by Tony Chen

Remember how Windows blew away DOS? Get ready for Windows to be blown away by a new technology: surface computing. Microsoft just announced this technology that will change how we humans interface with computers. Instead of mouse and keyboard, it's touch-based. Think about that movie "Minority Report" and how Tom Cruise could manipulate multiple items with his fingers. Click here for a great video tour from popular mechanics - it's a a lot easier to understand it by seeing it in action.

Now, this isn't a healthcare technology blog and I don't pretend to understand anything technology. But I have to wonder what applications are possible in healthcare.

Radiology - quick manipulation of multiple images or 3D models could lead to faster, more accurate diagnoses.
Surgery - will this interface make it easier for surgeons to manipulate laproscopic surgeries of very delicate and intricate areas? Essentially, this enables physicians to be smarter.
EMR - maybe this interface helps physicians quickly (and more intuitively) enter, view, analyze data within the EMR. Less clicks and less typing.

More news on Microsoft's Surface:
Washington Post
ABCNews
Reuters

by Tony Chen

Just in case you hadn't heard, go over to KevinMD for this post about Dr. Flea, a physician blog that was used against him in a lawsuit.

And yes, the blog is now non-existent.

by Tony Chen

I've been running into more and more hospitals recently that have developed a great new innovation and made it work so well in their own facilities that they are compelled to share it with the rest of us. Several had tried to offer their services to their fellow hospitals for free, but were overwhelmed with demand to the point of starting a fee-for-service enterprise.

I'll be using this post to keep a running list of these innovations. So if you have any others, please comment or email me, and I'll add it to the list. What are hospitals doing right now that is so successful and innovative that other hospitals want to get in, too?

- Memorial Hospital - Innovation Consulting - bring your team to visit their hospital & innovation lab.

- Memorial Hospital - Chocolate Cafe Medical Ventures - triple your cafe revenue by opening a "chocolate cafe"

- ValleyCare - Retail Strategies Visit/Tour/Consulting - Learn how they've embraced a truly retail approach to healthcare and diversified their revenue stream.

- Baptist Health Care - Baptist Leadership Institute offers a wide variety of consulting services (leadership, physician strategies) and tools (e.g. idea management, 360 feedback, etc)

- Harvard - Joslin Center for Diabetes - Open a Joslin-branded diabetes center at your hospital.

- Park Nicollet - International Diabetes Center - Same deal, open an IDC-branded diabetes center at your hospital.

By: Craig Allan Ahrens

It has been over three months since my last blog posting. Why? I have been busy starting a healthcare web based media company focused on providing primarily video and audio content dedicated to addressing healthcare business issues.

I believe in this industry's ability to be at the forefront of not only clinical technology, but also at the leading edge of business communication technologies. A weekly healthcare news video program, video interviews with healthcare executives, and audio editorials are only the beginning. Web based video is the future communication medium and I hope to help push what is seen as a dinosaur industry into the forefront.

It has been a long road and I have a new whole level of respect for business start ups. I want to thank the www.hospitalimpact.org team for their insight and support. Please take a moment to browse my website's top five weekly headline videos, video editorials/interviews, and podcast editorials/interviews sections. I appreciate your feedback.

The following is the press release scheduled to go out today:

Dear Healthcare Professionals:

The business side of healthcare; it's who you are, where you want to be, or who you want to reach. www.TheBusinessofHealthcare.tv is the first and latest in disseminating online healthcare videos and audio news, editorials and original content dedicated to the business issues impacting healthcare.

www.TheBusinessofHealthcare.tv is a perfect opportunity for you to:

• Learn about current hot topics in the industry
• Reach healthcare leaders
• Get your own message out
• Gain awareness
• Drive traffic to your own Web site or healthcare organization

Whether you have a featured video editorial posted to aid in product awareness and public relations, a desire to easily keep abreast on hot healthcare business topics, or a need for a company logo linking through to your own Web site, www.TheBusinessofHealthcare.tv connects you directly with healthcare leaders. Today's healthcare professionals are watching our video and audio podcasts, editorials and news on www.TheBusinessofHealthcare.tv. Are you there?

Sincerely,

Craig Ahrens, FACHE

President, www.TheBusinessofHealthcare.tv

Mr. Ahrens is President of www.theBusinessofHealthcare.tv and a healthcare strategy consultant 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.

by Nick Jacobs

USA Today ran an article last week questioning the great medical secret, hospital death rates. As many of you know, we are passionate about transparency in health care, but one of the problems that we face is a nuance problem.

For example, we have a palliative care unit, a hospice that is used by a five county area. It is a center that provides respite, pain control and end of life care. My opinion of this service is that every hospital should offer it to every family, but, bottom line, year after year, our hospital is penalized statistically because of the number of deaths that we have.

Even though the patients are coming to our unit to die, it just shows up as a 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. Consequently, the State statistics will show an inordinately high number of deaths for cancer and heart failure in the graphic depiction of our medical center's death rate. Then the newspapers cover this statistic, and we attempt to respond to the media by explaining what hospice services are and how they should be calculated.

Transparency in death rates must be carefully monitored so as not to penalize those facilities that help families by providing hospice services. We even have heard of some heart centers that will not operate on patients with high co-morbidities 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 Were All Created Equal – Man Made Us Different.

by Christopher Cornue

Our last post in the series focuses on collaborative efforts around disparities in cardiovascular disease for African-Americans and Hispanics.

