model creates a training environment akin to that used to train airline pilots and fighter pilots. Teams trained in this model we employ techniques patterned after those used to train NASCAR Pit Crews to work quickly and accurately in a high risk, high stress and fast paced environment. NDLS-FL and its partners cannot afford to miss such an opportunity.

Adolescent advice with bloom affliction providers

The peer educators in this video were trained through the Adolescent Health Care Communication Project



http://www.youtube.com/watch?v=FcGSGfGCzKw&hl=en

IP Telephony Market: Recent Trends

VoIP (Voice over Internet Protocol), or IP telephony, has become a widespread means of communication today. While earlier this was the choice of only a select few, people are now increasingly adopting VoIP solutions. The number of players in this field has gone up substantially and will continue to increase. The heavy competition prevalent in the IP telephony market has driven service providers to slash their prices and offer a wide range of features.

IP telephony uses packet-switching protocol to transmit voice signals over broadband lines instead of the conventional circuit-switching network. Analysts have predicted that when unified messaging services that include voice mail, email, faxes, and pages are coupled with IP telephones, it will propel the market to incredible heights.

Analysts have further predicted that by 2009, there will be over 155 million business IP endpoints in operation, and over 37% of these will be wireless. By 2009, 73% of customers the world over will be using a wireless handset. The wireless IP end points hold the key to sway the customers to their side.

The global VoIP market is expected to reach $3.3 billion by 2010. It is increasingly becoming an indispensable tool for businessmen because it provides cost savings, excellent coverage of voice and data, and better communication. In a recent study, the VoIP market was divided into three groups, namely VoIP over VPN, VoIP real-time QoS bandwidth, and hosted VoIP.

Multi-national companies use VoIP over VPN (Virtual Private Network) to eliminate long distance toll charges for communication between different sites. Healthcare (telemedicine) and broadcasting enterprises use VoIP real-time QoS bandwidth to provide real time audio and video data transfer. Hosted VoIP enables enterprises to save on upgrades and capital expenditure.

The growth of VoIP shows immense potential to influence the telecommunications market and bring about a radical change.

Building a Winning Workplace

Small business owners, for purposes of this article, dental healthcare providers, are unique to your typical office structure. It tends to boil down to the front office and the back office. This is where the business and clinical staff works. This delineation shows up in the bottom line. I am a proponent of winning teams and not internal separation of the work force. When everyone is on the same team, mentally and physically, profits increase.

A Winning Workplace requires more than aesthetically pleasing architecture, lovely interior design and beautiful landscaping. All of these are definite pluses, however. Image is everything, almost. A Winning Workplace requires an attitude of excellence from leaders for physical, emotional and fiscal responsibility to its people and outstanding care for its patients (services or products).

Happy employees make happier spouses, parents, neighbours, friends and citizens. The impact one's workplace has on an individual is like that of a pebble thrown into a pond. It's referred to as harmonic resonance in music. The ripples make harmonic rhythms that can be felt throughout the universe. An unhappy team brewing over an improperly delivered change in job description can make for a hostile work environment in a very small business. Most health care providers, whether dentistry or medicine, will readily admit they know very little if anything about the business of running a practice. They hire competent employees, consultants and others to take on the day-to-day requirements of business operations. Clinically, they are trained, skilled and experts in their given fields. This acceptance and confession promotes excellence in the workplace. An expert in dentistry who is not qualified to handle the human resource functions and organizational structure of a small dental practice will eventually manifest itself in the lack of motivation from the staff and a disregard of his/her authority by the employees. An office manager would eliminate the problems faced by many dental offices with a staff of 4 or more. This new leader can then take on the responsibility of building a winning workplace.

An Office Manager is required to ensure the team is treated with dignity, fairness, respect, and appreciation. He/she will empower the team to help solve problems, do challenging work, gain new skills, and develop as individuals and professionals. Each employee will then feel a sense of accomplishment, satisfaction, and value. They will also enjoy better mental and physical health. Because the employees are happier knowing they are being shown they are of great value to the practice; they will work more effectively, function better as a team player (destroying the front office / back office drama), eliminate or reduce tardiness and absenteeism and become loyal, committed and dedicated to the practice. They will have no desire to seek employment elsewhere.

