Saturday, July 6, 2019

Basics of Being an Employee in a Healthcare System: Focus on Performance Management, a Wisdom-Share Series with Sondra Abanto, MBA

keywords and phrases: hospital employee, being an employee, basics of being a health care professional in a U.S. health care system, clinician employee, employee acupuncturist, integrative health employee, basics of performance management for the professional health care employee; interview series, special topic; milspouses Megan and Sondra share wisdom for the integrative health community :)

Wisdom-Share Interview Series with Sondra Abanto, MBA

updated July 2019
This interview series is coming to you from the corner of Courage and Commitment.  After 5 years of military PCS moves, our (Sondra and Megan's) worlds are overlapping again.  So, let's take advantage of it!

This is a relaxed interview series where Megan interviews Sondra about the basics of what to expect when you are an employee in a medium to large organization, with emphasis on health care organizations and asides about working as an integrative health care clinician within the system.  We talk about what to expect in an ideal situation from parameters to resources.

This is a series of interviews we (Megan and Sondra) recorded in winter and spring 2019 where Sondra covers the following topics related to performance management:

  1. employee orientation process basics (onboarding)
  2. performance plans
  3. mentorship
  4. team communication
  5. career path mapping

This series is intended for the acupuncturist or related integrative health care professional working (or interested in working) in hospital-based practice in the U.S., whether the civilian sector or the federal sector of employment.  However, we go over basics that apply to any health care professional employee in the system.

Sondra Abanto, MBA, has significant experience in both civilian and federal sectors on program and performance management (metrics) who has also trained as an MSA (acupuncture) student.

As of summer 2019, the sessions have finished recording and will be going to the video editor. If you are interested in this interview series, sign up on the landing page email list and you'll be notified when the recordings and related materials are published. Go here to sign up.

We are still looking for sponsors for this series, if you or your organization is interested in sponsoring this series (partially or fully), please let us know via the website contact page very soon as the finished videos will start going to the video editor in summer 2019.

Sponsorship would help with the following:  creating recordings, editing recordings, creating transcripts, creating pdfs related to each session.

You can also provide feedback on the series and what you would like to see more of at the website contact page.

I am looking forward to hearing from you!
Megan Kingsley Gale, MSAOM

Founder and Facilitator of The Hospital practice Handbook Project for Acupuncturists and their Hospital Sponsors

Monday, June 24, 2019

June Community Survey and Opportunity to Submit Qs

keywords: research, community survey, conferences, electronic health record (EHR), hospital-based practice
Earlier in June, I sent out a community survey to learn about our community's hospital-based electronic health record use experience.

Goal: understand which EHR systems the community is using and any feedback about how that is working well or what the challenges are.
How will this info be used?
If there is a good response rate, the de-identified data will be used in a blogpost summary. If there are common concerns or issues reported, that will be added to our outline of issues to address in the future "Issues in Hospital Practice" community webinar/interview series. For more about this special Project series, see the post on the webinar series project.

This week I will be attending the 2019 Society of Acupuncture Research (SAR) conference in Vermont. This is an in-person conference. Several colleagues told me they are unable to attend, so I offered to submit their questions to the panels in the hospital-based practice pre-conference (Thursday) sessions. If you work in hospital-based practice as an acupuncturist or as a manager or department head of a program that includes acupuncturists as clinicians, you may send me your questions and I will submit them to the panels this week. However, for timing, you must get your queries in to me by Wednesday, 6/26/2019.  Since I am traveling, the best way for me to have all the queries together is to use the survey form. So, I just added the SAR query option as the last section to the June community survey.