A second approach has focused on cardiovascular disease and has its roots in the Institute of Medicine’s 2001 Crossing the Quality Chasm: A New Health System for the 21st Century, and the aforementioned 2003 report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Using these reports as a basis for proof that racial and ethnic disparities exist in Healthcare, the Robert Wood Johnson Foundation launched the Expecting Success: Excellence in Cardiac Care collaborative project, led by The George Washington University, School of Public Health and Health Services’ Department of Health Policy. Through a rigorous selection process, 10 hospitals nationwide were selected to participate in this 29-month collaborative project, with the aim to improve the quality of health care provided to minority populations. The ten hospitals include: Del Sol Medical Center (El Paso, Texas); Delta Regional Medical Center (Greenville, Mississippi); Duke University Hospital (Durham, North Carolina); Memorial Regional Hospital (Broward County, Florida); Montefiore Medical Center (New York, New York); Mount Sinai Hospital Medical Center (Chicago, Illinois); Sinai-Grace Hospital (Detroit, Michigan); University Hospital (San Antonia, Texas); University of Mississippi Medical Center (Jackson, Mississippi); and Washington Hospital Center (Washington, DC). Based in the roots of the project is the assertion that hospital cannot improve the quality of care without gaining a better understanding of the community in which they operate and their patients live. Launched in September 2005, each of the hospitals use the established core measures for AMI and Heart Failure, in addition to Measures of Ideal Care, Readmission Rates, and other metric, to measure ongoing clinical improvement and success. Woven into each of these metrics, is an application of collected race and ethnicity data. By measuring these metrics, in conjunction with the race and ethnicity for the patients, each hospital can assess how well they are doing in narrowing any observed disparity gap. Indeed, the collection of these data was the first step that many of the hospitals took to ensure they are appropriately measuring the effect of their efforts. With improvement plans for both the inpatient and community settings, each hospital has identified numerous opportunities to address the fundamental cornerstones in efforts to address disparities … namely:

o educating patients, families, healthcare providers (including community physicians) as to the essentials of superior heart care;
o increased presence in the communities in which our patients live;
o development of partnerships with key community & professional organizations;
o collection of race, ethnicity and language data for each patient;
o consistent and appropriate collecting, reporting and sharing of data and metrics to wide audiences

More information about Expecting Success can be found at www.expectingsuccess.org including a First Year Summary report. Further detail, with a report about successes achieved through this project, will possibly be the subject of a future posting.

As this series concludes, I think it is safe to state that we know that disparities exist … the evidence in numerous research, literature, studies and publications is incontrovertible. As Unequal Treatment suggested … research and the identification of the problem is a first step, but now we need to move toward action. This is the challenge for, and charge to, all of us in healthcare.

This post is part of a 5-part series on healthcare disparities:
- Part 1: Introduction to Healthcare Disparities
- Part 2: A few healthcare organization role models to follow
- Part 3: Measuring disparities meaningfully
- Part 4: Two big disparities projects in the works
- Part 5: Cardio in African-Americans and Hispanics

by Tony Chen

I heard through the grapevine that Geisinger has offered a version of a "money-back guarantee." Basically, if a patient is re-admitted for the same reason, they won't charge the patient (or the patient's insurance company). I saw this article on it - it only pertains to heart surgery. And apparently, re-admits are way down.

What an interesting consumer-friendly, quality-driving philosophy?!

We Were All Created Equal – Man Made Us Different.

by Christopher Cornue

There are many programs and initiatives nationally that are working toward addressing these disparity issues in healthcare. To illustrate some of these efforts, two innovative large-scale projects, working to address the call to confront this disparity in healthcare issue, will be reviewed. The first (discussed in this posting) is a city-wide effort in America’s 3rd largest metropolitan area, Chicago, to address the disparities that exist in Breast Cancer mortality. The 2nd, which will be the focus of the next & final post in the series, is a national collaborative addressing cardiovascular disease disparities and quality outcomes.

In October 2006, the Sinai Urban Health Institute, the research arm of Chicago’s Sinai Health System, released Breast Cancer in Chicago: Eliminating Disparities and Improving Mammography Quality, which summarized their research and findings. They analyzed the Chicago portions of data from the Illinois State Cancer Registry, Illinois Vital Records files, the Illinois Behavioral Risk Factor Surveillance System and the United States Census. Through this analysis, they found a very disturbing trend in Chicago – that although progress has been made in reducing Breast Cancer mortality rate in whites, the rate for blacks is essentially unchanged since 1980. This gap, where the breast cancer mortality rate among African-American women was 68 percent higher than that of whites, is higher than the national average (37%) and New York City, as a comparison city, (17%). Several reasons have been suggested – including the fact that some studies suggest that African-Americans are predisposed genetically to aggressive forms of breast cancer; however, there is significant evidence to suggest there are socioeconomic causes, too. Some of these include the following:

o patients refusing biopsies or treatment because they cannot afford it;
o unwillingness to seek treatment because they live too far away and transportation is a real issue for them;
o continued “distrust” of the medical system.

