by Jeff McKune

My Dad and I were recently discussing healthcare issues, and he told me that he argued healthcare topics when he was on his high school debate team. In fact, in 1947 he was given the debate topic "Should the Federal government provide a system of complete medical care available to all people at public expense?" Sixty years later, the question of government's involvement in healthcare is still a hot topic, and it is one of the leading topics of the 2008 presidential race.

A little over a week ago, John Stossel hosted a 20/20 program titled "Sick in America: Whose Body Is It, Anyway?" One of the things I liked most about the program was the way that Stossel covered some challenging issues such as the linking healthcare insurance to employment, over utilization, and the profit motive. He also had a nice segment comparing the system in the United States with those in other countries, specifically Canada. I found the whole program to be refreshingly frank.

The last part of the program focused on private solutions to healthcare problems versus government solutions, and the importance of competition and individual choice. Stossel gave a couple of examples where competition among healthcare providers has led to improved quality and lower prices, even during a time when most of the industry is experiencing higher prices. Those two examples were LASIK eye surgery and cosmetic surgery, both of which are usually not covered by insurance. LASIK prices have dropped 30%, and the quality has improved. Providers have to compete because patients are shopping around knowing they will pay for the procedure out of their own pocket.

When discussing healthcare challenges, we often focus on what does not work. But what does work? The things that work for healthcare are the things that have worked for our country in many other industries: Freedom of choice, competition, innovation, and the availability of information for potential buyers. If we know these things work, as hospital leaders, how can we best connect to these basic tenants?

by Tony Chen

All this talk about health care policy, healthcare blogging, and hospitalk, sometimes it's easy to forget that we are talking about real people, real sons, daughters, fathers, mothers, wives, husbands, and loved ones.

Yes, we have to run tight ships financially to ensure the long-term sustainability and advancement of our hospitals. Yes, we need to learn the business of healthcare. Yes, we have to think aggregate in numbers. But let's always remember that we are serving individual people, many who are in the most scaring, vulnerable moments in their lives.

I ran across this story at Blog, MD about Derek Madsen, a 10-year patient who had a rare childhood cancer. Please take a moment today and go through these 20 gripping Pulitzer prize photos of his journey.

Also, we've collected a few other patient stories here.

by Craig Ahrens

I have not blogged in a long time and I apologize. As most of you know, I attempted to launch www.thebusinessofhealthcare.tv months ago and unfortunately had to pull back on the website official launch again until next month. Long story short, it is difficult to start any business – legally the loops you have to jump through are extreme especially when it comes to this type of business model. It has been an all consuming effort and fortunately I have partnered with individuals who are going to ensure a smooth startup. So, look for it again and I appreciate your support and welcome your ideas!

At the same time, I left the consulting world to work for one of my clients. They offered me the opportunity to work in one of the most competitive markets and service lines in the country – Indianapolis as a Neuroscience Service Line Executive Director. Normally, I would not have been interested in this position, but the chance to work in a non-CON, advanced specialty hospital, competitive market with an excellent health system was too enticing. I thought that it would be interesting to post my experiences working in a new role.

Service line executives are difficult roles to manage. They are difficult primarily because of three reasons:

1. Many of the relationships with operational staff are matrixed through Chief Nursing Executives.
2. Physicians and CEOs are used to negotiating business development opportunities minus a “middleman”.
3. Operationalizing plans and business development initiatives is difficult given the myriad of relationships to navigate.

How does one overcome these issues? In my opinion, the most important thing is for the CEO/executive team to visibly communicate to administrators and physicians that you are the go to person for the service line. Without this support, you are dead in the water with the matrixed relationships. Further, the physicians will continue to pursue the pattern of going straight to the CEO to discuss any opportunity. To some this may seem odd, but you need to market yourself internally and to be seen as the person who shepherds initiatives and gets them done through navigating the internal political hospital dynamic. I will continue with part II next week. Any comments?

