hospital impact

by Nick Jacobs

A few years back while listening to a presentation from Dr. Leland Kaiser, my interest was peaked when he said, "If you are not doing genomics at your hospital, you are already behind the curve." In a recent H&HN magazine article (www.hhnmag.com) by Haydn Bush entitled "Practical Genomics," the author carefully outlines the current state of the science. He quotes Lyle Berkowitz, M.D., director of clinical information systems at Northwestern Memorial Healthcare who says, "In the near future . . .physicians will be able to integrate genomic maps, or complete, individual accounts of a person's 6 billion-piece DNA code into care."

At Windber Medical Center we have been working for six years with our partners at the Windber Research Institute and Walter Reed Army Medical Center to do just that, translational medicine. We believe that the best way to rapidly improve individual patient care, outcomes, and quality of life is by translating molecular research, driven by clinical questions, into new standards of patient care. Our primary focus is improving patient care and the quality of life for the patient and their family by rapidly translating molecular and clinical research into action.

Sound good? It will be. As the article goes on to explain, "If better genetic testing for heart disease emerges, patients with increased genetic risks could conceivably undergo more regular CT scans to check on artery blockage, while also improving their diets." We have been doing this for the past five years.

The idea is for the physician to work with the patient to start a lifelong treatment of the identified risk factors. This treatment includes stress management, diet, exercise and group support. As the article states, " . . . the physician is retooled into a lifelong coach or partner to go through your entire risk report, almost as a financial adviser would manage a portfolio."

Also as pointed out by the article, let's look at the details of why we're not there just yet. First, there aren't enough genetic counselors nationwide to achieve this goal quickly. Second, most hospital information systems have no capacity to handle genomic data. Third, the fears of most patients concerning the use of genetic data to keep them from buying insurance or worse yet, from getting a job are real and definite.

Finally, there is the question of whether the patient would embrace the steps necessary to alter the potential progression of disease. In the book Change or Die the author, Alan Deutschman, discusses the reality that when cardiologists tell their patients with heart disease that they have to "change or die," nine out of ten fail to switch to healthier lifestyles. It appears as if 90% of us would knowingly select death rather than change.

So, as we push forward with our efforts to promote behavioral change through the use of integrative health through programs like the Dr. Dean Ornish Coronary Artery Disease Program, and as we work toward making translational medicine a reality through the fusing of knowledge provided by M.D's and PhD's in our labs and hospital, we work and wait for the rest of the world to understand that the future is here and the future is now.

"If you are not going genomics at your hospital, you are already behind the curve."

by Jeff McKune

If you are looking at developing a new service line or you just want to have a better understanding of business patterns that impact your hospital, you may have some questions. What are the most prevalent DRGs in our market area? What percentage of patients in our market area are coming to our hospital? If they are not coming to our hospital, where are they going? Are we holding our own on surgeries? Are we capturing our share of cardiovascular business?

I did a quick survey of state hospital associations across the country, and it looks like most, if not all, have some means of collecting and providing admissions and utilization data for hospitals in that state. Some associations make the data available on the web, while others may provide it on CD or provide summary reports of various kinds. In Missouri, an MHA member hospital can purchase this data on CD for under a thousand dollars. It is interesting how much you can learn from data like this when you have a quiet afternoon, perhaps during some down time during business travel. In fact, each of the questions above can often be answered without a lot of effort.

Microsoft Excel has a powerful feature call pivot tables. Pivot tables allow you to easily summarize and digest large amounts of data, viewing it in different ways to answer relevant business questions. Using pivot tables with statewide hospital data can provide some valuable, and often hidden, insights. There is no programming involved, and a basic pivot table takes just a few clicks and a couple of drag-and-drops to complete. There are three steps: Determine what data you are going to use, run the Pivot Table Wizard, and drag-and-drop your row and column definitions into place.