One estimate from their studies suggests that each year 80 black women in Chicago die from breast cancer because their rates are not the same as the White rates. The publication is available at www.sinai.org/urban/publications.asp. This report provided a powerful impetus for the creation of a task force to address this issue. Late in 2006, a Chicago Breast Cancer Task Force was created and is chaired by three of Chicago’s most prominent health leaders: Sr. Sheila Lyne (CEO of Mercy Medical Center and past Commissioner of the Chicago Department of Public Health), Ruth Rothstein (former Chief of the Cook County Bureau of Health Services), and Donna Thompson (CEO of Access Community Health Network). This task force will charge healthcare leaders in Chicago, and the City of Chicago to address this healthcare disparity. This first step of this effort was the convening of the “Breast Cancer Quality Summit: A Call for Action,” which took place on Friday, 23 March 2007. Held at Rush University Medical Center, more than 100 leaders throughout the metropolitan Chicago area, including Northwestern Memorial Hospital, University of Chicago, Stroger Hospital of Cook County, University of Illinois at Chicago, American Cancer Society, Mercy Hospital & Medical Center, Mount Sinai Hospital Medical Center, Rush University Medical Center, Avon Foundation, Access Community Health Network, Sinai Urban Health Institute, Centers for Medicaid and Medicare Services (CMS), Y-ME, Harvard Medical School, Cook County Bureau of Health Services, among others, met to begin the process. Research presentations, national speakers about disparities, panel discussions and defined focus on three areas of the problem (1. Access to mammography, 2. Quality of mammography, and 3. Quality of treatment for breast cancer) highlighted the day. In the afternoon, three Action Groups, based upon the aforementioned focus areas, met to plan their course of action over the next six months with a report-out to occur in October. All of these activities, including the individual Action Groups will culminate in another Summit in Fall 2007 where recommendations will be presented to the City of Chicago, with actionable items soon to follow. More information about this Summit and these activities can be found at www.sinai.org/urban/summit/.

Next, a look at the Expecting Success: Excellence in Cardiac Care national collaborative, focusing on disparities in cardiovascular disease in African-Americans and Hispanics.

This post is part of a 5-part series on healthcare disparities:
- Part 1: Introduction to Healthcare Disparities
- Part 2: A few healthcare organization role models to follow
- Part 3: Measuring disparities meaningfully
- Part 4: Two big disparities projects in the works
- Part 5: Cardio in African-Americans and Hispanics

by Nick Jacobs

This is not the first time that I have written about the impact of access to religious or spiritual support for our patients during hospitalization. It is something about which I am passionate. This passion is not because of my personal religious zealot tendencies. It is because our basic philosophy is one of inclusiveness and existentialism in that there should be few if any limits as to the numbers and types of religious options that are made available to your patients, and, overall, we also embrace the philosophy that there should be no unreasonable limit to the availability of choices for patients when it comes to the type of modality or treatment philosophy that is available.

As often stated on this blog, it does not matter to me if our patients are brought closer to mental, physical or spiritual healing by pet, aroma, massage or music therapy; meditation, drumming circles or reiki. We don't care what the ingredient is that brings our patients closer to a cure, just that the healing environment gives them choices. Our labyrinths, walking trails and healing gardens provide just a few alternatives. Our 24 hour open visiting policy fits some, but not all patient families. The right to sleep in the same room with your loved one is a belief that we embrace to the point of having double beds in our OB suites and fold out beds in many of our patient rooms.

So, what about religion?

Recently featured on WebMD Medical News a piece on spiritual and religious doctors by Jennifer Warner which was reviewed by Louis Chang, MD agrees that religion and spirituality have a significant effect on a person's health. But doctors who themselves are religious or spiritual are more likely to see the impact of religion and spirituality on a patient’s health and believe it strongly influences their health.

It concludes by saying that consensus seems to begin and end with the idea that many if not most patients draw on prayer and other religious resources and overcome the spiritual challenges that arise in their illness.

Bottom line, if it works, don't limit access. Our wired world is not going to tolerate intolerance in any aspect of life, and, as we are exposed to truths that are effective all over the world, our decisions to reject them here in the United States will be questioned, as well they should.

Move on; open your mind, your eyes, your brain and your heart. We do not possess the definitive answers to every question. We are not the end all.

by Tony Chen

Mark Achler, CEO of patient communications pioneer Emmi Solutions, was gracious enough to answer a few questions about health literacy and the value of effective patient communications.

1. What are the top 3 things all hospital leaders need to know about health literacy?

1. It’s a bigger problem than most of us may realize. Over 90 million Americans have difficulty understanding and acting on health information. Even well-educated people have trouble understanding instructions on pill bottles, discharge sheets, informed consent documents, and the brochures and handouts that are supposedly there to help.

2. The health literacy problem is a patient satisfaction problem. It’s a quality and safety problem. It’s a risk problem.

3. Health literacy has huge economic consequences for hospitals. The IOM found that the US healthcare system spends an average of $993 every year per patient with low health literacy in excess hospitalization expenses. So, improving the health literacy level of patients should be on the top of hospital leaders to do lists and action items. It’s fundamental.

2. What is the value proposition for a hospital to augment its patient communications/education resources? Can you give any examples of concrete results from Emmi's experience?

Hospitals benefit in four major ways when EmmiPrep™, our perioperative product line, is fully implemented. 1) Improving patient satisfaction 2) Quality and safety improvement 3) Creating operational efficiencies and 4) Supporting their risk management efforts. It starts with engaging patients in their treatment process. When you can engage and inform patients about their treatment and options, you will have a more satisfied and loyal patient. And that engages the physicians. Happier patients who feel that the hospital and their doctor went the extra mile to educate them and their family in a personal and relevant way are more loyal to that organization. So you have multiple benefits here.

Now, about patient safety. EmmiPrep walks patients through what they need to know to have a safe experience before, during, and after their treatment – like the universal protocol around preventing wrong site, wrong person errors that the Joint Commission has established. We encourage disclosures around allergies, medications, and health history. And we help deepen their understanding of what to expect. In fact, 96% of 41,057 patients surveyed said Emmi improved their understanding of what to expect from their procedure.

