Medical Practice Management Ideas for Physician-Owned Clinics

Frazzled Medical Practice Manager dealing with many requests

“33% of Medical Group Management leaders plan to automate patient communications in some way due to staffing shortages.”1

 

If you’re a physician or practice manager, you’re likely tasked with medical staff schedules, bills, and patient responses.

With Hippocractic determination, you may have set out to provide value for patients and make a difference in your community. But how can you manage all these administrative duties while treating patient conditions?

Implementing effective medical practice software may improve your patient outcomes. With employee shortages and urgent requests affecting speed to care, we put together a list of ideas you can implement today. Let’s take a look at a few medical practice examples that others have found useful for improved workflows.

Medical Practice Management Examples

Larger Medical Group Medical Practices

Larger medical group management needs have a few differences compared to smaller, physician-owned clinics. They typically include multiple specialists, a large clinical staff, medical partnerships, and offices scattered throughout a city, county, or region. 

For example, Mid-Atlantic Nephrology Associates (MANA) had eight office locations which served twelve hospitals in their metropolitan city. With multiple locations, managing on-call physician schedules and patient requests were a challenge. Inefficient communication resulted in providers being contacted at the wrong time. Shared logins and passwords became inaccessible due to security lockouts, and practitioners were unable to share secure images and messages to accurately treat patients.

The needs varied from communicating the latest power outage to who was on which dialysis unit, where, and when. The practice managers did not have full control over the schedules, and there was no way of knowing when a schedule was updated. They were unable to match who was on call when and at which location.

After getting everyone on a unified communication system, the nephrologists were able to see lab results right away. Group texts were sent to the whole care team and medical staff, so they knew what to expect in case of early closures or emergencies. To improve patient response times, all practice managers received a backup notification when a provider didn’t respond within 48 hours. In this way, patient messages were never missed.

By putting these medical practice communication systems in place, the providers didn’t have to worry about their schedules being disrupted while off the clock. The organization was able to get everyone on the same page. The practice managers had full control over the schedules again, allowing them to update on the fly while syncing to each location and provider.

Physician-Owned Clinics and Specialties

Building reliable systems for a small practice now can help you when it’s time to scale. Aside from medical billing and medical supply inventory, an optimized communication flow between providers and patients forms the backbone for a physician-owned clinic’s success. 

Smaller medical practices often use medical answering services to inform patients and other specialties of holiday hours, weekly office times, and who to contact for which request. Much like the large group practice example, yet with fewer locations and reduced staff size. 

For example, one medical clinic needed to let patients know their Monday through Friday hours, lunch break from 12-1 PM, and who was on call for the weekend. They needed a way to check messages and follow up without the doctor being paged for non-urgent matters. For inpatient and outpatient critical lab results, physicians needed to access that information quickly and get notified about it.

After implementing custom voicemail prompts for inpatient and outpatient labs, office hours, and urgent versus non-urgent requests, patient callbacks improved. Timely messages were routed to the right on-call specialist. The office manager was able to login to the system each day through a secure app or web browser to verify and track messages. Any edits to the schedule went into effect immediately with their specific medical communication software.

Medical Practice Management Ideas

Effective and updated communication is instrumental for operating a medical clinic or group practice. You can have one provider and two part-time staff all the way up to and beyond 100+ physicians, nurses, medical assistants, and locations. Large or small, you may share these medical practice communication strategies with your medical team and administrative decision-makers, and see if it leads to positive outcomes.

Fundamental Medical Practice Management Thoughts

Consider who your frequent patients are versus one-time patients. What does the patient journey look like? Are there ways to enhance your process and decrease human error, such as billing needs, messages, and phone calls? 

From before check-in all the way to post-acute follow ups and pharmacy prescriptions, reminding patients, and communicating with them along the way alleviates confusion. Establish a clinical workflow plan for responding to patients, inquiries from other specialities, and care team members. Let’s take a look at a few ideas for implementing these practice management strategies.

Custom Medical Answering Service Software for Medical Practices

Use a custom voicemail message related to your type of medical specialty. Setting up automated calls and notifications can reduce nurse and physician administrative burdens, allowing them to effectively receive updates, read patient charts, and respond appropriately.

A few medical specialty examples:

  • An obstetrics and gynecology clinic may need to include call flow questions related to the number of weeks pregnant, patient’s doctor, and a reason for the call.
  • A nephrology clinic may need to ask about BUN, creatinine, and potassium levels before routing the call to the right provider. This allows time for the physician or nurse practitioner to pull up the patient’s chart or other remote patient monitoring stats.
  • A surgery center may need to route a call based on the patient’s surgeon, patient location, and reason for the call, such as post-acute treatment instructions. They may need to provide message prompts for an attending anesthesiologist schedule.

Providing patients and additional providers with clearly defined instructions ensures the message gets to the right person. Taking time to set up communication flows correctly can save medical practices hours of time later.

Applying Telehealth Solutions in Medical Practice Management

Does using a video telehealth visit mean I offer free medical advice? Not if you’re helping patients. Traditionally, clinics could only bill for in-person visits. The COVID-19 pandemic thrust virtual services into the forefront, changing how the Medicare Physician Fee Schedule works via telehealth.2 For billable hours and unique codes, check the most recent CMS policies regarding virtual services.

“Telehealth services can be provided to new and established patients via smartphone if the smartphone allows for audio-video interaction between the physician and patient.”3

With secure telehealth messaging, family medicine practitioners and other medical specialties can utilize video appointments for patient follow-ups. Video technologies may be used by the whole care team, and a primary care doctor and surgeon could hop on a simple video call to discuss their patient’s next steps. For a clinical psychologist or behavioral health center, this could be an effective way to form alignment between a therapist and physician.

Secure Medical Text Reminders

How do you handle patient no-shows? What if patients are ignoring your phone calls and not logging into their portal? Perhaps patients frequently call the office for non-urgent matters or office hour information—all of which could easily be automated. 91.1% of patients surveyed in one study mentioned secure medical text updates helped them avoid calling the office.

Image of Secure Medical Text phones sending messages

What kinds of texts are best to send?

For medical practice management, here are a few suggestions:

  • Appointment reminders including day and time of appointment.
  • Virtual check-in reminders before arriving at the medical office.
  • Quick ad hoc video visits as part of a patient follow-up session.
  • Reminder to login through the organization’s portal for the detailed physician notes or AVS (After Visit Summary).
  • Prescription refill reminders.
  • Group texts to medical staff for updated closures or emergencies.

