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Hospital Impact has been ranked one of the top 50 healthcare blogs by Wikio.
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by Nick Jacobs
It's Christmas Eve and, without being sentimental, it would be an understatement for me to tell you that I'm filled with confidence about everything that I'm facing in my next transition. After 21 years in hospital administration, it was my personal decision to move on to whatever life has in store for me. This is a jump-without-a-net scenario based on the belief that we are all connected in some wonderful way throughout this universe.
Some of you might ask, "Why would anyone leave a solid, meaningful, well paying job at a time like this?" Obviously, when the decision was made, it was not exactly a "time like this," but, if you track my life, it seems that the only thing that has remained consistent throughout has been my ventures into the unknown, into Whitewater. I'm sure that Christopher Columbus and I have the same astrological sign.
Looking back, it was, in many ways a very difficult ride. Truthfully, whoever told me that the wind blows the hardest at the top of the pole was absolutely accurate. Even as my tenure as a CEO counts down to days, hours, and minutes, the words spoken by a friend that "Life is not like college. Life is like high school," have probably been the most accurate.
Not unlike my 10 years as a public school music teacher, it is impossible to describe the positive emotions that have been part of this job. Thirty years later, former students still send me wonderful letters thanking me for helping them make their way through life, and a day doesn't go by in this job where people haven't thanked me for helping them work their way through a complicated and sometimes frightening system. If it all had to be summed up in one phrase, it seems to me that Angelina has it down. "Living a purpose driven life" is a wonderful thing.
I'm sure that the winds of fate will not stop blowing my way, but it is not without some degree of trepidation that I touch my heart and say a little prayer that this next chapter will not leave me feeling as if my purpose was left behind. It is my goal, my dream, and my desire that the lessons learned over a lifetime of giving in education and public administration can be passed on to those of you who are feeling your way through the morass. Don't forget me. I'm here to help. Oh, and have a wonderful holiday season.
by Christopher Cornue
Nick Jacobs recently wrote about what he will miss as a hospital CEO and, like most of you, I enjoyed reading about his final thoughts as he leaves his current role.
At the same time Nick is leaving his CEO role, I've had the opportunity, as some of you may know, to start a role as CEO. In September 2008, I started as the CEO of a hospital in Colorado. Now, I've read up on the "First 100 Days" literature, planned an approach to those first few days, and worked to identify what my leadership will look like. Still, while all of this has been done with the best intentions, no amount of preparation can adequately prepare one completely for assuming a CEO role.
by Nick Jacobs
Paul Levy's post regarding unnecessary deaths is something about which I am also passionate. While it may not currently be mainstream, I believe it is enormously effective.
Some of you might say that our theory is Pollyanna in nature, but there is quantifiable information that definitively demonstrates its effectiveness. And I believe that by embracing a philosophy that creates an optimal healing environment, many workplace "never" incidents will ultimately be resolved.
by Dr. Kenneth H. Cohn
As a patient who is also a doctor, I, of all people, should understand the concept of patient-centered care. Still, of late I have done several things wrong in making sure I was treated, and should have known better:
• I worked all day Friday, Saturday and Sunday on-call as an attending general surgeon in a rural Vermont hospital and did not get what the Institute of Medicine recommends for residents for breaks after being on call for a day (more on differing standards for resident vs. attending surgeons in a future post).
• I went into the hospital at 5:30 a.m. Monday to admit a patient with acute cholecystitis.
• I evidently used suboptimal body mechanics loading my suitcase into the car as I hurried on a windy, 7-degree day.
• I drove 140 miles back to a suburb of Boston, where I live when I am not traveling.
• Within 48 hours, I was unable to bend over to put on my pants or tie my shoes because of severe lower back spasm; it felt as though the muscles attached to my posterior superior iliac crest were on fire.
Picture and post contributed by Paul Levy
I just returned from Nashville, TN, where I was invited to appear in a panel discussion with hospital CEOs and board members on the topic, "The anatomy of serious high profile safety events--powerful stories from senior leadership," which was part of a broader session called "Never Events: The Clock is Ticking." I was honored to follow two terrific speakers (see photo above): Paul Wiles, left, CEO of Novant Health in Winston-Salem, NC; and Greg Kutcher, right, CEO of Immanuel St. Joseph's Hospital in Mankato, MN.
Wiles began with a heart-wrenching story about an infant's death from sepsis in his hospital, which was tracked to an MRSA infection. That infection was part of a spread of a bug in his neo-natal intensive care unit that led to the colonization of 18 infants in all, and may have contributed to the death of two others. "This was a direct result of staff not washing their hands appropriately," he said. Since that event, "we have been on a relentless hand hygiene campaign."
The crux of his, and the entire presentation hinged on this comment: "My objective today is to confess," Wiles said. "I am accountable for those unnecessary deaths in the NICU. It is my responsibility to establish a culture of safety. I had inadvertently relinquished those duties" by focusing instead on the traditional set of executive duties (financial, planning, and such).
by Nick Jacobs
As I look down the barrel of my last 17 working days as CEO at Windber Medical Center, three very important goals remain unfinished (but I am aggressively moving toward completing all three). The first is to achieve designation as a model patient-centered care Planetree hospital.
by Christopher Cornue
My colleague, Nick Jacobs, recently wrote about patient centered care gaining momentum. I couldn't agree more. At a meeting I recently attended with international leaders for healthcare, this was an major topic.
Each year when the International Society for Quality in Healthcare (ISQua) meeting convenes, there is always a focus in patient-centered care. Up until this year, one of the fathers of patient centered care, Harvey Picker (who passed away earlier this year) was always present, and gave us his insight, motivation and charge to "make a difference" at our respective organizations. This session normally culminated with recognition of leaders in the industry making change happen toward a safer environment for our patients.
by Tony Chen
I encountered two very interesting articles recently about the health care/hospital sector. One was a narrated chart from McKinsey (free registration required) that basically showed value creation by healthcare sector over the last 20 to 25 years. As you can guess, the bottom line (yes, the one at the bottom all by its lonesome) represents providers. Since 1985, the provider sector was the only sector in healthcare to underperform the S&P 500.
by Tony Chen
One of the key perspectives I've learning about as I read through Management Lessons from Mayo Clinic is to "act like a small organization even when you're a large one."
This is quite a task, given how huge Mayo is as a clinic. Think about how impersonal the service could be, how thick their policy book could be, how much bureaucracy there could be. So why doesn't it feel like a mammoth clinic to patients? It is because they allow, and in fact empower, everyone to relate to patients personally, respecting each one's individuality and uniqueness.
Guest post by Dr. Kenneth H. Cohn
With demonstration grants in Colorado, Oklahoma, New Mexico and Texas, The Center for Medicare and Medicaid Services (CMS) has stimulated our thinking about global payment and how physicians and hospital administrators can share one check. I cringe each time I hear, "We need to align our doctors...," because, as a fellow surgeon confided to me, "The hammer remains unchanged, but the nail gets pounded!"
We need to step back a moment, reflect on the desired end state, where we collaborate to improve clinical and financial outcomes and consider what we need to do to arrive there. Cultural change embodies personal change, wherein lies the rub.
by Nick Jacobs
Periodically, I write about articles that have appeared in Modern Healthcare; one of my favorite writers is Charles Lauer, former VP- publishing and editorial director of the magazine. The sweet irony of his most recent article, "Growing Evidence, Studies show the therapeutic value of healing gardens" was difficult for me to express.
by Tony Chen
Regardless of your political affiliation, yesterday was a historical moment; we have just elected the first African-American President of the United States. As I stayed up to watch Senator Barack Obama's speech after two long years of campaigning, I was struck by three main thoughts while putting on my hospital impact blogger hat:
By Nick Jacobs
The American Humane Association's Phil Akrow believes in the power of animals being able to help sick humans. More and more facts and figures, he says in a USA Today article, show that time with a pet may be, "as powerful in the person's recovery as the medical treatment."
Dozens of Planetree facilities, nursing homes, and other hospitals have embraced the concept of pet therapy for nearly a decade now; the amazing results that have come from the visitations to our facilities from our therapy dogs have been, not only amazing, but also rewarding and exciting.
by Christopher Cornue
Most likely, everyone is familiar with the Premier Demonstration Project of the past 4+ years. For those who are not … in summary, it was an opportunity for hospitals to voluntarily report their quality data to CMS through Premier, which would then be benchmarked against other hospitals. Each hospital would then be compared and would be eligible for additional payments if they achieved results in the top two deciles (20%) to baselines scores identified in Year 1 of the project. There was also an opportunity for hospitals to lose money if they fell in the bottom two deciles (bottom 20%) to baselines scores from Year 1. This project has continued beyond the original three years and will be expanding beyond the original areas of AMI, HF, Hip/Knees and Community Acquired Pneumonia.
by Tony Chen
Have 90 seconds to spare? Here are a few links on healthcare, hospitals, and innovation:
WSJ Health Blog: Overcrowded ER? Put patients in the hallway. Apparently, the data says it doesn't adversely impact quality. Nurses hate it, though some say that's exactly the point.
by Nick Jacobs
RAC is the magic bullet that CMS (Centers for Medicare and Medicaid Services) is using to describe the new federal Medicare Recovery Audit Contractor program that was officially started last week. RAC was started by the Medicare Modernization Act of 2003 to identify and correct improper payments. Third-party auditors get to keep a piece of the payments they identify and collect as inappropriate.
Not unlike the health care environment created during the Clinton Administration, there seems to be a natural assumption that hospitals are basically working day and night to game the system.
by Tony Chen
Many of you know Paul Levy, CEO of Boston's Beth Israel Deaconess Medical Center and Running a Hospital Blogger. He has long pushed for more transparency in healthcare and has led by example. He posts comments from staff, quality scores, and previously even asked if he makes too much money.
Well, this is a good moment to revisit transparency. Earlier today, there was an article in the Boston Globe about the various problems that this transparency has surfaced: firings, wrong-side surgeries, and this past week, a maternal death. WSJ piped in on the article this morning as well.
by Tony Chen
Apparently a lot more than we thought. Read this op-ed in the WSJ on an op-ed piece in the NYT. Here's the money quote from the article written by Newt Gingrinch, John Kerry, and the data-driven-decision-making GM of the Oakland A's:
America’s health care system behaves like a hidebound, tradition-based ball club that chases after aging sluggers and plays by the old rules: we pay too much and get too little in return. To deliver better health care, we should learn from the successful teams that have adopted baseball’s new evidence-based methods. The best way to start improving quality and lowering costs is to study the stats.
by Nick Jacobs
Tony asked me what I would miss as a hospital CEO? Let me begin by saying that I left teaching at age 31, and thirty years later I still very much miss the interaction with the students. Just yesterday, I received another E-mail from a 50ish year old IT executive telling me that my teaching had been one of the greatest influences on his life. That was the third similar E-mail that I had received in the last five months from that work of 30 years ago.
From teaching I miss helping the students find themselves, teaching them to fly, and saving those borderline kids who were hanging by a thread. My life as a teacher was completely built around being a care-giver and a mentor.
by Tony Chen
As I mentioned previously, I've been reading Management Lessons from Mayo Clinic and today was struck by Mayo's laser sharp focus on patient-centric care.
Now, of course, we've all heard about patient-centric care, but what is it really? Is it focusing on what the patient needs? or wants? And defined by who? (real example from the book) A physician who says "I can't take the time to answer your questions because then I won't be able to answer the questions of all my other patients" can actually believe that she is giving the patient what she needs, right? She is making herself available to a larger number of patients - isn't that what patients want? Patients don't think so. Isn't "patients first" always defined by the patient?
5 thoughts struck me after reading chapter 2:
1. Walk the talk, or just don't talk? If we "say" we are patient-centric with wearing lapel pins and in our marketing, and we don't deliver, isn't it that much more disappointing and disheartening for patients? Is it almost better not to put it out there publicly as a value until we can achieve it to a certain degree? The story of the non-patient-centric physician wearing the "patients first" lapel pin says it all.
by Nick Jacobs
As I approach my retirement from running a hospital Tony asked me to write some thoughts regarding this position.
