hospital impact

by Nick Jacobs

From the local paper, " Hospital A's mortality rates improved, while Hospital B, Hospital C and Windber Medical Center received poorer marks. The truth, the whole truth and nothing but the truth, . . . or so it would seem.

As many of you know, we are very passionate about transparency in health care and, as a Planetree Hospital, we are committed to demystifying health care. One of the problems that we face, however, is a nuance problem.

We have a palliative care unit, a hospice that is utilized by a five county area. It is a center that provides pain control, respite and end of life care. My opinion of this service is that every hospital should offer it to every family. Bottom line though is that each year, our hospital is penalized statistically because of the number of deaths that occur. Why does this happen? It is because the conventional thinking in this country is still that, even if a patient has a do not resuscitate order, death is not acceptable and must be statistically noted as something bad.

Consequently, even though patients elect to come to our unit to die surrounded with dignity and peace and embraced by their loved ones, their death shows up as a negative State statistic without differentiation.

If the terminal patient was there because of heart failure, the ultimate end of that condition is not life, it is, in fact, death. Unfortunately, the statistics will show an inordinately high number of deaths for heart failure in the category that graphically depicts our medical center's death rate. Then the newspaper will cover this statistic, and we will, once again, attempt to respond to the public by explaining what hospice services are and how their impact on our numbers should be calculated.

As Ronald Reagan once said, "Here we go again."

Transparency in death rates must be carefully monitored so as not to penalize those facilities that help families by providing transitional hospice services. We know of some heart centers that will not operate on patients with high risks because it will skew their statistics.

Numbers can do whatever you want them to do, and we want them to be honest and carefully depicted to demonstrate truth and clarity. We're not blaming the press, but we are, once again, questioning the Health Care Cost Containment Council's mechanism for production of these statistics.

by Tony Chen

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by Tony Chen

Well, it's that time of year again when we take a moment to reflect on Healthcare in '07. Go here to check out FierceHealthcare's Annual Review where they highlight these trends and get this conversation started:

1. The push for price and quality data transparency
2. Growing acceptance of retail clinics
3. Broader use of pay-for-performance programs
4. A shift away from payment for medical errors
5. Proliferation of physician ratings by consumers and health insurers
6. Tremendous pressure to adopt electronic medical records
7. Controversy over the future of regional health information organizations
(Source: FierceHealthcare.com)

I'm not convinced that P4P is really "business as usual." And I'd put 4 & 5 more as early trends, not very widespread quite yet. But nonetheless, I think this is a great list.

A few things I would add:

- 2007 was a banner year for the biggest hospital transactions ever - think back to all the M&As and all the public-to-private transactions (i.e. HCA!). Outsiders see potential even as we are missing it.

- Speaking of outsiders, 2007 will also be remembered as a year when many outsiders are starting to get in. RevolutionHealth, Virgin, Google, and Microsoft all made big announcements and/or launches into the healthcare arena. Time will tell.

- 2007 was also the first year in a long while that we've heard the words "universal healthcare" beyond just the typical wonkish journals. For better or worse, the idea caught some attention, no doubt with the help of Sicko

- 2007 was the year health 2.0 was born. I've done numerous posts on web 2.0 sites, facebook, and social media. The Health Care Blog held its first Health 2.0 conference as a smashing success (400+ attendees). Not much relevant to hospitals at this point. But lots more patients will be using these technologies, so ignore them at your own peril.

What did we miss? What else?

by Tony Chen

Definitely not the phrases you see together very often, right? Maybe it won't be so foreign in a few years.

I've posted in the past on whether hospitals should blog. I've also previously mentioned how pleasantly surprised I was to see a hospital classified ad on facebook. Where exactly are hospitals at when it comes to social media?

Obviously, as a whole, hospitals aren't even close to implementing (or even understanding) these new social media technologies. However, you might be surprised at how savvy some hospitals already are. Here are a few examples:

1. Cleveland Clinic is on Facebook. I think you have to be a facebook user to see these, but you too could join the Cleveland Clinic Lerner College of Medicine Group (currently 84 members) and the Cleveland Clinic Group (55 members). Their group description: This group is for all employees, interns, volunteers, patients, or anyone who is associated with the Cleveland Clinic or the CCF health system. If you look around, there are other hospitals that are also dabbling with various groups. Do a search for other hospitals (try MD Anderson), and you'll find all kinds of different groups and people who are associated as employees/volunteers.

