by Nick Jacobs

The book, Change or Die by Alan Deutschman, tells a story of three very different situations that prove that the title can, but rarely does happen. The author quotes the fact that, although we may be faced with the alternative of changing or dying, we are plagued with the reality that only about 10% of us are truly ever able to personally make that change. Mr. Deutschman takes us through three examples of an organization, a leader, and a physician who have helped hundreds of us beat those odds: Heart Patients, Criminals and Workers.

He examines the patients of Dr. Dean Ornish's Coronary Artery Disease Reversal Program (which has been in place at Windber Medical Center since 1999), the criminals who are participating in an effort to rehabilitate themselves under the guiding principles established by Dr. Mimi Silbert at Delancey Street in San Francisco, and the members of the United Auto Workers who were employed at a GMC plant at Fremont that was so hopeless mired in its own controversy that it was closed by GM. It was later re-opened by Toyota as a successful manufacturing plant equipped with the same basic tools and machines and 50% fewer employees, but the vast majority of them were exactly the same union employees who worked in that same failed factory for GM.

It's an interesting journey into human nature, the circle of failure and hopelessness, and the promise of hope that has always been a part of achievement and growth, of success and positive persistence, of debunking old myths and replacing them with empowerment. He embraces the three keys of relate, repeat and re frame to help us make positive changes in our lives.

If, like me, you are a little overweight, have high blood pressure, high cholesterol, a lousy set of genes and are a mouse potato (sit around too much with your computer), you might want to read this book and then, like the journey that I began in 1997 under Dr. Ornish's direction either "Change or DIE."

By Jared Johnson

The latest public hospital data Web site has made it to the Lone Star State, but the jury's still out about just how helpful it will be to consumers. Texas Price Point, sister to Price Point sites in at least 8 other states (IA, NH, NM, OR, UT, VA, WA, WI), is due to go live at the end of February. Most, if not all, are products of those states' hospital associations in an effort to "allow users to view and compare pricing information on common inpatient services."

I was able to take a test drive this week and it felt like I was handed the keys to the car and told to drive wherever my heart pleases. Some call this freedom or empowerment; others might say it's plain intimidating. Price Point includes median hospital charges for over 60 procedures, and they give you turn-by-turn navigation to find the ones you want.

Reaction has been mixed in other states (see Jeff Sturgeon in The Roanoke Times and Heidi Toth in The Provo Daily Herald). The following editorial from the Clinton (IA) Herald on February 1, 2007 is the best assessment I've seen:

In a free market society, it may seem ideal to let patients treat hospitals like a retail store, shopping around for the best price in order to save a buck here and there. However, medical care is much more complicated than that…

…It ought to be clear by now that this isn't the same as knowing how much a gallon of milk costs at Hy-Vee, Jewel and Fareway.

But still, Web site's [sic] like PricePoint are an important step in helping the consumer make educated choices. Health care is something everyone needs and one of the biggest headaches for the state and federal governments. The insurance business is a behemoth that sometimes appears too big for its own good, but it's the only real system we've got and can't be abandoned until a better solution is found.

The topic is confusing, to be sure, but having these conversations and exposing the many factors that boggle the mind are the best way to work toward getting everything cleared up for future generations.

I am rooting for Texas Price Point, and I hope it meets its objectives. My main question is how Joe Consumer will use this information. I can see him deluging the billing office with questions about why his charge is different than what's listed online. It opens more than a can of worms — more like a 50-gallon drum.

Still, the father of Price Point — Wisconsin Hospital Association's Stephen Brenton — pointed out to the House Ways and Means Subcommittee last summer that hospitals are doing their part to make prices available to consumers. That's one reason Price Point doesn't have to be all-inclusive. It is an effectual step toward transparency, not the ultimate answer.

Count me on the bandwagon.

by Tony Chen

Here are some random insights and tidbits that I've heard recently...

Check out this audio/visual slideshow about a day in the life of being at Newton-Wellesley Hospital in Boston. Since I recently picked up the banjo, I particularly enjoyed the background music on this!