Your data can be a list of data in an Excel worksheet, a Microsoft Access database, or some larger external database. You will need to know a little about the data you are wanting to study. For example, if you want to look at inpatient admissions you will need to make sure that the data source has that kind of data in it. The Pivot Table Wizard is found under the Data menu in Excel. It will walk you through selecting your data source and determining where you want to put your new pivot table. You will probably want to put it in a new worksheet. Finally, drag-and-drop the data fields you want to study onto your pivot table.

Do you want to understand the relationship between specific hospitals and counties where patients live? From your field list drag "Hospital Name" (or whatever the data field name is) to the left of your pivot table. Boom! Excel quickly lists all of the hospitals along the left of your pivot table. Similarly, drag "County" to the top of your pivot table. Excel will list the counties across the top of the table. Drag "Admission Date" (again an example name) to the Data area of the pivot table, and Excel will provide a count of all admissions by county for every hospital. Granted, this may be a large pivot table, but drop-down lists are provide for you to select just the hospitals and counties in which you are interested. If you want to look at DRGs or physicians, drag "County" off the pivot table and back to the list of data fields, and then drag "DRG" or "Physician" to the top of your pivot table.

Yes, there are a lot of benchmarking and data analysis services available, but it is amazing what you can discover on your own using pivot tables. If you would like some more guidance, Google "building an Excel pivot table" and you will get more than 400,000 hits. One of the links is a video that shows you how to build a pivot table in Excel 2007. Or, post a question here or email me, and I will be happy to help. If you have used pivot tables in an interesting way, be sure to share it with the rest of us!

by Christopher Cornue

Literature suggests that the “proper” Service Line model consists of all operational and other entities reporting up into a Service Line Director or Vice President. So, for example, in the Cardiovascular Service Line, the Vascular Lab, Catheterization Lab, Surgery Components, etc. would report into the Cardiovascular Service Line Director and it would be his/her responsibility to oversee the functions contained within this Service Line (e.g., physician recruiting, establishment of quality & operational metrics, operational oversight of these areas, FTE oversight, capital acquisition oversight, etc.).

But, what do you do when you are in a financially strapped institution? Furthermore, what do you do when you are in an organization that is slow to move away from the “silo” mentality toward a “matrix” one, as the previously mentioned “Proper” model would support? I have spent time in such an environment, which is moving in a thoughtful & deliberate manner from the “silo” model to the integrated “matrix” model. To support this direction, and address the immediate needs around Service Lines, I have created a structure that provides administrative support across the silos, and partners that with strong clinical (mostly RN) oversight in each of the key Service Lines in which we are concentrating. This is one approach, which obviously has pro’s and con’s associated with it. In the “pro” column – one can align individuals in an interdisciplinary manner; rally people to support a focus on a specific service line; integrate quality, financial, growth and satisfaction metrics to support the service; etc. Among those items in the “con” column – there is a lack of direct responsibility over all the components within a service line; control is more dispersed among several individuals; not all “key players” are aligned and “bought into” the efforts of the service line; and fiscal and capital priorities are more difficult to direct or influence. There are other models out there … if your organization is unable to adapt the “ideal” model, what has worked for you? Furthermore, has the implementation of the “ideal” model worked?

Regardless of which model to use … a focus on 2-3 key service lines, supported by the full organization, is probably all that should be attempted in a given period (e.g., fiscal year). A focus on more than 2-3 will dilute organizational efforts for fully supported, integrated, and successful service lines. It is clear the service line structure will continue to evolve in response to external (and internal) forces. I guess we all need to buckle up and make sure we’re able to be flexible and adapt the structure that best suits our respective organizations – and make that model successful!

by Nick Jacobs

According to an article by Harold Meyerson in the Washington Post this week, Dennis G. Smith, director of the administration's Center for Medicaid and State Operations announced standards intended to restrict families from purchasing health coverage if the parents’ employers choose not to supply it. It will also block states from providing health care coverage to uninsured children from families with yearly incomes in the order of $50,000.