2. Mayo Clinic Health Policy Center is also on Facebook with fans. This is different than a "group." As of just a few months ago, companies and organizations can join facebook, and individuals can declare themselves as "fans." This is a way for people to show their friends what they're excited/passionate about. Viral marketing at its best (and worst).

3. Partners Healthcare is on SecondLife. Check out their website for how they explain SecondLife and why they believe it is important. Some folks may have heard of Second Life as a 3D virtual world for gamers and slackers. Obviously, this isn't the case anymore. Tons has been written about it recently - everything from the pros/cons of job interviews done on second life to why GM created a pretend virtual dealership. CNN even has a blog that solely covers second life developments.

4. Hospital CEO blogs - I think we are all already familiar with these. Just in case you aren't, check out Nick's Blog (CEO of Windber Medical Center in PA) and Paul Levy's blog (CEO of Beth Israel Deaconess Medical Center in Boston)

5. Some hospitals are using internal collaborative tools (like Microsoft's SharePoint) to better facilitate cross-functional collaboration. Once organizations get over the initial hurdle of learning a new system, lots of synergies are to be had - worklists, wikis, lists, and calendars.

There are more, but this is a pretty representative list.

The bottom line is this: While some hospitals are embracing social media, hospitals as a whole won't be getting into social media anytime soon. But, many patients will. And as such, hospitals that take the plunge as early adopters will be well-known as savvy and transparent.

by Nick Jacobs

The other night I was surfing the net and saw a comment written in a blog by an employee who is working in a Planetree hospital. She explained her interpretation of what the Planetree philosophy means. The author objected to showing support and warmth to a family by hugging or touching in any way.

Part of the beauty of Planetree is that it isn't just about hugging or touching someone in pain or comforting someone who is afraid. It is about loving and nurturing, and it is about providing the type of care for your patients that you would for your own loved ones. Planetree is an attitude. Planetree is what's between your ears; a mind-set, an approach, a way of thinking, a frame of mind.

When we first introduced the Plantree philosophy of care, the Balanced Budget Amendment Act was wreaking havoc on our urban, non-teaching hospital. Because our payroll levels were behind those of one of our neighboring hospitals, we alternated between a revolving door exodus of our nurses and a disgruntled group of individuals who, regardless of the circumstances, wanted higher salaries immediately. Because of our passion for the Planetree philosophy, it became a target of those disgruntled employees. You would constantly hear people say, “We are not being paid well enough to be Planetree.”

During that time we did everything that we could to adjust those salaries and, about 16 months into the unrest, were finally able to do just that, but, more importantly, we realized that the Planetree philosophy could not be deployed with 100 percent dependence upon nursing alone. It was during that period of consternation that we began to circulate volunteers, reiki masters, massage, pet and music therapists throughout the patient floors.

Most importantly, however, we worked very hard at helping every one of our employees understand that it is not about customer service, it is way beyond customer service. Planetree is about sensitivity, passion for appropriate care, and loving, nurturing kindness. It is about creating a healing environment.

by Tony Chen

Sorry I haven't been posting as often recently. All the long-term bloggers know - blogging is fun, but it is indeed a lot of work. There are waves of ups and downs. A lot of people ask me, "how do you find the time to blog?" My answer for the last couple of months is that I don't.

Nonetheless, even as I've been preoccupied with other things, the blog has continued to surprise me. Got calls from editors of Spirit Magazine and the American College of Physicians to get quotes from me as an "industry expert" (little do they know how little I know). Through the blogosphere, I also met up with long-time blogger and knowledge management guru Jim McGee. Tomorrow I've got lunch with someone who I was introduced to via facebook from someone I met at a blogging conference.

