Fact Sheet
Overview
Who We Are
What We Do
Whom We Work With
Why We Do It
How We Do It
Standard Monitoring Agreements
How we are supported
Benefits
- Health care professionals have a profound impact on the safety of their patients and families, their co-workers, and the general public. Like other persons in our community, their performance can be compromised by factors such as high levels of stress and they may suffer from conditions that may include physical and mental health disorders, problems at home and/or the workplace, and substance use disorder.
- Puʻulu Lapaʻau is dedicated to promoting patient safety and care by improving the health, well-being, and effectiveness of healthcare professionals. We provide two options for positive intervention for those who may be struggling with personal, work or health-related problems.
- First, through Standard Monitoring, we rigorously monitor professionals using national guidelines established by the Federation of State Physician Health Programs, the American Society of Addiction Medicine, and the Federation of State Medical Boards. Standard Monitoring provides an independent alternative to discipline for professionals, who otherwise may practice unsafely which may result in the loss of employment, professional licenses, and their careers.
- Puʻulu Lapaʻau also offers a less intensive, short-term Supportive Case Management program for professionals who experience stress, work-life imbalance, burnout, and other symptoms that make it a challenge to meet the demands of their workplace, family life, and other personal and professional goals. Supportive Case Management is a voluntary, confidential, non-disciplinary program.
Who We Are
- Pu‘ulu Lapa‘au is an independent, non-profit organization dedicated to assisting our healthcare provider colleagues in their journey of life and medicine.
- We serve as a confidential resource for health care professionals suffering from potentially impairing conditions. We enhance and coordinate the early detection, intervention evaluation, treatment, continuing care and monitoring over time.
- We work cooperatively with the healthcare provider, community organizations, healthcare organizations, and regulatory agencies for the benefit of the public and the provider.
- Established in October 2006 to assume the responsibilities of the Hawai‘i Medical Association’s (HMA) Committee on Physician's Health (CPH), a dedicated group of volunteer physicians who assisted and monitored their colleagues in need.
- We are governed by a twelve-member volunteer Board of Directors. Eleven of the Directors are health care professionals, and one is an attorney with significant experience in non-profit governance.
- Our staff includes a Medical Director, a Program Coordinator, and an Executive Director. All positions are part-time.
What We Do
- Our mission is to promote patient safety and care by improving the health, well-being, and effectiveness of healthcare professionals. We do this by offering respectful and confidential support and advocacy for physicians, physician assistants, pharmacists, nurses, dentists, psychologists, medical residents, medical students, and other healthcare providers.
- We provide two distinct options for positive intervention for health care professionals who may be struggling with personal or health-related problems.
- First, for professionals whose condition, behaviors or performance is serious enough to warrant formal action, we offer Standard Monitoring using national guidelines established by the Federation of State Physician Health Programs, the American Society of Addiction Medicine, and the Federation of State Medical Boards.
- Standard Monitoring is an independent alternative to discipline for these professionals, who otherwise may practice unsafely and may lose their jobs, licenses, and careers.
- Standard Monitoring works! Though some view the monitoring requirements as difficult, there is ample international evidence that professionals have had their careers restored when they adhere to these conditions.
- The benefits of monitoring include
- Participants are rigorously monitored over a designated period of time by an independent entity to assure they comply with a monitoring plan designed to assure safe practice
- Professionals are held accountable
- Professional is able to continue practice with adherence to the monitoring requirements
- Employers and licensing boards receive independent reports
- Hospitals and other healthcare organizations meet Joint Commission Requirements
- Second, Puʻulu Lapaʻau also offers a less intensive, short-term Supportive Case Management program for professionals who experience stress, work-life imbalance, burnout, and other symptoms that makes it a challenge to meet the demands of their workplace, family life, and other personal and professional goals. Supportive Case Management is a voluntary, confidential, non-disciplinary program:
- Evaluation by a trained in-house medical professional;
- If indicated, referral to resources such as employee assistance programs, professional coaching, mindfulness programs, or medical or psychological counseling;
- Involves short term support for up to one year, without Standard Monitoring requirements;
- The benefits of Supportive Case Management include:
- Early intervention, before a professional’s behavior becomes so serious that disciplinary action might be considered;
- An opportunity for the professional to re-calibrate his professional life;
- Low cost for the professional. We do not charge fees for this service, and interventions such as professional coaching are far less expensive than formal interventions such as residential treatment;
- The professional is able to continue practicing with minimal disruption.