"There are more freestanding imaging centers in Florida than there are Burger Kings" - Florida Hospital COO (note: there are 617 freestanding imaging centers in FL)

"Critics' concerns about in-store clinics' continuity of care remain unfounded" - Richard Bohmer of the Harvard University Business School in NEJM

"Health care previously has been delivered on the health care system's terms -- not the user's terms. We're meeting a need." said Peter Miller, president, CEO and cofounder of Take Care. (not a great quote to engender good relationships with health care systems, eh?)

"They're too busy" - Spokeswoman Petra Langer for Partners HealthCare in Boston on why their executives are not a blogging group.

"Eclipsys being bought by Oracle? Any truth to this rumor?" - Mulva. For more HIMSS gossip, go to this post from HISTalk.

A 3 hospital system, MediSys, just started a blog... sorta as a community newsletter.

HCA gone private, now Triad... "The decision to take the company private is the culmination of a strategic planning process initiated several months ago to explore the various options available to the company to enhance shareholder value," Triad CEO Denny Shelton (anyone else wondering what the private investors see that hospital management doesn't? Untapped value)

In 2020, half of the US population will be living with a chronic disease. Out of those, 1/4 will have 2 or more chronic diseases. Hospitals must think carefully through continuity of care, or else." - Consultant

"The next generation of retail clinics will be chronic disease screening centers. First off, for heart disease." Hospital VP

"We don't have a healthcare crisis in the United States, we have a health crisis"

"Retail Clinics are here to stay" - Sg2 Director

"I think it's absolutely incredible. The smallest detail that can change a room has been thought of. None of the places I go to are remotely like this. It's a shame they are not" - Elizabeth Edwards after visiting Nick Jacob's Planetree Hospital, WindberCare

"Redmond's intent regarding the booming health care industry is reflected in the resources it's throwing that way. The company had six health care-focused staff members in 2000; now, its Health Solutions Group numbers more than 600." - Microsoft at HIMSS

By Tony Chen

Brian Baum, President of USPM, was gracious enough to answer a few questions about their new bold prevention business. Hospital leaders, what should our response be?

Q1 – What sets US Preventive Medicine apart from others targeting the “prevention market”.

Fundamentally, I think there are four key points of differentiation between the business approach of US Preventive Medicine and any other players that I see in the market:

Branding – perhaps the greatest challenge in capturing the preventive “dollar”, setting aside the “who pays” issue for a moment, is capturing consumer mindshare. As a society we are generally passive about our health. We take it for granted, abuse it, until something goes wrong. Our goal is to make prevention “sexy”. Make it desirable, package it, productize it and make it very attainable. Our tag line starts this communication process – “more good years”. Not everyone will get it at the same time, but evidence is mounting that there is a sizeable base of early adopters. As the early adopters become increasingly tuned in – the challenge is delivery – what is the solution, where do I “buy it”. US Preventive Medicine has set a goal to create a power brand in healthcare – the go to source for the solution.

Packaging – in my travels I have come to continually stress – our goal is not to invent the wheel. Rather, we seek to be the rim surrounding the spokes of the solution. So we are embracing traditional health providers – hospitals, systems, physicians as well as ancillary providers of services – behavior modification, disease management, and many, many others. We seek to package what is in place into a convenient “customer experience”. We cannot rely on the consumer to be the aggregator – no other industry would even think of burdening the consumer to assemble a service “experience”.

Expanded definition of prevention – I truly believe we’re almost dealing with a clean slate when it comes to consumer attitudes to prevention. Our goal – first, broaden the definition – let’s get beyond diet. Prevention = assessment – what is the current state of your health and what are your personal risk factors + intervention – armed with this knowledge what do you do to mitigate risks. The second expanded definition that we are bringing to market is actually grounded in clinical definition – we are simply transforming the definition to consumer terms. By this I mean – our goal is to have a prevention solution for everyone. Both economically, as well as state of health. In other words – yes, we want to help individuals prevent the initial onset of disease, but for those that already have a chronic condition, we want to help them prevent the escalation of their disease state. (No “consumer” wants to be treated differently – the goal is always prevention leading to “more good years”.

