hospital impact

by Tony Chen

First time seeing a hospital ad on facebook! This one was for careers/jobs at Rush University Medical Center. I'll have more on Hospitals and Facebook in a few days - some hospitals have a deeper presence there than you might think.

As we've been saying, it's not a "build it and they will come" mentality anymore. It's "go where they already are."

by Nick Jacobs

If the Material's Management Director receives a favor in the form of a trip or a gift from a vendor, and that gift is beyond a limited value, that may be considered problematic for the organization. If a senior officer, though, is flown to a reception in the vendor's corporate jet, wined and dined, and then taken to a professional sporting event in an attempt to influence that officer into using that company's product, does that present the same problem? If a U.S. Congressman is flown at no cost by a lobbyist, that now is considered problematic, but if the lobbyist is from an academic institution, that is considered okay.

If a board member puts undue influence on an executive to do business with his company, how does that play out? Sarbanes-Oxley sends a very clear message that the business community is expected to do things differently than the way they have been done in the past, but I've already heard of cases in health care governance where specific board members have required the calculation of just how much business is too much business to be pushed to the extreme before the law kicks in for non profit corporations.

According to the Columbus Dispatch, in 2000, 13 of central Ohio’s corporate boards were dominated by insiders — company executives, consultants and lawyers. Some owned jets that they leased to their companies. Others owned office buildings that their companies rented. Still others were relatives of the CEO.

Bottom line? Corruption by any other name is often called doing business in many countries, and in some countries, it is truly considered an art form. Who do you know? How do you take care of your friends and the friends of your friends? What financial favors do they do for each other? Unfortunately, in many cases, if you don't play by the rules of the GOB's (Good Ole Boys), there can be a heavy price to pay, unemployment.

So, for all of you who are looking at a high powered future, study the rule books and stick to your guns, but, unless you work for an absolutely wonderful board, hold onto your hats because situational ethics can be very difficult to surmount.

Regarding ethics in the military, Robert Prentice, a professor of business law at the McCombs School, said, "Nobody up the line is taking responsibility. Everyone is trying to pin it on the little guys." Remember, that little guy could end up being YOU.

Final thought, putting on make-up or shaving in the morning usually requires one to look in the mirror, and that can become challenging for those who are better known as the players. Of course, that depends on the situation.

by Jeff McKune

Having attended a couple of Joe Tye’s seminars, I was eager to read The Healing Tree, a book he first published in 2005. The book is now in its second printing.

The story begins with an evening with Mark and Carrie Anne Murphy and the tragedy that enters their lives. Carrie Anne’s struggle towards recovery is one thread that is carried through the narrative. But a deeper and richer fabric is found in her personal awakening, guided initially by young Maggie, a fellow patient at the hospital who provides unique therapy to Carrie Anne and other patients. Carrie Anne’s despair eventually leads to her discovering a new path for her life, more meaningful and rewarding than anything she had previously imagined. The story alone touched me, and I found myself sometimes both uncomfortable and inquisitive with the introspection it created in me. That alone made the book worth the reading.

It was impossible for me to ignore the glimpses that Joe provides into the healing environment that was a part of the fictional Memorial Hospital. I wondered how some of the innovations Joe discussed would ever get past a Board of Directors. But clearly Memorial Hospital was a hospital focused on much more than physical healing. The hospital’s ongoing transformation was a result of visionary leadership. One phrase that I cannot forget is “the soul of the hospital.” What is the soul of your hospital? How do your efforts contribute to the development and sustaining of that soul?

Throughout the book, Joe also reveals some thoughtful insights into nursing and those that serve in caregiver roles. The bidirectional aspect of the nurse-patient relationship is developed in a discussion between Carrie Anne and Maggie. And toward the end of the book, the hospital CEO reminds us that patients are not the only ones that need healing. Joe is a strong advocate of nursing, and it is no surprise to see this emphasis in The Healing Tree.