Craig Ahrens, MHA, MBA, FACHE is the Executive Director of Neurosciences for St Vincent Health in Indianapolis, Indiana (part of Ascension Health System). He is also President of www.thebusinessofhealthcare.tv (due to launch in late 2007), which is the web’s first internet tv program dedicated to healthcare business news and interviews. He can be reached at info@thebusinessofhealthcare.tv

by Nick Jacobs

From MSN Money: "Patients in the highest-rated, five-star hospitals in the United States are at a 65 percent lower chance of dying than patients in the lowest-rated, one-star hospitals, according to a study released by HealthGrades, a health-care ratings company. If all hospitals included in the study performed at the five-star level, the lives of more than 273,000 Medicare patients could have potentially been saved over a two year period. Fifty percent of these potentially preventable deaths were associated with four diagnoses: heart failure, community acquired pneumonia, sepsis and respiratory failure."

From "Health Daily News:"

Today, some health care executives, insurers and physicians are . . . fully embracing disclosure and apologies, not only because they believe it will reduce malpractice claims, but also because it's ethically the right thing to do."

Larry Dossey, M.D. from "Reinventing Medicine," "For more than a century the profession of medicine has tried to become increasingly scientific and technical, because this is where we believed the future of healing lay. Now a monumental shift is occurring, empowered by the evidence that consciousness is a powerful factor in the world."

Finally, Dr. Karen Donelan, Senior Scientist in Health Policy, Massachusetts General Hospital, gave a wonderful description of her experience in the health care system. A dear member of her family received timely access when the pcp's answering service worked, the receptionist, technician and doctor all showed compassion and demonstrated their desire to be there for the family and the patient. At every step information and decisions were shared, so much so that the family felt part of the care team, and finally the doctors were highly trained and had all of the right tools. She described this as truly, significantly different care than they had ever observed with other family members. According to Dr. Donelan, "It was seamless, high quality , accessible, compassionate and expert with a fully disclosed price and plan of treatment."

It was the care that her dog, Rico was given by the vet. Surprised, don't be.

by Jeff McKune

In an earlier blog entry, Tony wrote about upcoming offerings by both Google and Microsoft. It looks like the name of Microsoft’s offering is Azyxxi (“ah ZIK see”). Microsoft describes Azyxxi as a tool for integrating disparate healthcare IT systems to provide better management of patient data for clinicians and quality managers, as well as better decision support for financial managers and hospital administrators.

I have not been able to dig up many details about Azyxxi as yet, but it appears to be a collection of interfaces to “best of breed” healthcare IT systems which categorize and feed data into a generalized data warehouse. On the user side, data is presented through “on the fly” views to provide for real-time queries and decision support.

At first blush, it would be easy take the position that “Hey, we already have an integrated HIS.” My experience thus far has been that integration is a good word for HIS vendors to toss around, but when it comes to answering everyday questions about hospital operations, many existing systems are frustratingly inept. Will Azyxxi be able to fill the gap? Time will tell. There is certainly a lot of hype about the product. I would love to see it first hand and have a nuts and bolts discussion with someone who really knew the architecture of the system.

Though an incomplete and informal article, the entry in Wikipedia lists some of the hospitals using Azyxxi. With several of us blogging here, we should be able to provide more details as they become available. If you know more about Azyxxi, please share it. We would also be interested in seeing some good quality screen shots, as well as a list of compatible existing HIS products. Here are a couple of additional links:

Microsoft Pairs with MedStar Health and Washington Hospital Center on Healthcare IT Solution to Improve Patient Outcomes
(Background article on 2006 acquisition)

Azyxxi: New Clinical Informatics System Improves Practice of Medicine
http://www.georgetownuniversityhospital.org/documents/Physician%20Update/PhysnUpdJan06.pdf (actual link provided because blog software isn't accepting it as a link)
(article on page 2 of this document)

Microsoft Azyxxi One Year Later; 21 hospitals and counting
(August 2007 blog article by Microsoft’s Worldwide Health Director Bill Crounse, MD)

by Tony Chen

"We're all about making children happy, they are all about health and making children healthy. I think when you combine that together it's a very powerful one-two combination. - Disney Rep"

Just in case you hadn't seen it, Disney is going into the hospital business. With its $10MM donation, this newly renovated children's hospital in Orlando will bear the Disney name and benefit from Disney "imagineers" for how the patient (and family) experience should be. Previously we wondered in great detail what would happen if Disney ran your hospital. Now we're going to find out.