Continuity of Care – the US Preventive Medicine philosophy is that the physician/patient relationship must be the foundation of the prevention experience. The consumer tends to respect their physician – we simply need to put tools in the hands of the physician that make delivering prevention more efficient and economically viable for the physician. Finally, we want to make it an ongoing experience that is supported long after the patient/consumer leaves their physicians office.

Q2 – What has the response been to your ads in Wall Street Journal, USA Today, the Washington Points, NYT among others? Anything surprising?

The overall response has been overwhelming. I truly feel as though we’ve struck a raw nerve. We’ve actually had to step back to just organize the categories of responses. Every possible range of employer – from the largest global companies, to the smallest organization. Government leaders – from Governor Schwarzenegger, to Senator Harkin to Health and Human Services, to local city governments. Health organizations – community hospitals, academics, large systems – to alternative medicine providers, payors, pharmaceuticals. International interest. Finally – many, many individual health consumers. It is on this point that I’d say I have been most unprepared for the response. People have poured out their hearts to us. Telling us story after story of “if only”. Their most personal and painful stories regarding the loss of a loved one that could have/should have been prevented – if only they there had been a more aggressive focus on prevention/early detection. Everyone of these stories ended by cheering on our efforts and offering support.

Q3 – What are the top three things health leaders need to know about US Preventive Medicine?

Tony, now there is an open-ended question to which I could write a book. I spend much of my time on airplanes flying from meeting to meeting with some of the top systems in our country. We seem to have ready access to the most senior leaders of these organizations. I feel as though we are welcomed as a “partner” – if cautiously. To a system, I hear the same thing – we’ve been thinking about prevention for years – we have not mapped a strategy. We want to connect more broadly with consumers in our market. We realize that our footprint limits our ability to adequately and fully support our market. (I hear this regardless of the size of the organization.) The things I would like health systems to understand:

Prevention is coming – ignore it at your own peril.

Market forces are driving it – so if systems don’t step up to the challenge – entrepreneurs will. The stakes are too high. We’re already seeing reports from employers gloating that they’ve been able to dramatically cut hospital expenses by instituting prevention/diagnostic services in their workplace. They would much rather pay for prevention on the front end, then catastrophic intervention on the back end.

USPM is truly a partnership structure – we succeed when our health system partners succeed. Together, we’ll build this solution to its fullest potential. We’ve started the book, we’ll complete it in partnership.

We live in a global society. If you think your competition is the hospital down the street – you should think again – your customers in many cases have employees all over the world – certainly all over the country. Occasionally, I’ll hear something like – “we have four hospitals, or we have hospitals in six states – what do we need you for?” This point of view is puzzling – given the nature of our society. Here healthcare is not all that different from other industries. Take banking for example. A little over forty years ago – competitive bankers came together and recognized that they could enhance business for of all of them if they aligned around a focus on the consumer and the consumers need for a new more flexible currency. The result the Mastercard and Visa networks were born. Thinking of a health providers “market” as a local community, will ultimately force disruptive innovation. A far more attractive option is to unite – leverage assets and stay focused on serving customer needs. US Preventive Medicine offers a very low risk means of creating a national network for forward thinking health systems.

To contact Brian directly, email him at bbaum [at] uspreventivemedicine [dot] com.

This is the first hospital I know of to use guerrilla marketing tactics.

EDIT: and speaking of firsts, check out the firsts that Paul Levy's been bringing up that are ruffling some competitor CEO feathers. My favorite quote from that globe article: "What a blog?" - Hospital COO.

Guest post by Carolyn Kent

I'm going to venture into contentious territory and address what can be a touchy subject for hospital administrators: the application of lean manufacturing to a hospital setting.

First, a brief review. There are 5 basic principles to Lean (continuous process improvement):
1. Define value from the customer's perspective
2. Identify the value stream
3. Eliminate waste
4. Flow the process
5. Pursue to perfection

Is this management style transferable to a hospital environment? Cynics are quick to squash this idea, citing reasons such as "We don't make cars; we treat patients." (Harvard Business Review: Virginia Mason Medical Center) These individuals support personalized healthcare; after all, every patient is unique and by virtue of being such, deserves distinctive care. (No argument here)

Since, according to the cynics, achieving a lean state in a hospital is impossible due to the obligations to provide personalized care to every patient, one could naturally conclude that the hospital's management style should be one directed at increasing the quality of service, optimizing the patient experience, and improving customer satisfaction.

