by Christopher Cornue

During a routine inspection of a hospital in England by the Healthcare Commission in the late 1990s, a concern was raised regarding hospitals not having consistent, evidence-based, standardized care paths. From this, approximately a decade later, the Map of Medicine was launched.

Developed for use by the National Health Service in England and Wales, this tool was created as a framework for sharing knowledge across care settings and providing evidence-based care pathways to clinicians at the point of care. This electronic, website-based tool is an impressive collection of more than 700,000 articles and resource materials. While it is “localizable” as needed, it’s an awesome repository of information. As stated on their website, “for the first time all NHS staff such as doctors, nurses, midwives, allied health professionals, healthcare scientists and trust managers will have access to a single view of the best clinical information and latest guidelines relevant to a patient’s pathway and approved by NHS experts.”

While most physicians have a good sense of particular pathways to follow with patients, this tool is best used for those situations and conditions that are less familiar to the general practitioner. Research conducted has indicated that 80% of physicians will change the care they provide as the result of evidence-based knowledge. Among other desirable results, it’s been estimated that 12% more hospitalizations could be avoided and a 19% reduction in length of stay could be achieved as a result of practice changes based upon evidence-based information.

The Map of Medicine is being rolled out to all hospitals in England and Wales as an additional resource for physicians and to assist in NHS’ clinical governance. Dr. Michael Stein, Chief Medical Officer for the Map of Medicine, stated they are in discussion with some other countries to see if this would be adopted elsewhere. Who knows if it (or something similar) might be a resource available in your hospital in the near future?

by Tony Chen

Recently, I had the opportunity to experience a live demo of Microsoft's Azyxxi software. A lot of buzz has been circulating around the software for a few reasons:
- It was designed by physicians
- It's already working in 20+ hospitals across the country
- Pundits wonder whether Google or Microsoft will be the one to make the mark on healthcare. Personally, I think there's enough room for both of them.

Anyway, I have to say that I was actually quite impressed with what I saw. Azyxxi basically takes continuous data feeds from all the relevant hospital systems (lab, finance, patient, scheduling, ER, any system within the hospital) and rolls it up into one elegantly simple interface. While it's still unclear to me how these feeds are set up, I could quickly see the power that such a system could represent. Think about it - live data feeds in real time.

Anyway, here's the long-awaited screenshot:

You can't really see it well in the screenshot, but basically, users can:
- tailor their view & the data fields to be seen
- double click on any data field to get more info
- perform quick trending, graphing, averages, etc on any data element
- easily perform custom analysis
- easily get to key metrics, dashboard metrics, daily census, etc

Maybe the most impressive part of the demo was the person giving us the demo, Jon Handler, one of the original ER physicians that helped Azyxxi get off the ground. If you ever have a chance to meet him, I think you'll also quickly see that his passion for patients and consequently, for the right info in the right hands at the right time is refreshing. It almost makes me optimistic about the future of healthcare. Almost.

by Christopher Cornue

The retiring President for the Joint Commission, Dr. Dennis O’Leary, led a panel discussion at the ISQua annual meeting in October '07 focusing on the Hospital of the Future. Introducing the topic, Dr. O’Leary discussed the challenges that the Hospital of the Future will face, including:

•Increased cost of providing care;
•Reducing (or eliminating) preventable injuries and deaths;
•Increased scrutiny in a world of transparency;
•Increased number of uninsured and underinsured;
•Increased staffing and workforce challenges;
•Competition resulting from “disaggregation”

He also suggested we’re in the midst of several opportunities, including a boom in hospital construction, new / advancing technology, and new care models & concepts. These opportunities provide us the ability to meet several of the challenges he outlined and allow us to ensure we:

•Avoid doing more of the same in the future;
•Consider several factors and implications, including healthcare economics, professional staffing, patient & family-centered care, physical environment and technology;
•Allow that principles should guide development of the Hospital of the Future.