Remember, no matter how far you push the envelope; it still ends up to be stationery.
The primary reason that I wanted to be the President/CEO was so that I would have the power to make things happen. After nearly thirty years of working to achieve that status in healthcare; after three degrees, two certifications and a fellowship, when the mantle of power was finally bestowed upon me, I made a choice to “never be a president like the majority of the presidents who had been in charge of me.” My primary motivation for this path was that, for the most part, their leadership had not felt very rewarding or productive. The discomfort that they had caused both me and my family was why I wanted to become the boss.
It was my dream to become a benevolent despot, a kind and reasonable leader who cared about his co-workers, but clearly was in charge.
by Nick Jacobs
The issue of how much to fund scientific and medical research continues to raise it's ugly head, and it has become painfully clear to me that the research system in this country is broken as well. Science needs desperately to study the disease mechanisms that represent underlying causation. Researchers and physicians must develop unique methodologies that can appropriately and seamlessly explore environmental causation's as well as primary genetics.
by Tony Chen
I've always heard people say that we in the hospital industry tend to have a "product-centric orientation, instead of a customer-centric one." Often times, that comment references the fact that we are typically structured organizationally by service line or by specialty, not by customer segment. For example, typical hospitals don't have a "Director of Services for Men in Their 30s and 40s." Sure, we offer screenings for prostate cancer, heart disease, and can deal with tennis elbow. We have primary care physicians, and we might even have fitness coaches. But a guy would literally have to bend the rules of the universe to get access to all of these services on the same day, in the same place. Yes, we have "women's services", but aren't these services primarily about OB/GYN services?
by Nick Jacobs
Upon entering the world of healthcare management, it only took about a week for me to “get it” regarding the realities of the job. Having started my adult work life as a professional musician, band and orchestral director, the structure of a hospital was so similar that it was, in fact, almost disconcerting. Obviously, the entire ensemble was in some way reportable to me, and, not unlike standing on the conductor’s podium and looking into the music score in front of you, running a hospital had dozens of departments, each with specific assignments and each interconnected. For me, a Systems Approach to running a hospital was not only necessary, it was also imperative.
by Tony Chen
As you have probably figured out by the new look here at hospital impact, we have made some big changes. As I eluded to in an earlier post, I am excited to announce that the Hospital Impact blog is now a part of the FierceMarkets family. For those visiting for the first time, welcome! Read about us.
How We Decided to Team Up
After 3+ years of blogging, I've realized that Hospital Impact has become a great, fresh "hospital leader" perspective, one that is still very much needed in our industry. I have been getting the FierceHealthcare daily email newsletter for almost 3 years now, and have found them to be filled with great tidbits and even new business ideas. Those newsletters have even occasionally linked to posts here on the blog. With their fresh approach in delivering healthcare news and Hospital Impact's emphasis on the "insider" perspective and analysis, we think it's a great match going forward. For me, it's also a realization that Hospital Impact can be so much better with me out of the way and just involved with the work I enjoy most about it - the writing itself.
What This All Means for You
The main thing is that Hospital Impact will continue as a blog for hospital leaders by hospital leaders, and if anything, we'll be seeing a lot more traffic, and subsequently, more comments and discussions.
by Nick Jacobs
AOL ran a piece by Ashley Neglia entitled, “What Happens When We Die?” This article asks the question, “Is the mind an extension of the brain or its own entity?” This article was based on the work of Dr. Sam Parnia, a critical care physician who wrote the book of the same title. Through his work Dr. Parnia attempts to clarify what patients are experiencing during near death experiences.
According to the experts, it is absolutely clear that when the heart stops beating, the brain shuts down in about 10 seconds. Although the expectation is that brain activity would come to a complete stop as well, but anywhere from 10 to 20 percent of people who have actually gone through what is described as a clinical death still report some type of brain activity.
by Nick Jacobs
With the financial meltdown, a ground war in two countries, the oil crisis, and global warming all coming at us at once, it seems abundantly clear that the next president of the United States could very well be so wrapped up in this one of a kind Perfect Storm that, even if the Congress goes completely his way, it may not make much real difference to any of us. Of course we need to find a way to take care of the millions of uninsured in our own country, to help those of us who are about to lose our homes, to bring back our young fathers and husbands who are in harm's way in Afghanistan and Iraq, but with limited resources, entitlements are sure to suffer as the wars continue to drain the coffers.
by Tony Chen
Last week, I was trying to explain to a 9-year-old how this financial crisis happened. I explained it this way:
"Let's say you get a dollar every day. But every day you spend a dollar and a quarter. After a few weeks and months, the people you've been borrowing that quarter from want their money back. so what do you do?" Obviously, this is an oversimplication of this whole deal. And I obviously didn't go into all the ins and outs of how everyday folks are allowed (and maybe even "encouraged") by various institutions, incentives, and policies to spend that extra quarter. Nonetheless, the kid was smart enough to say, "why didn't we just spend, like, 90 cents every day instead?" That statement basically sums it up for me.
Where does this leave hospitals? I guess it depends on whether we've been spending 90 cents or $1.25 on the dollar. And it depends on how much your hospital relies on credit. Here are a few broader implications that I've been ruminating over:
1. Bad Debt - This is always one of the key line items that Wall Street looks at, and rightfuly so. Are patients going to slow down payments? Will some bad debt turn into charity care?
by Christopher Cornue
Anyone who knows me, knows I'm a very frequent (probably too frequent!) customer of Starbucks. During a visit there this past week, I noticed the 2nd in a series of "special reports" leading up to the November Election. These "Good Sheets," as they call them, focus on specific issues in each weekly edition. I was thrilled to see the one from last week focusing on Health Care. There were many facts and figures that I think we've all seen before; however, they were well presented and even offered an overview of each candidates policies for changing healthcare in their respective administrations. I applaud Starbucks for getting this information out to a larger audience who may not be living and breathing healthcare on a daily basis ... like most of us.
I encourage you to pick one up at your local Starbucks or visit their website to read. I think you'll find it very interesting and a quick read. Oh, and contrary to what you might think ... this isn't a paid endorsement of Starbucks, but a recognition of a major company trying to make a difference and educate folks about our healthcare crisis. Enjoy (& pick up a cup of joe while you're at it!)!
by Tony Chen
Just a quick note to say that we are looking for a few good hospital executives to join the blogging team here at Hospital Impact. Here's a refresher of what we're looking for. email me at tony [at] hospitalimpact [dot] org if you are interested.
We also have a big announcement to make in the next few weeks. I'll share the details as soon as I can, but the upshot will be that Hospital Impact will be getting a lot more exposure in the coming months.
by Tony Chen
I recently read the cover story of the Sept/Oct 2008 edition of Healthcare Executive, "Technology in Healthcare" by Marc Larsen, FACHE.
"Not another article touting the benefits of technology, please" is honestly what came to my mind when I saw the title, but then I found myself nodding my head enthusiastically as I read through the article.
Mr. Larsen makes the point that investments in technology are crucial for the survival and continued success for hospitals everywhere, but few hospitals seem to have a disciplined approach to truly evaluating the technology's value (and not to mention, making it work the ways it's supposed to). Why is it that even "progressive" hospitals seem to look at new technology primarily from a capital/budget perspective only?
by Tony Chen
Usually, it's us in healthcare that is learning from other industries. Previously, I've posted on what we can learn from the likes of Disney, Toyota, Jiffy Lube, autobody shops, and others. So, I was quite surprised to stumble upon a book that turns the table - it's meant for leaders of other service industries to learn from us hospitals. More specifically, the Mayo Clinic.
Management Lessons from Mayo Clinic is the most recent book I've booked up to sharpen the saw a bit more. (What are other folks reading these days?) And in the coming weeks, I'll be posting my reflections as I read through.
In some sense, it is a stretch to think that any other service industry is like hospitals. After all, our "customers" don't "want" us, they need us reluctantly. They come to us in the most vulnerable moments of their life, and our services can make them even more uncomfortable/vulnerable. Nonetheless, hospitals provide "services" just like anyone else - it's a hard-to-scale, labor-intensive, one-on-one experience that is provided to increasingly demanding and diverse consumers. When done right, folks can't stop talking about you.
by Nick Jacobs
Dale Dauten in an article written for CAP Today entitled, A Call for Imagination, talks about the differences between great bosses and ordinary ones. His first very salient point was that one boss spends the day answering questions while the other spends the day asking questions. Mr. Dauten quoted the late business guru, Peter Drucker, as having said, “My greatest strength as a consultant is to be ignorant and ask questions.”
What a phenomenal gift, ignorance. Think of it. The recognition that ignorance can be strength. By studying best practices, by asking plenty of questions, by not knowing the answers, and finally by leading thought patterns toward better, faster, cheaper; things can change in a positive manner. By asking the “what would it take” questions, we have an opportunity to short circuit the usual objections because it assumes the old methods aren’t enough.
Instead of asking, “Is that the best you can do,” the uplifting question, according to Dauten, becomes “How could it be even better?”
So, the call completely changes from a call for accumulated knowledge to a call for imagination, and the old methodologies begin to change dramatically.
by Tony Chen
I recently picked up Inc's list of the 500 fastest growing private companies in America. #1 must be some technology company, or maybe a new company in energy, right? Much to my surprise, it is Senior Whole Health, a company that specializes in healthcare and other services for (wait for it...) the elderly poor.
Huh? How does a company grow 31,000%+ over 3 years focused on the infamously dubbed "dual-eligibles" (Medicare and Medicaid). As with any company with such success, they offer a compelling value proposition.
Guest Post by Kristin Baird
Reputations are based on word of mouth. No amount of advertising will build the type of trust that you want from patients, their families and ultimately the community that you serve. You have to earn it. And you will only earn it through consistently positive experiences. No matter how much quality data we publish, people will gauge quality through their personal experiences. Consumers expect clinical competence but make decisions based on how the encounter made them feel. That means that even one disengaged employee can leave a patient and their family feeling nervous, insulted and on edge about the care.
by Christopher Cornue
So much of the research and literature out there speaks to the uninsured, which is an issue that needs immediate attention; however, there is an increasing group of individuals for which a focus is necessary. According to the recently published report by The Commonwealth Fund, How Many are Underinsured? Trends Among US Adults, 2003 and 2007, there are an estimated 25 million underinsured individuals in the US, which is a staggering 60 percent increase from 2003. The majority of this increase is in the middle class, while low-income households remain at significant risk as well. The report details how folks are identified as underinsured (which is very interesting) and specific groups that are hit the hardest. The biggest concern with this is that often care is not sought, which obviously impacts the health of the individual and will eventually add additional costs to the healthcare system down the line. As with issues we?ve raised in the past, one of the biggest issues we have is ensuring that preventative care occurs on an ongoing basis. This underinsured issue will only complicate our health care system challenge further.
by Tony Chen
If you've been following Hospital Impact, you'll be very familiar with the voice of Nick Jacobs. If not, let me give you a quick intro: He's a middle school band teacher turned hospital CEO in a mining town that had no business surviving the loss of their mining industry. Some would even say that Jacobs helped save the town through the hospital he led and transformed, Windber Medical Center. Instead of dying a slow death, the small community hospital is now internationally known for innovation, for proteomic research, and for its patient-centric healing environment. Not a likely place for the largest breast tissue bank in the country or the daily smell of freshly baked bread, wouldn't you say?
by Nick Jacobs
As we struggle on daily through the newly established higher fuel prices, several surprises have sprung up about which many of us have been oblivious. Corn, for example, had become the American epitome of green. If we could grow enough corn to make ethanol, life would be fine. Then, we were accused of causing food shortages world-wide because we used this precious food commodity to inefficiently produce a little extra enhanced gasoline product which, at least my oil distributor friends tell me cause your car to get less mileage. Why not sugar cane or grass or left over cooking oil from the fast food restaurants?