Choosing to have surgery (and where to have it) is a big decision and our programs help patients really understand, in plain language, what’s involved, what the risks are, what are the alternatives. Interestingly, Press Ganey has found that patients feel safer when provided with more information, specifically, information that aids decision-making. In fact, patient’s perception of safety increases with the number of pieces of information they receive. Not only do Emmi programs address key elements of patient safety, by virtue of offering these programs to patients and promoting them throughout the organization, it impacts a patient’s perception of safety.

3. How does Emmi make communications "emotionally-engaging?"

We work with real patients throughout the development process. They tell us about their experiences, fears and wishes. We listen and incorporate those insights and coping strategies into our programs. The voice of the program creates a very intimate experience. It’s the voice that addresses those embarrassing questions without judgment and anticipates the questions you didn’t know you had. Patients and their families are extremely responsive to this method of communication. It’s empathic. We have a high response rate to a survey that patients can go through after watching an Emmi program. And often people say how soothing the experience was and valuable. It’s filling a gap in communication that doctors and patients appreciate.

4. Are there particular types of hospitals that would benefit the most from Emmi's products and services?

Our hospital customers are forward-thinking. They believe in and invest in the power of communication and how it can transform their business.

5. There seems to be more and more companies that are attempting to address the health litreracy gap and the patient communications gap. What sets Emmi apart from the rest of the pack?

You really know it when you see it. It’s why an iPod is better than other mp3 players. You want to interact with Emmi. It’s the design, the methodology, the trustworthiness of the content, the whole approach. And our technology platform is very sophisticated. Unlike DVDs and brochures and web content, Emmi can be measured. Our clients know, in real time, that a patient was informed. You can’t tell if someone read content on your website or your brochures or other materials. With Emmi, our clients track and gather data, including patients’ questions and concerns. It’s 2-way communication. That’s a huge benefit for hospitals.

by Tony Chen

Check out this exclusive TIME interview w/ Michael Moore on his new movie, Sicko (no, the movie isn't an autobiography, it's a healthcare industry-bashing "documentary").

Pretty funny:

TIME: What was the hardest thing about making this movie?

Michael Moore: Getting insurance. How do you convince an insurance company to insure a film about insurance? I finally found this guy who’s got a little company out in Kansas City. I think he’s the only Democrat who owns an insurance company.

I can think of a lot of things to say about Mr. Moore. But regardless of what we think of them, I'm guessing there will be negative hospital images in this movie that will be etched in people's memories forever. While the healthcare insurance industry seems to be the main target, our hospitals will be guilty by association.

by the way, I emailed Mr. Moore to see if I as a hospital blogger could get a pre-screening of the film. Still waiting to hear back from him.

And I'm still waiting for the AHA or someone to tell the other side of the hospital story: the medical miracles, the lifetimes of tireless service, the relentless compassion of nurses against all odds, and the unexpected 2nd chances patients & families get through a skilled surgeon's hands. I applaud Rush for starting to tell their stories.

by Nick Jacobs

These blogs are supposed to help us move toward a better health system, a more perfect hospital. Well, a few weeks ago, I ran across a corporation that is as close to perfect as mankind is capable of delivering. It's a corporation that has been formed as a federation of like hospitals to help them survive and thrive.

What's the big deal? Well, this corporation isn't dominated by a large hospital. In fact the budget sizes range from $30 to 120 M a year. There are twelve of them, and their combined gross annual budgets hang well over $1B. They each pay monthly dues until enough money has been generated to operate the corporation, and then they don't take any more money; usually that means no dues in April, May or June.

They work together in the obvious areas like purchasing, health insurance for their employees and liability insurance. What they do that is not normal is provide their docs to each other for peer review of difficult cases. They are positioned to assist each other with virtual, telemedicine pharmacists, data repositories, a blood bank, and dozens of other creative initiatives that will virtually save each participant hundreds of thousands of dollars each year.

The beauty of this virtual organization is that it does not require the individual hospitals to give up their boards, their presidents, their autonomy, their strategic planning, their connectivity to their cities, towns and villages, their pride or their place in history.

Is it possible that all of the small and medium sized hospitals in the United States could find eleven friends to hang out with, to work together, and to help support each other? We've just applied to be hospital number 13 in this gaggle, and it is our hope and prayer that it will enable us to miss not one beat as we move into the next chapter of our history. There is absolutely a place for independent, well run, high touch hospitals, and there is a place for communities to stay plugged in to their hospital.

Find some friends and emulate this federated model of non strategic partners as they pull together to fend off the predators. Not a new idea, but a near perfect alternative model.

We Were All Created Equal – Man Made Us Different.

by Christopher Cornue

Next, how do we measure disparities? Most commonly, it can be accomplished through the collection of race, ethnicity and language data. While this may appear to be easy, many hospitals struggle to identify the best manner to collect this information. Many hospitals struggle with the categories they create. Others struggle with their healthcare employee’s belief that this may be offensive to patients and/or they feel awkward about asking the question. Organizations such as the Health Research and Education Trust (HRET) arm of the American Health Association (www.hret.org) have been helping organizations to address this issue for several years. Using well established classification systems, organizations can systematically collect and monitor the type of care they are providing to their patients. Some initiatives have incorporated the collection of these data, such as the Robert Wood Johnson Foundation’s Expecting Success: Excellence in Cardiac Care project, a national project looking to address disparities in cardiovascular care. This project will be discussed in an upcoming posting. Regardless of the approach, however, it is clear that all organizations will be expected to pay closer attention to disparities, and with that, collect this race, ethnicity and language data.

