Reflective Paper – She’s Strict For A Good Reason

/in /by

For four years, we studied 31 highly effective teachers in nine low-performing urban schools in some of the most economically depressed neighborhoods in Los Angeles County, Calif. The first thing that struck us was how strict the teachers were. But it was a strictness that always was inseparable from a grander pur- pose, even in students’ minds. For example, a 2nd grader admitted, “Ms. G kept me in the classroom to do my work. She is good-hearted to me.” A high school math student wrote, “I think Mrs. E is such an effec- tive teacher because of her discipline. People might think she is mean, but she is really not. She is strict. There is a difference. She believes every student can learn.”

She’s Strict for a Good Reason

Highly Effective Teachers in Low-Performing Urban Schools

Studying the work of highly effective teachers can help us better understand what really works to improve student learning and help us avoid practices that are complicated, trendy, and expensive.

By Mary Poplin, John

Rivera, Dena Durish, Linda

Hoff, Susan Kawell, Pat

Pawlak, Ivannia Soto

Hinman, Laura Straus, and

Cloetta Veney

kappanmagazine.org V92 N5 Kappan 39

MARY POPLIN is a professor of education at Claremont Graduate University, Claremont, Calif. JOHN RIVERA is a professor and special projects assistant to the president, San Diego City College, San Diego, Calif., and the study’s policy director. DENA DURISH is coordinator for alternative routes to licensure programs for Clark County School District, Las Vegas, Nev. LINDA HOFF is director of teacher education at Fresno Pacific University, Fresno, Calif. SUSAN KAWELL is an instructor at California State University, Los Angeles, Calif. PAT PAWLAK is a program administrator in instructional services at Pomona Unified School District, Pomona, Calif. IVANNIA SOTO HINMAN is an assistant professor of education at Whittier College, Whittier, Calif. LAURA STRAUS is an instructor at the University of Montana Western, Dillon, Mont. CLOETTA VENEY is an administrative director at Azusa Pacific University, Azusa,

T h in

ks to

c k/

C o

m st

o c k

 

 

The teachers we studied had the highest percent- age of students moving up a level on the English/lan- guage arts or math subtests of the California Stan- dards Test (CST) for two to three years. Toward the end of the school year, we asked their students why they thought their teacher taught them so much. One Latino 4th grader summed up much of what we discovered: “When I was in 1st grade and 2nd grade and 3rd grade, when I cried, my teachers coddled me. But when I got to Mrs. T’s room, she said, ‘Suck it up and get to work.’ I think she’s right. I need to work harder.”

We began our study with three questions: Are there highly effective teachers in low-performing ur- ban schools? If so, what instructional strategies do they use? And what are their personal characteris- tics?

There are highly effective teachers in these schools, and we chose 31 of them for our study. They included 24 women and seven men; 24 taught Eng- lish/language arts, and seven taught math; 11 taught in elementary schools, nine in middle schools, and 11 in high schools. In the year they were observed, these teachers’ CST data revealed that 51% of their students moved up a level, 34% maintained their lev- els, and only 15% dropped a level.

These results were very different from those of their peers teaching in the same schools. For exam- ple, in three high schools, we calculated every teacher’s achievement and found disheartening data. Fifty percent of the English teachers and 60% of the math teachers had between 30% and 75% of their

40 Kappan February 2011 kappanmagazine.org

Are there highly effective teachers in low-performing urban schools?

If so, what instructional strategies do they use?

What are their personal characteristics?Th

in ks

to c k/

B a n a n a S

to c k/

C re

a ta

s/ C

o m

st o

c k

 

 

kappanmagazine.org V92 N5 Kappan 41

students dropping a level in a single year. Sixty-five percent of the English teachers and 68% of the math teachers had the same number or more students go- ing down a level as going up.

Clearly, the highly effective teachers were differ- ent. What was happening in their classrooms? Who were these high performers?

THE CLASSROOM

Strictness. These teachers believed their strictness was necessary for effective teaching and learning and for safety and respect. Students also saw their teacher’s strictness as serving larger purposes. Students ex- plained that their teacher was strict “because she doesn’t want us to get ripped off in life,” “because she wants us to go to college,” “because she wants us to be at the top of 2nd grade,” “because she wants us to be winners and not losers,” and “because he has faith in us to succeed.”