Again, cynics remind us that while this may be nice in theory, consistently delivering superior service across the board can be inefficient, as this approach to service consumes more personnel and time resources - things that are already limited.

So it appears that we are at an impasse. Lean process v. superior service quality - it's got to be one or the other in a hospital setting. Achieving lean presupposes standardization, which is nearly impossible in a hospital. Delivering superior service necessitates employee training, personal attention, significant time investments, regular performance measurement, et,c. all of which are counter to lean, right?

Let's revisit the first principle of continuous process improvement: Define value from the customer's perspective. It appears that lean and superior service delivery are inextricably linked thanks to the customer. Does this mean that they can co-exist after all? Is it too much of a stretch to assert that they may even complement one another?

How would we impart both continuous improvement and superior service quality into our process? Here are 7 quick steps to merge these seemingly dichotomous objectives:
1. Management must commit to the strategy
2. Determine the product line/department to start with
3. Gain a good understanding of lean (Lean Enterprise Institute)
4. Draw the current-state map of your selected process (MAMTC - Lean Building Blocks)
5. Determine the goals to strive for and the metrics to monitor
6. Draw the future-state map of your selected process (see "Lean Building Blocks")
7. Implement with a specific plan that includes benchmarking

Is it possible to achieve continuous process improvement in a hospital environment?

Is it possible to consistently deliver superior service to patients?

Is it possible to do both?

Carolyn Kent is Creative Strategy Specialist at Cleverley & Associates.

by Nick Jacobs

From an article in USA Today entitled “Health System Struggles with spiritual care,” comes the following quote: “For patients who are dying of cancer, few things are as profound as their relationship with God.” Later in the article there is reference to Tracy Balboni’s study on the spiritual needs of dying patients. “She found that 88% of terminal cancer patients said religion was at least somewhat important to them. And about half had been visited by clergy. Yet Balboni’s research also suggests that hospitals, doctors and even religious communities fail to support the spiritual needs of their cancer patients at the end of life.”

The article went on to say that 70% of the patients’ spiritual needs weren't being met by hospital chaplains or others in the health care system.

As a zealot in total support of palliative care and hospice programs, these numbers were not a shock to me, but were, in fact, a further signal that our current national health care system is NOT meeting the needs of our patients.

Those individuals who felt that their spiritual support was adequate also reported that their quality of life on a fifty point scale was nearly 15 points higher than those without that spiritual care.

Far be it from me to suggest that we force religion on anyone, but, having said that, there is no reason why spiritual support is not more readily available to our patients. There are hundreds of reasons why our peers don't do this; HIPAA, fear of imposing religious beliefs on patients, or just a lack of belief in the entire concept of the contribution that spiritual care brings to a patient’s care, but we here at Windber Medical Center know profoundly what the true contribution can be from spiritual involvement to all of our patients. We typically deal with hundreds of thousands of patients each year, and one of our commitments to them is the availability of clergy, Eucharistic ministers, and spiritual professionals in our facility or available to our patients 24 hours a day, seven days a week.

In God we trust, whomever or whatever you believe that God to be. It is not our intent to confine your beliefs, to restrict your beliefs or to attempt to change your beliefs. It is purely our intent to help to support our patients’ beliefs. Is your facility supporting your patients?

by Nick Jacobs

Who has two legs, two arms, a dozen pair of cowboy boots and the ability to bring healthcare to its knees? You got it, President George W. Bush.

Citing the need for fiscal accountability, our President has projected dropping by $101 B the spending growth of both Medicare and Medicaid over a five year period. These combined programs serve approximately 1/3 of the population of our country and will cost about $560 B this year alone.

It appears that the anticipated cuts are, as predicted, arbitrary and could have a detrimental impact on the beneficiaries involved. We are all cognizant of the fact that there is a huge unfunded obligation that currently exists in these budget areas, but Democrats are accusing Bush of paying for the Iraq war and his major tax cuts by cutting or reducing health care for America’s poor and elderly. Others feel that this plan does nothing to address the underlying causes of the problems currently faced by Medicare and Medicaid.