Learn more about the topics, presentations, and panels to inform the queries you want to send me on the related subjects at this conference link.  😄

More about the Pre-Conference Agenda
“Research is formalized curiosity. It is poking and prying with a purpose. ” -Zora Neale Hurston
quoted from conference agenda page:

Pre-Conference Special Interest Group 2 – Acupuncture in a Health Care System: Research Opportunities and Obstacles  This workshop is for acupuncturists who work in a health system or hospital setting in order to provide a space for collaboration, networking and strategic initiative. Each two-hour segment consists of two sessions, as follows.
  • The Risks and Rewards of Using the Electronic Health Record (EHR) for Research
    • Jeff Dusek, PhD, Director of Research, Connor Integrative Health Network, University Hospitals, Cleveland, OH
    • One of the major transformations in healthcare has been the growth and reliance on the electronic health record (EHR) in healthcare.  The EHR is truly ubiquitous in 21st century hospitals. 
    • The goal of this talk will be to provide some helpful hints and education to assist researchers who are considering requesting data from the EHR treasure trove.  The talk will review both risks and rewards of using data from the EHR for research and provide some potential ways to be an active participant in the EHR build at their own institutions.
  • Developing an EHR Template across Systems for Clinical Care and Research
    • Helen Ye, MS, LAc., UCSF Osher Center for Integrative Medicine
    • As increasing numbers of acupuncturists work in institutional settings, electronic health records (EHR) are a fundamental aspect of documenting patient care; however multiple EHR systems are used across settings and institutions, and EHR training in acupuncture educational institutions is minimal. 
    • Documentation practices need consistency for patient care purposes, research, and to accurately reflect the work, skills and training of acupuncture and Chinese medicine providers in Western medicine environments.
    • In addition, the tremendous potential for “data mining” through EHR systems is severely constrained without common templates that allow for consistent data gathering of patient care.  
    • The University of California at San Francisco’s (UCSF) Osher Center’s Chinese medicine team has worked to develop consistent documentation practices with templates and shortcuts for frequently used content and tools within EPIC, one of the country’s largest and commonly used EHR systems in large institutions, to be published in the Journal of Alternative and Complementary Medicine. 
    • If researchers and practitioners are able to develop a consensus template(s) across institutions, data gathering for multiple research projects can be leveraged to a much larger degree; patient outcomes and best practices can be better monitored and identified, providing further support for the profession, as well as education and training programs and policy decisions.
    • This session will allow the opportunity to explore these possibilities through the presentation of UCSF’s work on their EHR, and a panel discussion to provide input on moving this fundamental shift in paradigm for all acupuncture practitioners and researchers in institutions across regions. 
  • Response Panel time
Afternoon sessions
  • Integration of Acupuncture into Health Systems: Where are the tipping points?
    • Arya Nielsen, PhD, LAc., Icahn School of Medicine at Mount Sinai, Department of Family Medicine & Community Health
    • Integration of acupuncture into health systems is not a uniform process.  At each institution, choices are made as to which inpatient or outpatient units will offer the service, which patients are eligible, and who makes the decision to refer.  These decisions are the inflection points determining how quickly integration proceeds, and several factors can tip them in one direction or another.  The acupuncture evidence base is one key factor; others include perceived benefits of acupuncture (by patients or care providers), cost data, and the potential for acupuncture to help with specific challenges already identified — from the need to provide smoking cessation services to the current opioid epidemic, or the paucity of treatment options for conditions such as pain, threatened miscarriage and irritable bowel syndrome. 
    • This session, intended for acupuncturists working in health care systems as well as researchers, will explore these three factors in practical terms.  
  • Panel discussion with Arya Nielsen and Claudia Citkovitz 
    • the panel will discuss areas of systems-based practice where acupuncture’s clinical impact appears to be strong despite lack of research to date, and areas where acupuncture may be useful in addressing patient care problems previously identified by the institution.
  • Integration of Acupuncture at the Veteran’s Administration
    • Juli Olson, Doctor of Chiropractic, Masters of Acupuncture and OM, Diplomate in Acupuncture (NCCAOM), Licensed Acupuncturist
    • Justin Heesakker, Doctor of Acupuncture and OM, Diplomate in Oriental Medicine (NCCAOM), Licensed Acupuncturist
    • The purpose of this talk is to share what is happening in the Veteran’s Administration, regarding the integration of acupuncture in the largest healthcare system in the United States.
    • We will talk about challenges and opportunities of rolling out acupuncture on such a large scale across a large area. This is a very exciting time where a large group of veterans now have access to acupuncture care that previously would have had to pay out of pocket, and new possibilities are opening for large-scale acupuncture research.
    • In 2017, a list of approved evidence-based Complementary Integrative Health (CIH) methods of care were added to the Veteran’s Benefits Package. Included are acupuncture, biofeedback, clinical hypnosis, guided imagery, massage, meditation, tai chi/qi gong and yoga. In 2018, the Veteran’s Administration created a Qualification Standard for Licensed Acupuncturists so they may be hired as full time federal employees. Developing policies and offering best practices allows for greater acceptance of the profession and quick integration.
    • The growth of acupuncture is expected to continue at a quick pace. In order to meet the immediate demand for acupuncture services, the VA has widely trained non-acupuncture providers in Battlefield Acupuncture (BFA). Policies have been developed to improve access, including allowing multiple disciplines to train and provide BFA, eliminating written consent for auricular acupuncture and utilizing note templates in the EHR to collect research data specific to BFA.
    • In preparation for the decision to add acupuncture to the Veteran’s Benefit Package, the VA underwent a systematic review of the literature culminating in the Acupuncture Evidence Maps published by the VA’s own Health Services Research and Development branch in 2014.  In collaboration with the Department of Defense acupuncture has been included in several VA/DoD Clinical Practice Guidelines (CPG). 
    • As acupuncture becomes more widely available, the ability to measure both subjective and biometric outcomes, conducting clinical research on a large scale will be possible through the electronic health and designed notes. Additionally, capturing utilization & cost data provides an opportunity to examine cost effectiveness for acupuncture, CIH and the Whole Health model.  The Whole Health framework is a patient-centered care model that emphasizes a patient’s own goals for their health with resources and skill building to help them achieve those goals.