The collection of this information is on all of our “front doorsteps.” As recently as 29 March 2007, The Joint Commission released a report recommending broad strategies designed to help hospitals overcome issues, such as language and cultural competency in the delivery of care. The report reviewed 60 hospitals nationwide and found that interpreter services and culturally appropriate care is practiced inconsistently. Reasons such as staffing challenges and financial strains were most commonly cited. The report stated that hospitals should establish a centralized program to coordinate these services. Additionally, a uniform system of capturing racial, ethnic and lingual information for each patient should be implemented. Further, they recommended that hospitals adopt policies to ensure patient family members do not become the medical interpreter, unless in extreme emergencies. Finally, they encouraged an increased engagement of the community in these issues. It has been widely believed that the Joint Commission will be requiring that surveyors review each hospital to ensure they are collecting race, ethnicity and language data in the hospital accreditation surveys, and this report confirms that it will be occurring soon, possibly as soon as your next survey…

Our final two posts will look at specific, large-scale efforts to eliminate disparities. One focusing on breast cancer mortality and the other on cardiovascular disease in African-Americans and Hispanics.

This post is part of a 5-part series on healthcare disparities:
- Part 1: Introduction to Healthcare Disparities
- Part 2: A few healthcare organization role models to follow
- Part 3: Measuring disparities meaningfully
- Part 4: Two big disparities projects in the works
- Part 5: Cardio in African-Americans and Hispanics

by Nick Jacobs

Will the next ten years provide the answers required to make our health system functional into the future? If we give serious attention to the tangible challenges presently at play, it becomes very apparent that our structure will not work without a unified, bipartisan approach to the issues in consideration. For example, the flooding of our emergency rooms with marginated patients, lack of health insurance coverage for 47,000,000 American citizens; the looming failure of Medicare; the outrageous demands of an incident by incident system aimed at intervention at a time of crises rather than a lifetime of well articulated preventative health related personal decisions.

It is well documented that, if we can embrace even a limited exercise regime, discontinue the consumption of saturated and Trans fats, and stop smoking, our country will experience a surge in the length of life.

If we, as a country, could conclude that our priorities should be directed more completely toward our own citizens’ well-being, we could end up far ahead of the game. The United States has just surpassed all other industrialized nations in the separation between rich and poor. We have now reached a ratio of rich to poor that is 500 times more pronounced than in Japan.

When asking these hard questions, it is important to realize that this is not liberal vs. conservative; it is not blue vs. red; or D vs R; it is about human beings caring about other human beings. It is about the irrefutable rights of all Americans. It is about embracing our fellow man and providing a net for those of us who are not as fortunate as others. It is about getting our collective act together as a country to put together a health policy for our country. Finally, it is about prioritizing our values in a mature, caring way.

Sorry if this ended up being a rant. Maybe that’s why I have been in nonprofit management my entire life?

We Were All Created Equal – Man Made Us Different.

by Christopher Cornue

As we take a further look at the “disparities in health care” issue confronting all of us, this post will highlight a few of the individual organization/hospital efforts underway to increase culturally-specialized care and decrease disparities.

o In March 2007, UnitedHealthcare announced a partnership with the US Department of Health and Human Services’ Office of Minority Health to create a web-based cultural competency program for physicians. The intent is to create an increased sensitivity among care providers to improve care for racial and ethnic minorities. Among the areas of focus for the CME, self-directed courses are culturally competent care, linguistic services and organizational support.

o In Northeast Philadelphia, Frankford Hospitals System has implemented cultural outreach programs to address the needs of their increasing diverse patient population. Many hospitals across the United States have implemented similar initiatives to those adopted by Frankford Hospitals System, including:

- Spanish-speaking operators & a patient liaison to help patients navigate their hospital system and assist with scheduling appointments and treatments;
- Modified visiting hours for patients’ extended families;
- Spanish-language television stations;
- Menus, signs and other materials written in Spanish;
- Certification program for hospital employees, allowing for more medically trained healthcare interpreters.

o The Journal of the American Medical Association published an online study on 19 March 2007 detailing improvements in HIV, unintentional injury and other factors that demonstrate a narrowing of the life-expectancy gap between African Americans and Whites. While researchers from McGill University in Montreal, Canada note that significant disparities in care still endure, they found this gap dropped to an “all-time” low of 5.3 years in 2003, a reduction from 7.1 years in 1993. Among the factors contributing to this decline are lower relative heart disease mortality, reductions in mortality from homicide, HIV and unintentional injury. A further note from the researchers indicates that this decline doesn’t appear to come from general mortality improvements among African-Americans, but from specific improvement among specific age groups and causes of death. Heart disease mortality for older African-Americans did not improve.

o Ongoing efforts to address these disparities continue at the Disparities Solutions Center (DSC) at Massachusetts General Hospital. To help promote these efforts, the DSC, in collaboration with the National Committee for Quality Assurance and Joint Commission Resources, is leading a year-long executive education program called the Disparities Leadership Program, expected to launch in late May 2007. Healthcare organizations across the county applied to be a part of this program, and 15-20 organizations have already been selected to participate. For more information, please visit their website at http://www.massgeneral.org/disparitiessolutions/ .