Guest Post by Heather Johnson
Over the last several years, much has been done to attempt to “fix” health care, hospitals, and public health. With somewhat noble intentions, new laws like HIPAA have been passed, as have innovations in the way hospitals do business, treat patients, and promote themselves in general. One thing is missing, however: the public still lacks the necessary faith in hospitals as well as the health care system in general. The fact of the matter is many people still wait until it is almost too late to receive much-needed care and treatment.
by Nick Jacobs
Penn and Teller, magician-comedians, have a cable TV show that basically explores all aspects of life in America with the intention of exposing those areas that are not valid. I'm not sure why the noble bull has suffered this indignity of their show's title, but, when it comes to making fun of the nontraditional, these magic men hold nothing back. They look at topics like integrative medicine, snake charming, and sensitivity training through their sarcastic, unprofessionally trained eyes and do all that they can to rebuke the topics being explored.
by Nick Jacobs
When the word quality was discussed back in the 80's, you often heard of the Baldridge Award or TQM, total quality management, as the programs that would take your organization to new heights. Today, more often than not, we hear about the Toyota Model of management or a more dated Six Sigma, 99.999999% approach to perfection. Recently, though, the government has taken over the quality quest in health care to push this industry to achieve levels of perfection.
by Nick Jacobs
Transparency in healthcare will facilitate the improvement of performance and quality by providing hospitals and physicians with the additional information necessary for benchmarking their work. It will obviously assist patients as they attempt to make informed decisions regarding their potential care. Finally, transparency will improve quality and efficiency by encouraging private insurers and public programs through providing necessary information to them to make necessary decisions. Transparency is not the end-all, but it is a solid start.
by Tony Chen
Can we stop talking about retail clinics as an "emerging" trend? These clinics are here to stay. Plus, there's already 1,000 of them (as we predicted almost 2 years ago), and probably thousands more on the way.
(We've touched upon hospital-acquired infections in the past. Nick posted previously about how they conquered it in his hospital. Today we highlight one of the most common & costly infections in our nation's hospitals)
Guest post by Thomas Cherry, RN, BSN
by Tony Chen
I've previously blogged about Partners Healthcare experimenting with the Second Life Medium as a means to deliver healthcare information and educational content.
by Tony Chen
So, I'm driving to work this morning, drearily listening to my fav sports talk show, Mike and Mike in the Morning on ESPN Radio. I enjoy the show because of the great banter between the two hosts (they play their parts well - klutzy metrosexual and retired linebacker. Today, their show was dedicated to raising money for the V Foundation for Cancer Research. Mike and Mike had donated the opportunity to have them do a live show at your house.
by Christopher Cornue
Hello - as most of you know, I've had a strong interest in comparing our healthcare system in the United States with those in other countries and have written about it in several posts in the past (and several in the very near future). I just heard about a series of reports from the BBC contrasting the NHS and the US System. Some of these reports will be broadcast on the BBC Channel on the XM Satellite Service (perhaps Sirius, too -- I'm not certain) today at various times. The one time I caught was 8:00 eastern tonight, but there are others earlier (at either 1 or 3 pm today). Also, on the BBC World Service website at the following link (http://www.bbc.co.uk/worldservice/ ) they have a report posted titled "Building Better Health." Take a look (er, listen) if you get a chance and are interested!
Check out the press release. One of ENH's physicians comments on this here.
by Nick Jacobs
As a sophomore in high school biology, I was first introduced to the smell of formaldehyde. My initial rendezvous with a scalpel and a frog’s underside followed shortly thereafter. Having grown up near the woods, it wasn’t as bad as I thought it would be, and it surely allowed me to begin to completely grasp the concepts of dissection, categorization, classification and itemization.
Charles Lauer, former vice president of publishing and editorial director of Modern Healthcare wrote an article this week entitled “The Human Cost.” In this commentary he carefully dissected the 47 million uninsured American’s by category. In fact, he acknowledged the Kiplinger Letter for the actual research that was done for his article. Although there were some very troubling numbers, there were also some extremely revealing statistics. For example, over eight million people are in fact eligible for some type of government program but they either do not realize that they are eligible, do know how to sign up for the program, or do not have the proper documentation to permit them to sign up for this assistance.
During previous itemization discussions, we have often asked the illegal alien question. How many illegal’s are there in this country? Do they have employer based insurance? Are they putting a strain on the system? According to Kiplinger and Modern Healthcare, there are approximately 10.2 M noncitizens in the mix of 47 M, but only 20% are illegal. That one seems a little doubtful to me. We have seen numbers ranging from five to 20 million illegal aliens? When you read the statistics of Texas, California and other border towns where emergency room visits are at near crisis levels, those numbers seem suspect.
Several of the uninsured are still young enough to mistakenly believe that they are invincible. This super hero phenomenon is nothing new to our society. These nearly eight million people are living without a net because they either can't pay for the insurance or believe that they will never need it.
How about those of us who are getting older, but are not old enough to collect Medicare, and the pre-existing conditions uninsured, those individuals who are rejected for coverage because of a health problem that disqualifies them from the insurance pool? There are about eight million people in that 47 M number who are retired or unemployed and everyday run the risk of bad luck or poor health.
Nearly 40% of the uninsured are putting off treatment or going without care, and that is not a good thing. It’s always better to maintain the engine before the plane falls out of the sky.
It is an absolute fact that the high cost of healthcare is serious stuff. As our employers attempt to compete internationally and the rest of us try to make our monthly deductible payments, the healthcare costs have a negative impact on our economy. For those who cannot afford insurance, we face that unique dilemma of hanging on the ledge by our fingernails as the window is being closed.
by Tony Chen
The latest list is out at US News and World Reports. As part of this report, they did a nice 5-day diary at one of the hospitals, Vanderbilt.
And by the way, the best Children's Hospitals were also announced about a month ago.
I've posted before about what being "the best" really means in the hospital business. If it's all about reputation and academics, then where does that leave the small community hospital? Can't they be one of the best, too? Let me pose a question that I posed 2 years ago:
Well, let me ask the question I'm really trying to ask: this blog has been dedicated to helping hospitals become "world-class" organizations. if you don't happen to be an academic medical center, you really can't become a "destination" hospital that people would fly to. Given that, can you really ever have the reputation as a "Best Hospital." And thus, can you really ever be a world-class organization?
Of course, my answer is YES. Just look at Windber Medical Center. In some sense, that hospital had NO business surviving the collapse of that town. When the sole industry (coal-mining) left, that town should have quietly gone away. But instead, now that hospital is the bedrock/driver/growth engine of that town. Go figure. And I'm guessing that's just one story of many that we will never hear about in US News and World Reports.
by Christopher Cornue
A few weeks ago, I wrote about a national effort by the Robert Wood Johnson Foundation that was formally launching in June, and I promised to offer a website when it became available. Well, the "Aligning Forces for Quality" project has been launched and you can learn more about it at the following link: http://www.rwjf.org/qualityequality/af4q/. Much of this work is borne from the RWJF sponsored "Expecting Success: Excellence in Cardiac Care" project that focused on disparities and cardiovascular disease (among others RWJF projects). I was involved in the Expecting Success project, led by the George Washington University as the National Program Office. They are again leading these more far-reaching efforts. It promises to be both a challenging and an impactful endeavor -- to change the care of 14 communities (currently, expanding further in the near future). Go to the link and learn more about this important project and see another step forward in changing healthcare across our nation!
by Nick Jacobs
In the July 3, 2008, Nature, a brief article titled “In rude health” explains the process that has evolved in the National Health Service of the United Kingdom that will result in “A treasure-trove of data in the UK National Health Service . . .that . . .is set to energize biomedical research.” Although the NHS takes a verbal beating from all of the criticism generated by its reported shortcomings, a recent survey showed 91% of 17 M hospital inpatients rated their care good, very good or excellent. More importantly, the NHS was rated above the systems of health-care in Australia, Canada, Germany, New Zealand, and the United States.
If that isn't enough good information, it turns out that the goal of the NHS has been, since its inception 60 years ago, to promote research. Sally Davies, NHS’s Director General of Research and Development has created the National Institute for Health Research which already has plans for virtual organizations to link universities, hospitals and industry, through which researchers will be able to conduct studies on patients more easily.
According to the article, the most important aspect of this plan is that it will open the myriad details of the patient data that has been collected over the past 60 years. This data will allow researchers to readily identify appropriate patients for clinical studies, an internationally unique resource that will swiftly move the concept of translational medicine into the current decade.
The article ended with this quote, “ . . . the NHS’s golden period may be yet to come.”
by Nick Jacobs
False security is something that typically comes from a lack of information or, conversely, an abundance of misinformation. As a young college student, we were taught about semantics, the study of the relationship between words and meanings. If you ever doubt that various national media outlets present things differently, watch the contrasts between the same news stories as presented on the numerous cable news networks and then watch the same story on the international news network. It is sometimes amazing how convoluted the actual facts can become from the interpretation of the stories by the different media sources.
Sometimes we just need to determine what the connection is behind the scenes. For example, I recently saw a newsletter called Environment & Climate News that was published by the Heartland Institute. The first article that caught my eye was entitled, Hybrid Vehicle Owners Report Adverse Health Effects. Because my family has two hybrid vehicles, I immediately immersed myself in this article. After paragraphs of fear mongering (my use of semantics to make a somewhat opinionated and prejudiced point), it quoted H. Sterling Burnett, senior fellow at the National Center for Policy Analysis who said, “There is no research definitively linking hybrid batteries to adverse human health effects.” When I googled the Heartland Institute, this is what I found, “The database contains 22,000 documents from 350 U.S. right-wing think tanks and advocacy groups.” Title vs. facts? Your call.
This article, however, is about at risk women and the various modalities that should be considered for ascertaining their risk levels. As a disclaimer, both local hospitals have MRI’s and will be performing MRI breast exams at centers near you. With that knowledge in mind, read this and decide for yourself.
Anne Wilde Mathews in the Personal Journal Section of the Wall Street Journal wrote a persuasive article that should be required reading for any woman at risk for breast cancer. The basic thrust of the article is a very clear revelation that mammography alone is absolutely not foolproof. Not unlike the accuracy or lack thereof of cardiac stress tests, mammograms can miss as high as 30 percent of malignancies, and, if you happen to be one of those unlucky, high risk patients, a clean bill of health after a mammogram is not always a reason for celebration.
As new and more refined modalities come to the forefront, the efficacy of these diagnostic tests is also continuously being substantiated. Ms. Matthews writes, “For those women whose family background, genetic, or other factors signal a high level of concern, a growing number of physicians are suggesting that MRI breast screening be recommended as the most sensitive form of screening.”
Some physicians regularly recommend ultrasound as well. Although ultrasound is much less sensitive; it still helps to identify sometimes missed lesions. According to the article, “MRI could detect cancers missed by mammography.” In higher risk patients, MRI’s detected over 70 percent of breast cancers while mammograms detect only about 40 percent.” The combination of mammography, physician examinations, and MRI resulted in a 90+ percent find rate.
One of the cautions expressed in the article from a study that appeared in the Journal of the American Medical Association, JAMA, was that both ultrasound and MRI’s can lead to false positive findings which, although disconcerting, are far better than false negatives which can be lethal.
One physician quoted in the article, Wendie Berg, a radiologist, said, “It’s a judgment call. The denser the breast, the more difficult the mammogram is to read, the more likely I am to recommend ultrasound.” Another physician, Constance Lehman, said that she never advises ultrasound for patients. “It’s not even in the same ballpark” as MRI.
My objective take on this one is, if you or your family member is an at risk patient from either family history or genetic propensity, seek further diagnostics. What you don’t know can kill you.
(Mr. Jacobs is not a medical profession - this blog is for educational purposes only and should not be construed as medical advice in any way. Please consult your medical professional)
by Tony Chen
I don't know about you, but I'm drooling over the new iPhone. I'm not a big gadget guy, nor am I one of those Mac enthusiasts. But I am someone that loves great functionality packed into great design, and this thing is the one gadget that I feel like is made "just for me."