Instructional intensity. The second most obvious characteristic was the intensity of academic work. There was rarely a time when instruction wasn’t go- ing on. Our first visit to the only elementary teacher identified for mathematics gains found Ms. N marching her 1st graders to the playground as they chanted, “3, 6, 9, 12, 15. . . 30” As the year progressed, they learned to march by 2s through 9s; by May her “almost 2nd graders” could multiply. She told us that she appreciated the standards as guides — “to know what I’m responsible for teaching” — and that she always tried to “push the students just a little bit into 2nd grade.”

The teachers transitioned from one activity to an- other quickly and easily. Many of them used timers, and students often were reminded of the time re- maining for a particular activity. At one school, teachers met students in the hallway during the pass- ing periods and talked with them. When the final bell rang, these teachers instructed students on ex- actly what should be on their desk when they sat down: “When you get inside the door, take your jack- ets off; get out your book, pencil, and notebooks; then put everything else in your backpack and un- der your desks.” As students entered, conversations ended and students prepared for work.

Most teachers began with an overview of the day. In some cases, students were required to copy the daily agenda in their notebooks — “In case your par- ents ask you what you learned today, I want you to be able to tell them.”

Movement. Perhaps the single most productive practice of most of these teachers was their frequent movement around the classroom to assist individual students. The time spent at students’ desks provided

feedback on the effectiveness of their instruction, kept students on track and focused, offered individ- ual students extra instruction and encouragement, and even allowed for brief personal interactions be- tween teachers and students. This simple, almost in- stinctive activity of walking around accomplished scores of purposes naturally — individualized and differentiated instruction, informal assessments, teacher reflection, teacher/student relationships, re- sponse to intervention (RTI), and classroom man- agement. By walking around, teachers came to know their students. For example, Mrs. M asked a middle school student whose head was on his desk what was wrong. He replied, “I don’t feel so good.” She headed toward him, proclaiming, “Remember what I always tell you, you’ll feel much better when you get your work done. Here, let me help you.” She stayed by his side until he had a good start on his work. We rarely knew which students were classified as special educa- tion or English language learners because teachers’ personal assistance helped mask this.

Traditional instruction. Traditional, explicit, teacher- directed instruction was by far the most dominant in- structional practice. We were constantly reminded of Madeline Hunter’s sequences — anticipatory set, in- put, modeling, checking for understanding, guided practice, monitoring, closure, independent practice, and review. Instruction was, for the most part, un- abashedly and unapologetically from the state stan- dards and official curriculum materials. Ms. N told us, “Open Court is very helpful and gives you good pac- ing.” This surprised the team, as there had been a good deal of contention in Los Angeles over requiring this series.

Typically, following energetic content presenta- tions and demonstrations, teachers entered into whole-class discussions. Students were called on ran- domly and had to use full sentences and high-level vocabulary. Teachers always pushed students (a term used by teachers and students). Ms. P said to one young girl, “That is absolutely correct! Now, can you say that like a 5th grader?” At one elementary school,

The single

most

productive

practice of

most of

these

teachers was

their

frequent

movement

around the

classroom to

assist

individual

students.

T h in

ks to

c k/

C re

a ta

s

 

 

teachers required students to reference the previous student’s comment before offering their own; this encouraged students to pay attention to one another. Teachers followed instruction and discussion with independent practice. At this stage, they began mov- ing around. One teacher said, “If I see two or three having trouble, I stop, go back, and teach it another way.”

What we saw least was also instructive. There were very few constructivist projects in their classrooms. The ones we saw were short-lived, and they often appeared to be used more as practice or a reward for learning than as a route to it. Cooperative and col- laborative learning activities were also limited except in two classes. Most cooperative activities were brief pair-shares. Some of our teachers were adamantly opposed to it. High school teacher Mr. Mc told us, “In school, I helped 500 students get a better grade, 495 of whom learned nothing from the experience.” His counterpart, Mr. T, said, “It’s not realistic.” From the back of the room, the team often observed that even the best cooperative activities allowed for a good deal of irrelevant socializing.