I consider The Healing Tree to be one of those books that takes a hospital administrator beyond mechanics and methodology – it invites and encourages visionary and transformational leadership. A section containing discussion questions is included at the end of the book for the purpose of initiating dialog regarding that transformation. Also, there is a website for the book at www.healing-story.com where you can download the companion workbook Healing the Hospital, which I understand has been popular at caregiver and leadership retreats. If you want to spark discussions as to how your hospital can better serve both patients and staff, I invite you to read and share this compelling book.

by Tony Chen

This is easily the most frequently asked question I get at healthcare conferences. I usually answer this by asking another question: what's the best way for the hospital to utilize the web to engage your stakeholders?

The web is quickly becoming the place where conversations happen and perceptions are being formed. And new technologies make it easier than ever to be a part of that conversation. I've seen it first hand here on hospital impact where a particular post gets linked to by other blogs, which are then linked to by others. All of the sudden, you've got a whole web of links that started with one good post. 1,000s of people found my site for the first time that day.

Beyond the increasing viral trend, there is also a trend towards open innovation - i.e. the line between "corporation" and "customer" is blurring. Corporations in all industries are realizing that customers have valuable, superior ideas that can't be generated within the 4 walls of even the smartest corporation. So, why not draw those ideas in? Everyone has seen that Superbowl ad that Chevy paid for - it was a raw, amateur home video of a loyal customer talking about his Chevy.

So, what does this all mean? There are people talking about your hospital and your physicians as we speak. Just go to RevolutionHealth, RateMDs, DrScore, and many other websites. So at the very least, we need to dedicate some resources (maybe even just 10% of one person's time) to be the "e-community relations manager" and be aware of what conversations about us are happening now.

In terms of starting a blog or a facebook profile, I do think it's a good idea for the right hospital. But I would first get educated about the web. Go find out what people are saying about you now. Does your hospital have free wi-fi? I heard about a patient who was blogging at her bed. "Nurse Betty just came in, and she was so cold to me..." In some instances, maybe it even warrants a response.

If you want to start a blog, check out other hospital CEO blogs (like Running a Hospital and Nick's Blog). It's a lot of work and there is no hard-core ROI, but for the right type of person, it pays off in other ways. Both of these CEOs can probably point to examples where their blog put out a PR fire before it could start. They've built trust and credibility through the blog. They've humanized the hospital through the blog. So when fires do come (and of course, they will), they're well positioned to engage authentically. We are entering an age where proactive transparency is rewarded and reactive transparency is lame.

One word of warning. Don't blog if your organization:
* Doesn't trust their employees.
* Doesn't want to hear bad news.
* Wants absolute control over their message and reputation (this isn't happening anymore anyways)
* (the kicker) Doesn't have someone who's really wired to do it.

And finally, all of this gets back to what we've been talking about all along - a great patient experience. Every patient that comes through our doors now can be our greatest champion or our greatest detractor. And now, through the power of blogs & social media, they can tell the world about your hospital.

by Tony Chen

Some of you may have seen that the Massachusetts Hospital Association (MHA)recently announced that all MA hospitals will take responsibility for preventable errors. Part of the press release:

"Massachusetts Hospitals will voluntarily adopt a policy to not charge patients or insurers for certain preventable adverse events. While many hospitals already follow such a policy, Massachusetts becomes only the second state in the nation to take the step of voluntarily adopting a concrete, uniform policy."

Read the ABC story here on a good overview of hospital preventable errors. Also worth checking on is MHA's patientsfirst website that highlights what have hospitals done for you lately?

guest post by Dr. Marc Rothman

We already have the Pediatric ER, the Psychiatric ER… so why not a Geriatric ER as well? That’s the upshot of an interesting article from last months Journal of the American Geriatrics Society. A prominent leader in emergency medicine and geriatrics from Mount Sinai writes that the special care needs of older adults are just not aligned with current ER priorities, practice patterns, or physical design. Think about it: your average adult over age 70 has multiple chronic diseases and comorbidities, takes around a dozen meds, and may have functional and cognitive impairments. Acute illness in these folks never looks the way it does in younger healthy adults.

Case in point: we had a man in our Veteran’s Hospital ER last month with back pain. He was obviously ill but nothing on exam or labs was a slam dunk. It took over 6 hours to rule out all the usual suspects and eventually diagnose him with acute appendicitis! A rare diagnosis in the elderly, presenting in a most unusual way.