This also got me thinking. What applications will the iPhone have for healthcare? Especially now since Apple opened up the floodgates for developers to create new apps. Here's 10 being talked about right now.
For Physicians
- Integrate all your other beepers/phones/PDAs, etc?
- Access medical files, charts, and mini-versions of clinical decision support systems?
- Download comprehensive drug information from drugs.com
- Use the camera to take pictures to send to specialists?
- See heart imaging with this software.
- refresh your CMEs or pick up medically-related videos/media? Read MEDLINE journals.
- Make the X-ray light box obselete?
For Consumers
- People with diabetes, Download your blood glucose levels right from the attachment.
- Track fitness? I've previously written about a wellness phone being tested in Japan
- Interface with your medical record. Looks like Life Record does this already. And I'd be surprised if someone isn't working on an interface between Google Health and the iPhone.
- Reduce anxiety/pain for kids during hospital stays?
Honestly, I probably could have made the same statements about many of the smartphones on the market today. But the iPhone just looks so darn nice, too. And the processing power is a plus.
What do you think will be the greatest healthcare use of the iPhone?
by Tony Chen
Now you can get your local map with color-coded hospital ratings. See below for an example.
Go to NetDoc to draw up your own. This is a nice little tool for patients, but as always, it's only as good as the underlying data.
(HT: Warren Johnson)
by Tony Chen
This just goes to prove again my conspiracy theory about Minnesota being the undiscovered hotbed of health care innovation. Check out this press release from Allina Hospitals & Clinics - a $100MM "living laboratory" to innovate new care models & treatments.
by Tony Chen
Remember's Google's big announcement when they launched Google Health? Their partners included the likes of Cleveland Clinic, Quest, CVS, among others? These were the partners that had built interfaces to the Google Health platform, and patients could choose to import data from those sources into (and out of) their Google Health record.
Got this in my email today:
Today Microsoft and Kaiser Permanente announced a pilot program between Kaiser Permanente’s My Health Manager personal health record and the HealthVault consumer health platform at the Microsoft HealthVault Solutions Conference. Connecting My Health Manager to the HealthVault platform will allow users to combine personal health information from Kaiser Permanente and a wide range of health and wellness management applications and devices, such as blood pressure monitors. Also at the conference, a wide range of health technology companies introduced more than 40 new online health applications and devices.
While Microsoft is probably nobody's favorite company, you have to commend them for landing such a strategic partnership covering xx millions of lives right off the bat?
by Nick Jacobs
Last month, I was invited to speak for the American Hospital Association in Phoenix, Arizona. One of the speakers who preceded me, Ian Coulter, PhD of the Samueli Institute and RAND Corporation provided a compelling analysis of healthcare around the world. He described his countrymen from Scotland as “Unarmed Americans with health insurance.”
Even more chilling was the fact that, “America is the only major economic power where, if you lose your job, you literally can fall into medical oblivion without health insurance until the age of sixty five.”
Another major problem identified by Dr. Coulter is that the food producers of America provide enough food products for every adult to consume 4000 calories each and every day. Unfortunately, we only need about 2000 calories per day. The more is not better theory works here as well as we overeat, become morbidly obese, develop diabetes, high blood pressure and high cholesterol.
Interestingly, in the rest of the industrialized world, the ratio of specialists to primary care physicians is approximately 40 percent specialists to 60 percent primary care. In the United States, that ratio is exactly the opposite; 60 percent specialists to 40 percent primary care physicians. This fact was very interesting as well. In the United Kingdom, primary care physicians earn approximately 130,000 pounds a year or nearly $260,000, significantly more than primary care physicians in the U.S. There is also a 30 percent pay for performance opportunity in the U.K. compared to a 6 percent pay for performance opportunity in the United States. Our primary care physicians are under incentivized while we may have too many specialists in some areas of the country.
Dr Coulter also corrected a previous set of facts that we have all read numerous times; 30 percent of all healthcare dollars are not spent on the last thirty days of life. Thirty percent of all Medicare dollars are spent on the last thirty days of life. What is not stated is that these expenditures typically do not improve the quality of those last thirty days of life.
If you aren’t too tired of facts and figures yet, how about this one from his presentation? Two thirds of Republicans and only one third of Democrats think that we have the best health system in the world, and 58 percent of Republicans and only 20 percent of Democrats are satisfied with the quality of our health care. These statistics may indicate that money does influence your perception of what you can buy in the health care system.
Finally, 20 percent of all American are consumers of complimentary and alternative medicines. On the other hand, 40 percent of the population or nearly 120,000,000 people are fully open to trying integrative medicine alternatives. Unfortunately, only about 30 percent of physicians embrace the various modalities offered through these alternative medicine approaches.
In closing, maybe we should consider this very broad interpretation of health as stated by the World Health Organization’s, "Health is relatively simple; if you feel better, that is health.”
by Christopher Cornue
Through an email distribution I receive from the RWJF, I was led to this article in the Washington Post from last week. It's an interesting read and a positive spin on what has been a difficult challenge for US Health Care - a total reform of our health care system and politics. If you get a chance, take a gander ... and feel optimistic about the future of healthcare!!
by Christopher Cornue
Allow me to be bold and perhaps even controversial for a few moments (er, paragraphs), please. During a recent collaborative visit with some healthcare organizations in England this month (of which I'll be writing future postings in the next several weeks), I was hit by a revelation during one of my presentations. I was talking about some of the innovative strategies for total access in some of our states ... specifically, Massachusetts, Illinois, California and Oregon and thought about the unique opportunity that each state has in the US. Also, each state focuses on specific metrics (as part of a state-run group, Joint Commission or other national body). As most folks know, each of these states (and others) have developed different versions of plans to ensure there is access to healthcare for kids, women, or everyone, depending upon the respective state. It was then that I realized the United States is a huge laboratory for health care reform ... with 50 separate labs working on solutions to health care. This is exciting!
So, what if we take this to the next level (here comes the controversial bit, and I admit I don't know all the dynamics regarding the plausibility of what I'm suggesting - so don't kill me!). What if the Federal Government were to identify a block of funding for each state... and each state would be overall responsible for the delivery of healthcare in that state with: 1) everyone having access to healthcare; 2) quality metrics are established and trended; 3) patient's satisfaction with their care is tracked, trended, addressed; and 4) poor performers (hospitals, clinics, physicians, etc.) are improved. Each state can do something different, depending upon their unique challenges, population, resources, etc. -- but they would have the ability to create programs providing healthcare to their respective groups.
I know there are other options too (i.e., federal funding could be provided to each state to develop a program that could then be potentially rolled out nationally, etc.), and that's the exciting part - that there are 50 test tubes for what could end up being a solution to our healthcare issues nationally. So, is this "out there," are there efforts like this already in place, etc.? OK, I'm finished - thanks for allowing the moment of boldness!
by Tony Chen
Okay, this post has nothing to do with retail clinics, except that like these clinics, I'm purposely only offering limited services on a limited scope. Okay, I apologize for the weak analogy. Anyway, here's a few quick links on what's happening in the healthcare blogosphere:
- The Health Care Blog: An insider look at Google Health
- Health Affairs: Kaiser has started a blog watch
- The World Health Care Blog: Privacy 2.0
- Foresight.org: Nanotech could revolutionize diagnostics with nano-sized barcodes.
- FierceHealthcare: NEJM's study on social network's impact on health decisions
- Forbes: Stem Cells Get Real
- Health Management Rx: Why I Believe in Consumer-Centric Care, Part II (may be the longest blog post I've ever seen, but still worth the read)
- Dr. Wes: Criticisms of "Consumer-Driven Healthcare"
- USAToday: America's Fittest Cities
- FierceHealthcare: Consumer Reports to rate hospitals
and finally, the new EMR that will rock your world. Brilliant.
by Tony Chen
This past week, I was at the Front End of Innovation Conference in Boston. Overall, it was a great time to reflect on my own mindset about how to bring innovation to hospitals & healthcare.
Here are a few things & quotes I'm still mulling over:
On Being Customer-Focused
- A.G. Lafley (P&G CEO) had a ton of great insight. When asked about how P&G became so customer-centric, he recalled his first days on the job as CEO. "We were all so busy every day, so much so that our heads were in our phones/computers and our behinds were facing our customers." First thing he did was to get people out of their offices and into customer's lives and watch them.
- Google does this as well. One "problem" they deal with is that they work pretty hard, have a great campus that almost allows employees not to leave. Employees start living in a "google bubble" and "googlers are not necessarily representative of the general population." Google continuously sends teams out to watch people do searches and use their products in their "natural" environments.
On Humans
- I know this sounds cliche or stupid, but we're human. And humans are emotional and experiential. The most beloved products/services in the world just happen to treat us that way.
- Apple isn't selling a high-tech device, Apple is selling a human experience
- A.G. Lafley: "we have to understand what customers can't articulate." Customers might be able to express what they dislike, but they won't necessarily be able to tell you why or how to fix it.
- Peter Guber (Mandalay) - storytelling has been the key to his success, and the key to the success of just about everyone he knows (in entertainment or not). When you can tell a good story (about yourself, your product, your cause, your goal), it resonates with people emotionally and memorably. Good storytelling is not informational, it's emotional - it engages the heart and the mind.
On the Future
- Ray Kurzweil (Ridiculously accurate futurist on all things tech and IT) believes in the theory of the "law of the accelerating returns." The reality of innovation and of human history is that things don't progress linearly, things progress exponentially. That's because every new innovation we come up with accelerates the next innovation. Just think about "Moore's Law" - a "doubling every two years." Check out his work here and here
- Exponential growth and linear growth are hard to distinguish in the early years (because the numbers are so small). But the turning point (the bend on the hockey stick) is hitting us now in the areas such as solar energy (within 5 years, solar energy will be cheaper than fossil-fuel energy) and reverse engineering the human brain (15 years, we'll have ridiculously real AI)
- Devices won't be laptops or PDAs - devices will be in our clothes, in our heads, in our bodies. Sound crazy? There are 50 studies being done right now in animals on implantable devices. One has cured diabetes in rats. One is an in-blood device that finds and destroys cancer cells.
- We can learn about innovation from the one obvious place no one really looks: nature. Why? Because every single organism has been an innovator for billions of years in order to survive (99% of all species are extinct) We can take advantage of those billions of years of "market testing" by reverse engineering nature. Check out some examples here.
As I said, I'm still mulling over what this all means. In general, I think I tend to overestimate what innovation will bring in the short-term, but greatly underestimate what innovation will bring in the long-term. New innovations are accelerating and will vastly change the landscape of healthcare as we know it. Hospitals that go out on a limb and catch the wave will have to take big risks but also stand to reap tremendous rewards.
by Christopher Cornue
I've written in this space before about a national collaborative, funded by the Robert Wood Johnson Foundation (RWJF), called Expecting Success: Excellence in Cardiac Care. This was a 29-month collaborative project, led by the George Washington University and comprised of 10 hospitals from varying communities in the United States. Detailed information is available at the website and further tools developed during this process will be available at a new website in June (I'll post an update when that becomes available). Briefly, though, I want to call out some significant successes from this project that "formally" concluded a few weeks ago and were shared at a national meeting in Washington, D.C on 8-9 May 2008.