Using a patient text solution, Ridgeview Rehab Specialties was able to reduce its no-show rate by 12.6%, generating an average of $175 per visit.4 This is one example of how streamlining medical practice communication can improve patient care outcomes and reduce hefty administrative costs. 

Need more ideas? Take a few minutes to read through these customer success stories. It might be the next step in your journey to effective medical practice management. 

1MGMA Staff Members. (2022, March 23). Outsourcing, automation may provide help to short-staffed practices. Medical Group Management Association. https://www.mgma.com/resources/resources/operations-management/outsourcing,-automation-may-provide-help-to-short

2CMS (2022). List of Telehealth Services. Centers for Medicare and Medicaid Services. https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

3AAFP (2022). Coding Scenario: Coding for Telehealth Visits. American Academy of Family Physicians. https://www.aafp.org/family-physician/patient-care/current-hot-topics/recent-outbreaks/covid-19/covid-19-telehealth/coding-scenarios-during-covid-19/telehealth.html

4PerfectServe Success Stories. https://www.perfectserve.com/success-stories/ridgeview-rehab/

Improving patient satisfaction and care with better communication

With the rise of value-based care, patient health outcomes are more important than ever. Healthier patients make a significant contribution toward increased reimbursement rates, but health outcomes are only part of the equation—patient satisfaction matters, too.

But that’s often easier said than done. With declining patient loyalty and the advent of consumerization in healthcare, patient satisfaction is difficult to achieve. It means your organization must make every effort to earn and retain a reputation for quality care that builds patient trust.

Technology plays an important role in keeping patients satisfied with their care. Dated solutions or disjointed patient care experiences can send them searching for smoother, more accessible, and more modern interactions.

In 2019, Hospital for Special Surgery (HSS)—America’s premier academic medical center focused on musculoskeletal health—wanted to elevate patient outcomes and experiences by improving care team communication across the organization. To do this, they implemented PerfectServe’s enterprise Clinical Collaboration solution.

PerfectServe brought significant improvements to care delivery workflows while also reducing stress and frustration among care team members. Not surprisingly, better clinical communication, more efficient care delivery, and happier clinicians contributed to improved patient satisfaction.

In fact, Press Ganey survey results from the quarters before and after PerfectServe’s go-live showed increases in the following categories (on a 0-10 scale):

  •  “Hospital rating” increased by 2.3 points.
  • “Hospital recommend” increased by 0.9 points.
  • “Staff address emotional needs” increased by 1.2 points.
  • “Response to concerns” increased by 1.2 points.

Faster Clinical Response Times

Critical Lab Results

Before PerfectServe, HSS relied on a manual process for delivering critical lab results—the lab tech had to call the ordering provider and ask them to log in to Epic. Leaving a voice message was not permitted, as a live verbal exchange was required to satisfy HSS’s internal protocols.

But physicians’ hectic schedules and fluctuating workloads meant delays in this process were common. Precious time was lost, and the risk of patient harm increased.

But now, once a critical result is verified, PerfectServe automatically delivers an alert to the appropriate provider using its proprietary Dynamic Intelligent Routing® technology. With all relevant information and patient context in the message, the provider can acknowledge and act upon the message right from their PerfectServe inbox—no phones, no callbacks, no delays.

After implementation, HSS looked at 1,100 critical lab alerts and noted an average 42% improvement in acknowledgment times. The quickest turnaround—from verification in the Laboratory Information System to provider acknowledgment—was just seven seconds. That’s less time than it takes just to dial a provider’s phone number.

PerfectServe also tracks when each result is received, read, and either accepted or declined by the recipient. Accepting closes the loop, while declining sends a message back to the lab for follow-up. Messages that are unacknowledged after six minutes are automatically escalated to the next provider in line.

Specialty Consult Requests

HSS also relies on PerfectServe’s Dynamic Intelligent Routing to automatically direct requests for neurology and stroke protocol consults. Regardless of who’s on-call or what kind of schedule changes have happened at the last minute, the right provider receives the request almost instantly.

Since implementation, PerfectServe has helped contact preoperative medical doctors over 8,000 times, with 80% of urgent messages read in less than five minutes. Similarly, HSS’s neurology department has received over 500 consult requests, with 85% retrieved in five minutes or less.

Sepsis Notifications

HSS uses PerfectServe to send out sepsis alerts using a two-part workflow:

  • The nurse alerts a physician assistant (PA) about a possible case. Then, if necessary, the PA alerts the responsible physicians (Modified Early Warning Score [MEWS] and Pediatric Early Warning Signs [PEWS]).
  • If needed, an alert is sent to the Sepsis Response Team and automatically escalated every minute until a doctor responds.

Since going live, nearly 700 messages have gone out to the MEWS and PEWS groups, and only nine of those have been further escalated to the Sepsis Response Team. PerfectServe’s ability to quickly and preemptively initiate the MEWS and PEWS teams is largely credited for keeping the sepsis alert number low.

Rapid Response Teams

Additionally, PerfectServe reduced HSS’s rapid response wait times to less than two minutes. These are scenarios when a patient’s clinical condition may be worsening dramatically, so fast intervention is critical. A review of the “signal one” alerts (similar to code blue) determined that PerfectServe reduced the median response time from two and half minutes to just 40 seconds— an improvement of 73%.

Staff Response Times

Additional analysis found that PerfectServe enabled HSS PAs to read 96% of initiated conversations from the PACU and inpatient floors in under 15 minutes. These were part of 8,000-10,000 monthly conversations where the average response time was less than 3.5 minutes.

These efficiency gains freed clinicians’ time and contributed to HSS’s improved Press Ganey survey results. Scores for both the “Response to concerns” and “Staff address emotional needs” categories rose by 1.2 points on a 10-point scale.

Reducing Readmissions

Because PerfectServe also provides HSS with a system-wide answering service, covering roughly 175 clinics, all the organization’s clinics have a built-in workflow for post-operative patients.

When one of these patients calls an HSS clinic, PerfectServe enables an immediate connection to a clinical nurse practitioner with the press of a button. Regardless of the reason for the call or the level of urgency, giving post-operative patients quick and easy access to a provider is a key part of care plan adherence and avoiding potential problems.

Better Communication, Better Care

Reducing obstacles that impede fast, accurate communication can go a long way toward improving patient care and satisfaction. Manual, inefficient workflows have been around for so long that they can sometimes seem like the only option. But for every delayed communication cycle, misdirected consult request, or unactioned critical lab result, there are countless potential ramifications that can negatively impact patient outcomes.