Do you agree with his assessment? What do you think is the biggest challenge facing the hospital of the future?

by Christopher Cornue

Dr. Don Berwick, President for the Institute for Healthcare Improvement (IHI), spoke to the delegates at the 24th Annual Meeting of the International Society for Quality in Healthcare (ISQua) about bringing improvements in healthcare to “full scale” and discussed the current IHI campaign to prevent harm to 5 million patients. I’m certain most of our readers are either aware of the initiative or probably active participants in it.

Dr. Berwick offered that 45% of needed care is not received, 22% of chronically ill adults report “serious errors” in their care, and 74% of these chronically ill adults say the healthcare systems needs “fundamental change.” He spoke about the vast variation in care and mentioned research by the Commonwealth Fund and the Dartmouth Atlas project. These data support the assertion that this high variation in the industry is not delivering better care or better access. He further suggested that our industry’s usual response of “demanding that things be changed” is not working. We aren’t addressing the fundamental flaws in the system, so our focus should really be on redesign of our systems. This is a foundation for the 100,000 lives initiative, as well as the campaign to reduce harm to 5 million lives.

In a discussion about where IHI has been, Dr. Berwick talked about the organization’s focus over the past several years, with each approach building upon the previous. So, the approaches for IHI have been Awareness, Education, Collaborative Improvement, Redesign, Movement and finally, currently, Full Scale efforts. He was proud of the evolution of the IHI, rightfully so, and is excited about what he expects to be a successful campaign to prevent harm to 5 million individuals. Visit the IHI website for more information about the campaign and the work Dr. Berwick and his organization have led the past few decades.

by Nick Jacobs

The World Congress on Cardiology met last week in Belgrade, Serbia, and, as an invited speaker, we are going to be exploring the efficacy of the coronary artery disease reversal program currently being studied at our research institute. One of the most unique findings of our studies, as identified by our lead researcher on this topic, Dr. Darrell Ellsworth, is a major reduction in measurable depression scores. After having personally gone through the program nearly ten years ago, it is very clear to me exactly why this is the case.

When any type of serious medical reality hits us, be it a cancer, heart disease, or neurological dysfunction, we are thrown into a spiral that feels irreversible. All of our lives, we have worked very hard to ensure that we had as much control over our personal situation as possible. At the same time, we tend to live in denial of our own mortality until we are staring it directly in the face.

What we/I have found with programs like the Dean Ornish Coronary Artery Disease is that, not unlike the old factory experiment directed toward seeing if low lighting or bright lighting made the employees happier, the outcome was that either worked equally well because the act of changing the lighting demonstrated that someone was paying attention to them.

In our research, a group of highly trained medical professionals work carefully with each participant to explain his or her condition, risks, challenges and alternatives. The most important outcome, however, is that the patients are taught how NOT to be victims of their disease anymore.

It is my deep belief that every human being would benefit from this type of exposure to medical professionals, people who take the time to help us sort through our personal situations, to give us hope and to ensure that we will have mental and physical support while working toward improving our health both mentally and physically.

by Christopher Cornue

I was recently at the ISQua Annual meeting where an interesting panel discussion involved three leaders from the Czech Republic, Thailand and France. Much of the discussion was on the imminent workforce challenges.

Information from the Global Health Workforce Alliance (which estimates we’re dealing with a worldwide shortage of 4 million professionals) and the World Health Organization (WHO)’s Global Atlas were shared with attendees. Among the most striking pieces of information is the Global distribution of health workers in WHO Member States chart at this link (pdf) . This shows the disparity in Health Management and Support workers across the WHO Member States. Specifically, it shows a density of healthcare workers for the USA is 24.76 per 1,000 people and UK 21.20 per 1,000 people in contrast to 0.00 per 1,000 for Sierra Leone, 0.01 per 1,000 for Sri Lanka and 0.04 per 1,000 for Zimbabwe. This WHO website offers other revealing information, including health expenditure ratios, and per capita expenditures on health. It’s worth a look!