* Each hospital implemented a consistent way of collecting Race, Ethnicity and Language, based upon OMB classifications - this is expected to become a Joint Commission requirement in 2009. These data allow hospitals to identify potential disparities, and then implement changes to address any that may exist;
* Through the project, 61 statistically significant changes in quality occurred (58 of which were improvements; while 3 were declines);
* Evidence-based "Measures of Ideal Care" for AMI improved significantly across the hospitals since the project began in Q4 CY2005 through Q4 CY 2007: mediancompliance increased from mid-70% to upper 80%; additionally, the spread of compliance across hospitals (which in the beginning was a large gap between approx. 17% to 93% to a much smaller gap of approx. 77% to 100%);
* The gap for "Measures of Ideal Care" for Heart Failure were even wider than AMI when the project began (approx. 5% to 88% compliance in Q4 CY 2005) and ended with a narrower gap of approx. 59% to 98%);
* Some hospitals demonstrated a significant reduction in the gap of care provided by race and ethnicity - with one example focusing on percentage of AMI patients receiving ACE/ARB for LVSD where in early 2006, whites received ACE/ARB 90% of the time while blacks received it approximately 76% of the time. By the end of the project, the gap had closed to such a significant degree that both received ACE/ARB 100% of the time.
There were many other noteworthy examples demonstrating the significant improvements. Suffice to say, quality has improved significantly at these 10 hospitals over the past 29 months, with the gap in race and ethnicity closing. While more specific info about next steps will be shared in June and July this year, RWJF plans to implement this project on a broader scale nationally, using lessons learned from these 10 collaborative hospitals. Their focus will be on dozens of communities across the country in an effort to spread the successes and ultimately improve the quality of care in cardiac care, while reducing disparities where they may exist. More detail to come ...
by Tony Chen
Google Health launched today. Check it out here
As you can see,, there's 4 calls to action:
- I can add info to my profile (stuff like conditions, medications, allergies, procedures)
- I can import my medical record into Google Health (right now, the only options for this are info from Cleveland Clinic, Beth Israel Deaconess, Walgreens, CVS, Quest, and a few others - so I'm out of luck here)
- I can explore online health services. The first 3 services listed? Cleveland Clinic's eConsult service, ePillBox.info (free med mgmt tool), and AHA's heart attack risk calculator.
- I can look for physicians using a drop-down specialty box and typing in key words/locations.
There has been a lot of hype about how Google and Microsoft will "change healthcare" because of their new services, so today we can get a sense for whether they're going to live up to all the hype.
What I liked
- I give Google high marks for what they do best - taking complex information architecture and making it simple and easy to navigate. The navigation for the site was very intuitive for me. I added to my profile the items I wanted pretty easily (I wish I can see how the import works - if anyone did this, please comment!). I searched for my primary care physician and clicked "add to my medical contacts", and boom, his info was stored there for me for future reference. It's pretty easy to add immunizations/procedures/meds - I could pick it from the list. Or I could start typing in the open text box, and the more letters I type, the likely field appear (just like we do now with email addresses)
- I liked the fact that there's a drug interaction area. As I added meds, it showed exactly which interactions to watch out for.
- I liked being able to create a new profile (which I did for my 2-year-old).
What I didn't like
- They still need to fix the "find a doctor" function. I typed in some docs I knew and for some reason, their practice partner's names come up, not theirs. So, it was pretty confusing.
- It's still unclear how to "use" the record besides just having it all in one place. I've heard that patients will be able to choose what part of the record to share and with you, but didn't see that in this release. There's no option to download the data, either. What else can I do with it?
- I wish they added some sort of HRA & fitness/wellness area. Now that would drive usage - if I could traffic my weight, workouts, bp, whatever. After all, it is launched as Google Health, not Google Health Care. Nonetheless, maybe they've decided to give that piece of the pie to others.
Where hospitals have opportunities
- Tech-savvy hospitals should be able to start looking at linking their EMR's into Google Health. Of course, there's some tension with this as many hospitals are trying to drive stickiness/traffic to their EMR portals. This would stand to compete with that. Why would a patient log into their hospital's EMR system when Google's system is probably easier to use and more visually appealing. On the other hand, hospitals that do have the link the Google Health provide their patients will this added benefit. Maybe patients will increasingly ask their physicians who will increasingly ask their administrators?
- Tech-savvy hospitals and others can try to have their online services added to Google's list of online services. This is essentially another channel to drive traffic/utilization.
- Hospitals who are savvy in the ways of 2.0 will have their physicians appear higher in search results. Yup, this is yet another way to search for physicians, but honestly, I doubt people will use this tool to make physician decisions. More so, they'll go onto HealthGrades or other Physician rating sites. The "Find a Doctor" option on Google is more so that we can automatically add our physician's info into our profile quickly.
Here are a few other notable mentions of Google Health:
Blogscoped
news.com
GeekDoctor (CIO BIDMC)
TechCrunch
ScienceRoll
Healthcare IT Blog
More on this soon, as they unveil more details in today's press conference.
by Tony Chen
I'll be at PDMA's "Front End of Innovation" Conference in Boston next week. If anyone is around and up for drinks, let me know.
Last time I checked, I couldn't find any other hospital members of the PDMA (Product Development and Management Association). Think of them as the ACHE for innovation & product development people. As I interact with this group, I'm definitely stretched by their progressive thinking about how to bring innovation into any culture/organization (apparently, the Russians did a lot of innovation theory work back in the day that are still being utilized widely today).
What can hospitals learn from the likes of Dow, Staples, Google, Starbucks, IBM, Kraft? I'll let you know.
by Nick Jacobs
What’s this generation coming to? It started some years ago with new rules for residents. They no longer were permitted to be worked 80+ hours per week as part of their residency. In fact, many residents actually keep time sheets and then tell their MD/Professors when their work week is complete. It wasn’t that many generations ago that student nurses and residents were the only people working the night shift in even prestigious medical centers.
What else is happening? New generations of physicians are actually seeking to attempt to balance their work time with their free time. A front page article in the Wall Street Journal by Goldstein reported that U.S. medicine is in the middle of a cultural revolution. According to the article, young physicians are beginning to challenge the fact that they must be available to treat patients around the clock. According to President Ronald Davis, M.D., “There has been a sea change in how young physicians today balance professional responsibilities and personal needs, compared to their colleagues from a few decades ago . . .Physicians who manage their own stress and feel happy with their own daily circumstances are probably better physicians.”
As a hospital CEO in Pennsylvania, we are seeing “The Perfect Storm,” as catastrophic liability insurance is no longer available to our physicians. Ninety plus percent of our State’s finishing residents are leaving. The newer physicians who are considering staying in State are actually demanding free time, comprehensive call coverage, and weeks of vacation and continuing medical education time. Quality of life issues?
So, as 78 million Baby Boomers head toward the proverbial wall, we not only have a significant shortage of gerontologists and other sub specialists, we are also faced with young, smart physicians who actually want a life. Hold onto your hats.
by Tony Chen
I have an idea that I wanted to share with you - please give me your honest opinion (i.e. you can tell me if I'm crazy!). I would love to find others to collaborate with on this. So, if you're interested, contact me directly (tony at hospitalimpact dot org) or comment below. Obviously, the idea is still very rough, but hopefully you'll see where I'm heading. And hopefully, we can refine it together.
What do you think about a new a philanthropic/VC hybrid that invests in preventive health projects that yield at least 338% ROI? (thus the name "The 338 Foundation.")
I'm going on 2 key assumptions:
1. Prevention is one of the biggest opportunities in healthcare. We don't have a healthcare crisis as much as we have a health crisis. We need to pour out a lot more creativity and resources for prevention/healthy living.
2. The biggest obstacle around prevention is a lack of (or misaligned) incentives. No one wants to invest the real money for what's truly best for the patient because these potential investors (whether they be hospitals, insurance companies, pharma, or other companies) make the investment, and others would get the benefit.
For example, a hospital may choose not to hire a chronic disease mid-level practitioner because the "cost savings" it generates essentially goes to the insurance company. Maybe the hospital saves some real costs from reduced ER visits, but not enough to pay for itself. With so many pressures on margin, I can't blame them for that decision. Insurance companies are investing in some disease management 2.0 items, but I doubt they will ever really invest because their members stay with them for only a few years (I've heard 2.5 years?). So any investment they make into keeping the patient healthy is most likely benefiting their competitor (i.e. who ever happens to be their member's insurance company 5 years from now)
It's the classic case of no one wanting to do what's "right" because they pay 100% of the costs while reaping only a fraction of the benefit. So this idea would turn that notion on its head by getting all interested parties to pool their resources together into initiatives that collectively will pay off for all of them.
How I could see this playing out:
- Some smart, collaborative healthcare people could solicit and collect all potential ideas/projects/research and rank them by ROI & approximate benefit to each industry.
- We would welcome individual and corporate donors to the foundation.
- We could do a targeted pilot (i.e. partner with the City of Chicago - i.e. trying to get Chicago to be the "healthiest city in the U.S. by 2015")
- Solicit proposals/applications from organizations who can most effectively implement these projects.
- Fund based on potential ROI and effectiveness of organization's implementation proposal.
So, what's the significance of 338? I'll leave that as a riddle for you. It has to with an important year coming up in our lifetime.
(one side note: One of the ideas I would love to see funded is a savvy viral advertising campaign that changes how people think about their lifestyle habits, like how http://www.thetruth.com/ reduced teenage smoking)
Imagine investing in a fund that yields $3.38 savings/benefit for our country for every $1 we put in.
Please comment/brainstorm with me! Is this crazy or what?
by Nick Jacobs
My first health care administration job began in 1988. It was a warm September morning when we met around a large table to examine the financial report of the hospital. The CFO reported out the income from operations, and, although I was new to this particular field, it struck me that all we were looking at was the inpatient report. When I asked where the outpatient information was, he replied, "Oh, we don't have any way of capturing that information." To which I asked, "Isn't that at least 50% of our business?" The answer of course was positive. It was at that very moment that the history of health care management came crashing in on me. Not unlike a University, if the money didn't balance, you just raised the tuition, or, in our case, the costs. Many refer to that time as the "good ole days."
This week, the Wall Street Journal had a blockbuster article that should have been entitled, "Dah." It was about the new wave in hospitals to collect cash upon registration for deductible insurance costs. It was entitled Hospitals Demand Cash Upfront from Patients. It's a revolutionary new idea in hospital billing where hospitals actually are making medical care contingent upon up front payments. At least that is how the WSJ depicted it.
In my world, it does not seem quite that drastic. Hospitals are just trying to collect those payments that seem sometimes rarely to be collectible. We do not deny access based on their ability to pay.
Clearly, bad debt is becoming more of a problem for us each and every day, and this is just one very late attempt to function like a business.
We need help, and, not unlike physician offices, why is it wrong to ask for co-payments as the patient enters? Your comments are welcome.
by Tony Chen
We've been talking about how hospitals and social media mix (and don't mix) for a while now. A while ago I wrote a little on whether hospitals should blog and more recently, I provided some examples of how hospitals are utilizing these new technologies today.
Health 2.0 as a topic is about to hit mainstream. Do you know how I know that? Simple - the California HealthCare Foundation just did a 28-page report (PDF) on it. While I'm sorta joking, give them some credit for tackling these emerging issues in healthcare. Case in point: they published a very influential and compelling report on retail clinics back in June 2006, when these clinics number in the dozens, not hundreds (almost thousands now!).
We all know that the trend of web 2.0 is hitting all industries, so it is inevitable healthcare will be impacted as well. I think the real innovation will come when consumer-savvy folks put their heads together with web-savvy folks and medical experts. We will see new types of patient communities, new collaborations between industries, and in general, the lowering of walls between traditional silos. We'll see more healthcare organizations investing in some sort of presence within online networks as more eyeballs (especially the viral type) seem to be glued there. And we'll see personal health records thrown into the mix as well, making it easy for consumers to manage it (instead of feeling like it's managing us).