As a hospital administrator, it is clear to me that these costs will simply be transferred to our emergency room and our uncompensated care. This will be a big blow to our teaching hospitals as well.

Overall the average federal spending for Medicare would slow from 6.5 to 5.6 percent while Medicaid would be about 7 percent. What are you thoughts?

By Andrew Barna

We have all seen the adds for prescription drugs and we all know the impact they have had on utilization. Once the pharmaceutical companies started direct to consumer advertisements, utilization of the advertised drugs shot up. It seems the medical device industry was paying attention. This weekend I saw an ad on TV for Zimmer's "Gender Solutions" knee implants - and get this - they are "shaped to fit a woman's anatomy".

Presuming that this will become a trend, the impact of this commercial will be far and wide.

From a hospital strategy perspective, I would revisit my orthopedic volumes after seeing this commercial for sure. I think there is no doubt that commercials like these will translate into higher demand for surgeries. But what about medical necessity, you might ask? There shouldn't be more knee replacements unless baby boomers start playing more one on one, right?

Not necessarily. Along with direct to consumer advertising of pharmaceuticals, we have seen another trend: the medicalization of problems that went untreated in the past (there may be a better word than "medicalization", but I think it does the trick). Now I am not a doctor, but there seems to be a new class of drugs available to treat, for lack of a better descriptor, free-floating symptoms. A drug like Zelnorm, for instance, is advertised to treat "bloating" and "irritable bowel syndrome." I saw another advertisement for a drug to treat "restless leg syndrome." We aren't talking cancer here, but we are creating medical solutions for quality of life issues (again for lack of a better term).

And of course the king of all advertised pharmaceuticals, sexual performance enhancing drugs, leads me to my next point. The arrival of artificial knees designed specifically for women ushers in the era of science and medicine improving the human machine. Today we can get knees that are more comfortable, tomorrow we will have knees that "last forever" or improve our performance on the football field. Combine the trends of consumer driven healthcare with advances in medical devices and even genetics and we could be looking at a healthcare industry that is radically different from the one we have today. Of course there are many ethical considerations here (don't worry ethicists are standing by to take your calls as they have been anticipating this for a few years now), but have we considered the impact on the healthcare delivery system? Will these advances only be available to those that can afford it? Will our focus on prevention and healing shift to a focus on improvement and replacement? Will your blown out knee become your bionic knee?

Who knew a knee could have such an impact?

by Tony Chen

Even though it's been almost 2 years since I posted the now-infamous 8-part series of "If Disney Ran Your Hospital," I continue to get impassioned comments (just got another one yesterday). Below are some criticisms of the book from hospital impact readers - mostly from seasoned administrators, experienced nurses, or former disney employees. See all 29 comments here.

Here's a long comment from Rick. If you don't want to read the whole thing, the summary: "The last thing I need is another hospital administrator yapping about the latest book craze"

from Rick...

I remember my wife and I taking my kids to Disney World. I had given my notice at one well-respected academic medical center to leave for another in another city, and this vacation provided a break in the stress of all the change affecting all and each of us.

I doubt that if I had been moving from one Disney location to another, I would have taken my family to a world-class hospital to relax.

When I was an undergraduate I worked in a consumer electronics business for almost three years. Part of my job involved home service of their televisions. Like those who believe they learned everything they ever needed to know in kindergarten, I believe I learned enough about customer service from what my parents and other adults taught me. I sure as hell didn't need to pad some writer's pockets back then to learn how to respect a fellow traveler, and I sure as hell don't now.

That said, a number of years ago I surveyed customers of a group I supervised regarding what they expected and appreciated about our services. As I expected, what they appreciated most was our professionalism, but key to that was the expectation of technical expertise. Professionalism, i.e., customer service, was of little value in the absence of competence.