Guest post by Dr. Marc D. Rothman

A sobering article this summer in Archive of Internal Medicine highlighted yet another way in which, despite all the good intentions of high-tech folks like us and our reliance and devotion to our digital tools, some of the most basic differences between groups of people continue to predict who does well and who does not when it comes to health care for older people.

As if income, insurance coverage, and race weren’t enough… enter ‘health literacy;’ the ability to read, understand, and utilize basic health-related information like prescription bottle labels and appointment slips. The authors looked at more than 3500 people over 65 years, tested their initial health literacy and followed them for 6 years. The results were eye-opening:

A quarter of the folks had inadequate health literacy, meaning they misread prescription bottles and appointment slips. This group had a greater chance of dying over the next 6 years (40% chance vs. 18% for those with good literacy), even when adjusting for everything else under the sun (race, income, smoking, diseases, meds, etc.).

The difference in death rates was most pronounced for cardiovascular deaths (as compared to, say, cancer), possibly because managing heart disease takes lots of appointments, medications, tests, etc.? And what’s most upsetting is that the magnitude of this association between inadequate health literacy and mortality is about the same as the association between low income and mortality.

Though the study was well done and interesting, it doesn’t come as much of a surprise to me. As a geriatrician it’s astounding to see the complexity of a patient’s diseases and management.

Six or eight chronic diseases, ten to twenty pills taken four times a day to treat them, five other docs each managing only one ailment, and so on.

In the future it’s not only the pill box label that will need to be read. It’s a maze of competing interests and trade-offs, decisions about how or whether to treat, possible complications and side-effects which sometimes resemble the diseases themselves. And harder still, the fact that so much is uncertain: the physician cannot always be sure, and neither can the patient. This last concept is the most complex, but ALL of it is complicated to a degree that is difficult to appreciate.

If you think I’m nuts, go to your grandparents house and ask them to show you and explain what pills they take, what they’re for, how that disease is doing, and what their system is for managing it all. They you’ll know what it’s like on a good day. Just imagine putting it all together the first day back from the hospital after a two week stay, when three pills were stopped and two new ones added.

I’m not saying it takes a PhD to understand one’s own health and health care, but it wouldn’t hurt either!

Dr. Rothman is a specialist in geriatrics and long-term care. He is finishing up his fellowship at Yale University School of Medicine.

by Tony Chen

Check out the list from Nursing Online Education Database:

1. Uninsured millions affecting everyone
2. Obesity is dangerously on the rise
3. Pharma companies control more than you think
4. Hospital Staff shortages are killing people
5. Veterans are being neglected

For us healthcare folks, these are probably pretty well-known and maybe even assumed. But for the general public, these are the issues that need to be raised.

Are there other issues that need to be on this list? Patient Safety/medical errors (sort of tied to #4)? Medicare bankrupt in our lifetime?

by Christopher Cornue

During one of the sessions at the recent International Society for Quality in Healthcare (ISQua) Annual Meeting in Boston, three thought leaders in physician practices discussed the physician’s role in patient-centered care. At the heart of their discussion was a document from the UK titled “Good Medical Practice”. This document details what is expected from each physician and sets the expectations for both physician and patient. In 2007, the National Alliance for Physician Competence completed their work creating a similar document for use in the United States, based largely on the document from the UK, as well as Canada and some other countries. Detail of their work is available at gmpusa.org.

They also discussed the apparent gap in preparing our professionals for their roles in healthcare. Specific to the discussion was the example of physicians vs. nurses. Physicians go through years of training, as do nurses. However, there’s no “transition” to the active role as practitioner for nurses. After medical school, doctors go through residency which then validates their training and they achieve in depth experience before they take care of their first patient. There are a series of accreditations that occur, with checks and balances to ensure every needed aspect of medical training is covered in residency and before they can obtain their license and become credentialed. In nursing, once they’ve completed their coursework, they start working at the bedside without a similar “transition” as with medical students. They asked the question … should there be something formal in place before they receive their license and start taking care of patients?