(by the way, after I wrote that series, I got a lot of criticism from people who thought Disney & fun just can't mix with the serious business of healthcare.)

Nonetheless, I continue to believe that this is a great development for healthcare. Customer delight and hard-core clinical outcomes are not mutually exclusive (in fact, some would argue that they are positively correlated!) How much better can a kid fight off a life-threatening disease if the environment isn't so intimidating, cold, or unfamiliar? This will be a great little test case.

I wish I could have been a fly on the wall when Disney execs discussed the pros and cons of this fairly risky business decision. Did they think about the risk of having their name on a facility where kids may die? Did they think this could be so successful that other Disney hospitals would start popping up all around the world? Did they think about whether this would be a brand-diluting move? Did they realize what a sleeping giant they may have awakened? Did they realize that this move may eventually challenge all hospitals to "imagineer" and redefine the patient experience? Do they know what they are getting themselves into with bad debt, collectibles, malpractice, and lawsuits?

Then again, $10MM for them is a drop in the bucket (they made $3.4 billion in net income last year). To them, this is probably a little experiment that could generate a lot of positive PR & leverages their brand/core segment perfectly.

What do you think? Physicians - how would you feel working at "the Disney Hospital?"

by Nick Jacobs

Tony said that he would write a summary of the happenings at the Consumer Health World Blogging Conference, and he did. Here's my take, overall, for as hard as everyone tried, it would have been cheaper for me to snail mail each participant a copy of my last blog with cash inside the envelope. When you consider the airfare, hotel, meals and tips, plus all of the money invested in my time by my employer, we are into some fairly serious numbers.

Truthfully, it reminded me of the first year that we did patient evaluations through a leading U.S. company that was completely insensitive to small hospitals. It cost so much to hire the company, and to use their forms and evaluations, that we could have stood at the door and handed each exiting patient a crisp new $100 bill and said, “So, how was your stay here?” I’m sure we would have gotten an even better set of responses than we had already.

The good news about this event was that there were savvy people in attendance who created podcasts, streaming videos and other means of communicating, and the people who were there were gracious, polite, serious and engaged.

Truthfully, as the earth’s first hospital CEO blogger, I feel a little like Christopher Columbus. I’m sure that eventually my peers will get this. They will somehow learn about the power of viral marketing, and realize that the earth is flat, but, like Chris, the big money, big acceptance, land grab, and recognition will probably comes years after I am just a memory in the blogsphere. They will say, “That Nick was certainly ahead of his time. He was such a genius.” Okay, maybe it won’t be that nice, but I’ll bet at least my grandkids will say that. Okay, maybe not.

Just so you know, this was NOT sour grapes. I got to hang out with some nice people, meet and work up close and personal with my hero, Tony Chen, had a two day reprieve from work reality and loved every minute of it. Besides, I’ve lived to see Elvis on Ed Sullivan, The Beatles, Man’s First Step on the Moon and me blogging. My share of the excitement is right up there with the best of them.

So, let me close by saying, “First is not always the best, but, when you’re first, you do get a much better view of the scenery.”

by Tony Chen

I'm here at the Consumer Health World Conference in Chicago, IL. Though at first the crowd seemed a bit sparse, it is shaping up to be an interesting conference. Smaller conferences with the right people make for very productive networking and conversations.

Today Nick Jacobs and I spoke at a session about Blogging & Social Media for Providers (after hundreds of emails and phone calls, this was the 1st time Nick and I have met face to face!). Thanks again to all for attending. As promised, here's my list of top 10 sites to check out as we think about the impact of social media on providers.

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

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

The bottom line is exactly what Nick said this afternoon - blogging and social media will never become mainstream within healthcare. Nonetheless, the brave ones that do authentically and purposely engage their community, their patients, and their employees will reap the benefits of the collective intelligence, collaboration, and good will of all.