According to Meyerson, this new pronouncement was in direct response to governors like California’s Schwarzenegger and others who have chosen to provide health coverage to children from families earning two to three times more than the federal poverty level or $20,650 for a family of four.

He goes on to say that it appears that this administration fears that parents in the selected income groups will abstain from enrolling their children in private plans. As we have stated so many times before in these blogs, nearly 9 million American children are without health insurance coverage, and this number is fast approaching nearly 400,000 more uninsured children than last year.

Smith told the New York Times that the states must institute a minimum of a one-year period of no insurance for individuals before children become eligible, and they must also show that the number of children insured by private employers has not dropped over a five year period by more than two percent.

According to Meyerson, if a state wants to provide coverage for a chronically ill 2-year old whose parents’ have lost their health coverage, the state has to wait until she’s a chronically ill 3-year old. The somewhat passionate opinion of Mr. Meyerson is that the administration’s fervor on this position is to ensure that we cannot permit our children to obtain health coverage that may diminish the market share of big insurance. Opinions please?

by Jeff McKune

Early in my IT career, I specialized in a particular series of personal computers. One interesting feature of these systems was a self-diagnostic capability that would draw a picture of the internal boards in the computer, highlighting a defective board. It was pretty cool to watch, and I couldn't wait for my first customer demonstration. In the demo, I showed the customer how easy it was to access the boards by removing the one-piece cover. I then loosened one of the boards to simulate a "failure", put the cover back on, and hit the power switch to start the self-diagnosis process. But, nothing happened - the screen remained black. Unfortunately, it was the customer who saw the problem and spoke first: "You might want to check your connections. Looks like the power cord is not plugged in."

It would not take much to get so caught up in the administrative concerns associated with the delivery of healthcare, that we forget what connected us to healthcare in the first place. Sometimes it is a good idea to make sure we "check our connections" to remind us of our purpose.

There are a couple of things that I try to do on a regular basis to keep me connected to my team and more importantly to our patients. We handle many pediatric dental patients each week. Frequently they arrive afraid, wondering about the people in funny looking clothes and what the procedure will be like. I enjoy sitting down with these little ones and reading them a story, or playing a guessing game to take their mind off things. Making a difference to kids means a lot to me, and helping others is one of the reasons I connected with healthcare a few years ago.

I also enjoy dressing out in scrubs and helping my team. Being a former IT guy with no clinical training beyond my BLS, I cannot provide direct patient care. But I can help my team clean and make beds between patients, wheel a patient outside to their waiting family, or just help the housekeeper empty the trash. I have found that this powerfully connects me to my team like nothing else.

What do you do to stay connected to your purpose and direction in healthcare? I would be interested in hearing how you "check your connections."

by Tony Chen

Recently, I had 3 experiences that are really changing the way I think about the future of healthcare.

We had GeekSquad (sort of like the IT dept for home computers) come in to look at the persistent network problems that had been plaguing us for almost a year. The consultant, who couldn't have been more than 20 years old, was very professional, got on the phone with AT&T, reset our modem, and fixed the problems in 2 hours. We started talking honestly about his job and he said, "No offense, but it's your generation that's clueless about technology and needs this service. Trust me, I don't have any job security - I know 7-year-old kids who could have fixed your network just as quickly as I did." (side: my generation?)

Speaking of AT&T, I heard a story on NPR about this lifeblogger who received a 300-page phone bill from AT&T for her iPhone. The bill listed every single text message she received/sent (all 30,000 of them!) for that month. Yes, that's 30,000 text messages in one month. Many of those text messages were "status changes" within her friend's facebook profiles. If you don't know what I'm talking about, it's hard to explain - just register onto facebook and check it out yourself. Professionals hang out at bars. Others hang out at cafes. A whole generation is hanging out at facebook. (don't even get me started about SecondLife)

And speaking of Facebook, I did check it out. What is all this fuss about? 3 million people joining Facebook per week? I invited all my friends from gmail who already had facebook accounts, found a long-lost childhood friend who lived across the street from me, "poked" a few friends, and sent them some virtual "beer." I watched videos of my friend's kids, saw some not-so-flattering party pictures, and joined a group called, "unlike 99.99% of other facebook users, I was born in the 70s." I tried to find other ACHE members (I think I found 3).