How else do you think this'll all shake out?
by Christopher Cornue
The third area of focus in the Commonwealth Fund’s recent report, Bending the Curve: Options for Achieving Savings and Improving Value in US Healthcare Spending is that of Aligning Incentives with Quality and Efficiency. In the report, it is stated that our current healthcare system, based upon a fee-for-service payment structure, often rewards overutilization and inefficiency. There is wide variation of cost & quality throughout our nation, as demonstrated by the comparison of Medicare outlays per beneficiary date reported in The Dartmouth Atlas of Health Care. As comparison, this range of outlays from Medicare is as wide as $4,530 in Hawaii and $8,080 in New Jersey, yet there is no obvious quality outcome that corresponds to any increased cost. The report suggests four strategies to help better align incentives with increased quality and efficiency:
Hospital Pay for Performance – many of us are aware of the many pilot programs working to align payments for better performance, probably most significant has been the CMS & Premier demonstration project. This project attempted to reinforce actions consistent with high quality … by penalizing poor performance and rewarding superior performance, based upon comparison with a peer group. The Bending the Curve report suggests expanding this demonstration project beyond the 250 participating hospitals to all acute care under the Medicare PPS system. Additional payments would be based upon the following: 1) Top Performance at or above 90th percentile composite quality score (2% bonus payment); 2) Absolute Performance at or above 75th percentile in any clinical area (1% bonus payment); and 3) Performance Improvement for hospitals that are at 80th percentile or above for the composite quality score improvement ratio (1% bonus payment). There are further details and conditions that space in this posting prevents elaborating on.
Episode of Care Payment – the current system of reimbursement doesn’t overtly incentivize efficient or coordinated care. An alternative to the fee-for-service system is a bundled payment system covering costs of care across different settings of a patient’s episode of illness (over a determined period of time).
These bundled payments would cover episodes of care (by DRG) for all inpatient, physician and other related services. Bundled rates would also be developed for the outpatient arena for chronically ill and healthy beneficiaries.
Strengthening Primary Care and Care Coordination – this strategy is based upon the need to have primary care physicians (PCPs) take on a greater role in the delivery of care, outcomes and overall costs. Recognizing that much of the infrastructure & services (i.e., HIM, care management, etc.) needed to support these activities are poorly reimbursed, the development of Primary Care Case Management (PCCM) programs will be needed. These PCCM models (currently in some states) allow for additional reimbursement to PCPs in a “per member, per month” manner for care management services. This is in addition to the usual fee-for-service payments. Among the requirements for this additional payment would be the establishment of a formal “medical home” for the patient. Included in these “medical homes” would be enhanced services such as care coordination/management, patient education, improved access, strong IT structure, specialty referral coordination, etc.
Of final note, we see increasing efforts nationally to tie metrics to pay-for-performance. Unrelated to the Bending the Curve report are recent actions by the government to now tie reimbursement dollars to Patient Satisfaction Indicators (in 2009), and the limited reimbursement to hospitals when a patient experiences a poor outcome while an inpatient, see the following link for the Hospital-Acquired Conditions (pdf).
by Tony Chen
Fascinating article in Fast Company this month on the future of Medical Tourism. Check it out - some great pictures of their lobby & some insights/questions that all of us in the hospital business need to grapple with sooner rather than later.
A couple memorable (though maybe a little unfair) quotes from the article:
"The process will pick up speed as heavyweight for-profit U.S. hospital chains such as HCA ($26.8 billion in revenue), Tenet Healthcare ($8.8 billion), or HealthSouth ($1.7 billion) realize that hospitals such as Singapore's Parkway Group or India's Apollo chain aren't competitors so much as links in a global, offshore supply chain that can be bought and brought into the fold just as easily as a Toyota or GM plant. Medical tourism hubs will become different stops on the same assembly line: Brazil and South Africa for plastic surgery; Mexico and Hungary for dentistry; Costa Rica for a little of both; and Southeast Asia for the bodywork of heart surgery, organ transplants, and orthopedics. Patients needing new hips or hearts will be the first sent overseas by their doctors for the same reason medical tourists are headed there now: The procedures are safe, low margin, and high volume -- always the first things to go in any globalization scenario."
"The biggest losers by far would be American doctors -- especially cardiac and orthopedic surgeons -- who face the most damaging blow yet to their pride, public standing, and paychecks. In one fell swoop, they'd devolve from the rock stars of the OR to glorified mechanics, and they'd really only have themselves to blame. Overseas patients routinely return home raving about the personal attention shown by their Thai or Indian surgeons."
What do you think? Really, what can a local community hospital do about this, if anything?
by Tony Chen
A quick tangent from the world of hospitals, healthcare, HIPAA, and DRGs. I love being in healthcare, but some of you know that the birth of my son Timothy almost 2 years ago has been a life-changing, exhausting, and exhilarating experience for me. And that experience (coupled with a lot of soul-searching) led me on a mission to create a website dedicated to fuel this passion to be a great dad. Check it out at savvydaddy.com.
If you like what you see, could you help me get the word out? Email it to your friends(dad and moms!), become a fan on facebook, link to it on your blog, subscribe to the rss feed, and stalk me on twitter. And most importantly, sign up as a registered user in 30 seconds (for free!) and start commenting on articles, posting questions/stories, and enjoy! Thank you!
It was really through my experience here at Hospital Impact that I experienced the value and the power of web 2.0 to catalyze conversations and bring awareness to new areas. Don't worry - I'll still be blogging here (though no where near the 6 times/week that I used to!) Thank you for all your support, comments, and friendship here on hospital impact. Let's keep the conversations going and let's keep fighting for better hospitals.
by Tony Chen
Pretty cool stuff. Some healthcare bloggers (and some friends of the hospital impact community) are liveblogging from the World Health Care Conference through Twitter. Check them out:
Jen McCabe Gorman
A Fortin
Highlight for me so far: "We have PDD - preventative deficit disorder (AMA Definition)"
Some folks might be asking: what in the world is twitter? Think "blogging" but shorter (a couple of sentences at a time) and faster (every time you think of something good to say).
by Nick Jacobs
For a decade now, we have been bragging about Windber Medical Center’s low infection rates. The cynics simply declare that it is due to a lack of patients, but this year 153,000 patients would probably differ with you. For those who know that this rate of infection is accurate and real, our amazing housekeeping staff is given the credit. That fact is not arguable for me. They are remarkable, but I know there is more to the story.
Recently, we once again produced annual infection rates that are well below the average national rate of nine percent. In fact, they are eight percent below that figure. Although I believe that our outstanding success is due to our total and complete commitment to patient centered care, for those of you who are in need of more quantitative substantiation that is less subjective, we decided to provide that for you as well. So, we went directly to the source, our infection control specialist, Carol, and asked her to elaborate on some of the steps that she takes on a daily basis. Here is her response.
"This is a listing of just a few things that we do to assure that we keep our infection rates low. Education is the most important factor. Keeping employees informed of up to date information on infections is the primary basis of our success. Yearly education includes hand hygiene, infection control, all transmission based precautions, Methicillin Resistant Staph Aureus (MRSA), and other related updates as needed.
If a nosocomial infection is noted, each floor that might be impacted by that patient’s presence is notified so they can focus enhanced attention on the necessary appropriate care each patient receives.
With special attention on rooms utilized by the patients who have an infection, education is also made available to all environmental services department employees on terminal cleaning of rooms.
Brochures have been created for all staff during the orientation process for Hand Hygiene. During the orientation process they are given information on Infection Control. They are also taught to report concerns relating to infections to the Infection Control Practitioner to evaluate and provide recommendations.
Alcohol based hand foams are available in all patient and ancillary rooms on the floors. Every bathroom is equipped with approved antibacterial soaps. Hand hygiene observation rounds are completed twice weekly, and when non-compliance is observed, the employee is immediately informed of the deficiency.
Each day we review all of the cultures that have been processed though our lab. These cultures are investigated for outpatient, inpatient, and nursing homes within our area. The investigation determines if Nosocomial or Community acquired infections are present. When suspected as nosocomial, prompt chart reviews are completed both for appropriateness of antibiotic therapy and to ensure that transmission based precautions have been instituted.
Brochures have been created to be placed strategically throughout the facility for our visitors regarding infection control issues and how washing their hands and taking other infection control practices can help significantly.
When necessary, special notices are included in paycheck receipt notification envelopes containing updates on issues that reach levels of concern.
If the surveillance indicates a specific area of concern, to assure that we can observe that area of concern, outbreak investigations are handled promptly and thoroughly. When an employee is found to have an infection, they are not permitted to return to work until they are treated with the appropriate antibiotics and their culture examination exhibits no growth.
Counseling is provided to patients and their families on outbreaks of MRSA or other infections that occur within the home. They are given instructions, and information, and they are also free to call me with any concerns or questions. Also available are the recent documents that have been published by the Pennsylvania Hospital Health Care Cost Containment. "
In closing, if you’re initial response to this list is “we do all of that, and still have a major infection problem,” then bring in the therapy dogs, open your facility to 24 hour visits, add fresh flowers, decorative fountains, guest accommodations for care partners, fresh bread baking machines, therapeutic music and humor, massage, reiki, aroma therapy and acupuncture. It’s a Planetree thing.
by Tony Chen
There has been a lot of debate around whether these new online social communities are really value-add or just hype. I've been pondering that same question about the Hospital Impact Social Network that was started a few months ago. Frankly, I've been debating with myself on whether to pull the plug on it all together, as the conversations have been sparse.
But little did I know that this little social network was really what planted the seed that has grown up to the first Healthcare 2.0 unconference in the Netherlands. Read the thread here on how it all happened.
This is a great example of how these online connections turn into offline face-to-face "real" friends and connections. Online communities by themselves probably aren't worth too much. But when used correctly and intently, they can facilitate real-life meet-ups that otherwise may not have happened. Hats off to Jen, Maarten, and Martin for taking the initiative to reach out.
I wonder if this has implications for "patient" online communities as well. It's nice to chat/listen with others who face the same struggles with disease as you. But maybe the real value is for these communities to become localized. Online + offline. This may be where progressive hospitals can really add value.
by Nick Jacobs
Over the past two years hospital emergency departments nationally have experienced considerable increases in the number of visitors that they see. The Centers for Disease Control and Prevention reported that emergency department visits rose to an all-time high of 11 million in 2005 which is five million more visits than in 2004. Both the closure of emergency departments and the overall increase in visits have contributed to these increases.
These numbers represent about a 31% increase in visits per department across the United States, the CDC report revealed. Overall there has been, on average, about 7000 more visits per year per emergency department with the highest number of visits coming from Medicaid recipients who averaged 88 visits per 100 recipients. In other statistics there were 42 million visits from injuries yet only about 14% of the visits were from non emergent medical reasons.
This has created challenges for both physicians and staff as more resources are consumed. The stress of increased numbers has encouraged numerous physicians to resign or retire. Demands for higher compensation are also much more common. Along with this the staff also suffers from periodic bouts of burn out from dealing with both the stressed physicians and the increased numbers of patients. Sub specialists are regularly canceling or limiting their privileges, and they also are retiring, or moving onto courtesy staff positions to avoid the relentless on call duties required.
Now, in your mind's eye, try to imagine a situation where care is compromised due to these circumstances.
Another level of complication occurs for the hospitals as patient's unpaid emergency room bills have reached a new high. Many individuals using these facilities are either incapable or unwilling to pay for their care and treatment.
If you're tracking here, what you are reading about is the all too often predicted beginnings of a healthcare train wreck, a potential medical disaster. Life as we know it has already begun to change dramatically in the acute care business. Recruiting emergency room physicians and sub specialists has been a challenge for nearly five years, and we have not even begun to feel the impact of the exodus of the Boomer Doctors and staff members.
Could it be that the 47 million uninsured who are accounted for are finding no other means of receiving care? Is it possible that they do not have access to primary care physicians, to medical coverage, and have no where to turn. Is it conceivable that they allow their minor medical problems to become major problems because of these same circumstances? Maybe we should all begin to pay closer attention to the Presidential candidates and determine if their health policies are meaningful for the United States of America?
by Tony Chen
Sorry I've been MIA for a few weeks - the flu bug hit our family pretty good - from my wife to our tot to me - all in all, about 2-3 weeks. Anyway, I'm back with a few healthcare 2.0 tidbits:
- The first virtual hospital is up on SecondLife, where you can have a good experience delivering a baby. Funny, even in the virtual world, people talk about patient experience.
- More and more patient "support communities" are popping up on Second Life, including the "Heron Sanctuary" for folks with MS.