Though the teachers were from a variety of eth- nic groups, we saw very little evidence of overtly planned activities that directly addressed culture un- less it was built into curriculum materials. Cloetta Veney (2008) studied two of our elementary schools’ classrooms and concluded that they resembled those in the effective classroom literature of the 1980s more than today’s cultural proficiency models. When we asked teachers to describe their classrooms to a stranger, not one of the 31 used race, class, or eth- nic terms.

Pat Pawlak (2009) found that the students of these teachers said — 60% more frequently than any other comment — that their teacher helped them because he or she explained things over and over. We consis- tently found that students expressed appreciation for explicit instruction with patience.

Exhorting virtues. Every few minutes, these teach- ers encouraged students to think about their future and to practice particular virtues. The top virtues were respecting self and others, working hard, being responsible, never giving up, doing excellent work, trying their best, being hopeful, thinking critically, being honest, and considering consequences. Re- spect was paramount, and even a small infraction drew quick rebuke and consequences.

Teachers always linked doing well in school to go- ing to college and getting good jobs so that they could someday support their families and own houses and cars. Mrs. C told her students how missing one word on a spelling test lost her a job she desperately wanted and needed. Ms. P told of problems she had

experienced in her life. One of her students told us, “She has passed through some trouble in her life and does not want that to happen to us. So, she is prepar- ing us for troubles and telling us what is the best choice.”

These teachers focused less on making the work immediately relevant than on making the link to their futures. Even 2nd graders knew this — “Ms. G is weird, strict, mean, and crazy. This classroom is smart and nerdy because she wants you to go to col- lege.”

Strong and respectful relationships. The teachers had a profound respect for students. There was a sense that teachers were genuinely optimistic for their stu- dents’ futures. Teachers often provided students with a vision of their best selves. Middle school teacher Ms. P told us, “All students need to know that you respect them and care for them. Fortunately, that is very easy. I try to make sure every so often that I have said something personal to each of them.” She bent down at a student’s desk and said, “Alejandro, I can see you are very good at math. I look forward to see- ing what you will do in your life.” Now, Alejandro has heard from a respected adult outside his family that his math skills may play into his future.

Respect for students is a more accurate descrip- tion of what we saw than simply caring for the stu- dents. The teachers did not need the students to love them; they needed to see their students achieve. Ms. B said, “I’m hard on my students, but at the same time, they know it is out of love. I’ve had to fail some students. . . . When I see them in the hall, they still greet me. They tell me they wish they were back in my class — they say they know why they failed my class.”

THE HIGH-PERFORMING TEACHERS

Though they shared common strategies, the teachers were quite diverse — 11 were black, nine white, seven Latino, three Middle Eastern Ameri- cans, and one Asian-American. Their ages ranged

42 Kappan February 2011 kappanmagazine.org

When we asked

teachers to describe

their classrooms

to a stranger,

not one of the 31 used race, class,

or ethnic terms.

T h in

ks to

c k/

iS to

c kp

h o

to

 

 

from 27 to 60, and years of experience from three to 33. Two-thirds of the teachers (23) were educated in nontraditional teacher education programs — teach- ing before they finished their credentials. Nearly half (14) were career changers. Almost one-third (9) were first-generation immigrants. While they were all highly effective, few fit the definitions of highly qualified in terms of National Board certifications and degrees.

The teachers were strong, no-nonsense, make-it- happen people who were optimistic for students’ fu- tures, responsible, hard working, emotionally stable, organized, and disciplined. They were also ener- getic, fit, trim, and appeared in good health. They were comfortable in their own skins and humorous. Ms. M told her high school students, “If you develop multiple personalities, you better assign one to do your homework.”

What do they believe? Their most central beliefs in- clude:

1. Every one of my students has much more potential than they use;

2. They have not been pushed to use it;

3. It is my responsibility to turn this situation around;

4. I am able; and

5. I want to do this for them.

Ms. M said simply, “They can do and be so much more.”

Teachers didn’t use the students’ backgrounds as an excuse for not learning, and yet they were not naive about the challenges facing some students. They had confidence that what they did in the class- room would truly help students.