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

by Nick Jacobs

As a young teacher, it was increasingly difficult for me to understand the system. It never made sense to me that the publicly funded buildings in which we worked were not made available to the community 24/7. After all, these buildings were purchased by the public funds but, for the most part, except for those special days when games or programs were scheduled, the buildings were locked up every afternoon and evening.

After leaving education and migrating to health care, I had an opportunity to hear Ken Dychtwald of the "Age Wave" speak in 1988 about the fact that hospitals were, for the most part, not available to be utilized appropriately by the people who ultimately paid for them and not built to take care of the aging population. The lighting was not appropriate, the stairs were not the correct rise, the furniture was built for people in their 30's, and, most importantly, they were used primarily for acute situations.

He talked about a new hospital that had been built in Scottsdale and how it had a regular driveway and a golf cart driveway. He spoke about how it was built to attract the community. It was a special experiment, and this presentation captured my imagination. Why NOT?

Over the past ten years we have added a community work out facility, a wellness center; labyrinths, gazebos, walking trails, fountains, meditation gardens, a caring park, therapy pool, and hills filled with flowers. Inside we used furniture that fit the average age of our patients, invited the Area Agency on Aging to move into our building, a building that we condo- minimized, for them. We built several community rooms, added an indoor walking track, decorative fountains and gardens inside and out and then worked to educate our market service area to utilize our space as their own.

My favorite memory of this entire community project came on the day that we had a dozen prisoners from the county jail carving out the walking trails in the back. It began to rain and the Department of Corrections provided them with bright yellow rain coats with the D.O.C. abbreviation on the back. One of our patients walked up to me, umbrella in hand and said, "How wonderful it is that your physicians would take the time to build a walking trail for you."

Moral of the story? Make all hospitals community centers for health and wellness. The pictures for the Senior (Citizen) Prom are taken inside on our grand staircases by the indoor gardens. Meanwhile, the High School Senior Prom pictures are taken outside by the magnificent fountain. Our employees use the outdoor areas for picnics, mental health breaks, drumming circles, and generally for overall personal healing. And that’s the way it should be.

by Nick Jacobs

In the middle of a board committee meeting, my vice chairman turned to me and said, "Hospitalk." "Listen to all the hospi-talk." I hesitated for a second while I focused on the word he was using . . . Hospi-talk, the talk that is specific to our profession, our business, our environment. As a judge I'm sure he deals in courti-talk, but this meeting wasn't about attorneys. He was listening to abbreviations: QD, PRN, C.C., increased CPK? How about an elevated BUN? In the kitchen that is probably a good thing.

Now, it's not unusual to read or hear medical terms during these meetings, but this meeting was loaded with medical banter, you know, separating the we know people from the we sure don't know people. It's funny how the use of these terms increase proportionately when the pressure increases. This particular meeting was about the "New Joint Commission." Clearly, the Joint has evolved into a tough, yet somewhat absurd version of its old self. The pendulum has swung to the opposite extreme, from everybody is perfect to every hospital is inferior, and hospital Boards have taken notice. Read the Boston Globe; April 21, 2007, by Liz Kowalczyk: Five hospitals release data on inspections . . . Surprise visits revealed some flaws in patient care.

Anyway, I digress, back to hospi-talk.

After the Judge pointed out how abstract the meeting had become to the lay people present, I literally had to stop five different speakers to translate their jargon into something a little more meaningful to the masses, and, as the shields were lowered, we could all settle into the knowledge that this meeting was about people, how to cure them, how to protect them, and how to ensure that every detail is being addressed . . . it just took a wrong turn down semantics alley started by a specialist's specialist who probably doesn't even know what a Game Boy is.

by Nick Jacobs

Recently, a $3 B initiative was proposed in Texas for cancer research. Not unlike the Stem Cell research program launched in California, this program could create a powerful source of funds for research. Because of cuts in the NIH/NCI budget, the efforts by these two states may contribute to both funding and economic growth for both Texas and California. In both cases there should be a boost to the biotech industry as well.