Thankfully, technology exists today that can automate clinical workflows, remove error and confusion from the communication process, and ensure that care team members are free to focus on keeping patients happy and healthy. Isn’t that the way it should be?

Reach out to learn more about how PerfectServe can transform the way your organization cares for patients while making your clinicians’ lives significantly easier. You can also download the HSS case study to learn more about their experience with PerfectServe.

How Remote Patient Engagement Solutions Reduce Readmissions

“Clinicians often perceive these initiatives as additive work that doesn’t seem to provide immediately obvious benefits to patient care. Executives tend to emphasize how important patient flow is to the organization’s efficiency and finances. But that doesn’t address clinician concerns, and they struggle to fully invest in these initiatives.” -Nursing Executive, Advisory Board1

Digital Patient Engagement: How to Address Challenges in Adoption

Misalignment and miscommunication of strategies lead to challenges among healthcare professionals and their team culture. A reluctance to adopt new technologies may have consequences, such as reduced patient response times, physicians being alerted or notified when they’re not on call, or non-urgent messages being delivered in the middle of the night when they should be held until normal business hours. If used well, however, these remote patient engagement tools can drive a variety of positive patient outcomes.

Medical directors, managers, and hospital leaders may grapple with physician resistance to digital patient engagement platforms. Their hesitancy might include the following questions: 

  • How can medical practitioners engage and connect with patients outside of brick-and-mortar facilities? 
  • Will remote patient engagement solutions actually improve value-based care outcomes and reduce patient readmission rates, or is this another technology fad? 
  • Can virtual visits and updated monitoring systems be turned into billable hours?

A plethora of new virtual patient technologies are being introduced in the marketplace. Hospital and clinical healthcare administrators are looking for ways to reduce patient readmissions and eliminate wasted costs. Yet, providers may see these new technologies as an added burden to their daily, in-person patient engagement workflows. Swamped with increasing demands and pay-to-perform incentives, patients may get lost in the shuffle, especially those who require chronic care management or specialty visits.

Both patients and providers may have a lack of awareness when it comes to ehealth engagement technology.2 Let’s look at a brief history and understanding of patient engagement, and how you can walk away knowing what strategies you should consider implementing for your medical organization.

What is Remote Patient Engagement in Healthcare?

Remote Patient Engagement Defined

Remote Patient Monitoring (RPM) is a broadly defined term which includes a range of digital tools that track a patient’s health. The information is sent back to healthcare professionals or caregivers to determine effective treatments. A few tech examples include heart monitoring devices, glucose meters, surveillance monitors, and digital reporting logs.3 

Remote patient engagement is the use of these tools and devices to communicate and follow up with patients in a secure, timely manner. These medical bands and devices are commonly used by physicians and practitioners to monitor chronic conditions and post-surgery assessments. Dieticians, therapists, and wellness coaches use these tools for preventive, proactive, and rehabilitative health plans.

Patient Engagement Before 2020

About 60 years ago, some of the first remote telemedicine technologies were developed by NASA to track the health of astronauts.4 As telehealth technology expanded, private companies and the government invested money and research into different healthcare delivery methods. Enter the Health Insurance Portability and Accountability Act (HIPAA) in 1996 and the Affordable Care Act (ACT) in 2010, which allowed more coverage for patients with chronic conditions. This opened the door for accessible and reimbursable patient visits that utilize remote patient monitoring and telehealth technology.

Patient Engagement After 2020

The consumerization of healthcare has accelerated, but the trend was in motion well before the COVID-19 pandemic. This fueled demand for healthcare organizations and providers to communicate more frequently with their patients and families. Sharing healthcare information digitally can accelerate speed to care, and 77% of patients are willing to do so if it positively impacts their care.5

In a recent interview, PerfectServe Chief Medical Officer Dr. Rodrigo Martínez shared that patient engagement technology adoption is a main need for healthcare organizations to stay relevant over the next decade:

Image of a doctor with a quote from Dr. Rodrigo Martínez

Patient Engagement Digital Platforms

The types of digital platforms that facilitate patient engagement vary widely. Some offer niche-specific chronic care and treatment, like Health Recovery Solutions, which tracks biometric activity, such as blood pressure and oxygen levels. Amazon has even joined the game with their Halo Band, which measures movement and sleep tracking. According to one study, 69% of respondents use smartwatches for chronic care management.6

List of Common Patient Engagement Devices

Like Gene Roddenberry’s tricorder in Star Trek, new medical devices are developed every year. One company invented DxtER™, a device designed “to prove the concept that illnesses can be diagnosed and monitored in the comfort of one’s own home by consumers without any medical training.”7 It was created to diagnose up to 34 different health conditions. While it’s not fully launched in the consumer marketplace, healthcare organizations and trained practitioners do use similar medical patient engagement devices.

Medical devices typically go hand-in-hand with a digital monitoring system for patient care, and for physician and nurse communication. Common devices used for patient engagement may include:

  • Wearable bands (Smartwatches, Fitbit, etc.)
  • Glucometer
  • Pulse oximeter
  • Electrocardiograph
  • Blood pressure cuff
  • Digital scale
  • Smartphones
  • Tablets or Laptops
  • DxTer Tricorder (Yes, inspired by Star Trek.)

Knowing these tools are available is one thing. Applying them in a way that enables patients to communicate with a physician or nurse is another. So how can a healthcare organization use patient engagement strategies to their full advantage?

Patient Engagement Strategies: Reach Patients Before They Get Readmitted

According to CMS, the Hospital Readmissions Reduction Program (HRRP) “encourages hospitals to improve communication and care coordination to better engage patients and caregivers in discharge plans and, in turn, reduce avoidable readmissions.”8 With 6 in 10 adults in the U.S. having been diagnosed with a chronic disease, patient engagement tools and workflows will remain a priority for healthcare organizations.9 An awareness of these needs, combined with actionable foresight, may reduce these readmission events.

Do You Have a Patient Engagement Strategy?

Create a plan to measure your patient outcomes, not just quick, transactional clinic visits. Identify which remote patient engagement solution is best for your providers—something that is easy to train and implement. Being proactive versus reactive with these tools could boost physician, nurse, and patient morale. 

What are the common goals your healthcare organization wants to achieve? Knowing this information can act as a filter for your patient engagement strategy plans.