Teachers had a pragmatic attitude about testing. “It’s required all your life,” Mr. T told us. Mrs. C said of the district assessments, “I really like them, I like them a lot. I’ve been embarrassed by them a few times, but I am all for them.” Ms. K said, “When stu- dents don’t do well, I take it personally. I know I shouldn’t, but I think that that bothers me.” These teachers neither taught to the tests nor ignored them; tests were simply another resource.

Several additional incidents were instructive for those of us who work in teacher development, su- pervision, and evaluation. First, not one of our teach- ers had any idea that they were more successful than their colleagues teaching similar students. The stu- dent achievement data that was available to them did not allow for such comparisons.

Second, in a couple of cases, the principals were resistant to a teacher who emerged from the data,

urging us to observe a different teacher. However, none of the nominated teachers made the cut when we rechecked the data. To be honest, when we first entered their classrooms, we also were surprised be- cause of our preconceptions about what effective in- struction should and shouldn’t look like.

An incident is instructive here: One day, Ms. N was visibly shaken after a visit from a district teacher development specialist. She told our team member that she must be a terrible teacher and didn’t think that she should be in the study. The researcher told her that she certainly wasn’t a bad teacher but, if she liked, the researcher could come back another day. This demonstrates the importance of knowing the achievement data before we target teachers for in- tervention. Many teachers in that school needed in- structional interventions, but it is counter-produc- tive to take a veteran teacher of 33 years who is highly effective year after year and to shake her confidence in order to make her use preferred strategies. Teach- ers who have demonstrated results should be granted considerable freedom in determining their class- room instruction.

The teachers respected their principals. The teachers were the authority in their classrooms, and their principals were their authorities. However, they did not seem to be particularly close to their principals because the teachers were more focused on the inside of their classrooms than on network- ing with administrators. One teacher summed up their relationships when she said, “We get along.”

CONCLUSION

Our concerns about the limitations of traditional, explicit instruction may be unfounded. What we found were happy and engaged students obviously learning from committed, optimistic, disciplined teachers. These teachers were realistic; they did not set their goals too broadly (saving children) or too narrowly (passing the test). Their students were be- ing taught that mathematics, reading, speaking, lis- tening, writing, and the formation of character are necessary for life beyond their neighborhoods.

We need to be cautious about adopting compli- cated, trendy, and expensive practices. We need to re- evaluate our affection for cooperative/collaborative learning, extensive technology, project-based learn- ing, and constructivism, as well as our disaffection with explicit direct instruction and strict discipline. These teachers were direct, strict, deeply committed, and respectful to students. Their students, in turn, respected them. Mr. L’s math students said it best: “It takes a certain integrity to teach. Mr. L possesses that integrity.” “One thing for sure, his attitude is al- ways up. He never brings us down, but we all know he has faith in us to learn and succeed.” K

kappanmagazine.org V92 N5 Kappan 43

Teachers often provided students with a vision of their best selves.

REFERENCES

Pawlak, Pat.

“Common

Characteristics and

Classroom

Practices of

Effective Teachers

of High-Poverty

and Diverse

Students.” Doctoral

dissertation,

Claremont

Graduate

University, 2009.

Veney, Cloetta.

“The Multicultural

Practices of Highly

Effective Teachers

of African American

and Latino

Students in Urban

Schools.” Doctoral

dissertation,

Claremont

Graduate

University, 2008.

HEALTH CARE ADMINISTRATION

/in /by

Hey everyone,

I need you please to read case 1 (attached file) and answer these two questions one paragraph for each.

1- Given the complexity associated with appropriate EMR analysis and implementation, please identify at least five representatives to be on the EMR Task Force. Please identify why these representative where chosen and the positives and negatives each party brings to the table. (External research from respectable sources is required to answer this question. Please ensure to number your representatives).

2: Please list and explain five factors associated with successful implementation and adoption of EMR systems at organizations similar to that of Saint Vincent Health System? (External research from respectable sources is required to answer this question. Please number your factors and ensure to explain why each factor was chosen).

Thank you.