The only caution that comes immediately to mind is that of having a "top notch peer-review process." If the top notch peer review process is similar to the system currently in place at both the NIH and the NCI, it is clearly a top notch "Good Ole Boy" process that protects the status quo, discourages funding to new organizations that do not look exactly like every other organization funded by them, and it contributes continuously to the "small science" approach of discovery.

Maybe this will be the new world order. Each State will become the center of some type of specific research specialty funded through a state bond issue. One of the responders, Lance Armstrong, said about this new program, "It could be incredibly powerful, particularly if it were salted with a bunch of new people."
Right on, Lance. Make that your message. Salt this program with NEW PEOPLE. Keep the politics out and encourage co-operation.

by Jeff McKune

This past week was certainly busy, and the last half of it was packed with our annual leadership retreat. My head is filled with tasks and action plans as a result of our leadership development sessions with the Advisory Board. Then Joe Tye challenged us with building the invisible architecture of our organization. I have so many action plans that I need to develop, that I may start with an action plan for my action plans!

There is a strong sense of being equipped that comes out of a retreat. With all of the collective enthusiasm that accompanies that sense, I have to wonder how much will survive the onslaught of the reality of daily operations at the hospital. There has to be more than just "retreat-speak" that follows me back to the job. Certainly there are a myriad of projects that I could attempt to tackle. However, I know that time and energy are not unlimited, and that I still have to maintain some sense of balance in my life - time for family, friends, and self (exercise, reflection, and spiritual growth).

So now that I am armed, to which efforts can I fully commit? First, I will renew my commitment to formally developing my own leadership skills. If my dream is to help build a better hospital, to have a positive impact on healthcare, I have to start with building a better Jeff. That will mean taking a critical and introspective look at my skill set, determining where the opportunities for growth are, and committing time each week to addressing those gaps. My second commitment will be to focus on bringing out the very best in each member of my staff. What are their dreams? What baggage are they carrying that I can help them overcome? What would it take to make them feel like this is the greatest place on the planet to work?

Maybe armed and dangerous is not the right phrase: How about aimed and determined!

Did you recently return from a leadership retreat or similar experience? What initiatives were you able to take back to your organizations?

by Christopher Cornue

Our organization just went through another “re-organization” and the phrase “Physician Integration” was added to my title in a slightly revised role in the Table of Organization. By raising the question of what this means, I’m being somewhat facetious (I had better be clear about it, since it is in my title after all) … but shouldn’t we all have “Physician Integration” formally, or informally, after our titles? Since we are leaders in healthcare, aren’t we all expected to integrate physicians into what we do on a day-to-day basis? So, instead of Chief Operating Officer or Vice President for Strategic Planning … the roles should read Chief Operating Office & Physician Integration or Vice President for Strategic Planning & Physician Integration. These revised titles speak more to a “matrix” style Table of Organization emphasizing the role of physicians in everything we do.

Let’s not make light of this – it is key that physicians are part of our operations meetings, service line discussions, marketing/planning, nursing leadership, etc. Too often I have heard physicians separate leadership between “physicians” and “administration.” Quite frankly, I get a little frustrated when I hear this stated … I truly believe we’ve moved beyond this “old school” style of thinking of separate accountabilities and we really need to marry physician and administrative leadership as supportive, not exclusive managing styles. Another one of my soapboxes, I guess.

While it might not be necessary to specifically identify the term “Physician Integration” in each of our titles, it is important that we remember, recognize and reinforce the importance that physicians play in everything we do. This is the true nature of a dynamic, progressive and successful organization and a moniker I am proud to attach to my new title, and any other title I hold in my future care in healthcare.

by Tony Chen

Previously, I wrote a post on what we healthcare folks can learn from facebook. I'm very happy about this post, not because it's that insightful, but because it probably swayed a certain hospital CEO to join facebook (chalk up yet another 1st for Nick).