Patient Engagement Example for a Chronic-Condition Specialty Practice

patient and doctor texting back and forth with medical messages

If you are a specialty practice, build common message templates related to your patient’s frequent needs, which, when delivered to the patient, allow them to respond and transition to a remote video visit initiated by the right on-call provider. Here is one example for a 65-year-old patient with a recent kidney disease diagnosis and low GFR:

Physician’s Office: “Thank you for calling Green Valley Nephrology Clinic. Our hours are 9 AM through 5 PM Monday through Friday. If this is an emergency, please hang up and dial 911. Otherwise, press one to leave a message, press two to schedule an appointment, etc.”

Patient: (Presses one) “Hi Doc. This is George. I’m calling about my test results and the blood draw you did for my kidneys. I can’t remember my login to look at it, and I’m not good with computers. Do I need to go to the hospital? I’m peeing more than normal and I have some swelling in my legs and feet. Let me know.”

Physician’s Office: (Call routes to the on-call physician. Message alert pings Dr. Shaeffer, the on-call nephrologist. He decides to send a text message back through a secure, front-office number that masks his personal cell phone). 

Dr. Schaeffer: (Via text message) “Hi George. I received your message. Do you have a few minutes to hop on a video call? I will send you a link.”

Patient: Yes, sure. Send me the link.”

Dr. Schaeffer: (Physician sends secure link.) “Here you go. [hyperlink]”

Patient: “Oh, there you are—got it. I see you now. Thanks for sending me the link. Wow, technology these days! So, do I need to go to the hospital?”

(Video conversation continues with patient and on-call specialist).

Scenarios like the conversion above may occur for any established, chronic-care patient and their physician. Let’s look at a few tips you could implement for your healthcare organization, so more patients like George can receive better care.

4 Ideas to Increase Patient Engagement

  1. Send frequent—but not too frequent—text reminders that are beneficial for the patient. Some examples include appointment reminders, critical lab results, treatment reminders, and clinic feedback questions. Let them know you care by using automated touch-points which save time for both medical practitioners and the patient in day-to-day interactions.
  2. When assessing chronic conditions, see if there is a way the patient can message you securely or log in to their health record to view the same data.
  3. Communicate a plan for the office staff and medical practitioners so they know what messages and protocols have been set up. This includes things like lab results, inbound voicemails, and which messages are critical versus non-critical for patient healthcare outcomes. 
  4. Coordinate schedules so all patients know at least one on-call practitioner can answer their questions. Updates to these schedules can be automated from the provider or administrative staff through a simple app, without chasing down a Google calendar or paper spreadsheet at the office.

For more ideas on how medical groups are using patient engagement strategies, see a demo of PerfectServe’s solutions for your medical practice or hospital.

1Nursing Executive Center. (2020). Engaging Frontline Staff in Patient Flow: Two tactics to engage clinicians’ hearts and minds [White paper]. Advisory Board. https://advisory-prod.azureedge.net/-/media/project/advisoryboard/shared/research/nec/success-pages/2020/engaging-frontline-staff-in-patient-flow.pdf

2Safi, S. Thiessen, T. Schmailzl, K. (2018). Acceptance and Resistance of New Digital Technologies in Medicine: Qualitative Study. JMIR Publications, 7(12). https://doi.org/10.2196/11072

3Delvecchio, A. (n.d.). remote patient monitoring (RPM). SearchHealthIT. https://searchhealthit.techtarget.com/definition/remote-patient-monitoring-RPM

4Gruessner, V. (2015, November 9). The History of Remote Monitoring, Telemedicine Technology In recent years, healthcare reforms and federal legislation has pushed forward the spread of telemedicine technology and other technological advancements. mHealthIntelligence. https://mhealthintelligence.com/news/the-history-of-remote-monitoring-telemedicine-technology 

5(2021, June 15). New Data from HIMSS Shows Rapid Digital Health Adoption Necessitates Personalized Patient Technology. HIMSS. https://www.himss.org/news/new-data-himss-shows-rapid-digital-health-adoption-necessitates-personalized-patient

6Neslon, H. (2021, January 22). Condition-Specific mHealth Devices Best in Chronic Care Management. mHealthIntelligence xtelligent Healthcare Media. https://mhealthintelligence.com/news/condition-specific-mhealth-devices-best-in-chronic-care-management

7DxtER™ A New Kind of Consumer Medical Device. Basil Leaf Technologies. https://www.basilleaftech.com/dxter/

8(2021, December 1). Hospital Readmissions Reduction Program (HRRP). CMS.gov. Centers for Medicare & Medicaid Services. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program

9(2022, January 24). Chronic Diseases in America. Centers for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm

Ochsner Health Drives Physician Engagement, Reduces Burnout With Better Schedule Management

The subject of healthcare burnout is not new. In fact, according to the KLAS “Clinician Burnout 2021” report¹ published in December, burnout levels are higher than ever, with the pandemic being a prime contributor:

For physicians in particular, KLAS notes that one of the biggest contributors to burnout is having no personal control over their workload. Taking care of patients is rewarding, but doctors aren’t robots—they need to rest and recuperate, and during times of elevated stress, they need to know there’s a light at the end of the tunnel.

At the recent ADVANCE 2022 conference hosted by the American Society of Anesthesiologists, New Orleans-based Ochsner Health presented research and findings² that demonstrate how PerfectServe’s Provider Scheduling powered by Lightning Bolt can help to stem the tide on burnout and loss of control.

At Ochsner, Lightning Bolt “significantly improves physician engagement and reduces burnout by creating fair and flexible schedules that support work-life balance—even during the COVID-19 pandemic.” The results presented by Dhruv Choudhry, M.D., lead author of the study and anesthesiology resident at Ochsner, are powerful:

1. Six months after implementing Lightning Bolt for a department of 60 anesthesiologists, a Press Ganey survey revealed that their average engagement score had increased by nearly 30%, from 3.3 to 4.2 out of 5. This was one of the largest increases across the Ochsner Health system.

2. Lightning Bolt drove this increase by granting more vacation days, reducing ungranted vacation days, and providing more predictability and flexibility than the prior staff-created scheduling system.

3. Compared to the previous manual scheduling process, which required 60 to 75 staff hours per month on average, Lightning Bolt auto-generates “the best schedule for the department” in just 14 hours. Collectively, that’s two and a half days of staff time saved per month and 30 days saved over the course of a year.

Anecdotally, Dr. Choudhry also reported that Lightning Bolt gives anesthesiologists  “one or two mornings and one or two afternoons off a month to allow for increased work-life balance so they are better able to attend events important to them.”