Yes, blogging is about great insights and great content. But for me, the greatest value has come from the real-life conversations with real-life people I met through the blog. It's about community and relationships as much as it is about information. Look out for an announcement related to this in the next few weeks.

guest post by Mike Pringle

The Boston Globe today (December 11, 2007) reported out on a precedent setting legal battle that the Massachusetts’ Supreme Judicial Court ruled is likely to broaden the liability challenges that physicians already face.

A 10-year-old boy standing on a sidewalk with his friend was struck and killed by a moving vehicle when the driver passed out on March 22nd 2002. The court ruled that the mother of the boy can sue the physician who prescribed a number of medications to the driver that could cause drowsiness as a side effect.

Justice Roderick L. Ireland who presided over the case equated…”that the actions of a doctor who fails to warn a patient about a drug’s side effect that could endanger others to a bartender who serves an intoxicated customer”.

The ramifications, both potential and real, of this type of ruling are far reaching. Certainly responsibility needs to rest with someone for this and similar type tragedies, however I think pointing the smoking gun at healthcare providers is not the way to adjudicate this type of event. My bias is simply this, if you are impaired from alcohol, lack of sleep, or medications and driving a vehicle it should be considered a “DUI”. Massachusetts is likely opening Pandora’s Box on this one.

What do you think?

Guest Post by Mike Pringle (a nursing supervisor) of the Mike's Viewpoint blog

An article in the Washington Post reports out on a survey conducted between November 2003 and June 2004 contrasting physicians’ beliefs about medical errors and incompetence reporting compared with what they really do when they know of a colleague who is not maintaining standards. The survey which was printed in the Annals of Internal Medicine incorporated 1600 physician responses which noted about 45 percent didn’t always report an incompetent or impaired colleague -- even though 96 percent agreed that doctors should turn in such people.

Chris Lee who authored the article describes how many providers are unwilling to provide negative feedback about other peers when asked questions by their patients regarding who is and who is not a “good doctor”. The article also describes how some physicians order expensive diagnostic tests for patients even though there isn’t any reasonable medical indication for such testing. The work up is done at the request of the patient. Other tests are ordered as a defensive measure mainly in hopes to stave off any future litigation.

Primum non nocere, -- do no harm, widely believed to come from the Hippocratic Oath but in fact this dictum actually comes from the Hippocratic Corpus, at least in essence. Noble words to guide ones practice of medicine for sure. Providing high quality healthcare is no easy task and in today’s world, it is expensive. For each measure of medicine that we practice there is an equally sized dose of law that most healthcare providers and institutions are practicing as well. Trying to cover all the bases with expensive diagnostic work ups, or ordering test just because your patient who comes to the emergency department and is insistent on having an MRI for chronic low back pain are common place.

Healthcare is not a drive up window for prescription medications and diagnostic workups. It is certainly not an opportunity for gaining financial freedom as is the lottery when your provider makes an honest mistake and a bad outcome prevails.

Defensive medicine is much more costly and time consuming and doesn’t demonstrate the appropriate use of precious resources. The focus needs to be on higher professional standards and doing the right thing for the patient.

by Tony Chen

Click here for some info on Nick Jacobs' podcast. Nick shares his "blogging story" - how he got started, how it evolved, how it has benefited his organization. Check it out!

by Nick Jacobs

The November 25th, Sunday, New York Times editorial provided an in depth analysis of "The High Cost of Health Care." Six possible solutions were identified that could possibly assist in ameliorating this accelerating problem: Geography, the wide variances that occur in pricing based upon location of the service; Stick to What Works, a demonstration that only those treatments that actually have proven merit should be utilized by the physicians; Managed Care, it worked for a while, but too heavy of a hand would cause passionate kickback by both the population and the physicians; Information Technology, knowledge is power and this will produce more efficient use of the system; Prevention, everyone knows that attention to prevention works; Disease Management through comprehensive management of chronically ill patients; and finally, Drug Prices, drugs are more expensive in the United States.

The seventh and probably most important means to reduce health care costs was omitted by the Times, and by what seems like 75 percent of physicians most days, and that is Hospice care. Approximately 30 percent of all health care dollars spent in the United States are spent on the last thirty days of life. If we are close to 2.2 trillion dollars in expenditures, then divide by three and see what an impact Hospice could have on our expenditures.