All in all, I got a taste of what this generation is growing up with. While I had MTV, Nintendo, and a neighborhood basketball hoop, they have Facebook, iPhones, and txt msgs. They are extremely tech-savvy and extremely connected (30,000 txt msgs is 1,000 per day?!). They value authenticity and relationships just as much as we do. Despite their tech obsession, they value community just as much as we do.

So how does this all relate to healthcare?

- Don't build it - they won't come. All of the technology we are investing in is trying to get people to come to us. Instead, maybe we need to develop technology that brings healthcare to where they are already. For example, I could totally envision a Facebook application or community group that helps Facebookers with diabetes manage their diabetes. Since users are loggging on all the time (20-30 times/day), isn't that where a smart diabetes company would want to be? Plus, the community that is built online gives them the value of a virtual support group (though don't call it that).
- Integrate healthcare into everyday life - make it easy. I was reminded that while healthcare is my world, healthcare is only part of the world for everyone else. The more we integrate healthcare into every day life habits/gadgets/products ( see my post on the Glucophone), the better. And if we have to carve out healthcare as a separate compartment in people's lives, it has to be as one-stop-shop as possible (maybe RevolutionHealth is the best example of this, though they have other issues).
- We healthcare professionals need a better network. We could learn a thing or two from these high school kids. Some new development happens and it gets picked up virally. No PR release. No marketing. Some kid adds it to their profile, their friends see it and add it to theirs, and it explodes. Where is that mechanism of information sharing in healthcare? 15 years from now, will doctors be going to their facebook physicians group to look for best practices? will administrators facing the same question/problem/challenge be able to find each other that much faster? We need a stronger healthcare community than we were are getting through current channels.

So, what do you think? Is Facebook irrelevant to our hospital leadership discussion? Will healthcare innovation evolve at a faster pace to truly impact the next generation?

UPDATE: Amy Tenderich of DiabetesMine is asking her readers - what do you want in a health care site/community?

by Tony Chen

Just a quick note: Christopher Cornue, Andrew Barna, and I were all quoted in this week's Modern Healthcare cover story (reg req) about ACHE's decision to change their certification program.

by Tony Chen

Are we hospitals only going to be transparent enough to appease the outcries? Or should we lead the way and proactively provide info before people ask?

I say we lead. Here's how we can start - by defining exactly what should be transparent. Also, learn from what others are doing. Check out this hospital's 6 principles that guide their transparent reporting. And read about what what Michigan has done to get all of its 146 nonprofit hospitals to post prices of 50+ common procedures, representing 80% of their business.

Where is your hospital at? How urgent of a priority is transparency at this point? Who would typically lead such an effort?

by Tony Chen

Our very own secretary of health and human services, Mike Leavitt, has started blogging about his work. He started it exactly a week ago and already has 3 posts up addressing everything from SCHIP to health literacy in Africa to Tamiflu. And contrary to my expectation, this isn't a corporate PR machine. Nor are others ghost-writing for him. He's promised that he's personally writing these posts.

(I'm honored to be the 5th blogger to link to the blog. Hat tip: Bob Coffield of the health care law blog.

by Tony Chen

Check out this post from DiabetesMine on the new GlucoPhone brought to us by HealthPia. An exerpt from the post:

The GlucoPhone is not just for SENDING blood glucose data over the net. It's actually a special glucose meter (GlucoPack™) that's fitted onto the back of a cell phone. So yes, you stick your test strip into a little slot on the side of the phone and bleed on it, just like you would any meter. Then you can immediately "text" your results to a database available online with the subscriber's permission, i.e. you set the access rights.