My guess is the expertise involved in portraying a duck, mouse, Snow White, etc, hasn't changed much in recent years. Ditto cooking a hmaburger, managing a ride, picking up trash before it hits the ground, etc. But the rate of change of health care is off the scale and accelerating. When I entered the field, computers were just showing up at the nurses' stations of ICUs. Now there are easily ten or more in the equipment at the bedside of a single patient.

Over the years, those of us in the field have heard how we should adopt 7 Habits, TQM, CQI, and now MIC KEY MOUSE. Every time, when we reply that we need tiome to learn how do it, other than for a pilot project here and there, there is simply no time in which tio fit it in. Why? Because we'd need money for that, and one thing that people will not part with to make health care work is a bigger slice of GNP. The same people who will hop on a plane amd throw thousands of dollars to spend a few days in a Magic Kingdom, the same people who would throw everything they at getting care for a family member suffering with a possibly terminal illness, these same people go nuts when they hear their health care premiums are on the rise.

Here are the choices:

1) Keep spending the same amount of money and treading water as the system continues to devolve under the pressures of accelerating technological and social change

2) Throw the money instead at gurus to teach us to say the equivalent of "Would you like fries with that?" and permit the system to devolve even faster than it is now?

3) Examine what we get for each incremental health care dollar and make the tough decisions whether the interventions and services we can provide are worth it. It would be a huge leap forward if we could move the economic discussion from guns-or-butter to health-or-entertainment. But that would require will and discipline that we seem to have lost from the days when we set out to build the health care system capable of what it is doing today. Now it's more "What have you done for me lately?"

Many people in this business know what needs to be done. We've figured out how to treat heart disease, cancer, and stroke among others; we can do this. Just let us know what you really care about by not only telling us what your choices are but putting your money where your mouths are.

The last thing I need is another hospital administrator yapping about the latest book craze. Five dysfunctions, indeed. After thirty years, I've learned it best to view MBA prattling with a Christian perspective: Forgive them, for they know not what they do.

Here's one from Dave who highlights that the ideas at Disney are not transferable to hospitals, given the vastly different environments.

from Dave... The idea that Disney has anything to teach us about how to run hosptials is a stretch, at best, and a more likely a counterproductive fantasy. A hospital is not a luxury resort, an operating room is not a ride, a surgeon is not a cute tour guide in a uniform. Nobody dies if they can't afford to go to Disney World. There is a lot that can be improved in our hospitals and our healthcare system, but I hope we can find better role models than the Walt Disney Corporation.

Dave, I agree that these are vastly different universes. Nonetheless, we are still serving the same market - people. Disney has transferable insights about how people feel safe, respected, and delighted - regardless of who those people are and what environment they are placed in.

from quade... Having worked at Disney for 29 years, lemme just say that the LAST thing you'd want a medical facility to be run like is a Disney theme park.

For example;

1. Perceptions > Reality

Perceptions are greater than Reality? Really? Isn't that what they call in the medical profession the Placebo Effect?

Quade - I'm not saying that we "fake" good care in order to somehow "trick" the patient. Good care is essential, but not all good care seems like good care to the patient.

from Lisa... About 10 years ago, I worked at an emergency department in an inner city. The Disney organization was paid to come to our facility to "teach" customer care. Needless to say I thought this was ridiculous, how do you compare an emergency dept with Disney World? There is no comparison. The E.R. is a place where emotions run high, life or death situations are a constant and patience by the patients is worn thin, not to mention the many, many people who use the E.R. as their doctor's office. What is the worst thing that can happen at Disney? Can it at all compare to death of a loved one? The Disney people who were recruited to come to our facility could barely speak to one another, never mind our patient clientele, they were in a word, shocked by what they had encountered. The staff at the ER had already been through sensitivity training, and are some of the most caring, compassionate, empathetic people I had the pleasure to work with, not to mention, not easily shocked. People do not need a book or a Disney staff to teach customer care, what they need is to look at how they'd like to be treated, "do onto others as you would yourself."