Introduction

 

Saint Vincent Health System is a large academic medical center based in Bolder Colorado. Saint Vincent Health Systems is associated with the state university, and includes three hospitals, a medical clinic facility, a medical research complex, and affiliated primary and specialty group practices spread throughout the region. Saint Vincent University Hospital is the main hospital campus with 500 inpatient beds and equipment and facilities that are considered state of the art. Saint Vincent Health System is well known for its cancer and rehabilitation service lines, and has recently expanded its cardiac service line in an attempt to keep up with the increasing demand.

 

Despite strong clinical services lines and an excellent reputation, Saint Vincent Health System has been reluctant to adopt new clinical information technologies (IT) such as computerized provider order entry (CPOE) systems or a more comprehensive electronic health record (EHR) system. Instead, Saint Vincent Health System’s services are mainly supported by paper-based processes, and a strong team in the medical records department that has been able to expand with the health system’s growth.

 

Changing Health System Leadership

 

Dr. Craig Johnson has just been appointed CEO of Saint Vincent Health System, and has come to the Bolder area after serving five years in his previous position as CEO of a 200-bed community hospital. Dr. Johnson’s predecessor, Jeffrey Ash had retired after serving 20 years as Saint Vincent Health System’s CEO, while the announcement of a new CEO was not unexpected, this change in leadership has left the organization unsettled, and staff and affiliated physicians are anxious about the new changes Dr. Johnson may bring to Saint Vincent Health System.

 

Assessing the Situation

 

Dr. Johnson is a definite fan of EHR and electronic medical record (EMR) systems, and is enthusiastic about the potential for incorporating an EMR system with CPOE capabilities into Saint Vincent Health System. In particular, he is aware of the opportunities to use an EMR system to improve Saint Vincent’s ability to provide care according to evidence-based guidelines, and to capitalize on patient safety improvements that are possible with an EMR system. Dr. Johnson knows that his daughter, Ellen, uses a handheld computer, or digital tablet, to help her keep track of her patients, check medications, and access important clinical information in her internal medicine practice, and has seen these tablets in the pockets of many of the Saint Vincent physicians as well.

 

Yet Dr. Johnson is aware of the likely resistance he will face in his efforts to introduce an EMR system throughout Saint Vincent. He has followed some of the IT implementation literature, and knows that common barriers to implementation, such as physician resistance to changes in workflow and a reluctance to use practice guidelines or “cookbook medicine,” may 2 create challenges at Saint Vincent. He also predicts resistance from the strong and capable medical records department. Given that successful EMR implementations are associated with a reduced need for space and personnel in medical records, it is unlikely that such changes will be warmly received. Dr. Johnson schedules a meeting with Ms. Leigh Rice, director of information services, because he suspects Ms. Rice might have some ideas about how to proceed.

 

 

 

 

 

Meeting with the Information Systems Department

 

Once Dr. Johnson scheduled his meeting with Ms. Rice, excitement grew in the IS department. Ms. Rice and her department had been enthusiastically following all of the changes in the EMR systems, but had met with resistance when they suggested that Saint Vincent consider adopting a new system. The previous CEO had been decidedly “old school” and had little interest in leading the charge to put Saint Vincent on the EMR map. Instead, Ash chose to placate the established physicians and the director of medical records, Ms. Amanda Chapman. Even though he was aware that the newer physicians were all carrying tablets and iPhones, he had no interest in rocking the proverbial boat at Saint Vincent.

Ms. Rice knew this was her opportunity to make the case for a system-wide EMR introduction at Saint Vincent. She had full confidence in her IS team’s ability to carry out this initiative. Ms. Rice had the group compile the information they had collected from different vendors about the various systems and capabilities, and summarize everything in an “issue brief” document that would be easy to skim. She also had her summer resident, Austin Mitchell, collect some of the key articles from the research literature that highlighted the potential and pitfalls of such a system-wide implementation. Ms. Rice’s meeting with Dr. Johnson went even better than she had hoped. Armed with the evidence, Ms. Rice laid out the various issues, pros and con, for a system-wide implementation of an EMR, and then explained the different vendor options that might be appropriate for Saint Vincent. Already convinced that this was a good idea, Dr. Johnson gave Ms. Rice the green light to develop a formal proposal for presentation to the Saint Vincent board, and directed her to Chase Aukland, Saint Vincent’s CFO, to make sure the cost proposal IS developed would be appropriate for Saint Vincent.