How cool is that! It'll be interesting to see how new technology potentially leapfrogs our current provider-based and payer-based attempts to address diabetes management. Because the diabetes market is so large (probably 20 million people) and impacts every day life, there are mountains of start-ups now trying to capitalize.

Going back to the same DiabetesMine post, here's an extremely insightful quote from the HealthPia CEO on the "felt need" of people with diabetes:

"The fact of the matter is that most people with diabetes are more concerned with the daily hassle of managing the disease than the long-term complications. But with something like this, we can help cut the hassle and focus on what's important"

by Tony Chen

This past week, the NYT reported on that both Google and Microsoft are each unveiling a major healthcare product in the next 12 months. While they remain hush-hush on specifics, one thing is for sure - both see the avalanche of consumer-driven healthcare coming. For better or worse, consumers will be in control of their health.

From the NYT article:

The Google and Microsoft initiatives would give much more control to individuals, a trend many health experts see as inevitable. “Patients will ultimately be the stewards of their own information,” said John D. Halamka, a doctor and the chief information officer of the Harvard Medical School.

Already the Web is allowing people to take a more activist approach to health. According to the Harris survey, 58 percent of people who look online for health information discussed what they found with their doctors in the last year.

It is common these days, Dr. Halamka said, for a patient to come in carrying a pile of Web page printouts. “The doctor is becoming a knowledge navigator,” he said. “In the future, health care will be a much more collaborative process between patients and doctors.”

The blogosphere has been ablaze since the article came out. Some screenshots of Google's patient interface/record have surfaced on the web here. The WSJ Health blog and other blogs make note of recent healthcare acquisitions by Microsoft (bought MedStory, a healthcare web search engine) and Google (23andme, a genetic profiling company).

As noted in this ZDNET blog, the future direction seems imminent:

In the future of the “data Web,” healthcare information and alerts relevant to an individual will show up in the same way Amazon recommendations surface. With the data online, you could input symptoms, upload images and the “system” could check against your history, medications, allergies, etc., prior to an online video consult with a physician thousands of miles away.

Of course, all the same old data issues have to be worked out - privacy, malpractice, storage, interoperability, and security. Plus, there's a little problem with funding and business model (hopefully we will never see a Google banner ad within our medical record!) Nonetheless, Microsoft already has their products in lots of hospitals, and Google obviously dominates search (12% of people consult Google before visiting their doctor!). And both have mounds of cash.

Make no mistake about it- this is not a continuation of the Google vs. Microsoft War that's been going on for years. This is Google or [insert brave company name here] against the most powerful force of them all: the healthcare industry status quo.

by Jeff McKune

In my former life in IT, I worked on a number of biotech research projects. The company organized resources around the different portions of their biotech pipeline. For each segment of the pipeline, a user steering committee was responsible for overseeing the systems and projects that affected that segment.

These committees were comprised of key stakeholders of systems at different geographical locations, project managers, and IT representatives. Even though these were IT systems, the end users had ownership, and it showed in the ratio of users to IT staff on the committees - usually three to one.

The steering committee responsibilities were fairly comprehensive. They recommended changes to systems based on their changing business needs. They reviewed and approved all changes, including those proposed by IT subgroups such as the database team or the networking team. In short, to a great extent they controlled their own destiny with regards to their operational systems.

When I joined PCRMC early in 2006, I was pleased to see the hospital beginning to use this same structure. A "user" steering committee had been organized around the management of the complexities of the revenue cycle. The committee is comprised of several department directors, as well as representatives from coding, finance, and compliance. Having the stakeholders all in one room at one time smoothes the coordination and discussion around issues that impact each of them, and it has led to significant improvements in revenue cycle efficiency.

In what other areas could steering committees be deployed in hospitals? Would it make sense to have an admissions steering committee that managed that portion of the hospital "pipeline"? In this case, the "users" would be patients - more specifically, non-hospital representatives of our patient community. What about a nursing care steering committee, or a discharge management steering committee, each with a higher ratio of patient representatives than hospital staff? Without a doubt we would gain new insights from those we serve, and the effort would bring more meaning to patient-centric care.