I wouldn't be surprised at this. Talk about culture shock. I have mucho respect for those folks who spend a career in the ER. How do you keep from getting jaded, bitter, calloused when you've seen it all?

other comments, criticisms? Let's keep the conversation going.

note from Tony: you've recently seen the posts from Jared Johnson on The CEO's Golden Question and color commentary on PwC 2007 healthcare trends. Today, we welcome him in as part of our blogging team - he'll bring unique perspective as a progressive, thoughtful PR professional. Please join me in welcoming him in to the Hospital Impact community!

by Jared Johnson

I count it as a great privilege to join Tony and the rest of the HospitalImpact family. I am the PR coordinator at a hospital in suburban Dallas. Ever since a Communications 101 class led me to pursue PR professionally, I have set my sights on the health care field. Something was always intriguing about all of the moving parts, plus the fact that health care affects everyone. I view health topics as a patient first and as a hospital employee second. It's one of the best ways I have learned to stay grounded and keep in mind the best interests of those we serve.

I have always been one to join in the conversation — not just to speak, but to listen. In fact, I'll admit that I usually gain more by hearing than by being heard. I am constantly in the middle of conversations — administrators speaking with clinical staff, clinicians speaking with patients, patients offering feedback to administration — it's an endless loop. I see words like "transparency" and "accountability," and I think how much more manageable these mandates could be with a more dedicated approach to communications. Fortunately, the blogosphere is a place where such communications can take place.

It may sound a little ideological, but I see an ongoing, intelligent conversation and a good dose of optimism as two necessities for making progress.

by Nick Jacobs

Bigger is better? Better is bigger?

The most incomprehensible part of this theory of business to me is that we spend billions of dollars on small, boutique experiences every day in this country, yet we have begun to look away from our most precious nonprofit's, small and medium sized hospitals. Could it be that health care is so complex and we are so confused about the nuances of this health care world that we embrace the herd mentality? Or is it that, we are so enamored by the lore and promise of technology that we assume that all smaller facilities cannot afford to purchase in order to keep up with the Jones of the medical industrial complex.

We should take a lesson from the War in Iraq where the most heavily funded war machine in the world is disrupted day after day by cell phones and IED's, a.k.a., roadside bombs.

Conversely, it is amazing to me that the simplest of things, a stethoscope, in the hands of a talented physician, can diagnose, more than any of the most sophisticated diagnostic technologies, complex ailments that don't always appear in digital depictions of that affected area of the body.

Cottage Hospitals are still embraced in England, and spa hospitals are the norm throughout Europe. Why is it that we are beginning to reject the fact that there is a place for small and medium facilities in our country? If your goal is to have an infection free surgery, ask about the infection stats at the various hosptial's where your doctor is credentialed.

Yes, of course this is personal, but it is amazing to me that our society continues to embrace the mega Systems as the only way to fly as we are many times pushed, tugged, stacked, ignored, and infected in some of our health care factories.

In a recent conversation with a former cardiac center employee from one of our nation's finer facilities, I explained that I had personally watched one of my closest friends forgo the opportunity to be treated locally so as to ensure their safety and to enjoy the professionalism afforded them at this institution. He died from an infection contracted. After describing this to him, he nodded and replied, "Yep, they have a bad bug there that they just can't seem to get rid of . . . " Could it be that sometimes smaller is better?

by Nick Jacobs

The hospital is full. There was one, male bed available today in the entire hospital, one. The emergency room has been packed this week-end, and each and every employee has been pushed to the maximum to continue to provide Planetree quality care to our patients and their families. We have not had any respiratory influenza this fall or winter, until yesterday, but it was only one case. This may be a preview of the next several weeks.

As we made rounds this morning, department by department, it was clear that we were dealing with the "A" Team. It was like observing the insides of a well-oiled machine. We contacted dietary and had their parent company deliver hundreds of large cookies that we personally distributed through the hospital to the employees to thank them for doing a great job.

We watched each department and each floor to ensure that we had appropriate coverage, and every patient and family member with whom we came in contact were queried as to their care, their feelings about their care, and how we could assist them.

After going home we continued to call in throughout the evening to check on the status of the medical center and our employees.

It worked today because we love our employees. We care about them, and we don't hesitate to let them know. No one is taken for granted. No one is a number. Everyone of them can feel it, and understand that it is real.