 

A Hallway Conversation

 

Dr. Johnson left the meeting with Ms. Rice smiling, but his smile faded when he was stopped in the corridor by Amanda Chapman, who was leaving the Medical Records Department. Dr. Johnson: Hi, Ms. Chapman. How is everything going in Medical Records? Ms. Chapman: Not well, Dr. Dr. Johnson. I heard a rumor that you were considering bringing an electronic medical record system to Saint Vincent, and that makes me very concerned. Dr. Johnson: Well, Ms. Chapman, nothing has been decided yet, but there is a strong push nationwide to introduce EMR systems in all hospitals and we don’t want to be left behind. 3 Ms. Chapman: I understand that, Dr. Dr. Johnson, but I just don’t think we want to do any of this too quickly. Mr. Ash had been very consistent in his message that Saint Vincent had no reason to be an “early adopter” of such systems. As he repeated said, “Let all those other health systems make the mistakes first. Then we can learn from their mistakes and make our own decision. And in the meantime, we can keep doing well what we already do well.” Dr. Johnson: I appreciate that perspective, Ms. Chapman, but I have to admit, I am a bit more likely to push the envelope than Mr. Ash. I believe an EMR system would be a great boost for Saint Vincent, helping us to track everything electronically, and potentially helping us to reduce medical errors in the process. Ms. Chapman: But don’t we already have the ability to track everything? I’m just not sure what’s wrong with paper. Out medical records team is very capable and responsive. I certainly haven’t heard any complaints about our ability to access patient records. Dr. Johnson: That’s true, Ms. Chapman, but I don’t think that we are looking far enough ahead. As other hospitals and health systems go digital, we’re going to be left behind. I truly believe we do not have a choice in this situation. It is not a matter of “whether,” but a question of “when.” I think it would be in the best interests of Saint Vincent to get this going on the sooner side so that we can take advantage of the capabilities of an electronic medical record system as soon as possible. Also, Ms. Chapman, before we select a system, a task force will be created which is charged with the analysis, selection, and implementation of an EMR system. Ms. Chapman: Well, Dr. Dr. Johnson, I disagree. I tend to believe “If it isn’t broke, don’t fix it.” And the Medical Records Department “isn’t broke.” Dr. Johnson: Thanks so much, Ms. Chapman. I appreciate your time. As Dr. Johnson headed back to his office, he was once more reminded that none of this was going to be easy. Even though Ms. Rice and her IS department seemed fully capable and on board with the idea, there were plenty of others throughout the health system who might not share their enthusiasm. He was especially concerned about resistance from the physicians. While he was a physician himself, that did little to improve his credibility when he was making a case “from the dark side” of administration. He decided to seek out Dr. Jody Smith, the chair of internal medicine, to begin to gauge some of the sentiments from the physicians. He headed to her office to see if he could catch her for a moment.

 

A Physician’s Perspective

 