Talking more specifically about the pandemic, Dr. Choudhry noted that Lightning Bolt allowed Ochsner to quickly and seamlessly build schedules for COVID ICUs as they were opened. Physicians could also indicate in the system whether they preferred to work in the operating room or the ICU, which added a degree of control to an often-uncertain situation.

In addition to the results Ochsner presented at the conference, the organization has seen other notable improvements after implementing Lightning Bolt:

  • Auto-generation and publication of schedules through Lightning Bolt saves Ochsner roughly 720 hours per year versus previous scheduling methods.
  • Vacation request approval has increased by 55%.
  • Lightning Bolt has improved OR case handoffs, saving Ochsner $600,000 per year.
  • The use of reporting has allowed for greater transparency and helps physicians to better understand equalization rules. For example, it’s easy to demonstrate that weekend work is being evenly distributed to avoid any one person feeling like they’re shouldering too much of the load.
  • Integration with Epic On-Call Finder has improved transfer center operations and yielded better speed to care for patients.

Taken as a whole, Ochsner’s experience with Lightning Bolt is a strong endorsement of advanced scheduling technology and the many ways it can improve the lives of providers, staff, and patients. When providers have more control of and better visibility into their schedules, and when they know those schedules can be built equitably while accounting for their personal preferences, they are more likely to be satisfied at work. Greater provider satisfaction often leads to better patient care, better retention, and better metrics across the board.

We thank our friends and partners at Ochsner not only for presenting their findings, but also for reminding us that healthcare technology has the power to change, improve, and even save lives every day.

Ready to learn more about transforming your organization through better scheduling?

Citations

  1. Clinician Burnout 2021, KLAS Research Arch Collaborative, Jacob Jeppson, Dec. 3, 2021: klasresearch.com/report/clinician-burnout-2021-covid-19-increasingly-cited-in-rising-burnout/2080
  2. Using AI to create work schedules significantly reduces physician burnout, study shows, American Society of Anesthesiologists, Jan. 28, 2022: asahq.org/about-asa/newsroom/news-releases/2022/01/using-ai-to-create-work-schedules-significantly-reduces-physician-burnout

Develop a Clinical Communication Governance Strategy

Ensure the investment you’ve made is used and adopted as intended

Governance is an important tool organizations use to ensure that software implementation and adoption aligns with business goals and complies with external regulations. A good governance program offers a framework for achieving measurable progress toward organizational objectives and maintaining compliance standards.

Adding to operational complexity, organizations now operate in an environment defined by distributed networks, distributed teams, and cloud-based everything, and a rapidly expanding big data ecosystem that’s becoming increasingly difficult to control.

A good governance system addresses these issues and is designed so that assets such as clinical communication tools provide maximum value to healthcare organizations and patients.

To make governance work for your organization, we’ve developed a checklist to help you manage your Clinical Communication Governance Strategy.

HIPAA Compliant Texting: Tips on Patient Communication

With the number of smartphone users in the U.S. expected to cross the 300 million milestone in 2022, it’s now possible to connect with anyone at almost any time.1 This digital transformation gives healthcare providers, patients, and family members a great opportunity to communicate during and after care.

Here are some ways HIPAA-compliant secure messaging can help, especially during times when going to hospitals and medical practices in person isn’t always an option.

HIPAA Compliance Rules Explained for Healthcare

The rules for HIPAA compliance in healthcare prohibit medical providers—including physicians, nurses, and staff—within the practice from releasing protected health information (PHI) without the consent of the patient or guardian. All health organizations are required to train their staff annually on how to comply with HIPAA regulations. With the installation of HIPAA-compliant software like PerfectServe, providers can safely integrate patient communications in secure clinical messaging.

Healthcare Before HIPAA

Have you ever wondered what healthcare was like before HIPAA? Before the introduction of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the U.S. Department of Health and Human Services (HHS) did not have a National Health Privacy Law, and patients relied on laws in each state about patient privacy. HIPAA was created to set national standards to protect PHI from being disclosed without the patient’s consent or knowledge.2

Healthcare After HIPAA

After HIPAA was established, medical providers had new guidelines for protecting patient information, regardless of their practice size or specialty. Today, HIPAA requires all practices to attain patient consent forms to use PHI for healthcare delivery, payments, practice communications, and other uses of PHI for marketing or research purposes.3

How Does Secure Patient Communication Work?

Traditionally, practices and medical providers have been forced to use multiple platforms to achieve secure patient communications. Ensuring all information on multiple platforms is current and correct requires more staff and time. Now, they have options to streamline the workflow for health information, provider communication, reminders, HIPAA-compliant texting, and patient records all within one platform.

Voicemail and Phone Message Prompts

Different medical practices use voicemail and phone message prompts as conduits for communicating securely with their patients. But this method of communication is often cumbersome, requiring a lot of follow-ups and tracking, which leaves the door open for missing information. Practices have often found a positive response in patient satisfaction, appointment scheduling, and overall communication when switching to a streamlined and secure messaging patient platform.

Secure Medical Texting

Smartphones are veritable Swiss Army knives these days—they’re used for communicating, maintaining calendars, browsing the internet, wayfinding, and many other tasks or activities. To emphasize the immediacy of contact when smartphones are in play, one research article indicated that 90% of people read a text message within the first three minutes, whereas emails are often overlooked.4 Allowing communication between healthcare providers through secure HIPAA-compliant texting creates a win-win for not only the patient experience, but also the medical practice managers and hospital staff.

Secure Clinical Messaging for Better Patient Communication

PerfectServe provides HIPAA-compliant secure texting solutions to empower clinicians to text nurses, physicians, patients, and family members all in one app that can include attachments, videos, and more for communication purposes. As medical providers, it’s crucial to obtain accurate, up-to-date information and reminders for each of your patients.

Text Messages Help with Patient Reminders

One PerfectServe client, Ridgeview Rehab Specialties, was able to reduce no-show appointment rates by 12.6% using automated secure text messages to patients. Ridgeview reported 6,264 no-show appointments in 2016 and realized it was imperative to make a change using new technology to streamline messaging. Over two years, the switch to secure text reminders resulted in more patient engagement and fewer no-show appointments. Overall, the facility was able to reduce no-show appointments by 792 annually with an estimated revenue gain of $138,600.5

Providers Can Message Patients on the Fly

Having access to reliable connectivity across locations makes it easy to deliver timely communication and care. Providers can use secure video, voice, and HIPAA-compliant text messaging from specialty practices to the hospital staff while using a phone, tablet, pager, computer, or landline. Organizations with more advanced PerfectServe deployments have even embedded the communication platform directly within the EHR, which allows providers to cut back on time spent toggling between devices and other apps by up to 76.3%. Imagine being able to admit a patient into the ER, receive blood work, and contact their primary care physician all within one platform.