There are many, many more examples illustrating efforts to address this issue. Through these examples and discussions about the literature, reports and publications supporting the evidence of disparities, it’s easy to see there are significant implications to everyone. If individuals are unable to receive treatment in a timely basis, a grim conclusion can often be appropriately drawn: patients may be more likely to die and the costs for more advanced treatments will rise. Additionally, our commitment to improve the health of individuals is decidedly compromised and as we move toward increased efforts to provide more preventative medicine, these examples are very compelling to say the least. So, what can we do to address this issue? How do we measure this “disparities issue” at our own institutions? The next few posts in this series will attempt to answer these questions.

This post is part of a 5-part series on healthcare disparities:
- Part 1: Introduction to Healthcare Disparities
- Part 2: A few healthcare organization role models to follow
- Part 3: Measuring disparities meaningfully
- Part 4: Two big disparities projects in the works
- Part 5: Cardio in African-Americans and Hispanics

by Tony Chen

It's not everyday that a patient's blog makes the front page of CNN.com - check out this great write-up of a teen cancer patient's blog. His blog, along with many other patients blogs, are at CarePages - a free, easy-to-use website that helps family/friends communicate when a loved one is receiving care. It's sponsored by RevolutionHealth and Edward Hospital.

Read this story about 5-year-old Matthew Langshur - CarePages was really started by his parents when they had to go through a difficult period right after Matthew's birth.

CarePages has been used by over 1 million families worldwide (~45k patient sites). It definitely stresses emotional support and seems to be more geared towards traumatic difficult events (their resource center is focused around 4 diseases: breast cancer, lung cancer, premature birth, and congenital heart defects). These are diseases that we really can't fathom unless we are living it - no wonder some have said that CarePages is the most meaningful use of the internet.

PatientsLikeMe, a similar site (and one of the healthcare 2.0 sites I've highlighted previously) seems to be more focused on longer-term diseases where you can track clinical progress with patients like you (current focus is on Lou Gehrig's, MS, and Parkinson's). As such, the focus is more on education and support for newly diagnosed.

CarePages seems to be the one getting all the attention, though older sites also exist: CaringBridge (1.8MM people use visit per month, viewing ~60k patient sites) and theStatus.

Regardless of which one is utilized, patients blogs are changing the way patients educate themselves. I heard a physician say the other day that most of the formal diabetes and congestive heart failure websites out there are terrible and that you can get much more useful information about those diseases on blogs (for example, go to our friend diabetesmine!)

I applaud forward-thinking hospitals like Edward Hospital, High Point Regional Health System, Via Christi, UPENN, and many others that are joining with this to support their patients. I convinced that this level of emotional support invariably improves outcomes & patient loyalty.

For patients, they can connect in a meaningful way to the people they need most - family/friends & the select others who know what they're going through.

UPDATE: also check out DailyStrength

by Tony Chen

FierceHealthcare just announced their Top Hospital Innovators for 2007.

Glad to see familiar names that I've posted on previously (Congrats to Nick over at Windber).

From buying monthly newspaper ads to publicize quality metrics to building sister hospitals in Italy to offering the best of spa/hotel/hospital to negotiating directly with drug-makers, these are an innovative bunch!

by Tony Chen

did anyone else start using iGoogle? I'm lovin' it as a way to keep track of my favorites blogs and news sites. Here's a nice comparison between iGoogle and Netvibes.

by Nick Jacobs

Each and every day hospital CEO's are faced with the reality of the sometimes overwhelming responsibility of ensuring that life is carefully delivered, maintained and, eventually transitioned. We are ultimately responsible for the appropriate allocation of funds for addressing all of these life transition situations.

Each day we face the challenges of probability and statistics as we attempt to deal with whatever the odds parse out. Some days the chiller stops and the house heats up. Some days we have a crush of sick people who all hit the emergency room at the same time, and each time we think the day is running smoothly, a major piece of equipment breaks or one of our twenty plus regulatory agencies shows up with a check list. It's all part of the day.

When you think about running a $50M, $100 M or $1B business with 500, 1000 or 30,000 employees, consider that each one of them typically represents a family of four. Consider the fact that each and every one of those family members in some way, shape or form also come under the umbrella of your responsibility.

If that isn't enough for you to consider, then look into the eyes of a family member who's loved one died because of something that one of your physicians or employees might have either done or forgotten to do.

Bottom line, if you're thinking about trying to make it to the Big Show, just remember that you've gotta pay to play.

By Tony Chen

There's been a lot of good discussion at the World Health Care Blog around preventive health as a essential piece of the healthcare solution of the future. These past week, Intel Chief Andy Grove said in no uncertain terms that prevention is not the answer. As I mentioned in this previous post, I agree that changing human behavior is hard. But it is doable with the right framing.

by Tony Chen

Here's an interesting article from the Boston Globe about Boston-area hospital CEO salaries. Doctors and nurses not washing their hands between patients? If so, Paul Levy, CEO of Beth Israel Deaconess Medical Center loses almost $70,000 of his bonus. This is the same guy who asked his blogging audience whether he makes too much? Not surprisingly, commenters are impressed/shocked at his openness, though some were cynical about his real intentions. So, what's fair? There are a few schools of thought around CEO compensation:

- Market Value - "whatever the market will bear" is of course the most American, capitalistic answer. It becomes purely a supply/demand question. If you don't offer market value, the person you're trying to woo for the spot will go somewhere else. Typical factors to consider include the individual's unique characteristics (qualifications, experience, responsibilities, skills), the company's situation (revenues, geography, competitive positioning), and the industry's status (market conditions, availability of talent, economic conditions).