Just a few days after that, I found out that Healia just launched a new healthcare application on facebook called the Healia Health Challenge - it quizzes your healthcare knowledge (and challenges your friends to do the same). Read Laurie's interview with Healia's marketing associate Jonathan Shaw. How refreshing that there are some web 2.0 savvy healthcare people out there!

by the way, I scored a 661 out of 800 on the quiz, landing me a lowly "resident" status.

by Tony Chen

Head over to the World Health Care Blog to read my latest post on 4 healthcare proposals that have been unveiled this week:
- John Edwards wants mandatory MD visits for all Americans
- The UK Tories want to deny care for people with bad healthcare lifestyles
- The UK and Germany want to improve healthcare for 7 developing nations
- Steve Case wants to start a healthcare (you guessed it) revolution

by Nick Jacobs

On my hospital blog (Windberblog.typepad.com), my entry this week was about twisted truths, not ours, but others. As the art of spin has become more and more refined, we begin to reach a point in communications where reality is whatever the loudest voiced pundit can emphasis the longest and the most intently. This practice has become true in health care as well. Especially in areas of high competition.

Last year I wrote another blog about an author by the name of S. I. Hayakawa and his book, Language in Thought and Action. As a freshmen college student my impression of the book was that it was about thought and mind control through the use of disinformation.

"The original version of this book, published in 1941, was in many respects a response to the dangers of propaganda, especially as exemplified in Hitler's success in persuading millions to share his maniacal and destructive views. It was the writer's conviction . . . that everyone needs to have a habitually critical attitude towards language — his own as well as that of others — both for the sake of his personal well-being and for his adequate functioning as a citizen.

The reality now, however, is that this art has evolved into a science, and the science has become an accepted part of our world. It is fascinating to observe the use of disinformation as a means to attract patients, to see the truth twisted just enough to confuse the public so as to appeal to their lack of technical and medical knowledge through misrepresentations that lead to business.

A few weeks ago, one of our visiting sub specialists told a patient that they had to be transferred from our facility because we didn't have the necessary equipment for his surgery. As it turned out, the piece of equipment was an orthopedic nail that, had we not had cases of them, could have been delivered almost instantly by a local sales rep. The reality is that a competitor requires each surgeon to do a certain number of surgeries each day that they have scheduled. If they do not, they will have a decreased number of slots to work from in the future that are exclusively designated for their use.

What is the definition of an Open MRI? It is not a larger bore device, it is, indeed, open. Who cares? A facility that has purchased a larger bore device cares. Say that it is OPEN, confuse the public, and take business away from the facilities who purchased the OPEN MRI. A nuance, you say? A tiny twist, you think? Well, if you have a $34,000 a month payment to make, it is just good business, right? Twist to sell.

Finally, we hear, everyday, the little whispers about skill level. Perception is reality, and unless or until total and complete transparency becomes the guiding light of health care, we will be in the same boat that we were in before "Consumer Reports."

Buy our gasoline, "It will put a tiger in your tank!" It wasn't that long ago when we believed that there was a huge difference between the quality of different brands in that business as well, at least we believed that until we were informed that all of the gas was coming from the same refinery or, in some cases, all of the stations were being fed from the same truck!

Bring on open communication, just don't let some of the major, existing evaluators take the lead. They are from a different paradigm, a world where, many times the twisted, interpreted detail is the basis for a pronouncement that has no bearing on the reality of the care.

by Christopher Cornue

Unfortunately, I cannot take credit for this very accurate description of leadership in healthcare at the moment. This was a resounding theme at a recent Health Care Advisory Board meeting I attended a few weeks ago. Supporting this assertion, the Advisory Board discussed changing reimbursement methodologies, revised DRG structure later this year, global competition for paying patients, increased costs, expected growth/volume decline, shift from inpatient to outpatient, proposed legislation forcing hospitals to absorb costs for adverse events that occur during a patient’s hospitalization, a more informed consumer, increased transparency of quality outcomes for hospitals, evolution of “retail clinics,” workforce challenges, etc. No need to go through the whole list – you get the point! While many of these issues have challenged hospital leaders for several years, it’s probably safe to say that a “perfect storm” type scenario is on the horizon, whereby all of these are impacting hospitals simultaneously. Which issue do we spent the majority of our time focusing on first? How do we manage this change going forward? Regardless of our focus, I just wanted to share this “Leading Through Disruptive Change” statement, as I think it’s a perfectly appropriate label for our efforts in healthcare at the moment.