- Paul Levy, hospital CEO blogger extraordinairre, writes about his view on "friending" people and co-workers on facebook. As you might guess, Paul is all about open communication.
- Matthew Holt has a great post on what patients care about when it comes to physician ratings & info. Interesting development: Angie's list, the widely popular home repair services ratings website, is doing healthcare now, too (yeah, join the crowd). Another site Matthew points out that I wasn't aware of: TheHealthCareScoop, a social media / patient opinion site for plans/providers in MN.
by Nick Jacobs
The arts, tourism or health care; the profession didn’t matter. Volunteers have always been squarely in the center of my personal universe. No matter what the job, the challenge or the non profit profession, we have always worked very hard to create meaningful positions for volunteers. In fact, it has been our distinct pleasure to be intensely concerned with our volunteers over the years.
What have we discovered? There are virtually no boundaries, no Mission Impossible jobs, no challenges too great or too small and there is no end to what dedicated volunteers will do for any non profit organization. They need only to be empowered, encouraged and recognized. In fact, most of them will perform above and beyond the call of duty without even a nod and a smile.
The volunteer experiences that have become part of my personal history have been very unique but the essential ingredient for us has always been to be open, honest and thankful. It has been to provide them with a vision and ownership, but most importantly, it has been to embrace them as partners, as critical participants in our business, as key providers of the proverbial icing on whatever cake is being baked.
I remember once asking the father of one of my students to stand at the boy’s room and make sure that all went well there throughout an entire professional sports game where the students were performing. He never saw one minute of the game. I later found out that he was the president of a university? He had just told me to call him Frank?
Be it putting up tents in 100 degree weather, or making runs to buy the needed decorations required to top off the center pieces, we have always had people waiting in the wings to get it done. Our volunteers currently add at least 30 percent to our care giver numbers as they serve as greeters, are clowns, do hand massages, help family members, deliver communion, or sort files, our volunteers represent a bedrock element of our organization that would be impossible to replace.
Volunteers can make the difference between your patient’s happiness and comfort and their disgruntlement. They don’t have to do what they do. They do it out of commitment and caring, and your patients can feel that love, too!
by Nick Jacobs
Cell phones prohibited in our hospitals.
About five years ago, on a visit to MIT, we had a casual discussion with a physician leader, and asked why we hadn't seen signs banning cell phones. His response was fast and simple, "They don't bother anything." Ever since that visit, we lifted the ban on cell phones in our hospital, and nothing has happened to anyone.
In March 2007, Mayo Clinic researchers published the results of a study in which they attempted to deliberately create interference in medical devices through the use of cell phones. They used them near 200 different medical devices in 75 patient rooms at their facility. They also tested BlackBerry models as well. The paper published in March of '07 in the "Mayo Clinic Proceedings" says there are no "clinically imprortant interferences" when cell phones were used in a "normal" way.
According to Mayo Clinic researchers, Jeffrey Tri, Rodney Severson, Linda Hyberger, the long-held notion that they are unsafe to use in health care facilities is not valid. Three hundred tests were performed over a five-month period in 2006, without incurring a single problem.
You can look this up at www.mayoclinicproceedings.com or on Snopes.com.
Makes you wonder if cell phones are safe to use on airplanes? Maybe they're banned because the phone companies can't track you down to bill you? Any studies out there on that one?
by Nick Jacobs
After 20 years as a non medical observer in a health care setting, some of my greatest observations regarding personal change have come through my own interpretation of the results of brushes with mortality. It’s interesting how the human mind works, the depth of denial that we persuade ourselves to embrace and the creation of sometimes self-created turmoil that helps us avoid the daily realities that are occasionally too emotionally unforgiving to acknowledge.
Typically, we go on until we hit the well-known, proverbial brick wall that causes us to stop, rethink our future and make decisions as to how we should attempt to proceed.
The most extreme outcome resulting from these near death, life threatening and often life changing experiences, has been my observation as a lay medical person of primal change. So many times people have entered my life with a terminal or near terminal diagnosis, survived that illness and come back to a life that even they had never imagined. This brush with death made them realize that they were either lucky or, in fact, selected to stay a while longer and potentially make a difference. This is what I refer to as the sickness epiphany.
Don’t get me wrong. There are still plenty of us who hit the wall and happily return to the life that brought us to that event. What is that quote that is attributed to Benjamin Franklin? You know, the one that I used to think of when I practiced my trumpet for four hours a day, “The definition of insanity is doing the same thing over and over and expecting different results."
On the other hand, we have all seen the heart attack victim who, after smoking heavily for 45 years, stops cold turkey without hesitation and then tells every smoker he knows how awful the habit is for them. It is has also not been uncommon to begin a discussion with someone who had a physical scare, and then decided to quit their job or change their marital status. Finally, we have met those individuals who were barely hanging on to a spiritual thread when they faced death and found their faith. It’s the epiphany. "It came to him in an epiphany what his life's work was to be!"
Some people decide that their new found life should be spent more at home, in church or at play. We have all heard the well worn expression, “No one on their deathbed ever says I wish I had worked longer hours.” On the other hand some survivors become passionate toward causes, i.e., helping similar patients face the same situation that they survived. Still others have decided that they will take the time they have left and work to literally change the world.
It is this type of purpose driven existence that can have a phenomenal impact on all of us.
A little over three years ago, I faced death. When I realized what many people have embraced for decades, that each day was truly a gift, my initial response was, “Why me? Why was I saved?” As I searched for that why, it came to me that at least one purpose for still being here was to change the way health care is being delivered.
Co-incidentally or maybe serendipitously, another individual from a completely different background met with me today to discuss the fact that his life had taken a similar health twist. His passion, as described by him, was literally to change the way that health care is delivered.
We only have about 4500 more hospital to change in order to make this transition.
by Nick Jacobs
Tony’s original mission statement, business guide and raison d'être is clearly defined at the top of this site: What will it take for our hospitals to be the best run organizations on the face of the planet? Periodically, it is important for us to revisit this question with the same passion and commitment that originally fed this site.
A few weeks ago, a very engaging young woman commented on my writing. Her name is Reut Schwartz-Hebron, and the book that she authored is entitled: Outswim the Sharks: How to Quadruple Your Team's Productivity with Kindness.
Upon further investigation of her work, it became clear to me that Reut’s philosophy is very similar to my own, and it is without a doubt one very well defined path to Tony’s goal.
We have written often about the Planetree Philosophy, about the removal of bullying from the workplace, the concept of patient centered care, and the exploration of various employee considerations and benefits that lead to a successful organization; treating people with kindness, dignity and respect.
When you observe the really functional organizations, you will quickly conclude that their secret is their employees. In the book Leadership Jazz, Max Depree, the former president of the Herman Miller Furniture company, creates a convincing and revealing parallel between jazz and leadership.
In both jazz and leadership, autonomy and performance, creativeness and convention, muse and self-discipline must be expertly combined. This book describes “why beauty and harmony must pervade an organization and all it does; how to reach for the renewal, innovation, and vitality required for truly lasting solutions; and how to understand and evaluate your own gifts and motivations.”
So, if you want to find the secret of “what will it take for our hospitals to be the best run organizations on the face of the planet?” You don’t have to look very far. Reut’s company, KindExcellence is just one more gateway to transformation. It is about treating each other as we would want to be treated; employees, patients and peers.
Start with the most uncommon issue, common sense, and work from there. Just remember that high performance can emanate from kindness.
by Nick Jacobs
How do you stop a speeding freight train? Type 2 diabetes is one of the most poignant ailments of the 21st Century. According to the American Diabetes Society website: If present trends continue, one in three Americans, and 1 in 2 minorities, born in 2000 will develop diabetes in their lifetime. That prediction alone could lead to our children having shorter life spans than their parents. In 2005 1.5 million new cases of diabetes were diagnosed in people age 20 years or older.
Diabetes is the fifth-deadliest disease in the United States. Since 1987 the death rate due to diabetes has increased by 45 percent, while the death rates due to heart disease, stroke, and cancer have declined.
Sedentary lifestyles and inappropriate diets are at least two of the primary culprits contributing to this situation. It is no secret that diabetes is a disease that can destroy your body in numerous ways including:
* High Blood Pressure
* Blindness
* Kidney Disease
* Nervous System Damage
* Amputations
* Dental Disease
* Pregnancy Complications
* Sexual Dysfunction
* Others
What is the answer? Maybe the answer is to employ the Ad Council? White bread is bad. Broccoli is great. If all else fails, however, there may be one last emergency rip cord to pull for the auxiliary chute.
A few weeks ago, Parade Magazine featured an article that reported the findings of a study from Melbourne, Australia confirming what many of us have known definitively for a number of years now. Type 2 diabetes can, through weight loss attributed to bariatric banding surgery, be reversed.
Bariatric banding surgery involves the careful placing and then inflation of a small silicone type band around the top of the stomach. How is the surgery done? A miniature camera is inserted through a small incision and transmits images back to a video monitor. The band is then inserted through very small incisions that, post surgery, can simply be covered with band aids.
This procedure limits the amount of food a patient eats and thus begins the weight reduction process. That is what contributes to the reversal of diabetes. The study found that, “after two years, 73% of those treated surgically went into remission from diabetes. That was in comparison to the other 15% who underwent the conventional therapy of diet and exercise. The surgically treated patients lose over 20% of their weight during that amount of time. The researchers did observe that the magic number leading toward reversal seemed to have been a weight loss of about 10%.
Of course the reversal itself is directly attributable to weight loss, and is only recommended and paid for by most insurance companies after everything else has been tried.
The pitfalls of the various solutions available including any surgical procedure must be fully understood, but bariatric banding surgery is: 1.) Less risky than traditional gastric bypass surgery 2.) It is minimally invasive, and 3.)Finally, it is reversible. Although this procedure as compared to the complete bypass procedure may result in a little slower weight loss, it is, according to the study, very effective.
Regardless of the type of procedure chosen, the patient must make a commitment for several months to attempt to reduce the weight through conventional diet and exercise, and in a quality, comprehensive program, numerous professionals including: a physician, dietitians, exercise physiologists, a psychologist and nurses are provided to give the patient the support needed to enable them to stay on the program.
Post surgery, that same team of professionals must be available to monitor you so as to ensure that your progress is appropriate, that appropriate nutrients are consumed, and that no complications are permitted to go unchecked.
If the train won’t stop, maybe banding is the solution.
by Tony Chen
We posted a while back on the concept of a "wellness phone." Now Adidas and Samsung have partnered up to create a Fitness phone called "miCoach". Read this journalist's first experience with miCoach. Billed as a "total coaching system," it can measure your current fitness level (run a mile w/ it strapped on your arm & the chip in your shoe) and your pulse. It talks to you. And its coupled with programs on the web to track progress.
More accurately, I wonder if this is more accurately billed as a "runner's phone", but nonetheless, continue to expect more healthcare applications/programs showing up on our phones. Convergence is the name of game. These healthcare applications/technologies won't work as separate one-off programs - they've got the be integrated into daily life (e.g. facebook, cell phone, google?).
by Tony Chen
Recently, I've been thinking about this: what are the most critical societal and healthcare trends that most significantly impacts hospital strategists and innovators? What is going on in our world that will most impact how hospitals are run/defined/positioned 15 years from now? Please share your thoughts in the comments area.
Here's a few trends that come to mind:
- Everyone talks about Baby Boomers, but have any hospitals really designed a new program specifically for Boomers?
- Global warming and the green movement has been huge. But will a patient actually choose one hospital over another simply because they're more green? Not here in the midwest, but maybe in CA?
- Everyone also talks about prevention and wellness, but hospitals face 2 big problems in this arena: warped incentives (you know what I'm talking about) and no compelling business models. How do you get someone to pay you for something they don't want to do (i.e. change their lifestyle)? Maybe the folks at Virgin will figure this out.