Those companies making the "100 Best Companies to Work For" serve as examples for every company, small or large. The employees of these companies are providing a higher standard of care to their customers because a higher standard of value has been placed on them. These companies get to enjoy a competitive edge. Their teams outperform the competition. Coming from a professional sales background, such accomplishments are sweet!

A Winning Workplace is better for your people and better for your business! Start the building process, now.

© 2006 Avis Ward of AWard Consulting, Inc. (Reprints permitted provided all links are kept active.)

You May Well Be The Victim Of Workplace Bullying

You may be in a situation of "Workplace Bullying" or even worse. You want to keep your job. Your boss is a ... . It may even hinge on the borders of sexual exploitation. The victim may be yourself or perhaps another coworker, friend or relative. You or they want to keep your job. After all it's a livelihood, a source of substance for the employee and perhaps their family. And yet you know you may win the battle and lose the war. What can you do? What can be done?

First of all despite the cost to employers and the devastating consequences to employees such workplace bullying and intimidation are still more than prevalent in the workplace. You may well have heard the description "They may be this, and they may be that but I will tell you one thing. Management sticks together like glue to protect themselves as well as their god given perks and privileges." You may well be on the low end of the totem pole. Companies and management have financial and legal resources that can well outlast you. Companies often have lawyers that "can beat you on a traffic ticket".

Bullying at work can be said to the repeated health or career endangering mistreatment of one or more employees. The mistreatment of a form of psychological violence and is often a mix of verbal and strategic insults preventing the so called "victim" or "target" from performing work well. As you may well have guessed by now most bullies are in management positions. It is as if the exact same person who beat you up in the sandbox when you were four years old is now your boss, manager or supervisor.
The attitude may well of the "Golden Rule". In this case the management interpretation of this basic rule of life and employment is "The rules are golden and they are my rules."

What can be done in such a situation? First name the abusive behavior for what it is - simple bullying. Next "step out on the balcony" so to speak. Take a breather. Have your physical and mental health checked by your doctor and health care providers.
If you are not getting regular exercise or other forms of stress relief see to that this situation gets improved.

Nothing takes the place of pre call preparation so to speak. Find out your state, federal employment rules on such bullying behavior. Nothing clears a mind like true facts. You may or may not want to visit your human resources department. You never know how word travels or the "Radio Moscow "grapevine travels. Still there are other sources. The internet may afford quiet research. Perhaps old documents from when you were hired or were promoted. Other present or past co workers. Competitors? Industry or accepted standards of the industry that you are in and your employer may be a signatory of? Often the best source of information can be a competitor in the fields to speak. . Just make sure your notes are on the company work computer. After all it is their computer property which allows the employer full legal access to their computer and your incriminating notes.

You may have company employee documents that may be of great help to you in your cause. Employer job descriptions and job postings and ads. Your company evaluations may be of great help to document your case. Company documents serve your cause - they are beyond dispute. It like that old joke "Have you stopped beating your wife yet?"

Facts can never be disputed. Opinions can. Take time to document all events - regularly, promptly, accurately and with full thoroughness. Document specific, specific times and dates. Solicit witness statements. Note insults, putdowns, intimidation screaming and other unwarranted abusive behavior. Remember everyone has a bad day from time to time. What counts is the consistency of the actions - not one shot deals.

When this is all done present your business case / evidence to the highest ranking official at your workplace. It is neither a good idea to confront the bully directly nor their immediate supervisor. The supervisor of the bully can be held responsible as well and he may often see the bully as merely "getting the job done". Indeed this behavior may seem to reward the supervisor with perceived extra power and salary bonuses plus other perks.
Sort of like the management style of pharaoh's slave drivers when they were building the pyramids.

You can well seek third party mediation or legal advice. Perhaps your job union can serve as an intermediary.

In the end if you find that you are getting nowhere it is best to search out another job while your reputation is unsullied and you receive a good job reference. If nothing else it is a quick way for management to continue to sweep the problem under the rug.

