If you’ve been in healthcare long enough, you would probably agree that the old “deer in headlights” look could easily be changed to “family member in headlights”. Like the somewhat vacant, slightly panicked, definitely confused look of a son picking up his father after an emergency or major surgery. Certainly the patient can’t be expected to remember all of your discharge instructions, so that’s why you give it to the family member. You care deeply about your patient’s health and well-being and want to ensure his recovery.

But put yourself in the shoes of that son. You gave him detailed instructions for his father’s post-op care. I’m sure he was nodding and even giving you verbal affirmations but in reality, he may not have heard a thing you said. So it should come to no surprise when you see that patient back in the hospital sometime within the next month.

If you’re working in hospital medicine it’s likely this scenario has played out more times than you care to admit. In fact, it’s such a common occurrence a study was recently featured in the New England Journal of Medicine that showed 20 percent of Medicare patients were back in the hospital within 30 days. And, it’s been reported that 75 percent of those readmitted could have been prevented by proper post-discharge care.

No, you’re definitely not a bad healthcare provider. The example above is what many healthcare providers face when handing off their patient to family members, nursing facilities or even hospice care. Ideally, your work as doctor, nurse or other provider would not end when your patient leaves the hospital. But hand them off you must, and then you cross your fingers!

The problem of patient’s returning to the hospital in such a short time period is being faced head on by the Society of Hospital Medicine. SHM is a leader in providing quality improvement programs and was officially recognized this year as a Patient Safety Organization by the Agency for Healthcare Research and Quality (AHRQ), the lead federal agency for improving the quality, safety, efficiency and effectiveness of healthcare. SHM is one of the first professional medical societies with a division listed as a Patient Safety Organization.

SHM is especially proud of their Project BOOST, a discharge-transition program. This past week, the Washington Post profiled one hospital that began the program a few years ago and proactively targeted patients considered to be at high risk for readmission. Results showed a 30-day readmission rate for patients under 70 years old dropped from 13 percent to under 4 percent, and patients 70 and older dropped from 16 percent to 11 percent.

More than 250 hospital sites have taken advantage of SHM programs to reduce readmissions as well as improve patient care in other areas. If you want to learn first-hand how to help reduce that “deer in headlights” look and effectively manage your hospital medicine program, look into SHM’s Leadership Academy March 21-24 in Las Vegas.

Last week the Association of American Medical Colleges (AAMC) reported that the number of minorities enrolling in med school is rising, something schools around the nation have been pushing for a long time. Sounded good to me, and I moved on. But then I got to thinking, “Why is this important news?” So I started surfing the net looking at different facts and figures and realized the importance of this upswing.

By the year 2050, it is projected that 50% of our country’s population will be made up of ethnic and racial minorities. But less than 10% of our doctors are minorities. Furthermore, the CDC stated in a March 2010 report on Heart Disease and Stroke Prevention these two disconcerting facts:  “The cost of cardiovascular diseases in the United States, including health care expenditures and lost productivity from deaths and disability, is estimated to be more than $503 billion in 2010 . . . [and though] overall, death rates for heart disease and stroke have decreased in the United States in recent decades . . rates for incidence and death continue to be high among some populations, including members of certain racial and ethnic groups [and] people with low socioeconomic status.” According to AAMC President and CEO Darrell Kirch, “Improving the diversity of U.S. medical students will be a driver of excellence in our health care system.”

Statistics have shown that patients search for doctors within their own racial or ethnic group and decline care if they can’t find one. Whether they need someone who speaks their language or simply desire someone to whom they can relate and who understands where they’re coming from, it is important that there are doctors representing the different groups to help ensure their health and well-being. And minority doctors (and nurses) may be more motivated to go into underserved areas where there is a great gap in the quality of healthcare available to racial and ethnic minorities and those of a low socio-economic status.

We can all encourage this particular improvement in American healthcare by becoming corporate sponsors of or individual mentors within undergrad pipeline organizations such as the National Network of Latin American Medical Students  or the Student National Medical Association, a student-run organization dedicated to the needs and concerns of medical students of color. It is especially important that those of us in the healthcare profession continue to promote diversity so that we may see quality healthcare options available to all sectors of the American population because a healthy nation is a strong nation!

I talk a lot about being a stand-out on the job as one of the ways to help you get a job and keep a job. One of the ways to stand out is to take the high road when faced with conflict or criticism on the job. This will help you to develop a reputation for being thoughtful, mature and resilient.