Integrations are another key differentiator that set PerfectServe apart from similar HIPAA-compliant texting apps. Unnecessary provider disruptions can be avoided by integrating schedules with workflow engines, and integration with the EHR to incorporate information like patient lists unlocks a wide number of valuable workflow capabilities. Integration with the nurse call system frees nurses from the bedside by giving them the ability to monitor and respond to patient alerts and requests from any location, especially if they’re equipped with smartphones.

PerfectServe provides secure messaging, connectivity from any location, accessibility on all devices, embedded EHR messaging, automated routing, and improved workflows all from one easy-to-use application.

For more information, read how secure text and video messaging helped other practices communicate effectively across the care continuum.

1O’Dea, S. (2021, March 19). Number of smartphone users in the United States from 2018 to 2025 (in millions). Statista. https://www.statista.com/statistics/201182/forecast-of-smartphone-users-in-the-us/

2(2018, September 14). Health Insurance Portability and Accountability Act of 1996 (HIPAA). Centers for Disease Control and Prevention. https://www.cdc.gov/phlp/publications/topic/hipaa.html

3Kibbe, C. (2001, March 8). What You Need to Know About HIPAA Now. Family Practice Manager, 8(6):43-47. https://www.aafp.org/fpm/2001/0300/p43.html

4Lane, N. (2010, June). Conversational Advertising. MobileSquared. https://mobilesquared.co.uk/wp-content/uploads/2017/12/Conversational-Advertising.pdf

5PerfectServe Success Stories. Ridgeview Rehab Specialities department reduces non-show rates by 12.6% with automated text messages to patients. https://www.perfectserve.com/success-stories/ridgeview-rehab/

AnesthesiaGo: How Software Can Help Operating Room Scheduling

Healthcare is a noble profession, but as many will attest, clinicians still have to overcome far too many daily obstacles to do what they were trained to do—treat patients.

Eliminating these obstacles with smart technology has been PerfectServe’s remit for 25 years. To be sure, medicine will always require some level of human oversight, but when you can automate manual processes that cause delays and add frustration, you’re going to make clinicians very happy. 

Provider Scheduling has been doing this for years by automating the creation of provider schedules, and the newest solution to join the PerfectServe fold—AnesthesiaGo, which auto-generates daily OR case schedules—is cut from the same cloth.

Disrupting the Operating Room Case Scheduling Process

When AnesthesiaGo’s founder, a practicing anesthesiologist by the name of Dr. Mike Bronson, was unexpectedly given the responsibility of building daily OR case schedules for his group, he came face to face with a vital process that was in desperate need of a revamp.

Image of Dr. Mike Bronson

This responsibility is usually given to a senior anesthesiologist, and it’s normal to find them building the next day’s schedule in the late afternoon or early evening—after they’ve dispensed with their clinical duties. Depending on the size of the group, it can take anywhere from 45 minutes to a few hours to finish this process. After the schedule is sent out, it’s also inevitable that the creator receives texts, phone calls, and emails requesting revisions.

Taking on this kind of tedious task after finishing a day of procedures is, to say the least, not ideal. And that’s why Dr. Bronson was convinced he could do it better with technology.

With help from a friend who had deep experience in the fields of data analytics, advanced algorithms, and UI/UX designs, Dr. Bronson spent four months studying past data and figuring out different ways of scheduling. The next ten months were spent building the basic solution infrastructure, laying a foundation for the algorithms, and then optimizing said algorithms.

Image of clocks and provider schedules

Case Scheduling with AnesthesiaGo

The solution born from all of this work, AnesthesiaGo, has four main goals:

  • Be Faster: Save hours (or even days) each week by cutting time required for schedule creation.
  • Use Automation: Leverage technology to reduce administrative burden.
  • Reduce Human Error: Minimize double-bookings, scheduling someone at a location for which they’re not credentialed, not leaving enough time for travel between locations, etc.
  • Improve Efficiency: Find a better way to create daily case schedules.

To put it simply, AnesthesiaGo aligns the best anesthesia provider to the best case schedule, promotes efficiencies and transparency for all surgical staff, and helps prevent delayed or canceled cases associated with less optimal—but still very common—manual scheduling methods.

12 Minutes to deliver care

The proof is in the pudding, too. AnesthesiaGo customers can now auto-generate and deliver a daily case schedule in just 12 minutes on average, which is down by 44 minutes versus traditional manual scheduling methods. That’s almost an 80% improvement!

And taking it a step further, AnesthesiaGo also leans heavily into provider wellness by supporting the concept of teaming (sometimes called “best matches”). For a variety of reasons, it’s common for anesthesiologists and surgeons to have well-defined preferences about who they work with during a procedure, and AnesthesiaGo will pair these optimal teams as frequently as possible. It sounds pretty simple on its face, but by including this functionality, AnesthesiaGo helps to improve provider satisfaction and wellness while facilitating continuity of care.

Anesthesiologist and Medical Providers with a Checkmark

In an interview with AIMed, Dr. Bronson noted that anesthesiologists often deal with life-threatening, traumatic events. But despite the high stakes of their clinical duties, “the most stressful part [of our jobs] is not about saving lives, but handling the paperwork that needs to be completed in the shortest possible time.”

AnesthesiaGo can make that stressful paperwork a thing of the past. Learn more about our Case Scheduling for Anesthesia Staff, or fill out the form below if you’d like a member of our team to contact you for a demo.

Healthcare Trends in 2022: Top 6 Needs to Consider for Medical Groups

The pandemic has accelerated some of the healthcare trends that were on the rise before 2020. In our interview with Dr. Rodrigo Martínez, practicing otolaryngologist and Chief Medical Officer with PerfectServe, and Matt Kothe, Manager of Corporate Communications, they unpack the six factors healthcare organizations need to understand for their staff and patients.

Read below for a deeper explanation of these trends and needs expressed in the interview with Dr. Martínez.

Digital Transformation Management

Digital tools allow individuals to send messages through methods like HIPAA-compliant secure messaging. Whether it’s between clinicians, or to patients and family members, it’s crucial to implement a controlled workflow for this communication. Without digital management in your healthcare system, you run the risk of potentially overwhelming clinicians, which is less than ideal given observed burnout levels across the industry.