Think about how the ER feels to an older person with poor hearing, vision, and memory who is weak and dehydrated. The constant din of voices, the appearance and disappearance of faces as shifts change, the glaring lights, and the lack of windows; these things can only disorient people or cause delirium. Stretchers are high, bays narrow, and floors slippery; a recipe for falls and injuries. And the rapid ‘diagnose and treat’ approach of emergency room care increases the risk of misdiagnosis and adverse drug effects (when the medicine given interacts with one of a dozen meds the patient is taking).

I’d have to ask my colleagues, but I think delirium, falls/injuries, and medication errors are among the top three in-hospital complication today (and coincidentally where most of the dollars are being spent to improve inpatient outcomes?). Maybe we need to back our quality improvement strategies all the way to the point-of-entry to our hospitals… the ER?

by Tony Chen

Thanks again to all who attended our New Media/Blogging session today at the MCHC Conference. I sensed a lot of curiosity and interest around the opportunities of blogging in healthcare. As promised, let me share some of my key take-aways as well as some key sites for you to let through to get more acquainted with the blogging/social media phenomenon.

Key Take Aways
- Blogging is just one tool in your marketing/PR toolkit. It's not going to take over the world. It's not going to replace traditional PR outlets. But it's a great complement to your existing structure because of the speed & authenticity that you're able to interact with your stakeholders. Start there. The real innovators will use blogs/social media to engage their community far beyond what traditional PR/marketing represents today.
- There is no hard/financial business case established yet for an organization to start blogging. This is a new media, and many organizations are experimenting with various models. Nonetheless, I believe there is a real value to the organization to: (1) be proactive instead of reactive to addressing issues; (2) be transparent and build long-term credibility and trust (maybe your most precious asset); (3) lower the walls between you and your stakeholders in this new era of open innovation. Bottom line - you get better, faster information, and so do your stakeholders, and that can lead to increased trust, higher-quality ideas, and increased loyalty & referrals.

Healthcare Blogs/Social Media sites
1. Nick Jacobs' Blog - the first hospital CEO with a blog recently posted about his "journey to web 2.0" - he shares how he almost got fired for his blog. Good thing he didn't.
2. Running a Hospital - Paul Levy (CEO of urban hospital in Boston) takes transparency to the next level, asking the public if he makes too much money and posting the intimate details for their plans and quality metrics.
3. Hospital Impact - One day, Hospital Impact will truly be community, a two-way street, where best practices in hospital leadership can be shared more quickly, thoughtfully, and practically.
4. ratemd.com - 100,000+ doctors rated by patients, is yours?
5. Revolution Health - ratings for doctors, hospitals, and health plans + shopping comparisons + tools to keep your medical records & insurance straight. This is Steve Case's bet that consumer-driven healthcare is the next big thing.
6. Carepages - Patients can blog from their hospital bed about their hospital experience and their experience with their disease.
7. patientslikeme.com - a very powerful patient community whereby patients with the same illnesses can share notes AND compare test results. There's no way we could provide this kind of support for these specific patients, so shouldn't we providers be enthusiastically referring patients to this?
8. webmd.com - Everyone goes to WebMD for their medical information now (they've even recently come out with a magazine that sits in physician waiting rooms). Attention physicians: Find out what your patients are reading (and what they're being coached to ask you) before their physician visit.
9. The Paris Site - I'm somewhat hesitant to link to this site, as I'm sure they will comment on this. We talked about the "horror stories." A group of bloggers have been very vocal about the hospital's quality and performance - so much so that they've been sued by hospital.
10. Dr. Wes - A specialist who blogs that has actually gained referrals from his blog.

In addition, check out my "consumer's guide to health 2.0 sites" post.

Blog & web tools
1. Search blogs at Technorati - I think this is best blog-only search engine out there. Just type in a search term/word & hear what bloggers are saying about it.
2. Start a blog at Blogger - the most popular place to start your own blog. You can be literally up and running within minutes.
3. Aggregate blogs with a blog reader. I use igoogle. Choose to "add content" and type in the url's of your favorite websites and blogs. Pretty soon, you'll have a snapshot one-pager with the headlines of all your favorite blogs.