Looking forward to hearing from you all in the survey! Stay tuned to the newsletter for post-conference notes.  :) 

You can buy me a coffee while I am traveling this month and while I am at the conference, whether a shot of espresso, a cup of cocoa,
or a carafe of coffee while I meet with other hospital-based colleagues at the conference. 

Tuesday, April 30, 2019

April Leadership and Workplace Mondays Summary

keywords:  leadership, workplace, workplace culture, being an employee

Inspiration for Employees and their Leaders 

Review of the "Leadership and Workplace Mondays" theme from the public HHP Facebook Page, April 2019

Dare to Lead  by Brene Brown

  • Recommended books to read/listen to this month:  
  • Articles
    • Good sleep (quality and quantity) fills your resilience bucket. Don’t underrate it. 
      • Results from a Cigna workplace survey notes that women surveyed reported more lack of sleep than men. Not clear from this article if this is (a) better self-awareness of health than their male colleagues (b) self-awareness of lack and significantly less hours (quantity and quality) due to managing work responsibilities
    • “Instead, invite them to think about what kind of person they want to be — and about all the different things they might want to do.”

Want to see more resources related to the workplace for hospital-based integrative health practitioners?

If you enjoyed this, check out our public Facebook Page and subscribe to our email list. 

For more recommended reading (books and audiobooks) on leadership, see our Reflecting on Leadership post.

More posts on Leadership

If this was useful, please support this community work.  
You can buy me a coffee, sponsor a newsletter, or sponsor a project via the website.

Research Thursdays Summary for April 2019

key words:  research literacy, funding and grants, sharing related research in the field, research in integrative health; JACM special focus issue on whole system approach to integrative health in mainstream systems, the new Flourish Index from Harvard T. Chan School of Public Health in Boston, update on Medicare and Medicaid (CMS) policy papers on acupuncture for chronic low back pain (cLBP), humanism in healthcare spotlights from the Gold Foundation's research roundup, review of some research literacy basics, and funding announcements
The JACM Special Focus issue March 2019
 "Multimodal Approaches in Integrative Health: Whole Persons, Whole Practices, Whole Systems"
 entire issue is free access

The April Research Roundup

Review of the "Research and Metrics Thursdays" theme from the public Facebook Page and newsletter

At the Hospital-practice Handbook Project, we encourage practitioners to cultivate mentor-relationships and practice research literacy.