Perhaps your hospital is already using steering committees in this way. If so, please share your experiences with the rest of us.

by Tony Chen

This week's medical blogosphere grand rounds is up at Swiss blog Med Journal Watch, where the theme is sudden changes of all sorts.

A few links to check out:
- ChronicBabe has come to accept her chronic disease
- A gut-wrenching story and picture about parents coming to accept that they can't do anything to change their newborn's disfiguring birthmark.
- DiabetesMine tells us about the "GlucoPhone" - a cell phone combined with a glucose meter. Now people with diabetes can test their blood sugar, let their phone read the results, and then text those results into a database.

by Tony Chen

Now, here's a great way to use a hospital CEO blog. Nick Jacobs is asking for everyone's help to get the word out on his hospital, Windber Medical Center. Turns out that Windber is actually one of the most progressive hospitals in the country. It may even be the best hospital that no one's ever heard about.

Maybe I'm biased since Nick blogs here at hospital impact, but point me to another rural hospital that has 3T MRIs, one of the largest (I believe) tissue banks in the country, numerous videos up at YouTube, and a hospital CEO whose in the board at Planetree. (And what other hospital has a link to hospital impact from its front page!)

Now, Nick's blog still has a relatively small following. But because he's been blogging for so long, he's built a readership that is loyal. And we all know how word-of-mouth marketing works - a few intensely loyal fans can take you so much further than thousands of lukewarm fans.

by Nick Jacobs

In a recent meeting with one of our most senior surgeons and a relatively new surgeon, the discussion revolved around the older physician's extremely successful career. It was one of those moments that locks into your memory as the senior doc stated the following, "If you want to be successful, you need to embrace the three "A's." To which we all moved forward in our chairs with an obvious question mark in our eyes.

He said, "You must be available all the time, 24/7. When the calls come, you need to say, "Yes, I'll be there." "It doesn't matter if it is morning, noon or night, drop what you are doing, and make yourself available."

Then he said, "You must be affable, affability is the key to continued support from the various primary care physicians who will refer to you. If you are not polite, pleasantly easy to approach and talk to, cordial, courteous, warm and friendly, neither the patients nor the referring physicians will be inclined to continue to refer to you.

Finally, he said with a smile on his face, "You must have ability." To which he went on to add, and ability, by the way, is a very distant third priority in this scenario. People will tolerate imperfection if you are available and affable.

So, there you have it, Availability, Affability, and Ability. I watched curiously at the wheels turning in the young docs mind. I'm not sure that his training has ever embraced such simple, common sense advice.

by Jeff McKune

It is interesting to visit with those at other hospitals and see commonalities between institutions. One of the first of these commonalities that I noticed was the five pillars. Sometimes the pillars are expressed as part of an organization's values, and other times they serve as a means of categorizing strategic plans. Perhaps your hospital has these same pillars, or something similar: People, Service, Growth, Finance, and Quality. Each time I have heard of these pillars, the "People" pillar is listed first, and often someone will say something like "Our People pillar is first, because we put our people first."

A quick glance at an income statement will certainly confirm that people costs - salaries and benefits - typically comprise 55 to 60 percent of a hospital's operational expenses. But do those expenses really count as investments in those all important human resources that make healthcare work? Fundamentally, healthcare, at least in the context of a hospital, is delivered by people. I won't downplay the importance of facility expansions and technology purchases that keep a hospital in the forefront of quality care. But let's remember that it is not the facilities or the technology that are actually delivering the care - it is our people.

We can look back at our institutions and remember a timeline of growth. It often goes something like this: "We added our East Addition in 1990 at a cost of $20M, increasing our capacity by 50 beds. In 2000 we added two 16-slice CT systems to our imaging department at a cost of $3M. Our new Cardiology Department has allowed us to provide new services to our community at a cost of $25M."

