Ms. Stevenson, an intensive care unit nurse at Eskenazi Health in Indianapolis for the past seven years, cries as she talks about her patients and their families, making clear the grinding toll of the pandemic on already exhausted hospital work forces.

“We’re pretty short-staffed,” Ms. Stevenson said. She added: “It’s getting harder.”

Instead of taking holiday vacations this weekend, workers at strained hospitals across the nation are working 16-hour shifts. Some have been on the job every day for weeks. Festive meals have been replaced with protein bars and sports drinks.

This Christmas weekend, with the United States facing another surge of illness stoked by a proportion of the population that remains unvaccinated, frontline workers are again sacrificing time at home with family to tend to Covid patients. In Indiana, which has among the highest rates of hospitalization and lowest rates of vaccination in the country, the situation is especially acute.

from the New York Times  Dec 25 2021

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An employee’s wife had received her COVID vaccine ( both shots) in January 2021. She is a healthcare worker.

Her two year old son got the sniffles. She was concerned. She took her son for his COVID test. She also got tested.

Her COVID PCR test came back as positive. Her son’s test was negative.

That was a stunner for us.

But this means that even though a person has been vaccinated, they can still spread COVID.

But an Israeli study of about 3,000 patients who had all been vaccinated, indicated that the viral load in those who have been vaccinated is low.

That means that the vaccinated persons even if they test COVID positive are much less likely transmit the virus to others.

But to be safe, it will be important to wear a mask and do social distancing even after you are vaccinated.

Raymond Rupert patient advocate and health educator.

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If family doctors give about 50% of all flu vaccines, then why would Public Health not involve family doctors in the distribution of COVID 19 vaccine?

This is a head scratching moment.

Lives depend on this very poor decision about distribution.

Who is making this decision? Public health? Provincial health? The Feds? The bureaucrats? Who?

Has anyone asked the authors of BlitzScaling what to do? That is Reid Hoffman and Chris Yeh.

If you asked Hoffman, of Linkedin fame, and Yeh what to do they would say that we need “SCALEABLE DISTRIBUTION”.

Using hockey rinks and community centres for COVID 19 vaccine distribution is not scaleable distribution.

Using established distribution channels such as family doctor’s offices and pharmacy chains is scaleable distribution.

The Public Health folks should ask logistics experts knowledgeable in healthcare what to do and not those with the knowledge of moving tanks and battalions.

Ask the experts at the Rotman Business school or the Schulich School of Business or the Ivey School of Business about scaleable distribution of COVID 19 vaccine.

Lives depend on how this is done.

Why are we acting like ludites when approaching Vaccine distribution?

And let’s not forget about the vaccine database that is being developed too late to be of any use.

That’s another $16M mistake.

Let’s put the smart and informed decision makers to work fixing this mess.

Raymond Rupert patient advcoate and health system disruptor for the public good.

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This case conference proved to be magical for the family. Raymond Rupert of RCM Health Consultancy was the facilitator. The 3 specialists were able to explain their viewpoints in plain English. The 3 specialists agreed on a neurosurgical procedure for the patient.

The logic and rationale were explained to the family for the first time. The family was able to understand the implications of the surgery including possible side effects and complications but also to understand the possible benefits. Emphasis on possible.

The team at RCM Health Consultancy is committed to organizing case conferences for our clients in order to give patients and their families the opportunity to contribute to the narrative, to understand the basis for decision making and for RCM to advocate for our client’s rights to access appropriate care.

Raymond Rupert patient advocate & healthcare consultant.

info@rcmhealthconsultancy.com

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Health systems are, on balance, very bureaucratic and have fixed structures which are not open to innovation. In fact, innovation is seen to be disruptive and therefore resistance is present.

But to overcome the gaps in the system which have become more apparent in COVID 19, there has to be an acceptance of innovation in clinical management and system wide management.

Four critical elements support development and deployment of innovation in a health system:

(1) workforce capacity to actualize innovation;

(2) an organizational infrastructure that supports integrated, systematic, repeatable pathways for change;

(3) an innovation-nurturing culture; and

(4) strategic external partnerships and collaborations. 

It will be interesting to see if there is motivation over time to innovate by health system designers and health policy analysts.

Raymond Rupert patient advocate and healthcare consultant.

Reference:

• Ryan J. Vega, MD, MSHA & 
• Kenneth W. Kizer, MD, MPH

Vol. 1 No. 6 | November — December 2020
NEJM Catalyst Innovations in Care Delivery 2020; 06DOI: https://doi.org/10.1056/CAT.20.0263

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When cardiology saw Laura, it was evident that she was in trouble. An immediate cardiac echo showed her to have very severe valvular heart disease. And she was in right heart failure.

She was immediately considered for cardiac surgery. However the doctors managing her care were not communicating with the patient and the family.

In fact, the doctors had failed to communicate effectively over the several months of the patient’s hospitalization. This lead to a failed and somewhat contentious relationship with the family.

Our job as patient advocates was to immediately talk to the treating doctors and then brief the family about the plans for cardiac surgery.

Our job as advocates was to understand the plan for cardiac surgery and to understand how Laura would be transitioned to the cardiac surgeon.

The patient advocate has to understand how the plumbing works in the complex web of healthcare relationships.

By talking to the treating doctors in a collaborative manner and then translating for the family, our team at RCM Health Consultancy was able to fully inform the family, reassure the treating doctors, to assist with the transition to cardiac surgery and then provide monitoring and quality control once the transition had occurred.

So a key role of the patient advocate is to communicate often with clients to keep them totally informed and up to date with issues and information.

To find your patient advocate, you should email RCM:

info@rcmhealthconsultancy.com

or call 647 350 5500

Raymond Rupert patient advocate and healthcare consultant.

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Arranging for the treating team of doctors to have a conversation about a patient’s case is called a case conference. 

Case conferences can be decisive in helping to make big decisions about both investigations and treatments for patients especially when the patient is complex. 

Unfortunately, case conferences are not used as often as they might be. It is our job at RCM Health Consultancy to encourage participation in case conferences.

When case conferences do occur and when they involve the patient and  family, they can be revelatory in terms of sharing valuable information with the patient and family to assist in making decisions. And it is the patient and the family who have the ultimate say in these decisions. 

The team at RCM Health Consultancy has a track record of organizing case conferences with the treating doctors. This is most useful when there is complexity and some confusion about next steps instead of clarity about how the case should be managed. 

When the details of the case are unpacked within the structure of a case conference, then the treating doctors can quickly move to a harmonized view of the case. 

Our objective in organizing case conferences is the best possible achievable outcome for all our clients.   We encourage our clients to engage in case conferences with the treating doctors in a collaborative manner guided by the team members at RCM Health Consultancy. 

Case Study

Jay was 73 years of age. He was very complex. He had hydrocephalus which is a blockage of the cerebral spinal fluid (CSF) flow in the brain. This blockage causes neurologic complications and a tendency to fall. He also has early and progressive dementia.  The biggest risk was the risk of falling. He had 3 super specialists ( 2 neurologists and one neurosurgeon) involved. They had never spoken together about the case until we had organized a case conference. The outcome of the case conference was the decision to stent and fix the hydrocephalus to  reduce the risk of falling. Jay’s wife participated. We recorded the call for her. She and Jay were able to finally make a decision. The family appreciated the support from the team at RCM. 

Conclusion:

The case conference is proving to be an essential process for our clients. The case conference assists the treating team of doctors and the patient and family at achieving clarity about a definitive care plan. Once the definitive care plan is articulated, then the team at RCM assists in implementing the plan for our clients.

Raymond Rupert patient advocate

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