Finally, the session concluded with a discussion about research showing that, according to patients, a doctor is good if he/she: 1) has expert medical knowledge & skills; 2) is empathetic & respectful; 3) has excellent interpersonal skills; and 4) is honest. These are very realistic expectations by patients. The Good Medical Practice document is offered as a foundation of expectations between patients and physicians, and will hopefully help to bring additional attention to these very real expectations.

by Nick Jacobs

The World Congress on Cardiology is meeting this week in Belgrade, Serbia, and, as an invited speaker, we are going to be exploring the efficacy of the coronary artery disease reversal program currently being studied at our research institute. One of the most unique findings of our studies, as identified by our lead researcher on this topic, Dr. Darrell Ellsworth, is a major reduction in measurable depression scores. After having personally gone through the program nearly ten years ago, it is very clear to me exactly why this is the case.

When any type of serious medical reality hits us, be it a cancer, heart disease, or neurological dysfunction, we are thrown into a spiral that feels irreversible. All of our lives, we have worked very hard to ensure that we had as much control over our personal situation as possible. At the same time, we tend to live in denial of our own mortality until we are staring it directly in the face.

What we/I have found with programs like the Dean Ornish Coronary Artery Disease is that, not unlike the old factory experiment directed toward seeing if low lighting or bright lighting made the employees happier, the outcome was that either worked equally well because the act of changing the lighting demonstrated that someone was paying attention to them.

In our research, a group of highly trained medical professionals work carefully with each participant to explain his or her condition, risks, challenges and alternatives. The most important outcome, however, is that the patients are taught how NOT to be victims of their disease anymore.

It is my deep belief that every human being would benefit from this type of exposure to medical professionals, people who take the time to help us sort through our personal situations, to give us hope and to ensure that we will have mental and physical support while working toward improving our health both mentally and physically.

by Tony Chen

I had the pleasure of reviewing a new site, Huspital.com, which officially launched just last week. "Healing Us and Changing Healthcare," Huspital is a perfect example of web 2.0 in which consumers, scientists, physicians, and just about anyone can connect and share healthcare-related information.

From the founder, Jason Schultz:

"The old Industrial Age paradigm, in which health professionals were viewed as the Exclusive Source of medical knowledge and wisdom, is gradually giving way to a New Information Age worldview in which patients, family caregivers, and the systems and networks they create are increasingly seen as important healthcare resources."

To give you a snapshot of the conversations that have been going on within the site, here are a few snip-its:

"If I mention that I read something about a health condition on the internet, my doctor immediately gets an attitude and tells me not to believe anything I've read on the internet. It doesn't seem to matter that I've gotten this information from well known sources..."

"I took an article I had printed out from the internet to my family practice doctor and had her react with great anger and throw the paper in the trash..."

Like I've said in the past, the "magic" for these social media sites is to attract a critical mass of users to have consistently high quality and highly specific content. And apparently, there are ~1,000,000 users on a private site that will be transitioned over in the next few months. The site I previewed was the beta site with just a handful of test users.

As most of you know, RevolutionHealth has also tried to create this healthcare vertical social network. I think they've experienced only limited success because it is too exclusively consumer-driven (let's not throw out the baby with the bath water). I believe the "magic" of a successful healthcare social network will be intelligently blending the opinions & ratings of consumers with real medical/clinical insights from practitioners. Let's see if Huspital.com can do just that.

See the PR releases here and here.

by Christopher Cornue

As a follow-up to my previous post on the ISQua annual meeting, I wanted to share some thoughts on one keynote speech by Dr. Karen Davis of the Commonwealth Fund. She delivered an impressive and humbling assessment of healthcare in the US and internationally. There is a great deal of work ahead of us all. The premise of her discussion is that if we, as a global community, are to achieve long and healthy lives, we need to have: 1) high quality of care; 2) access & equity; 3) efficient care; and 4) system & workforce innovation and improvement.