It's taken me a lifetime to get here and a lifetime to have the opportunity to prove that raising your voice, being dictatorial, tramping on people to get what you want, and causing people to shake and hate is NOT the way it needs to be. It's about "Doing unto others as you would have others do unto you." It's about working together for common goals. It's about caring for the people who do the job because they will take care of the people who need the care. That's what health care could be. That's what health care should be!

By: Craig Allan Ahrens
The Business of Healthcare
A talk show and discussion forum dedicated to the strategic issues impacting the business of healthcare

As most of you know, I have been engaged in an interim executive "turn around" project for a major health system. During the process of getting into the operational details and day to day management, I realized how much I owe my fellowship mentor, David Olson, CEO, FACHE.

He is going to be embarrassed, but he deserves my gratitude and recognition for taking an arrogant raw graduate student and instilling in him a since of duty to the profession and knowledge about how hospital operations really works. The things I learned from him seem basic to me today, but were profound to me as a Fellow. He taught me the following:

- Physicians drive healthcare and are your clients. Listen to them and make them happy, but don't forget the ultimate customer, the patient and the community. When physician versus patient/community needs conflict, side with the patient/community always. In the long run, the organization willl succeed with this simple formula.

- Nothing determines the success of an organization more than hiring the right people and letting them do their job.

- Let people do their job, but let them know that they are being held accountable through measurements. Tie their measurements to incentives.

- Create connections with knowledgeable colleagues from across the country who share your healthcare passion. Through this not only will you have good friends, but there is strength in numbers to make a positive change in the industry.

- "Make Haste Slowly". Most things are not things that need to be addressed today. Prioritization is key to success. Sometimes in our hurry, we do not look at all the details and miss something.

- "Be Decisive". One of the most difficult things is to make a decision. You will never have all the information necessary usually to make sure that you have the right answer. You have to make a decision balancing your judgement, data, and the timing necessary to succeed.

- "Be Fair, Not Everyone's Friend". It is impossible to be everyone's friend, when you have to make difficult decisions concerning resource allocation, budgets, etc. Remember, your duty to the health of the organization is first and not to friends. Explain decisions, but do not justify.

Thank you David. I utilize these concepts on every engagement I have and thus far they have helped me succeed.

It is a new year with ambitious personal goals. As most of you are aware, I am completely redesigning the www.thebusinessofhealthcare.com website and related podcasts by the first quarter of this year and that is why you have not seen new podcasts posted. I apologize, but I want to migrate all the podcasts to the new site and I hope that this doesn't impact the loyalty of my listeners. The wait will be worth it with new services, material, and innovative programming!

You can listen to the previous podcasts on my website or on Itunes!

A podcast is up on the "The Business of Healthcare" website or on the Itunes store under the Business of Healthcare. Our last guest was Parveen Chand, who is a facilities and business development planning executive for BJC Health System's Barnes Jewish St. Peter's hospital in St. Louis, Missouri. We discussed their innovative approach to facilities planning and budgeting.

If any of you have any ideas, people, or topics that you think that would be interesting for the "The Business of Healthcare" podcast, please email me at info@thebusinessofhealthcare.com.

Thank you.

If you have Itunes on your computer, click here
If you don't have Itunes, go straight to "The Business of Healthcare" blog

Most recent podcasts:
Show 8: Healthcare Facility Planning and Strategy - A New Approach
Show 7: Roundtable Discussion with Three Healthcare Leaders: Strategic Issues - A Midwest, East Coast and West Coast Perspective
Show 6: Service Line Success and the Strategic Impact of the Rebasing of DRGs
Show 5: Orthopedic Service Line Planning
Show 4: Neurosciences Planning for Healthcare Institutions
Show 3: Human Resources as the Critical Hospital Strategic Partner?
Show 2:Patient Satisfaction and Customer Service as a Hospital's Strategic Priority
Show 1: Surviving and Thriving as an Independent Hospital in a Competitive Market

Mr. Ahrens is a healthcare strategy consultant at ECG Healthcare's Midwest office with expertise in general hospital strategic planning, operational turn-arounds, physician business development, and service line planning. You can reach him at info@thebusinessofhealthcare.com.