What were your main take-aways from today's conference?

by Nick Jacobs

Sometimes we all have to chug down a big glass of reality and begin to take a hard look at where we are, what we have become and what we need to do to take charge of those things about which we may have some control. We are well aware of the challenges that we, as a nation and a world, are facing every day. Yet, in the last election approximately 65% of us didn't bother to vote, again. Admittedly, in the presidential election about 50% of us may vote, but not this time.

If the premise of James Surowiecki's 2004 book, The Wisdom of Crowds: Why the Many Are Smarter Than the Few and How Collective Wisdom Shapes Business, Economies, Societies and Nations, is as he argues, then decisions made by groups are often better than could have been made by any single member of the group. Maybe 65% of us know something that the other 35% don't know, but in this case, I sincerely hope not.

It is my strong belief that we have simply allowed apathy to take over. Furthermore, it seems evident that some elected officials have grown to count on the fact that we don't care enough to vote. They continue doing business as usual because of our lack of commitment to endorse those things about which we should be passionate.

Where's this all coming from? It's coming from the fact that every day our emergency rooms are still dealing with the 47M uninsured human beings who are called Americans. Yet, even the very poorest countries in the rest of the industrialized world do a better job than we do of making sure that their citizens are cared for in some way.

So, the wisdom of crowds says, get an education, get your flu shot, don't drink and drive, look both ways before you cross the street and allow your country to continue endorsing a system that does not provide for nearly 50 M people? We endorse those elected officials in our country and states that have not paid serious attention to tort reform, that embrace a system of health care that is not adjusting from acute to chronic illness and that compensates some pediatricians and family practice physicians less than many blue collar professions.

Be it children's health care, health care for single, under employed mothers with children, or those who just fall between the cracks, something must happen in the next election.

It can still be about supporting capitalism, but we must find a more equitable way to embrace our fellow man.

by Nick Jacobs

How do you stop a speeding freight train? Short of placing a tanker truck on the railroad crossing, the only thing that will work is education. That is the challenge that public health is facing world wide.

It used to be, twenty years ago, that, if you wanted someone to know about something, they had to be exposed to a specific piece of information about seven times from multiple sources.

No one has provided me with the updated version of this statistic, but several of my marketing friends have indicated that, between the hundreds of cable stations, the Internet, numerous new media opportunities like podcasts, wikis the target has moved. The new estimate is that an individual must be exposed to the topic at least 21 times. If it is going to sink in with the masses, they need to be exposed to a piece of information over 20 times.

Of course that piece of information is not going to apply to people who are looking specifically for the information, but if you are attempting to change the habits of people, if you are hoping to change behavior, to improve life, to move civilization forward, then 20+ times is probably accurate.

Some of my younger friends are convinced that vegetables and fruits can easily be replaced by gummy bears and chocolate. They love cookie dough, white bread and pasta and nacho chips for dinner with extra cheese. Of course, they are blessed with good teeth, strong bones and YOUTH. When, however, the attributes of fruits and vegetables are touted, the passion of indestructible youth takes over.

So, what's the answer? Twenty plus times? Tell them twenty plus times in twenty different ways. You have to love the commercial where the man orders his meal at the drive up window and deletes the vegetables, the employee reaches into his car window and smacks him on the forehead. Get the message?

Maybe the answer is to employ the Ad Council? White bread is bad. Broccoli is great.

Or maybe we should just wait until they are all over weight, diabetic and having dental implants . . . Oops, too late.

(originally posted at the World Health Care Blog)

by Tony Chen

I'm sure most of us are very familiar with Zagat, the "go-to" resource for rating restaurants all across the world. I wore out my NYC Zagat's guide when I lived in NJ - there is a sense that you're getting the "insider scoop" on each restaurant along with objective ratings. Their success has led them to also rate nightlife, golf courses, hotels, shopping, and other entertainment destinations.

And now, Zagat will be rating physicians, or to be more specific, WellPoint physicians. The methodology will be quite similar - they'll use real patient comments that are representative of the larger pool of comments. And they'll provide numerical scores (up to 30) for 4 key factors: trust, communication, availability, and office environment.