Recent studies conducted by the Commonwealth Fund have focused on some 30+ metrics (as part of a scorecard they created) and their findings may or may not be surprising to all of us. In the Why Not the Best report (2006), the United States scored 66th out of 100 – ranking it one of the lowest in the provision of healthcare. Another report released by the Commonwealth Fund compared six top countries, based upon 69 indicators, and the United States ranked last.

With regard to information technology, these reports indicate that the United States and Canada lag other developed countries significantly in primary care physicians usage of electronic patient medical records, with compliance percentages of 28% and 23% respectively. Denmark has 98% of their records electronically based … and have implemented a fee-based structure to encourage physician compliance. Specifically, physicians are paid for communicating with their patients electronically (e.g., through email), for “phone visits,” and are not paid until all electronic health information is submitted. The Danish health system has created a central data repository for patient information, which can be accessed by patients at any time – in fact, they can track who has accessed their information, so that privacy has a “check and balance” associated with it.

Preventative information is built into this central repository (e.g., they are contacted for routine, preventative appointments, screenings, etc.) and patient satisfaction has increased to a level that is top across Europe. The Danish health system also has 24-hour physicians available for consultation if a patient needs to access medical advice or help at 2:00 in the morning, for example.

Another example cited was the Geisinger Health System in Pennsylvania, who has been an early adopter of electronic healthcare information. They’ve implemented an electronic medical record and have created a portal for patients to access the hospital’s services, their records and have developed a “virtual” closer relationship with their healthcare providers. Patients can now schedule their own appointments, which has led to reduced no-show rates and increased participation by patients. There isn’t enough space in this posting to do their work justice, but suffice to say this is an excellent example of a well coordinated, patient-focused technology that will most likely change healthcare.

In closing, Dr. Davis charged the attendees, and in fact everyone in healthcare, to work toward a series of solutions she feels will rectify our healthcare crisis. Among them are: 1) extending healthcare insurance to all; 2) coordinating care around the patient; 3) pursuing and raising the benchmark, while decreasing variability in care; and 4) ensuring the private and public sectors work in harmony. Finally, she discussed the concept of a “medical home” for everyone – where a patient can feel comfortable knowing there’s one place one can go for coordinated and good health care. Patients all want their information in one place. They also want physicians who know them and provide specific care to their needs. These are laudable concepts that I believe are becoming the foundations for our work going forward in healthcare. Thank you Dr. Davis, for your charge to, and willingness to work with, all of us in healthcare.

by Jeff McKune

Tony posted an entry about HealthVault, and it looks like Microsoft has multiple healthcare irons in the fire. HealthVault appears to be more of a consumer oriented PHR platform, while Azyxxi is a data warehousing and query tool that is directed at healthcare organizations such as hospitals. It should not be any surprise that the healthcare industry has caught the eye of one of the world's largest information technology companies. We hope to see a demonstration of Azyxxi soon, and one of us will provide an update with additional details at that time.

To add to the discussion regarding using generalized networking tools such as Facebook in a healthcare context, we should mention the Joint Commission's most recent efforts. The Joint Commission has started a wiki called WikiHealthCare based on the TWiki enterprise collaboration and knowledge management solution. A wiki is a tool that allows knowledge to be shared and edited by multiple contributors. Wikipedia is good example of a very popular wiki.

It looks like smoking cessation was the sprout from which WikiHealthCare grew, and it now includes the following general discussion categories:

Quality Improvement Discussion & Solutions
Smoking Cessation Counseling Programs
Smoke Free Hospital Campus

Standards Development & Research
The Transfer of Health Information
Pharmacist Review and Use of Protocols for Contrast Agents in Radiology
Microsystems and Patient-Centered Care

WikiHealthCare was announced on September 12 and in less than a month, there are 2,774 registered users of the system.