These are all good things, but when was the last time you heard a healthcare leader say "In 2002 we recognized a need to improve staff retention and maximize the productivity of our human resources, and we invested $3M in our new leadership development program. Seeing significant improvements in several areas, including employee satisfaction and patient satisfaction, we continued our investment in our people in 2005 by establishing an in-house university, improved tuition reimbursement for academic education and professional certifications, and mandatory annual HR training for all leaders at the director level and up - all at an initial cost of $7M with annual operational expenses of $2.5M. In addition, all of our senior staff are actively involved in our leadership development efforts, participating both as students and instructors on a regular basis."

There are ample research studies to demonstrate the benefits of this kind of HR focus in an organization. Would it make a difference in our hospitals if we really took that first pillar seriously?

by Tony Chen

Not every day that a hospital CEO is featured in mainstream media. Jim Citrin, a columnist for Yahoo Finance, wrote an article on Ochsner CEO, Dr. Patrick Quinlan, applauding the resourceful, dedicated, and nimble organizational culture he's created. Quinlan and his crew have been an inspiration and a beacon of light for the folks in New Orleans.

Dr. Quinlan stresses that it's the job of management to support the decision-making of employees on the frontlines. "Fear robs people of their ability to make decisions," he said. "If they feel they'll get in trouble, people will avoid making decisions, leading to inaction. But at Ochsner, whatever we do has a common path. There are no recriminations.

"When the crunch time came [during Katrina]," he continues, "our people exercised calm courage and selfless behavior. They saw problems and owned them. Their attitude was, 'We're just doing our jobs,' and 'What can I do to help?'" What did Dr. Quinlan himself do to help? For one thing, he led from the front. "You have to be there with your people. I stayed in the office for seven weeks straight."

by Tony Chen

Dr. Alan Adler, Medical Director of Independence Blue Cross, recently wrote an excellent article in Managed Care Magazine entitled, "Why Blogs?"

Not everyday that a stodgy industry trade publication addresses blogs in such a thoughtful way. Dr. Adler argues that blogs are increasingly relevant for providing consumer health information and for providing refreshingly candid insights, perspectives, and conversations amongst the medical and healthcare professionals.

Though he failed to mention hospital impact, his list of blogs is definitely worth checking out!

by Tony Chen

Most hospitals have some sort of employee wellness program. You know what I'm talking about - walking programs, smoking cessation classes, seminars for healthy eating, maybe even discounts to local gyms.

Clarian Health in Indianapolis is taking an unconventionally aggressive approach - they'll dock your paycheck $10 for every pay period your BMI is 30+. Starting next year, they'll dock $5 per paycheck if you smoke.

A few questions do come to mind:

- Do sticks work better than carrots? Maybe a better approach would have been to increase healthcare costs for employees by $15 per paycheck, and reward the non-smoking, <30 BMI folks with cash back. Same cost, but different mentality.
- Will this have a positive or negative impact on employee retention? Nurse recruitment efforts? Inevitably, they may lose a pool of employees and/or candidates. $15 every two weeks is $400/year, not an insignificant amount for some. Then again, maybe this attracts a healthier candidate pool.
- Will others try this incentive-based health, too? We'll see how many people actually change their behavior & how much costs are reduced. I suspect these type of programs will begin to show real ROI, and then the floodgates will open quickly.

What do you think?

by Tony Chen

Yes, it's true - a grocery store chain with almost 700 stores in 5 southern states will be offering 7 popular prescription antibiotics for free. Like most retail strategies, this has been done in the name of increased foot traffic.

by Nick Jacobs

As a leader, your days are filled with problem solving tasks. Every day your cohorts present you with their problems, and they look to you for the solutions. There have been numerous books about management that teach us to deflect those invitations to suffer with them by refusing to accept their monkeys on your back. The 4-Hour Work Week, by, Timothy Ferriss, boldly proclaims, “Escape 9-5, live anywhere, and join the new rich.” The book tells you how Tim went from $40,000 a year and 80 hrs. per week to $40,000 per month and 4 hours per week. He suggests that you find out which customers generate the most money for your company and only recruit customers like that. Easy enough. Then he suggests that you should find out which customers waste most of your time and get rid of them, however, you know for sure that Tim's not talking about hospital administration.