Recommended Research Reads this Month
  • Models of integrative health in hospitals and medical centers.  An entire special issue focused
    on this topic in the March 2019 JACM.  volume 25, issue S1.  Special Focus Issue on Multimodal Approaches in Integrative Health: Whole Persons, Whole Practices, Whole Systems.  Article titles include:
    • "Values Align for Researching Whole Systems: A Reflective Overview of the Special Issue" by John Weeks, Heather Boon, and Cheryl Ritenbaugh
    • "What Should Health Care Systems Consider When Implementing Complementary and Integrative Health:  Lessons from Veterans Health Administration" by Taylor et al
    • "Whole Health in the Whole System of the Veterans Administration:  How Will We Know We Have Reached This Future State?" by Tracy Gaudet, MD and Benjamin Kligler, MD, MPH
    • "Evaluation of an Integrative Post-Traumatic Stress Disorder Treatment Program" by Hilton et al.

  • From this April’s IHPC newsletter—measuring health and wellness
    • A different set of metrics than the conventional paradigm of measuring presence of disease: The Flourish Index

“Harvard T. Chan School of Public Health, Boston, released a much anticipated manifesto in JAMA on April 2, 2019 that dramatically shifts the philosophy of patient care from an "absence of disease or infirmity" to a concept that embraces whole-person care and patient well-being. This important paradigm change that "reimagines health" is a concept that is not new to integrative health. It respects patients' desires to grow and feel satisfied with their health and subsequent quality-of-life. 
 Author Howard, K. Koh, MD, MPH defines this as a flourish index, which includes six domains of patient wellness: 1: happiness and life satisfaction, 2. physical and mental health, 3. meaning and purpose, 4. character and virtue, 5. close social relationships, and 6. financial and material security. 
 Dr. Koh writes: "Measurement of flourishing makes possible weighing the effects of different treatment decisions not only on physical and mental health, but in the full context of what matters in a person’s life. While this makes treatment decisions more complex, it lies at the heart of patient-centered care."  link to JAMA article

  • New paper from Memorial Sloan-Kettering on insomnia in cancer patients
    • Both cognitive behavioral therapy and acupuncture had clinical effectiveness in treating severity of insomnia and had sustained benefits for 20 weeks It was the first comparative effectiveness study for this clinical research query
    • Sheila N Garland, Sharon X Xie, Kate DuHamel, Ting Bao, Qing Li, Frances K Barg, Sarah Song, Philip Kantoff, Philip Gehrman, Jun J Mao, Acupuncture Versus Cognitive Behavioral Therapy for Insomnia in Cancer Survivors: A Randomized Clinical Trial, JNCI: Journal of the National Cancer Institute.

When Clinical Research Impacts Health Policy

“States have considerable flexibility in determining what non-pharmacologic services are available in the state plan under optional benefits. For example, a state may elect to provide coverage for acupuncture, massage therapy, chiropractic care, cognitive behavioral therapy, physical therapy or other Medicaid-coverable services through an array of Medicaid coverage authorities. States wishing to add coverage in optional benefit categories described below would need to submit a state plan amendment for CMS approval.” 
Reviewing the Basics

Bodywork/Massage Therapy
  • Massage therapy can relieve low back pain, fibromyalgia pain, arthritis pain, tension headaches, and improve post-operative recovery.  AMTA article has a concise list with links.
    • “Research continues to support the health benefits of massage therapy for pain management. Find out how massage therapy can help these five painful conditions.”