Dr. Johnson (knocking as he enters Dr. Smith’s office): Hi Jody. How’s everything going? Dr. Smith: Craig. Just the person I wanted to see. I heard a rumor that you were considering an EMR for Saint Vincent Dr. Johnson: Well, Jody, the rumor is actually true. I just met with Ms. Leigh Rice, the head of IS, to get her and her team to begin to develop some estimates and plans for what an EMR adoption would mean for Saint Vincent . Dr. Smith: But Craig! Have you been following the latest research? Despite what the vendors claim, every place that puts one of these systems in reports that it actually takes the docs more time to do what they used to do on paper. Even after having the system in place for a while, the docs are still spending more time doing record-keeping than before – and that time is time that they used to have to care for patients! Also, when they put in a system somewhere in Pittsburgh, the EMR system was actually associated with an increase in the number of medical errors! Dr. Johnson: I have followed that research, Jody, but I think there’s a bigger picture to consider here. While it’s true that EMR systems do require the physicians to spend more time entering data and so forth, there’s also evidence that with an EMR it is actually the right people who are entering the data – not some non-clinical person trying to decipher a physician’s notes about what was done, or trying to figure out if a visit was long or short. Also, evidence is beginning to build that when EMR systems are coupled with decision support logic such as order gets with CPOE systems, this type of systems can actually save time. Instead of going through multiple screens to find all the meds and tests that need to be ordered, the physician can just click on the asthma order set, for instance, and review the options there. Dr. Smith: But what about patient-centered care? Who says that every patient is alike? For heaven’s sake, what if your patient needs something different? How long does it take to find that when everything is based on a standardized order set? And how about the resident physicians? Maybe they will stop thinking about making patient-specific clinical judgments and just click the standard order set for everyone! Have you really thought this through? Dr. Johnson: I know there are issues, Jody, but I truly believe the future of medicine is in electronic records. I’m guessing you’ve been following what’s going on at the national level, and there are policy-type folks involved making a strong push toward expansion of EMRs into outpatient settings as well. Policymakers are concerned that hospitals and physicians have been too slow to adopt these systems, which they believe will improve both patient safety and the quality of care delivered, and they are beginning to propose incentive systems to encourage adoption. As I just mentioned to Amanda Chapman, the director of medical records, I don’t think this is a question of “whether” any more – it’s just a question of “when.” Saint Vincent is a terrific system that should be at the forefront of medical and technological advances, not waiting to see what everyone else does. 5 Dr. Smith: I’ll bet Ms. Chapman was thrilled with the prospect of losing control of her medical records area. I understand your desire to help Saint Vincent, but I don’t think you’ve been here long enough to appreciate how great we already are. Our docs are content with paper, we have a functional and responsive medical records department, and I’m not sure I sense any burning need to be the “most digitized” or anything. This isn’t Boston, after all. A lot of us chose to practice here because we could what we do best – provide excellent clinical care – without the distraction of a push to be number one in the world or something like that. I’m just not sure you can make a major like putting in an EMR and keep everyone happy like they’ve been for so long here. Dr. Johnson: I realize I haven’t been here at Saint Vincent very long, but I’ve been working very hard to get a sense of this place before I propose and major changes. I also realize that introducing and EMR system to a place that is completely paper-based is no easy task. At this point, I know there is still considerable work to be done to better understand both Saint Vincent and the opportunities and risks associated with implementing an EMR. However, I strongly believe the future of medicine will require the electronic capabilities associated with an EMR system, and I am not willing to “watch and wait” much longer. I’d like to make an EMR system implementation a major goal for the coming year, we will form a task force which will be charged with the selection and implementation of an EMR system. Dr. Smith: I think this is crazy. I agree Mr. Ash. We should wait and see what happens at other hospitals and health systems and learn from their mistakes. There is no reason to stick our necks out on the “cutting edge” of EMR system implementation. And by the way, I’m not alone in my beliefs. Lots of other physicians agree. What we do here works just fine, and the people who work here are happy doing things the way they are done now. Dr. Johnson: Thanks so much for sharing your thoughts. Dr. Johnson left Smith’s office with his mind reeling. Was Saint Vincent truly content with paper-based records and letting other hospitals pass them by with electronic capabilities? Regardless, Dr. Johnson knew he was right about the future. He knew Saint Vincent needed to get on the EMR bandwagon, and the sooner the better. However, he now knew the implementation challenge was even greater than he had anticipated. Not only were the member of the medical records department threatened, but apparently physicians weren’t all that interested in changing their practice pattern either. His only allies appeared to be among Ms. Rice’s IS team.