- Puʻulu Lapaʻau monitors the following conditions:
- Substance abuse disorders
- Mental and Physical Conditions (including cognitive disorders
- Behavioral Health (Disruptive, anger management)
- Sexual misconduct or other boundary violations
- Stress management (burnout)
- We subscribe to the Physician Health Program Model, which has been endorsed by the American Medical Association
- The essential elements of the model are;
- Confidentiality
- Independent Governing Board
- Evidence-based Methods
- Peer-to-Peer interaction
- Qualified staff
- Mutual immunity
- Under this model, we conduct the following essential activities
- Referrals to qualified professionals for evaluation and/or treatment
- Behavioral and toxicologic monitoring
- Compliance documentation
- Documentation of well-being
- Appropriate advocacy for the professional
- Facilitated reentry to practice
- We provide educational opportunities to our contract partners and others on issues of relevance to the well-being of health professionals.
Whom We Work With
- We work with health care professionals whose performance can be compromised by factors such as high levels of stress and those with conditions that may impair their ability to work with skill and safety. These include physicians, medical residents, physician assistants, pharmacists, nurses, psychologists, social workers, and dentists. We also support medical students.
- Our participants are referred to us by healthcare organizations, hospitals, other employers, and professional boards. Some seek our services on their own.
Why We Do It
- Health care workers have a profound impact on the safety of their patients and families, their co-workers, and the general public. As such, the community-at-large must be able to trust health care professionals, and the health care professions must do all it can to maintain that trust.
- The data is compelling:
- Three hundred to four hundred physicians die by suicide every year, a rate more than double the general population.
- Over 50% of physicians exhibit symptoms of burnout. If these indications are not addressed, they may lead to problems, including inappropriate workplace behaviors, job dissatisfaction, substance abuse, early withdrawal from practice, and sometimes, suicide.
- 8 to 10% of healthcare workers suffer from substance use disorders.
- The cost to the community includes reduced number of available healthcare providers.
- The cost to employers can be very high, in terms of inefficiencies, increased error rates, and replacing experienced professionals.
- Standard Monitoring following established guidelines works. A study examined outcomes for 904 physicians monitored for substance use disorder by 16 state PHPs. 78% of the participants were licensed and working at the end of the five-year monitoring period.
- Consistent with our mission, we firmly believe that our health care colleagues can benefit from our program.
How We Do It
- Standard Monitoring follows national guidelines regarding physician health established by the Federation of State Physician Health Programs, the American Society of Addiction Medicine, and the Federation of State Medical Boards.
- Every participant referred to us is interviewed by our Medical Director. If warranted, the Medical Director will arrange for a formal assessment by a qualified provider so that we can help the participant develop a plan that will effectively address the presenting issue.
- Establish a plan
- Treatment if warranted
- On-going therapy, counseling or coaching as needed
- Documented activities, which may include attendance at 12 Step meetings
- Random toxicological screens if warranted
- Once a viable plan is established, we enter into a monitoring agreement with the participant.
- If the plan entails referral to professional services, such as coaching or treatment, we assure that these services are conducted by qualified persons experienced with working with health care professionals.
Standard Monitoring Agreements
- Three types:
- Substance
- Medical (includes physical, mental health, and cognitive disorders)
- Behavioral (includes “disruptive behavior”)
- Duration
- Agreement duration varies based on the individual circumstances, but substance use disorder contracts are usually 5 years.
- Requirements
- Requirements vary according to the specific circumstances but most require:
- Abstinence from all potential substances of abuse
- Random, observed drug (multiple tissue type) or alcohol testing
- 12 step meetings, documented with signature logs
- Worksite monitoring and/or meetings with the Medical Director or Board of Directors
- Releases of information
- Treatment if indicated
- Examples of Non-Compliance
- Drug testing irregularities (positive test for substances, missed tests, dilute urine)
- Not attending the required number of 12 step meetings
- Not meeting with the medical director or board of directors
- Not meeting with worksite monitor
- Refusal to follow recommendations (for example attending evaluation or treatment)
- Possible Actions for non-compliance or impairment
- Order to cease practice
- Re-evaluation of sobriety/compliance status
- Change in monitoring requirements (Increased meetings, drug screens, etc.)
- Notification of 3rd party organizations (Licensing Board, employers)
- Extension of the Monitoring Agreement
How we are supported
- We have contracts with various hospitals in the State and from organizations that recognize the value of our work. In exchange for funding, the hospitals are able to refer any of their professionals to us for an informal assessment, and when required, formal monitoring. Hospitals receive periodic compliance reports on the professionals they refer to us.
- In addition, Participants on full-term contracts are assessed a monitoring fee. A Participant on a short-term contract may be assessed a reduced fee, and in some cases, no fee. This fee is imposed to assure the Participant has a tangible investment in their own success.
- As a non-profit organization with 501-c(3) status, we are able to receive donations from those who support our work.
Benefits
- Rigorous monitoring by an independent entity
- Professionals can manage the stress that may impede their ability to practice at the high level required by their occupation
- Professionals are held accountable
- Professional can continue to practice safely
- Employers and licensing boards receive independent reports
- Hospitals meet Joint Commission requirements