Intermountain Healthcare

            My internship at Intermountain Healthcare was one of my strongest learning experiences I have had at BYU.  Through daily experience, the changing world of healthcare was explained effectively.  I saw what hospitals are doing to get ready for Obamacare, by preparing their staffs and programs to efficiently maintain the rules of Obamacare.  Without my internship, my knowledge of HCAPHS would be minimal. Now I know staff performance affects each hospital’s reimbursement rate.

            In my internship, my main responsibility was “rounding on” patients, asking questions about their care in the Emergency Department.  Hospitals will only receive full reimbursements from the government by improving their HCAPHS scores. The best way for hospitals to heighten their HCAPHS scores is by improving nurse communication consistency, responsiveness, and pain management.  Nurse communication is the biggest contributor to a hospital’s HCAPHS scores. So, my job, when I went “rounding on” patients would be to ask all important questions.  How is the medicine to take?  What did they expect from the information from their labs or tests?  What was their pain level?  For the most part in talking about their care, all of the patients had the best things to say about the nurses and staff members.

Truly, the nurses that work in the emergency department are some of the brightest nurses I have ever encountered. Several of the patients echoed that belief back to me.  I once saw a nurse helping a patient carry her belongings, including a baby, to the patient’s car.  A nurse’s ability to make a patient not only understand but care about a patient, I believe, makes them gain their health back more quickly.  I had a fantastic time rubbing elbows, and gaining wisdom from the nurses.

Next, the actual staff helped me to see the process of running a hospital.  Each has their part or specific job.  Those who take blood, those who give breathing treatments, those who take x-rays each have a specific task to accomplish that must be done properly to maintain the scores each hospital receives.   And the fact that those individuals all work independently throughout the day or night shift illustrates that a hospital would be a large undertaking for an administrator.   The doctors, though the directing part of the system by ordering labs, treatments and procedures, are only a small part of a much larger service.

It could seem daunting to manage a group as diverse as the staff at a hospital, or, at least highly problematic without a specific protocol of enforcement.  I was able to see this firsthand with the use of a program that all the interns were asked to work with, called AIDET.  AIDET stands for acknowledge, introduce, duration, explain, and thank you.  AIDET is one of the up and coming “best practices” programs that hospitals are starting to use.  Intermountain was one of the first to implement AIDET.  This program illustrates the quality a hospital can achieve with their patients.  It takes consistency to work through problems of duration with patients. The problem that Intermountain has been having is to get all staff members to commit to use AIDET with every patient under their care.  The nurses that were committed to AIDET performed efficiently with enhanced communication.  However, the nurses that didn’t commit to AIDET struggled with their communication skills and had inconsistent results.

My increase of knowledge of the health care system is something I needed not only for my professional life but my personal life as well.  This opportunity to do an internship at Intermountain Healthcare helped me plan for my professional career quite specifically.  If a person’s understanding of a future job can be enhanced through knowledge of how a system works, then the chances of a consistent, enjoyable job is also more likely.  This internship taught me so much about how hospitals operate and the problems hospitals face.  The depth and breadth of diverse problems a hospital can face took time to believe.  At one point I wondered if it were possible to overcome the budget and human communication problems I saw.  Yet, once I began to learn the various protocols that were used in the emergency department I could see that skills could increase if they were followed, especially by using the HCAPHS scoring system.

Further, the guest speakers we had throughout the internship became a highlight of my time by giving me insight into different fields within healthcare. There was one common theme from the guest speakers, and it was how they got to where they are now.  All of them had very different paths getting into healthcare, an assortment of varying degrees and jobs they worked in before coming to Intermountain.  Since I am now considering becoming a hospital administrator, the path of the speakers was of keen interest to me.  Do I go for an MBA or an MPA?  How many years of experience should I strive to get before I enter graduate school?  Each speaker helped me look at decisions I was about to make. The Intermountain internship was a great experience that I would definitely recommend to anyone thinking about looking to work in the healthcare career field.  

Provo Ut; Intermountain Healthcare Cardio Rehabilitation- Kaitlin "100 Day Heart Challenge"

For the last 100 days, I have had the opportunity of working with the 100-day heart challenge participants here at the hospital in Provo.  At the beginning of the program, I was given three participants for whom I would devise work-out routines, and essentially, oversee their physical fitness during the course of the challenge.  With my three participants this summer, I have seen struggles, disappoints, failures, heart aches, successes, and joys.  I have watched as they have motivated themselves to work through pain and trials to change their lives for the better.