- Entrenched Executive Compensation Committee - Some would say that it's all a conspiracy. Executive compensation is typically set by a subcommittee of the board working in conjunction with an executive committee consultant. These consultants perform benchmarking research to determine market value. I've heard (someone please verify this for me) that they are sometimes paid a bonus if the candidate accepts the position. So it would seem their incentive is to recommend a higher salary? Plus, in some companies, many board members have existing and strong relationships with the CEO, and you wonder how much sway the CEO has in selecting committee members.

- Value - Some also think about the real value/impact of a CEO. For $1MM spent on this CEO, is s/he bringing in more than $1MM in value? For a $1B company with $20MM in net profits, this person would have to increase profits by 5%. This becomes a straight-up ROI calculation. Of course, this value is difficult to measure, but some have argued that this money would yield a higher return elsewhere.

At the end of the day, there's no denying that the CEO position is a very difficult position. Stress levels are high (hospital CEOs like other CEOs get death threats, too), the hours are long, the skill set needed is unique, and the long-term impact to the organization is tremendous. And I think it's a good development to have incentives more closely tied to key non-financial metrics.

Check out the most recent Fortune 100 CEO Salaries. And go to Guidestar for non-profit executive compensation information. I should note, too, that American CEOs are much better compensated than their European and Asian counterparts.

(Note from Tony: you may ask why we're dedicating two posts to hospital housekeeping! For Nick's hospital and for many others, housekeeping is a key factor for patient safety, quality, infection control, and patient loyalty!) Read Part I here. Read why I dedicated my first hosting of Grand Rounds to a hospital cleaning lady.

by Nick Jacobs

The Critical Care Unit is always a priority area in the hospital. There is never any waiting at all there. When the CCU calls, the staff goes immediately into action. All equipment is cleaned, disinfected, and cared for after each patient. Special care is taken in this unit due to the nature of the types of services performed there, i.e., blood borne pathogens, special emergency procedures, and critical cases sometimes lead to extra maintenance issues for staff, but there are no short cuts taken here.

The Palliative Care Unit also presents special challenges. It is used for pain control, respite for the families and end of life situations. This unit often times might have its own washer and dryer and housekeeping takes care of the patient’s personal items here. This includes special types of care, i.e., Afghans are cleaned, folded and made available for patients.

Some hospitals use walkie talkies for housekeeping staff to keep in constant contact with nursing stations, and whomever is closest helps on the call.

The Operating Room Floor is scrubbed and buffed every week constantly. Each surgical suite is disinfected after each case, and special mops specifically for the OR are used there only.

Generally the public areas and public restrooms are monitored throughout the day to be sure that everything is available and clean. The same holds true for patient lounges. Because patient lounges have refreshments for families, they are monitored very closely.

Infectious areas are also addressed very watchfully. Depending on the type of infection, various precautions can be taken. Usually all equipment that typically is in a patient’s room that is not needed by the infected patient is removed. That limits the need for infection control to just the area immediately around the patient.

Specific chemicals can be used to kill respiratory infections. The housekeeping staff will wear masks, use gloves, and separate cleaning cloths will be used for each room. Special hand sanitizers are also used.

Finally, chemicals can be added to disinfectants to improve the aroma. It is a nicer, non-antiseptic odor. Air fresheners are also used in bathrooms and all throughout hospital.

by Christopher Cornue

Our daily lives in healthcare are focused addressing crises that arise, managing our expenses, developing new growth opportunities through Service Lines, implementing new ground-breaking technology and the like. However, one area that many safety-net & inner-city hospitals confront on a daily basis is our ability to address disparities in healthcare. As reports and studies have demonstrated, this is becoming an increasingly difficult issue to address. In Chicago alone, there are many examples of groups and organizations that are leading efforts to address this. These will be discussed in upcoming posts. But first, what are disparities and how do they impact all of us?

General information suggests that by 2050, racial and ethnic minorities will account for 90% of our US population growth. As a result, there will be increasing racial and ethnic minorities seeking healthcare at our hospitals and health systems.

The Institute of Medicine’s groundbreaking 2003 book, Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, brought to light, on an international scale, the issue of disparities in healthcare. Their argument is that “racial and ethnic minorities tend to receive a lower quality of healthcare than non-minorities.” At the urging of Congress, the IOM conducted a study to assess the “differences in the kinds & quality of health care received by US racial and ethnic minorities and non-minorities.” Examples of disparities they found in their research were 1) overuse & underuse of treatments and services; and 2) mortality rates among difference racial & ethnic groups, among others.

Their analysis and assessment demonstrated that 1) evidence of racial and ethnic disparities is consistent among many illnesses and healthcare services; 2) they are associated with socioeconomic differences; and 3) these disparities, if adjusted for socioeconomic differences, often remain.

The following five findings provide the foundation for most initiatives working to address this issue, and are a sobering reminder to us of our call to action in our roles as healthcare leaders:

o Finding 1 – Racial and ethnic disparities in healthcare exist, and because they are associated with worse outcomes in many cases, are unacceptable.
o Finding 2 – Racial and ethnic disparities in healthcare occur in the context of broader historic and contemporary social and economic inequality, and evidence of persistent racial and ethnic discrimination in many sectors of American life;
o Finding 3 – Many sources (including health systems, healthcare providers, patients, etc.) may contribute to racial and ethnic disparities;
o Finding 4 – Bias, stereotyping, prejudice, and clinical uncertainty on the part of healthcare providers may contribute to racial and ethnic disparities in healthcare. While indirect evidence from several lines of research supports this statement, a greater understanding of the prevalence and influence of these processes is needed and should be sought through research;
o Finding 5 – A small number of studies suggest that racial and ethnic minority patients are more likely than white patients to refuse treatment. These studies find that differences in refusal rates are generally small and that the minority patient refusal does not fully explain healthcare disparities.