When a patient takes time to log into a portal and send a message, not getting a timely response can dissuade them from trying to engage with their healthcare provider in the future. If that patient includes important medical information and nothing is being done, it can have devastating consequences.

Here are a few questions an organization can ask when setting up new technologies:

  • Is someone sending a message to someone else? 
  • If yes, who is it going to, and who is responding? 
  • Does the current workflow include the appropriate recipient?

Developing basic workflow hygiene will help, especially when the communication involves time-sensitive medical issues. 

Adapt to Competitors

With consumer behaviors evolving, the ability to create a better patient experience is key to the success of your organization. Competitors like large retail pharmacies now offer on-site healthcare services, with customized, easy reminders and interfaces for patients. They are leveraging technology to provide all-encompassing healthcare services—a push health systems can no longer ignore.

A few examples:

  • CVS Pharmacies now have the ability to schedule appointments and exchange information online, in addition to having a pharmacy on site. CVS offers services for their walk-in patients called the MinuteClinic®, which provides care similar to a primary provider for things like skin conditions, minor illnesses, and wellness check-ups.
  • Walgreens started offering similar walk-in services at their Community Clinic in 2017, treating chronic conditions and patients 12 months and older.
  • One Medical is also leveraging technology to provide a more all-encompassing healthcare approach and currently offers options in major cities across the U.S.

Interoperability

Sharing critical information with competitors hasn’t been in the best interests of many companies. Instead, the burden of moving or transmitting medical records from one format or location to another often falls to clinicians, nurses, and even the patients themselves.

In non-clinical settings, it’s possible to send an SMS message using multiple tools, but the problem is you cannot typically send messages between these tools. Exchange standards have not been established, and connecting these disparate tools is challenging. Even so, progress has still been made between a few EHR vendors, which use technology that functions as an intermediary.

True interoperability with “one app to rule them all” is not a reality at the moment, but it’s still the “holy grail” of healthcare technology needs. Not enough tools are robust or extensive enough to handle the complexities of modern healthcare. However, solutions are underway to build integrations and other interoperability workflows, such as PerfectServe’s simple one-tap messaging features.

Address Provider Wellness and Burnout

There is no silver bullet for improving clinician wellness by addressing burnout. Pre-pandemic burnout influences are certainly different from the ones experienced post-pandemic. In the initial phase of the pandemic, even with the overwhelming number of sick patients, clinicians and providers rose to the challenge, thinking, “Okay, this is what I’ve trained for all of my life.”

But, the simple truth is that sustaining an emergency state can tire and negatively impact humans in a very profound way. It creates unendurable situations where people are physically and emotionally drained. Adding to the challenge is the fact that a sizable portion of the population in the United States has not been vaccinated, which has created a bit of an “empathy gap” for some medical professionals who desperately need relief but continue to see avoidable COVID hospitalizations. When developing technology, it’s important to be sensitive to current circumstances so you can offset some of the more onerous inputs clinicians deal with every day.

Nursing Shortage

Nursing shortages affect all layers of healthcare. This trend has been on the radar for a while, but the COVID pandemic has exacerbated the problem as some nurses have left the profession entirely for a number of reasons. Further, if you’re a nurse or physician, you’re also a husband, wife, brother, sister, son, or daughter. If your loved ones get sick, you’re not able to serve patients at the same time. When you throw in additional patient surges, it makes the workload of those who remain more challenging, creating a snowball effect.

Empathy in Healthcare Technology

The people on the front lines of the pandemic have always been heroes, but their efforts have truly been herculean over the past few years. If we develop collaboration technology in these circumstances—which PerfectServe certainly does—we have to be proactive and responsive to current needs while using our product innovations to offset and redirect some of the administrative or logistical inputs that add to care team toil. Much of PerfectServe’s technology reduces these kind of burdens for health systems and their staff every day.[/vc_column_text][/vc_column][/vc_row]

Invest in the Patient Experience

In the U.S., healthcare is not just the individual interactions between a patient and their physician, nurse practitioner, or other caregiver. It takes a team to provide optimal care for an individual patient. Examining how to facilitate and maintain these workflows efficiently needs to be at the forefront of patient care.

Healthcare Technology Solutions for Patients

When designing clinical collaboration solutions, healthcare software providers need to keep the patient experience in mind.

As people grow older and acquire chronic diseases, personalizing care will be important. We have the remote technology to reach patients outside clinic and hospital walls, yet it’s the application and collaboration of these tools that will make a difference in patient outcomes.

As more emphasis is placed on taking care of patients at a distance, the pandemic has forced us to move into the realm of what you might call “healthcare 2.0.” Some of these advances are long overdue, while others are just in the beginning stages.

The intelligent application of analytics and AI could help siphon through data to emphasize important things so the right people can take timely action, or automate the correct action. Using technology this way should ultimately lead to improved and more personalized care for all patients.

Asynchronous Healthcare Delivery

What comes to mind when you think of an ideal experience with a provider?

Whether it’s seeing your physician, having an interaction with a nurse in the hospital, or a visiting with a team of chronic disease care nurses, these consultations can happen face-to-face, by phone, or over a video call.

With technology, you can start collecting most of the information for better care ahead of time without having to wait for a live interaction, minimizing the need to fill paper forms on-site.

How does this help healthcare professionals and their patients?

Asynchronous Healthcare Delivery Outcomes

Asynchronous technology offers a new convenience for individuals who are comfortable revealing their information to the healthcare provider, feeling confident everything has been packaged correctly in written form. Many adults don’t seek in-person care because it can be inconvenient, taking hours to plan and get to a clinic. This technology creates more convenient methods for patients to seek quality care.

It allows access to healthcare for individuals whose schedule may not align with the provider at the moment of the live visit. This helps care team members in the prioritization process. Digital, asynchronous technology can allow one person to interact with many people, improving care outcomes for all of them.

Safe and Transparent Healthcare Communication

Technology helps medical providers gather a lot of patient information ahead of time, and it allows everything to be collected and then placed in a queue so a human can review it. A digital intake form is just one example, and sometimes patients are more comfortable writing down a message about their health condition versus talking about it during a face-to-face interaction. Sometimes patients prefer a phone call and don’t want to be seen on Zoom, or they’re perfectly happy writing out information for the physician to get back to them.

5 Ways Clinical Communication Technology Reduces Clinician Workload

A clinical collaboration platform can make it easier and quicker for physicians to coordinate care inside and outside the organization, giving physicians more time to focus on patients.  With increased demands for documentation, streamlined communication can help reduce click fatigue and better support physician work-life balance. Click on the image below to get the infographic!