Humanism in Healthcare: Patient-Centered-ness and Clinician Resilience
  • The April edition of the Jeffrey Silver Humanism in Healthcare Research Roundup includes:
    • "The timing of family meetings in the medical intensive care unit." Piscitello GM, Parham WM 3rd, Huber MT, Siegler M, Parker WF. Am J Hosp Palliat Care. 2019 Apr 14.  quote:
"This troubling pattern suggests that family meetings are often used to negotiate withdrawal of life support rather than to learn about values. The authors conclude that there are ample opportunities to improve communication skills training for clinicians in the ICU to help maximize the role of family meetings."
    • "The crossroads of posttraumatic stress disorder and physician burnout: a national review of United States trauma and nontrauma surgeons." Jackson TN, Morgan JP, Jackson DL, Cook TR, McLean K, Agrawal V, Taubman KE, Truitt MS. Am Surg. 2019 Feb 1;85(2): 127-135
    • "Healthcare provider compassion is associated with lower PTSD symptoms among patients with life-threatening medical emergencies: a prospective cohort study." Moss J, Roberts MB, Shea L, Jones CW, Kilgannon H, Edmondson DE, Trzeciak S, Roberts BW. Intensive Care Med. 2019 Mar 25.

Research Conferences
  • The Society of Acupuncture Research (SAR) conference will be June 27-29, program here.
  • The 2019 International Massage Therapy Research Conference will be May 9-10, 2019 in Alexandria, VA.  "IMTRC 2019 will feature keynote speaker Helene Langevin, MD, Director of the National Center for Complementary and Integrative Health (NCCIH), and panel sessions on pain management and addressing the opioid epidemic with massage therapy.  Education sessions will explore the use of therapeutic massage for arthritis, breast cancer, low back pain, and anxiety."  

Funding Announcements

For more on the topic of research
  • follow the tag/label in this blog for "research literacy"

Other monthly research summary blogposts

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Monday, April 22, 2019

Happy Earth Day and National Parks Week!

keywords:  spending time outdoors (nature) and health, environmental health, self-care, supporting kids and their adults to connect with nature, integrative healthcare paradigm, recommended books and resources

Unless someone like you cares a whole awful lot, Nothing is going to get better.  It's not.  -Dr. Seuss

In the U.S. we honor today as Earth Day and the following week or so as National Parks week.  My school-age kid loves Earth Day and the variations of school-sponsored activities she's participated during the last several years.  If you've been following the blog and the HH Project newsletters, you know I love an excuse to get outdoors with the kids.  Growing up in the northern Midwest, I was taught that we can be outdoors in most weather, as long as we prepare for it (proper clothing, changes of clothes, etc).  Exceptions, of course, for dangerous-to-health weather conditions like skin-freeze warnings (cold weather) or the black flag days (hot and humid), etc.

I feel that building confidence in kids (and adults!) to enjoy the outdoors (and feel safe doing so) helps foster a sense of wonder.  And, there's nothing quite like wonder and finding wonder in natural world, from backyards to local park, to national parks. I am sure there are personal health benefits to feeling wonder and awe.  In fact, this is one of the many areas of nature research Florence Williams writes about in The Nature Fix.

If you are looking for ideas of how to get outdoors with kids of all ages (or need some fresh ideas for your list), check out Richard Louv's Vitamin N:  The Essential Guide to a Nature-Rich Life or the website for the Children and Nature Network.  I recently started reading How to Raise a Wild Child: The Art and Science of Falling in Love with Nature by Scott Sampson (who my kids know as the paleontologist from the PBS show, Dinosaur Train).

There has been a trend in "natural navigation" lately.  An old way of understanding our environment and direction that has been lost to some in the past generation or so that requires practicing your skill of observation and pairing it with some farmer's almanac-style facts mixed with modern science.  Tristan Gooley has a full set of resources to learn more about this on his natural navigation website.

Nature time and Your Health
Connecting with nature, whether it is a walk in the town park, gardening, or a trip to your state or national park, is healthy for us.  Health benefits are myriad from movement to the air we breathe to the scenery (see Nature Fix for the details and research citations).  Also, hopefully, it keeps us mindful of our impact on our environment, on both local and regional/national scale.  From gardening classes in schools or your local Master Gardener county extension community courses, you can learn how to grow plants in your area from veggies to local flora.