I have to say - I think this is brilliant on a few different levels. First, I can't think of any brands more trusted than Zagat's when it comes to peer-to-peer info sharing & rating. Second, the 4 factors are perfect. Some may say - what about clinical quality? clinical outcomes? cost? I think WellPoint purposely decided not to touch quality, cost, or other factors that would draw on claims data - this keeps them from being part of recent controversies. Plus, this is a consumer-driven tool - in the mind of consumers, quality is a subset of trust. Let other sites deal with the complexity of costs.

What do you think? Any physicians out there that care to comment on this?

UPDATE: read more conversations and reactions here.

by Christopher Cornue

At the ISQua Annual Meeting I attended in October, we heard from leaders in Thailand about the Bumrungrad International Hospital, in Bangkok. Its evolving “state-of-the-art” facility is in the process of being converted. This hospital, which has over 1,000,000 patients per year (a third of which are from outside of Thailand) and serves 150 nationalities, is creating family & patient-centered private rooms, similar to those VIP rooms in major academic medical centers and some hospitals ststeside.

This type of room is quickly becoming the standard in an emerging and booming economy of medical tourism. Each of the rooms will have dedicated family space (for family members to live during their loved one’s stay), a kitchenette, all “hospital-looking” items (e.g., drapes, supplies, oxygen, etc.) will be hidden, and a top-notch entertainment system (e.g., 1,000 satellite music stations, hundreds of international tv channels, on-demand movies, wi-fi, i-Pod connection, etc.) will be provided. Their driving forces for creating these individual rooms over the next 18 months are:

•Provide patients a sense of control;
•Allow for family involvement;
•Provide for caregivers at the bedside;
•Create a sense of privacy and confidentiality;
•Develop a patient-centered model of care;
•Encourage a quiet and comfortable environment.

It’s amazing to see and while this is becoming a reality in Thailand (and some other hospitals internationally), it’s most likely several years off before becoming the norm within the industry.

by Nick Jacobs

What can you do for just $186E per year? If you're located in the small Balkan country of Serbia, the answer is relatively simple, that's what you have per person to provide health coverage to all of your eight million citizens. On a recent trip to Belgrade for a medical conference, I had the privilege of meeting privately with the Crown Prince; the Prime Minister of Health; also with the Major General in charge of the country's primary military hospital, and hundreds of physicians. Their primary message to me was that everyone needs to move on as we begin to seek co-operative opportunities to explore medical research that will provide a brighter future for all mankind.

We visited a rehabilitation hospital that provided spa coverage for its patients in the form of massage, mud wraps, heat treatments, saunas, hot springs, and numerous other amenities. At this spa hospital, the average stay for a joint replacement and rehabilitative treatment is about 21 days. In the U.S. you are usually released to Home Health and Home Physical Therapy after three.

We had an opportunity to visit a primary teaching hospital that does approximately 1200 invasive heart procedures annually and is fortunate enough to have over 30 cardiologists on staff. Although the average physician in this country makes less than a first year school teacher in the United States, they are so abundant because government supported education is still provided to all citizens.

But what of this challenge to care for the masses with less than $200 per year per capita compared to a nearly $6000 per year per capita expenditure in the United States? Obviously, there are not three MRI's per hospital in a country where the MRI was made possible through the work of Nicholas Tesla, a phenomenal Serbian scientist and inventor.

It's also a fact that their society is not so litigious as ours. In fact, during a presentation by a British MD/PhD he alluded to the fact that their guidelines were not written like those of the United States by and for the attorneys. Because of that fact alone, medicine is practiced very differently. It was interesting to watch a physician examine a patient without millions of dollars of diagnostic equipment meant to protect that physician from potential legal exposure and litigation. It seems like twenty years ago when you could observe a physician in the U.S. make a diagnosis from examining a patient by looking at them and listening to their breathing, heart beat and blood flows.

When patients ask me why an emergency room visit takes hours, the usual answer is that no one wants to take the chance of diagnosing or, worst yet, miss diagnosing a patient because of the lack of back up from numerous pieces of diagnostic equipment.

Moral to this post? Under $200 per year per capita is not nearly enough to protect and help an entire country's population, but $6000 with still questionable outcomes is probably significantly more than needed in a normal world.