By Mark Watts
I think the use of simple direct communication via SMS messaging can help address burnout and keep our staff whole during this stressful time.
“Referral bonus of $7,000 for an RN who will work in ICU” the ad read. How do we connect and keep our teams engaged and well?
My friend and former employee called me to announce, “Mark I am retiring, I don’t know if I want to or can keep coming here every day!” This decision was accelerated by the current health care crisis. About 20 percent of doctors are considering retirement or change in careers, some research is pointing to a PTSD-like response by health care and frontline workers to the stress of their everyday work. What can be done? What happens when providers turn into the patients in need of support and care? How can an employer express care and compassion to an employee who carries the emotional weight of this unprecedented time? A friend recounted that a nurse walked off the floor in the middle of a shift because she was offered more to work somewhere else. How do we treat the needs of our employees and reduce our cost of delivery of services?
Employment, as with almost all health care, is voluntary. Patients choose when to engage in care, when to take medicine (if they choose to) and whether to return for follow-up visits. Without adequate patient engagement and care that centers on patients, their management can be challenging, especially for chronic diseases. Mobile health (mHealth), the application of mobile technology for the provision of health care support to patients and care providers, has shown great promise. mHealth is increasingly being integrated into existing health care systems to improve access, engagement and delivery of health services. However, the vast majority of proposed mHealth solutions have not been tested. Many have not adopted the core value of patient-centered care that is critical in improving the quality of services and long-term patient health outcomes. Instead, mHealth is commonly used as a reminder.
May I suggest WelTel Inc. (www.weltel.org) a Canadian-led patient communication and outpatient case management tool that is recognized as a world leader in the field of mHealth. This health technology solution was initially designed to address the problem of adherence for patients initiating antiretroviral therapy (ART) in Africa (Lester et al., 2010). WelTel has since expanded its application to include a wide range of other conditions and settings including primary care; tuberculosis; asthma; maternal, newborn, and child health; as well as preventative health in different regions across North American, African and European countries. WelTel uses mobile phones and SMS at the base of its pyramid through an interactive tool for care providers to communicate and engage directly with their patients. In the last two decades, WelTel has led the global medical field in evidence for outpatient digital clinical support by focusing on patient communication as the priority followed by monitoring and reporting. With over $4 million dollars in research and development, WelTel’s rapidly growing service platform is currently in its fifth iteration. It has been created based on patient and provider preferences. WelTel has undergone several iterations after using the hierarchy of evidence evaluation framework adopted for digital health solutions. The evidence suggested that empowering patients through self-efficacy is more effective at improving health outcomes than monitoring alone. WelTel offers a patient-centered care solution because it was specifically and purposefully designed for patient engagement from its inception. The WelTel solution works by encouraging the patient to self-manage and gives them critical access to care when needed. This enforces and reinforces long-term provider-patient relationships for engagement and patient-driven self-management.
Based on field research with patients and frontline providers to inform preferred messaging content, frequency, and process, the system sends automated text message check-ins to registered patients asking them: “How are you?” on a weekly basis (or at any other frequency). The patient can respond by text with “OK” or “Not OK” to indicate a need for communication with the health care provider who can respond using text, voice or video outreach when appropriate. The communications are captured via a Web interface that is mobile device. It is friendly and organized for intuitive provider access and clinical workflows (provider case management). The system records all communications and patient-centered care plans can be noted. A video component has been integrated for optional use in settings where smartphone access and sufficient data connections are available. However, the base of the pyramid approach, both economic and digital, is maintained by ensuring access to the platform through basic cellphones to ensure access for any user. In addition, WelTel can send a patient clinic appointment reminders via SMS. Provider-side alerts tailored to specific patients can be shared between different colleagues who operate in team-based care settings. Overall, the system’s ability to triage urgency of patient-reported issues can help identify which patients require additional support and when.
I see this system as a tool that can be deployed to check on the mental status of health care workers via a daily text check in. If the worker needs help the connection to support services already established through employ assistance programs is engaged. This could be deployed via secure cloud technology in 60 days and save lives and careers.
If one ICU nurse stays on your staff, the program pays for itself. I am concerned about the metal health of health care workers and any tool to assist them to be resilient during this pandemic I am open to.
Take care of your self and each other, we can make it through this together.
Mark Watts is the enterprise imaging director at Fountain Hills Medical Center.