Next week, we’ll look at some nationwide initiatives that are attempting to address this significant issue in healthcare.

This post is part of a 5-part series on healthcare disparities:
- Part 1: Introduction to Healthcare Disparities
- Part 2: A few healthcare organization role models to follow
- Part 3: Measuring disparities meaningfully
- Part 4: Two big disparities projects in the works
- Part 5: Cardio in African-Americans and Hispanics

by Tony Chen

I'm pleased to announce that Christopher Cornue has joined the hospital impact blogging team. Christopher is currently a Vice President at Mount Sinai Hospital Medical Center and brings a great breadth and depth of healthcare experience. His bio is below.

Mr. Cornue has been leading operational, quality, clinical and growth strategies at Mount Sinai Hospital Medical Center (MSHMC), a 325-bed Level-1 Trauma Center, on Chicago’s near West side since 2004. Included among his areas of responsibility are the Departments of Medicine, Surgery, Anesthesiology, Pathology, Perioperative Services, Laboratories, Physician Development, Trauma Services and Service Line Development. In addition to these responsibilities, he is leading efforts to address disparities and improve quality in the Chicago Metropolitan Area as an Executive Sponsor of the Robert Wood Johnson Foundation’s Expecting Success: Excellence in Cardiac Care national collaborative project. Prior to his time at MSHMC, Mr. Cornue worked with sixteen major academic medical centers nationwide in his role with University HealthSystem Consortium (UHC) in the identification of strategic cost containment & revenue enhancement opportunities and the development of operational strategies. Prior to UHC, he held several leadership roles at the University of Chicago Hospitals and the University of Chicago. He also provided operational consulting to an international start-up company in Belgium.

Mr. Cornue received his Bachelor of Science (Biology & Chemistry) and Masters of Science in Health Services Administration degrees from Gannon University. Active in the identification of international health care strategies, he is a member of the International Society for Quality in Health Care (ISQua), International Union for Health Promotion & Health Education (IUHPE), and the Chicago Council on Foreign Relations. Furthering international healthcare strategies and partnerships, he has completed a collaboration site visit with the Improvement Foundation, based in Manchester, UK and will be visiting with the NHS Quality Improvement – Scotland Group in May 2007 and the London-based Healthcare Commission in October 2007. Through these relationships, Mr. Cornue hopes to contribute to the efforts addressing healthcare quality, access, disparities, policy and operations globally. Also a member of the American Public Health Association (APHA), Medical Group Management Association (MGMA), Chicago Health Executives Forum (CHEF) and the American College of Healthcare Executives (ACHE), he became a Certified Healthcare Executive (CHE) in 2005 and a Fellow (FACHE) in 2007.

Also wanted to note that Jared Johnson has decided leave his hospital PR post and move onto greener pastures. So, we thank Jared for his contribution to Hospital Impact and his thoughtful posts on transparency.

by Nick Jacobs

As a first time hospital president, it was clear to me that I could not tolerate a business as usual environment. My background had included visits to plenty of hospitals that allowed me to see blood on the walls in the patient’s rooms, filthy corners, stairwells, and waiting areas with waste baskets running over, cigarette butts at the entrance ways and infection rates raging at around 10% or above. For the most part, it was not because of a lack of pride. It was because of accepted standards, history, and tradition. It was about mediocrity. It was about doing it the way it had always been done.

When you enter many hospitals, you feel fortunate if you are overwhelmed by the smells of disinfectants. At least it smells as if someone is trying to clean the place. You feel lucky if you don’t see fluids on the curtains or walls, and, if you don’t get an infection.

What do you look for in clean hospital? What questions can you ask? Well, here’s the drill. There are several very important extra steps that can take place. The first thing in the morning, the public bathrooms are thoroughly cleaned. This gives the patients time to eat breakfast before the housekeeping staff begins to clean their rooms. Having said this, however, since they are the focus of the entire hospital, the patient rooms and operating rooms are the priority for the staff.

The patient rooms are done every single day; the window, windowsills, floors, tables, telephones, telephone cords, restrooms, end tables and bed trays are sanitized. The staff uses disposable wipes for each room so that the tools used to wipe up and clean up one patient room are used only once. This ensures that each room is getting it’s own cleaning equipment. It’s more expensive, but much safer for the patients this way.

The water in the staff’s cleaning bucket is changed for every room. To ensure cleanliness and to protect from infection, any blood or bathroom accidents are handled as soon as the staff is made aware of it. If any rooms need any type of maintenance or work performed, the housekeeping staff will contact the maintenance department immediately to get the problem fixed.

Staff is always on the lookout for exposed needles in patient areas to ensure everyone’s safety. They also check out the floors for paperclips because these little organizational tools can cause slips and falls on the floor. Further, they are very careful that any hazardous waste material is disposed of properly every time to ensure safety from infection.

Most importantly, when possible, they also have an important roll in taking care of the patients themselves. If they are doing their cleaning, and the patient needs a pillow, wants propped up in bed, needs a drink, or whatever non-medical request they might have, the housekeeping staff will do all that they can to help.

If it’s a medical task; they will find the person who can help the patient. Some of these requests may seem beyond the realm of a typical job duty, but if the request is valid, they will go far beyond the norm. For example, if the patient has spilled some food or drink on their personal items, the housekeepers will even wash those items for the patient. Further, they will then return it to them pressed and cleaned. (Obviously, to avoid spread of infection, any blood borne pathogens are not included in this extra service.)