Having spent several college summers on the railroad in the yard master's office, it became obvious to me that the problem solving techniques established by that particular industry were primarily directed toward triage. The proposition went something like this: listen very carefully in an engaging and somewhat sympathetic manner, when possible take whatever steps necessary to help move or remove barriers that had become the road blocks to the resolution of the problem being presented, and encourage the presenter to continue to move forward to solve the problem by triaging it to the appropriate levels within the organization. When this method doesn't work, it reminds me of a picture in my office of fifteen well dressed professionals pointing at each other. It should have been entitled, "Spread the Blame."

Actually, as an act of impatience, frustration or simply boredom, I often times come up with the solution on my own, immediate, timely and definitive, and most often in a vacuum. Usually when a unilateral decision comes from me, the response is phenomenal. It starts out with a smile and a nod of agreement from the visiting party, a commitment to move forward and a sincere thank-you. Then the push back begins. Clearly, in this type of decision making situation, there is a lack of endorsement and the outward resistance intensifies like a tropical storm, ensuring damage or at the very least failure.

On the other hand, when the problem is triaged back to those presenting it in a constructive manner that offers support but not a complete solution, the results are phenomenal as well. It's about a combination of empowerment and encouragement that directs them toward embracing the scientific method. We talk through the observation phase, help them in the creation of potential hypothesis that is consistent with what has been observed, try to make predictions from that hypothesis, encourage them to modify it in the light of their results, and finally, remind them to repeat steps three and four until there are no discrepancies between theory and end result.

The amazing thing about even this method is that, if we apply it very purely, we will probably fail miserably because, for the most part, we are working with moving targets that are enveloped in emotions, politics, unpredictable outcomes and yet to be defined options, but, having said that, it is the basic premise for engaging our personal hard drives in a way that will move/triage the problem forward toward solution.

Bottom line? As I re-read this post, it is obvious at least to me that I have no real answer, no definitive solution, no optimal choice, but that some order, some persistence, some method is better than just forcing your solutions down everyone's throat, and it will help to keep at least a few more monkeys off your back.

by Nick Jacobs

As a 40ish rookie in health care management, the common conversation around the board table in the late 80's was a chorus of woeful sobs directed toward the good ole days of cost based reimbursement. That was a time when hospital CEO's could pretty much count on getting checks equal to their costs to pay for services rendered. In fact, a book entitled, The Hospital That Ate Chicago, was a good example of how hospitals could actually make a profit from the government from building projects.

Ah, to have been an Executive Director or Superintendent in that era. If you didn't golf several days a week, you were not considered competent enough to be an administrator. One of my early mentors used to say, "Son, If you want to survive and thrive in this field, you are obligated to learn to golf and play a good game of bridge."

Needless to say, I sometimes drive over a bridge, on my way back from Washington D.C.this week, I actually filled up at a Gulf station?

Today, we are seeing the beginning of an end of another era. As the tide begins to sweep the post WWII generation closer to retirement, it is clear that the System is about to change. It is about to change or die, and, once again, the ole timers will wish for better days when they actually got reimbursements that, for at least a small amount of time, would allow them to pay the bills and make a little profit for the organization.

One problem with writing a blog like this is that it's easy to criticize, easy to point out, and easy to suggest, but it will take an engaged group of hard working, deep thinking leaders to set the path for the future, a path that pays attention to the infrastructure, that will work to ensure the bridges don't collapse, the discoveries aren't curtailed, and the future becomes all that it can be. That path should be inclusive, comprehensive and for the good of mankind. Hopefully, we can help make the directional signs for that journey because, our future depends on it.