Our connection and stewardship of our environment is integral to our health and the health of our community.  In traditional Chinese medicine, we talk about the body as a garden, affected by both internal and external factors.  Our environment is an essential piece to the integrative health paradigm. 
Rachel Carson, known for her groundbreaking book, Silent Spring, also wrote a book of poetry-prose of her time with her nephew and mentoring his sense of wonder.  If you are interested in this poetry-prose book of hers, The Sense of Wonder, I recommend the audiobook version narrated by Kaiulani Lee for the lyrical style.

How are you and your healthcare practice connecting to the environment/nature/Earth?
So, how are you connecting nature in your healthcare practice?  Does your healthcare system already have environmental stewardship, nature-mentoring, or other sustainable-environment health practices in place?  Maybe you have a nature area nearby for easy walking or a hidden sitting garden?  Are you connected to a Teaching Kitchen? Or maybe you have a gardening program with your county's Extension Service and Master Gardener resource? How are you working with your patient population in developing a healthy connection to nature?

More resources and ideas below.  And, please add a resource in the comments if it is not listed here and you think it may help others!  Thank you.

Reflective reading and poetry

Resources for Parents, Grandparents, Educators (for kids)

Get Outside and Learn More 


Gear and Games

Related Blogposts

If you follow one of the Amazon links above and buy something from Amazon within 12 hours of clicking the link, a few pennies goes toward the project.  
Most direct way to support the project?  
 If you love supporting your local library system, most of these books are available through Overdrive or through the Libby app via your library card.  :)

Happy Earth Day from the Hospital-practice Handbook Project!

Sunday, March 31, 2019

Highlights from the Maple Syrup March Newsletter

keywords:  community news, research papers, community discussion resources, newsletter

“Often when you’re at the edge of something, you’re at the beginning of something else.” Fred Rogers
Tidbits from the March 2019 newsletter
March:  The Maple Sap is Rising
It is early spring.  The sap is rising; the season for growth and movement.
What are you noticing about the spring energy of growth and movement?  Uncomfortable? Blocked?  Perfect weather?  More than ready to jump into summer after a long winter?

Short Topic Summary for This Newsletter

HH Project News
  • Free Download from the Project
  • Looking for sponsor(s) to help cover the cost of video edits for the latest in the “Paths to Practice” interview series. 
    • In the “Paths to Practice” interview series, I interview a colleague about their path into hospital-based practice. 
    • There are options for full sponsorship and partial sponsorship. 
    • Please contact me if you or your business or organization is interested.  Thank you for supporting this work.  
  • Did you know we have an online short course available?
  • Thank you for supporting this work!

March Discussion Topics in the Community
  • Acupuncture for post-surgical pain
  • Knee/joint replacement integrative care models:  The Bree Collaborative’s bundled payment model 
    • On knee/joint replacement care, let's take a step back and look at models of care for the patient's care process from pre-surgery to recovery.  The Bree Collaborative of Washington state finished the total knee replacement bundled payment model standard last year (2018).  This is a one-to-watch for your medical centers. 
    • The Bree Collaborative is a standard-setter in value-based model care with patient-centered outcomes.  It sets standards for WA state health care policy. These models they discuss work best in “centers of healthcare excellence (COHE or COE)” where patients can have access to all services in the bundle in one system and in a timely manner.  From assessment of surgery to surgery to inpatient stay to post-operative care to rehabilitation care.  
    • share-able published articles on this topic: 
Recommended reading this month (book and article recommendations)

National News

More on research this past month--Basics and Bodywork-focused
  • The Massage Therapy Foundation (research) and the NCBTMB (massage therapy and bodywork) have collaborated to create a webinar series on the basics of research in 2019.  The first webinar aired in February 2019, with the episode, "Why Research?"
Support the Project
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  1. Share blog posts 
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Thank you for your support!
Happy early spring!

Here's the link to the full March newsletter if you missed it.  Sign up on our email list to get future newsletters.