Culture As A Barrier To Communication

Each of us is exposed to people from other cultures on a regular basis, in the workplace, in our social activities, at school, or even within our families. Our culture hinders us from getting our message across as well receiving the full message that others want to convey to us. This article expound on three aspects: what culture is, the main causes for cross-cultural misunderstandings, and the attitudes and skills that we need to communicate cross-culturally.

When we think about culture we first think about a country, and particularly about its food, art, customs, and patterns of behavior. These are the outward manifestations of a system of values, assumptions, and deeply rooted beliefs. Culture emerges as a group of people face and then react to the challenges of life. The responses to those challenges that are successful are taught and shared among members of the group and are passed on from the older to the younger members. Culture is then learned through experience.

You can think of culture as having three levels:

o The top level is the outward manifestations, the artifacts: visible behavior, art, clothing and so on.

o In the middle level are the values. These are invisible rules that cause the artifacts

o The most powerful dimension of culture is the implicit cultural assumptions. These assumptions lie so deep that they are never questioned, stated or defended

Culture also exists among Americans, but what are the implicit cultural assumptions of Americans? Some of the most distinctive characteristics of the American culture are: individualism, equality, competition, personal control of the environment, self-help concept, action orientation, informality, directness, practicality, materialism, and problem-solving orientation.

These American values and deeply rooted beliefs are very different from other country's values and beliefs. The implicit cultural assumptions of Americans are often opposed to those of other cultures. When individuals from different cultures run into each other's values and beliefs, cross-cultural misunderstandings take place.

People constantly interact with people who have similar views and who reinforce their beliefs. To be able to distinguish between the in-group and the out-group is of central importance for individuals because it allows them to find an identity as to who they are and who they are not.

In the book entitled Cross Cultural Encounters , Brislim states: "If individuals have out-groups whom they can blame for troubles, the in-group is then solidified since there is a common goal around which to rally." Later on he says: "Individuals become accustomed to reacting in terms of in-group and out-groups. They continue to use such distinctions when interacting with people from other cultures whom they do not know."

This in-group/out-group distinction provides us with the basis for ethnocentrism, which is the tendency to interpret and to judge all other groups, their environment, and their communication according to the categories and values of our own culture. We are guilty of ethnocentrism when we hold that our view of the world is the right one, the correct one, and the only one.

We are all familiar with stereotyping, which is one of the most serious problems in intercultural communication. Our tendency to hold beliefs about groups of individuals based on previously formed opinions, perceptions, and attitudes is often a defense mechanism, a way of reducing anxiety.

There are many other causes of cross-cultural misunderstanding: lack of trust, lack of empathy, and the misuse of power. All of us know what they are about and the turmoil that they cause. But, how can we do a better job at communicating among cultures?

The same skills that we need to communicate in general apply to cross-cultural communication. Lets look at some of those skills:

Know yourself: Identify your attitudes, your opinions, and the biases that we all carry around. Identify your likes, your dislikes, your prejudices, and your degree of personal ethnocentrism.

Take time: Listen to the other person and allow him or her to accomplish their purpose. Don't jump to conclusions. Some times we finish the thoughts and ideas of the other person before he or she has finished talking. Some cultures non-verbal styles call for periods of silence and long pauses.

Encourage feedback: Feedback allows communicators to correct and adjust messages. Without feedback we cannot have agreement. First we must create an atmosphere where others are encouraged to give us feedback. Again, don't be afraid of silence. It could be the appropriate feedback at times.

Develop empathy: The grater the difference between us and others, the harder it is to empathize. To develop empathy we must put ourselves in the other person's place. By becoming more sensitive to the needs, values, and goals of the other person, we overcome our ethnocentric tendencies.

Seek the commonalities among diverse cultures: Despite our cultural differences we are all alike in many ways. We need to seek that common ground to establish a bond between ourselves and the rest of humanity.

Although our own ethnocentrism might have hindered us from getting to know people from other cultures, let us be more than ever committed to help ourselves and others overcome the barrier that culture creates. Let us endeavor to minimize the occurrences of cross-cultural misunderstandings as we develop the attitudes and the skills that are needed to communicate cross-culturally.