I will admit, at the onset, I was skeptical.  I did not really know if 100 days could make a significant difference in the lives of these individuals.  How wrong I was!  And the benefits run deeper than I ever could have imagined.  They are physical, emotional, and spiritual.  Not only have these people learned to sweat and enjoy it (both physically as well as through emotional and spiritual trials as well) but I have gained so much from my experience with them.  Not only have I learned that I actually could love personal training (who knew?), but I've seen the examples of these individuals, and have learned greatly from their life wisdom.  Each has been a blessing to me in my life as I struggle through the many decisions I am facing.

Soon, these contestants will have their final weigh in, and one of them will be declared a winner, but to me they are all winners because of the decision they made to change their lives for the better.  At this time, our paths will part, but I know that I will forever be changed by the decision I made to do an internship this summer. 

Provo, UT: Central Utah Surgical Clinic -Cory Pettit

This summer I had an internship at the Central Utah Surgical Clinic working under Dr. Nelson, an orthopedic surgeon.  It was a great experience, as I got to see all parts of the surgical process.  I would begin by doing clinical visits with him, where we saw people before and after their surgeries.  For those coming in pre-surgery, Dr. Nelson would use subjective assessments of pain and mobility, as well as medical imaging to determine a course of treatment.  What most struck me about these meetings was how friendly and personable Dr. Nelson was with everyone.  He greeted each patient as if they were long time friends,  and after the consultation he would usually spend about 5 to 10 minutes talking about some common interest they shared, whether it was sports, fishing, or even a mutual acquaintance.  It always seemed they had something in common.

After the consultations, the next step was the surgeries themselves.  I was fortunate enough to be able to actually be in the operating room during the procedures, and got a close-up view of what was going on.  Dr. Nelson would explain to me what was the steps in the operation, and would help me understand and see the anatomy in the area he was operating on.  What most surprised me about the surgeries was how intensive they were.  Many called for power tools such as a power drill and a bone saw.  It reminded me of a carpenter's shop, where instead of working with wood, they were shaping bone.

The last step in the process was to visit the patients a few weeks after their operation.  He would check up on them to make sure there had been no complications, and that everything was healing correctly. Although they were sometimes still in pain, almost all of the patients saw improvement and were very grateful for Dr. Nelson.  Being an intern with him was a great experience, and helped solidify my desire to go into orthopedics.

For more information visit  http://www.centralutahclinic.com/departments/surgery-center.

Italy -Jarom Bridges 2010

"I finished the internship last week. The first few weeks I spent most of my time just becoming familiar with the clinic and patients and all the different exercises they do for different types of rehabilitation (upper body vs. lower body injuries) as well as comparing different modes of therapy like ultrasound, laser therapy, one called Tecar (similar to ultrasound, but different wavelengths), electrostimulation therapy, and massage. 

In my last week and a half I did a study with as many patients as I could get, which turned out to be about 20 (it's not a very big clinic, and a lot of the patients come 3-5 times per week, so there's a lot of overlap). Anyway, I asked them questions to find out what type of injury they had: chronic or acute, bone v. muscle v. tendon/ligament injury, what sort of situation they were injured in, etc. Then I asked them questions regarding what exercises they were assigned, which ones they found most and least effective, and whether they did exercises at home in addition to their treatments at the clinic. I also asked them about the intensity of pain they felt at the time of injury (or if a chronic injury or post-op, how much pain they felt prior to beginning therapy), compared that with their current level of pain on a typical day at their respective stage of rehab, and then asked if a session of treatment increased or decreased their immediate level of pain. 

In summary - and this is probably all you really need to know - I asked them detailed questions about their manner of treatment, levels of pain at different stages of treatment, and perception of the effectiveness of each of their prescribed exercises/modes of treatment. I haven't compiled all of the results for a specific analysis yet, but that will all go into my paper for Dr. A-Y when I get back. It might be interesting for people to know that I found the style of treatment here was almost exactly the same as what I've seen in the US, and in some cases it even seemed that they were advanced in their variety and technology of treatments. So while the language and the culture were of course different, the science of physical therapy remains the same in practice. Anyway, I had a great experience, met a lot of people and made some new friends, and now I have a great international experience to put on my grad school applications and help me stand out from the rest of the crowd. Plus, they told me when I left that if I'm ever back in Italy and I'm looking for work, I should be sure to contact them because they'd love to have me back. So not only was it a great educational experience, it's also opened a possible door for a career pathway as well, which I would guess is often the case with student internships."

ITALY:  Medical Fisio Gym (through Societa Dante Alighieri)
For more information visit: http://www.dantealighieri.com/