Simply too complicated

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Gary Tetz
Gary Tetz

Every now and then, I wander innocently and foolishly into a complex long-term care topic that makes my brain hurt. This time, it was managed care.

I was talking to a noted expert on the subject this week and went long minutes without understanding more than about four of every ten words he spoke — including ifs, ands and buts. It appears to be an entirely different language, and I'm hoping there's an online course that will allow me to learn it subliminally while I sleep. Except that I can't sleep because I'm so anxious about how little I know about managed care.

Now, had the topic been mismanaged hair, I know plenty about that, as is evident from my author photo. But managed care, not so much. On the bright side, I guess nothing really rides on this embarrassing level of ignorance. I'm almost never asked for input on rates, carve-outs or contract renegotiations, or to explain why the rules are different in Goosewaddle County than they are in Upper Lowersville.

Which leads to the question, asked plaintively and in desperation, why does everything have to be so incomprehensively difficult in this profession? Healthcare wasn't always this way. Early physicians asked only two questions: How do you feel, and where should I attach the leeches? You were either getting better or you were dead. It was a simpler time.

Now it's all technology and data, and even the regulations have regulations. But thankfully, there's a respite — one sole remaining practice that isn't so mind-numbingly complex, yet. Hand washing. You just place your hands under some clean water, squirt on some soap, lather them up while singing “Happy Birthday” twice, rinse thoroughly and then dry. That's it. Five steps. Hang the banner. Mission accomplished.

The payoff for this simple act is simple too. In recent long-term care research reported by McKnight's, mortality rates and antibiotic prescriptions dropped when residents, visitors and staff were exposed to a hand-hygiene promotional campaign, given greater access to sanitizer and educated on how to use it properly. It was all a roaring success, but for the fact that “…changes did not sustain after the intervention ended.” In other words, once the study was over, they didn't do it as much. Mission not accomplished.

Why? I have a theory. Maybe the hand-washing process is just too simple for our world, where only the complicated gets our full attention. Perhaps personal responsibility isn't challenging enough, and it needs to be raised to a managed care level of difficulty. Naturally, I have some suggestions.

On the national level, we should create a Phalangical Sanitation Frequency Initiative, with clear, data-driven outcome expectations for the entire profession. At the facility level, we should document the time and particulars of each occurrence with an indecipherable 14-digit code, and ask an off-duty regulator to inspect our palms with a forensic UV light. Finally, we'll add another 10 steps to the best practice guidelines, including a triple-rinse, quadruple hand twist and another round of “Happy Birthday,” hummed backwards.

Hopefully, this new approach will not only improve hygiene, but will also yield rich dividends at your next managed care negotiation session. “Your Five-Star looks great, and your readmission rates are stellar,” the contract representative will begin, “but we're particularly impressed by your hand-washing data, especially compared to national averages and regional competitors in the window of 3:45 to 4:19 p.m. on cloudy Thursdays. Would you please accept more of our money? Seriously, we insist.”

You'll shake hands warmly, and then you'll all go wash them together. It will be the start of a beautiful, hopelessly complex partnership — just the way things are supposed to be.

Things I Think is written by Gary Tetz, a national Silver Medalist and regional Gold Medal winner in the Association of Business Press Editors (ASBPE) awards program. He has amused, informed and sometimes befuddled long-term care readers worldwide since his debut with the former SNALF.com at the end of a previous century. He is a multimedia consultant for Consonus Healthcare Services in Portland, OR.

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Things I Think

Things I Think is written by longtime industry columnist Gary Tetz, who resides in Portland, OR. Since his debut with SNALF.com at the end of a previous century, he has continued to amuse, inform and sometimes befuddle long-term care readers worldwide.

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