My friend Pamela recently found herself in the painfully classic position of being hired into a management role over someone who had been there longer and felt the position should have been hers. Amy, the management wannabe, shares her bitterness vocally and regularly in Pamela’s presence, continually complaining of how the boss treats her unfairly and also pointing out every one of Pamela’s mistakes.

Rather than react emotionally as would certainly be one’s natural inclination, Pamela has listened impartially, nodded empathetically, and after she feels Amy’s had enough venting time, redirects Amy’s attention to a task or project that needs immediate action.

It’s a daily challenge, trying not to be distracted or influenced by Amy’s negativity, but it may pay off in the end. Pamela’s boss said to her in passing one day, “You’ve been very indulgent with Amy’s behavior. We value her work, but we’re aware of what’s going on and this will be dealt with. Thanks for your patience.”

Adam was training for a new job and after three weeks was called into the boss’s office for a meeting. The training period had been rough and Adam was feeling discouraged, especially when his boss, John, raked him over the coals. His judgment was called into question as was his commitment to the position. Adam felt unfairly judged on many counts and was quite hurt and angry. But he listened impartially, took notes, repeated back what he heard to be sure he understood, apologized for his mistakes and perceived offenses and presented his side of the story.

He went into work the next day determined not to nurse his hurt feelings and to think the best of John (John was, after all, a highly talented man whom Adam respected and had wanted to work with). Not long into the day, John said to him, “I really appreciated that we could talk yesterday. That we could tell each other how we feel, get it all out in the open and move on without having to come in today walking on pins and needles – that we can work together without feeling uncomfortable.”

Adam gave himself a big pat on the back. This was a big step for him because had the previous day’s encounter taken place just a few years earlier, it probably would have become a major confrontation. But now Adam is glad that he had the foresight to react as he did.

The moral of the story? Take the high road. Or as they say at my daughter’s elementary school: STP – Stop Think Plan.

1. Stop – Don’t react emotionally. Stop the behavior when possible.
2. Think – Listen and carefully consider the situation and the other person’s feelings.
3. Plan – Be intentional about your words and actions.

My final words of wisdom: If you’re not sure how to handle a conflict in the workplace go to your supervisor, your HR manager or ask a respected friend for advice.

Few people like the responsibility of correcting other people but of course, it is often the job of managers and HR departments to do so. We’ve all heard the horror stories of firings that seem overboard and (on the flip side) employee actions that were never addressed. Last year, one of my friends was fired after writing a letter to her supervisor asking if they could talk together to resolve a situation. She spent many upset months thereafter trying to figure out what she really did wrong and had little confidence to even go job searching again. Less than three months later, the position she had held at the company was completely eliminated, resulting in the lay-off of six additional people. When she looked back, it seemed pretty obvious that the company had initially let her go with the motivation of saving money versus a letter that she had written.

There is an honest way to deal with people, as we all know. Unfortunately, not all companies practice it. Sometimes orders come from above to “cut staff” and although no one wants to be on that particular bad-news team, they are required to get it done somehow. In this life we lead, and as imperfect humans trying to do our best, sometimes we get it wrong.

Here are some guidelines to assist in working with employees the right way:

1. Always state the problem with specifics and examples. Focus on the employee’s choices in the matter and why it was not a good decision.
2. Listen carefully to what they say. If someone who is genuinely shocked or sorry for their actions, it is a positive sign. Listen to their side of the story, give them the benefit of the doubt and be willing to adapt how you understood the issue if needed.
3. Always keep a record of disciplinary action and any talks with the employee. If your company issues incident reports, etc, always fill them out.
4. Follow your chain of command and policies for discipline carefully. With questions, ask your supervisor and company’s legal team.
5. Even if employed by an “at-will” company (employer can fire and employee can quit for no reason stated), remember that your employees are human and try to be fair. Don’t fire without telling them your reason and having your process backed up. It’s a good way to have a bunch of scared employees tiptoeing around who are afraid to speak up.
6. Consider discipline other than firing, if the offense did not hurt the employee/anyone and was not against the law. A Write-Up is often enough to help the employee see the issue and work to resolve it. After all, you do want your employees to be able to problem solve, right?
7. Never contract out for firing. I don’t care if you have thousands of employees under your care and have to let them go all in one week, this is one of the worst things you can do. It can be psychologically damaging to the employee getting the ax (and the ones not getting the ax-trust me, word gets around) and it’s extremely bad form on the part of an employer to not take the time and do what needs to be done.
8. Go out of your way to be kind and do what you can for the employee. If a severance package or help with unemployment would be helpful, provide it. This will help the person feel valued (even if they didn’t work out as an employee) and is considered good form for company practice.