 

 

 

 

 

Considering the Resistance

 

Dr. Johnson recognized that in addition to uncovering some attitudes toward EMRs, he had learned quite a bit about Saint Vincent’s organizational culture during these exploratory conversations about EMR adoption. It appeared the predominant culture was comfortable clinging to the status quo, and that few individuals were open to considering the possibility of change. He had felt resistance from Ms. Chapman and Dr. Smith, and knew that resistance to 6 change was a major hurdle he would have to overcome if there was any hope that an EMR implementation process could succeed. Yet Dr. Johnson sensed that this resistance was not merely resistance to change, but resistance to change that would result in a loss of control for the individuals involved. As he reflected upon his conversations with Ms. Chapman and Dr. Smith, he thought about some of the unspoken messages they had sent. Ms. Chapman and her group felt threatened by the loss of control they would have over the medical records process. With electronic systems in place, they would no longer have a major role to play in health systems operations, and their jobs might even be at stake. Dr. Smith’s comments suggested that the physicians were uninterested in changing their practice patterns because they would lose some of the control as well. The introduction of standardized order sets and other decision support tools could truly change the way physicians practice medicine thus leading to less discretion for individual providers with respect to viable treatment options. As both Dr. Smith and Dr. Johnson knew, with electronic medical records, there would be a searchable digital trail, which could be used to monitor those providers’ practice patterns. While Dr. Smith mentioned her fear that newer physicians would to rely too much on decision support systems and stop thinking for themselves, there was also an unspoken fear that if a physician did not do what the order set had defined as the “right things,” they might face problems.

 

Learning More

 

Dr. Johnson knew of several IT implementation failures that had occurred over the past several years, with the most notorious at Cedars Sinai in Los Angeles. There the hospital had rolled out a CPOE system across both the inpatient and outpatient settings and the process was deemed an utter failure. Physicians revolted and the hospital had to retreat, going back to paperbased processes while they decided what to do. On the other hand, he had also heard anecdotal stories about implementation successes, such as an incremental implementation that had been taking place at Children’s Hospital in Columbus, Ohio. While the Children’s physicians were all hospital-employed and thus had little ability to “just say no,” as the physicians at Cedars had, the process at Children’s had been carefully planned and seemed to be proceeding according to schedule – without alienating the entire provider population. Dr. Johnson had to plan his next steps carefully. He knew doctors valued evidence, and he had to build a good case for moving forward with an EMR implementation, and he had to build a good case for moving forward with and EMR implementation. He suspected there might be value in learning more about implementation successes and failures, but he also guessed there was other information out there he was not aware of. Dr. Johnson decided to recruit Ms. Rice’s summer resident to help him expand his search for evidence and help build the case for EMR adoption.

Describe how the developments changed society’s understanding

/in /by

For this assignment, reflect on what you consider to be some of the most significant developments covered in this theme (for example, discoveries, changes in thinking, or research advances), and address the following:

THEME: History of social science and perspectives presented in these timelines that are  most interesting .

  • Identify the developments and how they impact individuals or larger groups/cultures.
  • Describe how the developments changed society’s understanding. How is the development applicable outside of the social sciences?

This assignment can be completed through a “micro-presentation” format (1 to 2 slides) or a short-answer response (1 to 2 paragraphs).

Healthcare Portfolio Project Paper

/in /by

Quality Risk Management Plan

For your final Portfolio Project, you will write a paper detailing a risk management plan based on the case study scenario, HBR Case Medication Management at ACME Medical Center, linked below. Your goal is to address the areas of risk and healthcare/medical error and to safeguard future patients from having their safety compromised in a manner like what occurred in this case study.

Your risk management plan must include:

· a root-cause analysis;

· at least three recommendation(s) for improvement;

· identification of all employees’ roles in your analysis;

· an assessment of what the facility can do to create a culture of quality and safety;

· quality, risk, and performance improvement diagrams and charts (e.g., a fishbone or other visual forms of root cause analysis; Pareto chart or tables, for example) to support your analysis; and

· commentary that relates the case broadly to what you have learned throughout the course and describes the roles played by quality and regulation to prevent occurrences such as the case described.

Your paper should meet the following requirements:

· Be 10-12 pages in length, not including the cover or reference pages.

· Be formatted according to the CSU-Global Guide to Writing and APA.

· Provide support for your statements with in-text citations from a minimum of eight scholarly references—four of these references must be from outside sources and four must be from course readings, lectures, and textbooks. The CSU-Global Library is a good place to find these references.

· Utilize headings to organize the content in your work.

The case study scenario is: [HBR Case Medication Management at ACME Medical Center]

 

Please see attached HBR Case Medication Management at ACME Medical Center reading material, thanks.