Ready to see what PerfectServe can do for you?

How to Improve Nursing Communication and Collaboration

Nurses are trusted experts who provide incredible patient care. The profession is a calling, a passion, and it is incredibly important that we have the nursing workforce that prioritizes caring for themselves to be fully present for the patients who need them.” – Ryannon Frederick, Chief Nursing Officer, Mayo Clinic, (Becker’s Hospital Review).1

Outdated systems, silos, and disconnected communication among nurses and physicians cause added strain to an already in-demand nursing workforce.2 Nurses can work 9-5 at an acute care facility or they can be seen pushing through 10 to 12-hour rotations. In every situation, nurse communication is a crucial part of their shift, as they are required to share accurate patient information between care providers, in addition to the other responsibilities required of a front-line caregiver for patients and their families. 

If they had a list of additional job descriptions and responsibilities, it would include:

  • Prescription Interventionist
  • Medical Administrator/Transcriptionist
  • Emergency Responder
  • Counselor/Therapist
  • Care Coordinator
  • Educator 
  • Server
  • Mechanic
  • IT Troubleshooter
  • You name it, they probably do it.

Let’s now look at how nurses communicate and balance responsibilities in different contexts.

Nurse Collaboration at Hospitals and Clinics: The Current Situation

Nurses at Hospitals

Imagine you’re in the ED. You have to react moment by moment in the queue as patients pour in, decompensating right in front you. How do you respond? Which patients need care faster? These nurse triage decisions can feel overwhelming.

Now imagine you’re a nurse on the labor and delivery floor. Last-minute emergency C-sections, women rapidly moving through the stages of labor, and patient screams echoing through the hallways. An infant may get rushed and transferred to the NICU for additional neonatal nursing care. It may be an intense, yet rewarding experience when the babies arrive.

Nurses face many different scenarios ranging from geriatric to post surgery care, all while maintaining required documentation demands and changing shift schedules. Nurses have to collaborate quickly and there is a need for communication to be efficient, timely, and reliable. If nurses need to make frequent calls to another care provider, patients may not receive adequate treatment on time.

Nurses at Private Practice Clinics

Imagine this situation at a medical specialist office. They have 2 main clinic locations, and different patient demographics visit each site. Nurses are required at both locations, yet office A is open until 7 PM while office B closes at 5 PM.

It’s 5:10 PM. One patient who regularly visits office B accidentally calls office A from their Google search, thinking they can walk-in to the clinic. The call messaging routes them incorrectly to office A. The covering on-call nurse says it’s okay for them to check in to the office for their chronic condition. However, the on-call nurse doesn’t see in their health record which location this patient usually visits, and there is a lack of notes on file. The nurse waits for a long time, and the patient doesn’t arrive. Frustrated about a lack of provider collaboration and communication, the patient leaves a 1-star review online for the clinic.

The next day, the physician and nurse on-call at site B call site A, disappointed their clinic location received a low patient satisfaction rating. They get the practice owner and manager involved. Now they have a warning discussion with the nurse on-call, when it was truly a breakdown in communication systems for their healthcare clinic.

The physician and nurse collaboration framework in this faux scenario led to poor patient outcomes. In one real-life study, nurses may not always have input or say on how a medical practice is managed. “The participants stated that if nurses were more involved in the development of nursing policies, this would have a positive influence on patient care.”3

Poor communication between clinicians and patients can result in misunderstandings about medications and the miscommunication of follow up instructions, which can result in poor outcomes and readmissions, and could result in a patient coming to harm.4

Whether nurses work for a hospital or private medical practice, better scheduling collaboration and nurse communication software is needed. If nurses are able to find the best communication options for their day-to-day interactions, it would significantly reduce barriers to effective healthcare treatments.

How to Improve Nurse Collaboration for Better Support

Some nurses said they felt like labourers…if you’re not valued at work, you don’t have the desire to stay in the public system.5

Nurses Need Opportunities to Receive Care in Order to Give Care

Nurses are in short reserve, but the demand for nurses continues to grow. What can hospitals and group practices do to alleviate their stress? Organizations may increase pay incentives, but is that enough? It’s not just about the money.

Nurses need a platform to communicate not only the needs of their patients, but for their colleagues as well. Promoting team-based care, sharing of new evidence-based care guidelines, and management of staffing shortages are strategies that leaders can rely on for effective communication platforms. This reduces the burdens experienced by nurses.

When Nurses Collaborate, Patients Feel It

With all the roles nurses fill, it’s important for them to communicate in a timely manner. Nurses may leave due to burnout and better pay opportunities,6 and this could result in more miscommunication mistakes among staff. This leads to poor patient outcomes and expensive provider costs. However, there is good news…

When nurses have time to collaborate patient care through text, cell, EHR, or face-to-face, the results improve for patients and providers. Hospital executives and nurse leaders who take time to care for their teams and find appropriate medical communication solutions will create bright spots for the future of nursing.

Need a better way for nurses and clinical teams to communicate?

See how PerfectServe’s medical communication software can eliminate wasted time and help nurses be more efficient.[/vc_column_text]

1Jensik, L. (2021, October 29). Will nurses come back? 3 healthcare leaders weigh in.Becker’s Hospital Review. https://www.beckershospitalreview.com/hospital-management-administration/will-nurses-come-back-3-healthcare-leaders-weigh-in.html
2NursingTimes. https://www.nursingtimes.net/news
3Kieft, R.A., de Brouwer, B.B., Francke, A.L. et al. How nurses and their work environment affect patient experiences of the quality of care: a qualitative study. BMC Health Serv Res 14, 249 (2014). https://doi.org/10.1186/1472-6963-14-249
4Effects of Poor Communication in Healthcare. HIPAA Journal, https://www.hipaajournal.com/effects-of-poor-communication-in-healthcare 
5Wilton, K. (2021, September 16). ‘Not about the money’: Nursing report addresses exodus from Quebec’s public sector. Montreal Gazette. https://montrealgazette.com/news/local-news/not-about-the-money-nursing-report-addresses-exodus-from-quebecs-public-sector 
6Virkstis, K. (2021, August 12). Why so many nurses are leaving amid delta—and how you can keep them. Advisory Board. https://www.advisory.com/Daily-Briefing/2021/08/12/nurse-shortage#our-take-weve-reached-the-tipping-pointhow-do-organizations-move-forward-see-our-3-keys