It would seem that the vision of online collaboration using multiple information technology tools and covering a wide variety of consumer and management healthcare topics is unfolding as we discuss this. So what will the future bring as these systems develop? The key concepts of integration, consumerism, transparency, and quality will no doubt shape these systems. Will there continue to be separate and distinct physician, hospital management, and patient wikis, blogs, and networking tools? These are growing now, but I believe that we are not very far from a time when patients, physicians, and hospital administrators will be sharing information, expectations, challenges, and collaborative solutions using these online tools. You may be seeing some of this already at your hospital.

The technical walls for sharing information are, for all practical purposes, non-existent. The expansive school of hard knocks, coupled with business models that demand trust (HealthVault won't stand a chance if there is a breach), are forcing companies to more stringently address online security issues. It's not technical and security bricks in these walls - it is more likely legal and cultural issues that hinder open communications.

The pieces are falling into place. How will this change health care when we all sit down at the virtual table and talk on a global scale? It sounds sci-fi, but it isn't. It's happening.

by Nick Jacobs

I'll admit it. I'm a Starbucks addict. It's not a coffee thing. It's the chai tea thing. My cup last week had one of those "The Way I See It" quotes, actually it was #251, and it hit me right between the eyes. "Our greatest prejudice is against death. It spans age, gender and race. We spend immeasurable amounts of energy fighting an event that will eventually triumph. Though it is noble not to give in easily, the most alive people I've ever met are those who embrace their death. They love, laugh and live more fully." This was a quote from Andy Webster, a Hospice chaplain in Plymouth, Michigan.

Actually, that morning I got a call from home that our dog of 15 years was going down hill fast and that it was my turn to handle this situation. Actually, it has always been my turn, but that's another story. So, I took him to the vet, held him close and petted him as they tranquilized him and helped him transition. It was very difficult, but it was absolutely the right thing to do for him.

During that visit, my fourth time to the vet for a similar situation during the last several decades, my mind went back to the Netherlands, to the very moving scene in Soylent Green where Edward G. Robinson visits a euthanasia clinic and is put to sleep amid montages of a peaceful green world and finally to the nearly 78,000,000 people in my generation of Baby Boomers.

My prediction for my peers is that we will change health care in the United States. My prediction is that we will, as a generation, embrace death, and that, as Andy Webster said, we will not give in easily. We will get plastic surgery, exercise, watch our diets, do our yoga, take our fish oil, and laugh, love and live life fully until it's time to go. Just like Brody.

by Tony Chen

Is your organization seeking to make an impact in healthcare?

If you are interested in purchasing a link (see the sidebar) under our "Healthcare Impacters" area or learning more about other partnership opportunities at hospital impact, please feel free to contact me for more information.

tony [at] hospitalimpact [dot] org

Hospital Impact consistently attracts ~10,000 unique visits per month. Our readers tend to be tech-savvy, progressive, forward-thinking healthcare and hospital leaders - could be a great niche for the right company.

by Christopher Cornue

The overarching theme of this year’s annual International Society for Quality in Healthcare (ISQua) meeting, being held in Boston last week, is how information technology is shaping and advancing healthcare on an international level. Many of the speakers touched upon how technology is being used effectively to improve healthcare – one example, Denmark is approximately 98% electronic medical record compliant (this is for the whole country, not just one hospital!). More about Denmark later, but first, you need to meet a remarkable person, Karen Davis, Ph.D.

I’ve had the pleasure of spending time with Karen Davis, and she’s one of the nicest and most down to earth people I’ve met. She wields a great deal of power in Washington, D.C. and across the globe & she’s absolutely brilliant. Dr. Davis, recently named one of the 100 Most Powerful individuals in Healthcare and one of the top Women Leaders in Healthcare by Modern Healthcare, is President of the New York City-based Commonwealth Fund.

All healthcare leaders should become familiar with The Commonwealth Fund, an organization engaged in independent research on health and social issues, and a leader in the discussion of international healthcare issues. Just peruse their website and you’ll get a flavor of their work and pay special attention to two recent reports:
- Why Not the Best? Results from a National Scorecard on U.S. Health System Performance
- Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care

More on Dr. Davis's plenary talk in my next post.

by Tony Chen

In the past, we've talked about a "GlucoPhone" that can read and transmit blood sugar results. We've also talked about the wisdom of incorporating healthcare into everyday life (versus compartmentalizing healthcare as a separate destination). Well, here's one idea that aligns with that concept: a (prototype) wellness phone that assesses your stress level, measures your body fat %, takes your pulse, analyzes your breath, and gives you pep talks.

Still in prototype (and they're only testing it in Japan for now), but nonetheless, a great idea. See more pictures and more on how they fit it all in there here.

Sooner or later, someone is going to figure out how to make wellness un-annoying enough (or maybe even fun!). How great would it be if hospitals could be a part of that conversation?

by Tony Chen

Read my post over at World Health Care Blog on Microsoft's announcement today on HealthVault. Props to NY Pres Hospital for being a part of this. And get ready for Google's announcement within the next 6 months.

by Tony Chen

Okay, I think it's time to talk about the big pink elephant in the middle of the room. Time and time again, we have skirted the issue. But no more.

Has anyone read the book Men are from Mars,Women are from Venus? I skimmed it quickly once standing at a Borders, and it's surprisingly good. It's like men and women are talking a completely different language. A lot of words are exchanged, but somehow nothing is connecting. Is there that much of a difference?

In the hospital world, the stereotypes go like this:

Physicians are greedy. All they care about is money, money, money, just trying to make that extra buck, squeezing in that extra patient.

On the other extreme, physicians and nurses don't care about money or business at all - they don't care if we lose our shirts and close shop. While we applaud their compassion, they have no sense of the system and how things need to be run to be sustainable.

As for adminstrators, they are just heartless and clueless. They have no idea what happens on the front lines of patient care. They have no idea that every patient has different needs, different issues. Every patient has a family. Administrators are just about bean-counting. They just care about numbers and metrics and these spreadsheets that have nothing to do with anything. Isn't healthcare about helping people in their greatest moments of need?

Okay, so there, I said it. It's out there.

Now, let me just be clear that most of the physicians and administrators I know don't fall into these extreme stereotypes. Most physicians are patient-focused to the core but also have a sense of the bigger systems picture. Most administrators care about healthcare, care about the long-term health of the hospital, and desire better results for the right reasons.

The problem is that this perception has been ingrained by so much previous bad experience and miscommunication. How do we begin to turn the tide?

1. Spend a day in my shoes. This goes both ways. Spend a day (or even just an hour or two) shadowing your counterpart. So many people gave me this advice when I first started working for the hospital. For administrative and corporate folks, go on rounds with physicians. Spend 4 hours on a nursing floor (during a shift change) and you'll begin to understand how many split-second decisions are made with such precision and finesse by your front-line clinicians. And for clinicians, take some time to listen to the pressures and challenges that the administrator faces. Think about how one seemingly "small" decision sets a precedent for a thousand others and the potential impact on the whole organization.

2. Get to know the people behind the roles. This probably goes without saying, but I haven't seen this done nearly as much as it should. And I'm just as guilty of this, too. When you know that Lucy has 3 kids and one of them is having a hard time at school, when you know that Dennis went into healthcare finance because his 3 aunts went broke from hospital bills, it's that much easier to work together. We're all just people. And eventually, we are all patients, too.

3. Begin to learn each other's lingo. This goes with the previous points. More and more, I'm realizing that it really is a different language. Literally. The acronyms, the abbreviations, the slang, the inside jokes - sometimes we spend so much time in our own little world, we forget that others don't understand (or worse yet, misunderstand) what we're trying to say.

4. Give people the benefit of the doubt. I know this is soft and fluffy, but remember that those stereotypes above probably don't apply to 90-95% of the people you work with (Nick just commented that only 10 out of his 550 physicians fall into that "greedy" category).

5. Realize that you need each other. Like it or not, someone has to see each patient, and yet someone has to focus on the aggregate. More importantly, there are some issues and problems that may never be solved without the two working together. Some finance guy looking a spreadsheet doesn't understand why a cost started going up, while the clinician may not even notice that it's gone up. Working together and bringing both expertises/perspectives, a better, more creative solution can be found.

What else would you suggest?

by Nick Jacobs

It dawned on me the other day that several of my recent posts have been about problems, but many of them do not prescribe solutions. This one has a solution. If your doctor doesn't give you alternatives, fire him. If he or she doesn't encourage you to get a second or even third opinion, get another physician. If, as a man over 40, you have not had your prostate checked, question your physician's ability to practice. If you're a female over 40 and you are not receiving advice relative to your breast or pap exams, your physician is not doing his or her job.

Where is this coming from? Over the past twenty plus years, it has been my very bad experience to have known a number of physicians who are completely driven by finance. The goal of these physician is to do the fastest, least thorough medicine possible, just above the lawsuit level. It is their challenge each day to get as may patients through their practice as humanly possible, and skip the details. We've all known people like this, but in medicine they can be lethal.

When questioned about the percentage of patients recommended to have mammography each year from one of these practices, the reply is short and sweet. "Don't know, don't care. Takes time to write prescriptions and make arrangements. Probably less than 10% of those who need it."

When asked how much can be made by selling drugs to patients from an in-house pharmacy, though, you will receive a price quote per pill, per ounce, per patient or per hour. If there is a piece of equipment for which this physician can receive a professional fee on the property, every patient possible will be run through it as often as insurance will allow. Chest x-ray? Stress tests? Halter monitors? If it's part of the financial base, it will be part of your bill. In chiropractic they call these practitioners churners.

Somewhere along the way docs like this get off the Hippocratic path. They stop remembering what medicine is about, and many times stop caring about those people who have placed their lives in their hands. Nothing infuriates me more than a physician in a meeting who ignores three pages and three cell phone calls. It makes me ask the question, “What if that page was about someone that I loved?” These physicians usually avoid admitting patients to a hospital for even severe situations, and they are most often extremely rich.

Watch out for the signs of greed displayed by your personal physician because they are not always materially visible. Sometimes it's ownership of a lot of land, a place in Aspen, the newest Porsche, more diamond rings on their fingers than could be mined in a week; but, most often, it's a detached, cold, fast paced, business-like approach to you that makes you feel more like a widget than a person.

If you experience this, say, “Thank you doc. Please give me a copy of my medical record,” and then run like hell.

by Christopher Cornue

If you aren't familiar with the International Society for Quality in Healthcare (ISQua), you should be! This organization, based currently in Australia, has been leading efforts the past quarter century to advance quality and safety in healthcare on an international front. They have representatives from more than 100 countries and have the majority of their membership based in Europe (38%), USA (roughly 1/4) and Pan-Asian (roughly 1/4).

Their 24th Annual Meeting is occurring this week in Boston, and it's guaranteed to be thought-provoking and innovative. Approximately 750 attendees are meeting in Boston to discuss quality, patient safety, international healthcare collaboration and research efforts. The theme this year is integrating information technology in efforts to improve quality. Keynote speakers include Karen Davis (President for The Commonwealth Fund) and Don Berwick (President for IHI), among other noteworthy leaders in the industry. I've been proud to be a part of this organization the past four years and look forward to offering insights from the meeting through upcoming postings. Look ISQua up on the web and stay tuned for more postings regarding this meeting and organization.