- Everyone is also talking about how healthcare is going retail. If you think the recent surge of retail clinics is a big deal, you ain't seen nothing yet. Hospitals may need to develop a "retail strategy" sooner rather than later.
- What about globalization? telemedicine?
- What about the prospect of logging onto your patient record from google.com (not from your hospital's website, your employer's website, or your insurance company's website)? Won't this make EMR late adopters want to wait even longer?
Your thoughts?
by Tony Chen
Of all places, Hospital Impact has been quoted in Southwest Airlines' In-Flight Magazine, SPIRIT. Go figure.
by Tony Chen
Check out this interesting interview (free reg req) on Toby Cosgrove, CEO of Cleveland Clinic. He touches upon a variety of topics, such as:
- how CC gets the most out of its money (metrics and more metrics)
- CC's take on patient charts (they belong to the patient, not the hospital)
- patient "experience" (and why you won't find those behind-revealing hospital gowns at CC)
- Partnership strategy (very clear about what they want and don't want)
- CC's core value proposition - technology leadership
- how CC finds new ideas (they unleash their 1,800 physicians all over the world!)
- His greatest challenge - bringing in the right people.
- what Cleveland Clinic is doing in prevention (it's not just the no-smoking employment policy)
One question I want to bring up to the community - what else should a hospital be doing in the area of prevention/wellness?
by Nick Jacobs
From America Online’s Confessions of a Flight Attendant, “For example, half a day was spent with someone dryly lecturing us on four personality types and how to handle them; yawn?” Too bad, for him because this very same lecture changed my life. It taught me enough about human nature to give me an edge when dealing with people.
The journey started with a book by Daniel Goleman entitled, Emotional Intelligence: Why It Can Matter More Than IQ. It dealt with the concept of emotional quotient which is described as the ability, capacity, or skill to perceive, manage and assess the emotions of one's self, of groups and of others.
While working on a certification at Harvard University, we were actually tested and then placed in study groups of like personalities. It was disconcerting for me to be placed in with a group of M.D.’s who, because they hated details, simply closed their checking account when it didn't balance. Why? Because that’s exactly what I would do, and I'm not sure I'd want ME as a doctor.
What are the DISC personality profiles? Well, I’m not an expert, but the first is Dominant which can best describe someone who is a Driver, Direct, Demanding, Determined, Decisive and a Doer. They are typically independent, persistent, energetic, busy and fearless. They focus on their own goals rather than people. They tell rather than ask, and when they do ask, they ask “What?” General Patton was a “D.”
The next category is the Influential, someone who specializes in inducement, inspiring, interacting, who is interesting and impressive. They are very social, persuasive, friendly, energetic, busy, optimistic, distractible and imaginative. They focus on the new and the future. They may be a poor time manager as they focus more on people than tasks, but they tell rather than ask, and when they ask, they ask “Who?” General Eisenhower was a High “I.”
The next category is that of Steady, an individual who is submissive, stable, supportive, shy, status quo, and a specialist. They display traits of being consistent, stable, accommodating and peace-seeking. They enjoy helping and supporting others and are good listeners and counselors, have close relationships with a few friends, ask rather than tell, and when they ask, they ask “How and When?” Marilyn Monroe was an “S” forced to act like an “I.”
Finally, the category of Conscientious describes someone who is cautious, compliant, correct, calculating, concerned, careful and contemplative. They tend to be slow, critical thinkers, perfectionist, logical, fact-based and organized. They follow the rules, don’t show their feelings, are private and have few but good friends. They look for big-picture outlines and when they ask, they ask “Why and How.” Probably, your accountant would fall in here.
· The High “D” will Build respect to avoid conflict
· The High “I” will be social and friendly thus building the relationship
· The High “S” will be genuinely interested in them as a person
· And the High “C” will warn them in time and generally avoid surprises
If you take the test, have your loved ones take it, your fellow employees take it and then sort out the results, you will know who you are working with, living with and interacting with on a daily basis. When you return to the workplace and know that the person beside you is a High “C,” it will help you interact with him in a meaningful way.
The same is true of interactions with your customers or patients. If someone displays all of the descriptors of a High “D,” and you don’t respond accordingly, the result will be “Lead, follow or GET OUT OF THE WAY.” Of course there are also those who have a combination of at least two of these areas, for example, a High “D” over “C." So do your homework.
By the way I’m a High “I.”
Surprised, don’t be.
by Tony Chen
Here's a couple of deliciously controversial items that I saw in the news recently:
- I just read an insightful report from Deloitte on the Medical Home concept. Though the conceptual model is an old one, Deloitte presents a nice case (complete with financial ROI) for the U.S. healthcare system to move in this direction. Basically, PCPs as we know them would change into true care leaders/managers/navigators, coordinating all of our care (everything from IP hospital stays to dental care to coaching/behaviorial modification). And instead of seeing 5-7k patients/year, they'd be responsible for 1-2k. Sounds crazy, I know, but the model does address the impending chronic disease explosion no one has solved yet.
- Nanotech has received a lot of buzz lately for its amazing potential for good and for evil. Read a great article here that looks beyond the hype/controversy and gets at what the potential really is. Not surprisingly, medical applications will be huge - wire-to-nerve interfaces, coatings to reinforce osteoporic bones, and "labs on a pill."
Bottom line: as strange as this sounds, I'm betting nanotech will hit our healthcare system before the medical home concept sees the light of day.
by Tony Chen
At HIMSS today, MSFT announced that it's setting up a $3MM Be Well fund. It'll award approximately 20 proposals (of ~$150k) that "should make use of shared health data and connected home health devices to improve the potential for positive health outcomes for patients."
Of course, this probably doesn't come as a huge surprise. Microsoft is essentially accelerating their ecosystem vision (and of course, HealthVault would be central). But nonetheless, it is a strategic and smart move that brings in talent & expertise that they don't have internally.
From their press release, they are specifically looking for:
Microsoft is soliciting proposals from areas that include, but are not limited to, the following:
* TRACK 1: Primary Prevention Applications
Proposals targeting primary prevention could help people and caregivers create and maintain strategies that prevent or delay onset of disease by reinforcing healthy lifestyle factors and addressing modifiable risk factors such as hypertension and weight.
* TRACK 2: Secondary Prevention Applications
The identification of major modifiable risk factors (such as dyslipidemia, hypertension, smoking, obesity and inactivity) is a prerequisite to the implementation of preventative interventions — known as secondary prevention. Proposals in this category could help people and their caregivers measure things such as blood pressure, lipid profile components (LDL and HDL cholesterol and triglycerides), diet and nutrition, weight, smoking, and activity level to create the optimal plan to prevent or delay morbidity and acute care.
* TRACK 3: Acute Care Applications
Certain conditions require immediate diagnosis and treatment, whether at the doctor’s office or in an urgent care setting. Proposals targeting acute care scenarios might track progress, improve communication and share data between the silos in the healthcare system, providing caregivers with a longitudinal view of a patient’s health history that ultimately may lead to superior outcomes.
* TRACK 4: Juvenile Disease Management Applications
Health conditions in children often require specialized detection, diagnosis and treatment. Parents typically become eager partners in the plan of care, and seek information specifically related to their child’s condition. Proposals focusing on juvenile disease management might provide age-appropriate tools to help children, parents and caregivers understand and manage their conditions.
* TRACK 5: Women’s Health Management Applications
Women’s health issues can be complex and are often influenced by biopsychosocial and environmental factors. Proposals targeting this track might choose to create online tools or services that help manage health within the context of lifestyle and family.
* TRACK 6: Community and Social Health Applications
Patients and caregivers dealing with illness or people interested in wellness are increasingly sharing information and support with each other through various Web-based social applications. Proposals targeting this category might include applications for health in areas such as collaboration, communication and the use of social relationships to improve care.
Alright, all you wired up hospitals and health solutions start-ups, start your engines!
by Nick Jacobs
Renee Cree, a writer for the Temple Times of Temple University, wrote an article entitled “School of Medicine creates new pipeline for future doctors,” in which she explores the “Silver Tsunami.” Inadvertently, this is a topic about which I have obsessed for over twenty years, and a topic that will be wedged sideways in the gullet of our culture as the nearly 80,000,000 Baby Boomers prepare for their transition.
It was the professional futurist, Ken Dychtwald who tapped me on the head with a 2x4 in the late eighties as he began to point out the nuances of aging and what they would eventually do to our country and world. He wasn’t a sooth sayer, but he did project our idiosyncrasies into the upcoming decades.
Ken, the President of an organization called “Age Wave,” pointed out the frailties of our system. “After all,” he said, “when the majority of our buildings were designed, the average age that they embraced was the 30’s because the average person was dead before their late sixties.
When Germany's Chancellor Otto von Bismarck designed a system of social security for industrial laborers late into the 19th century, he knew exactly what he wanted to achieve. Not only could he consolidate the strategic position of his party, but also he could bring those workers under the control of the State. He knew, too, that most of them would be dead before they ever reached Social Security age. We, though, are heading toward economic challenges generated by overspending in our government for decades, and are significantly surpassing the targeted pension years.
All of this was food for thought, but what else was common sense? The chairs in our waiting rooms were too deep and difficult for the elderly to get in or out of. The lighting was that horrible fluorescent style that pulsated and virtually blinded cataract challenged visitors. The steps were designed to accommodate someone without arthritis. Finally, the life style to which the typical Baby Boomer had become acclimated was more sophisticated than that of their parents.
We weren’t depression babies. We weren’t used to reusing our tea bags, and, heaven knows, we had no interest in being Plutoed*. ((Plutoed, according to BuzzWhack.com means to be unceremoniously dumped or relegated to a lower position without an adequate reason or explanation.)
So, here we are with not enough doctors, nurses or hospital beds to go around. Oh, and lest we forget, there’s not enough money either as our deficit grows into the trillions and our ability to generate our own income will soon begin to reduce exponentially.
Well, the Temple Times says that Temple University is about to introduce pathways for new doctors. The School of Medicine will be providing programs to address either those undergraduates who didn’t take the appropriate courses to get into Medical School, or will be providing programs for those individuals who did take the right courses but are not sure of their ability to pass the Medical College Admission Test, MCAT. These students are classified as either “career changers” or “career enhancers.”
Having done physician recruitment for over twenty years, there is no doubt in my mind that these steps should be taken. On the other hand, it sounds like a Band-Aid solution.” The word Tsunami is absolutely the correct word. This fix is clearly like sending a gallon of water to the hundreds of thousands of victims to share.
Our medical schools are currently unprepared to deal with the shortage of physicians, techs and nurses that we are already facing on a daily basis. Not only are the schools not responding, government seems to be doing all that they can to discourage physicians to come to or stay in Pennsylvania.
Maybe it will all go back to the wisdom of indigenous man. We will have midwives and medicine men that we can pay with chickens and crops.
by Nick Jacobs
"Compassion is not weakness, and concern for the unfortunate is not socialism." (Hubert H Humphrey)
Each and every day hospital executives 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 management of resources, allocation of funds and commitment to excellence that allows all of these life transition situations to be addressed appropriately.
In addition, 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 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 consider this one. Think about what it would take to 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 failed to do. That would be my most dreaded experience.
The burdens of leadership are all put to task when the added responsibility includes life and death situations.
Because of the intensity of this role, quality assurance, risk management, and six-sigma perfection are all realities of our day to day activities. There also is a tendency, however, in this world of health care to create protective mechanisms, to insulate, to attempt to limit access and to prevent pain to oneself. This is achieved in many ways by self-talk. Rationalizing of each and every situation to create the space needed to keep it unreal.
We do this by becoming the sun around which the planets are forced to orbit. We become the center of the universe, and we completely strip the power away from those for whom we have been hired to protect and nurture. That is Employee Centered Care.
It has been my philosophy to have an open door policy, to provide transparency in every way possible, to reach out with compassion.
Interestingly, the most difficult part of leading such an organization with compassion includes development of the skills necessary to cope with the social fabric present and with the previous training of the employees and other stakeholders. In our current world order where tough is a daily requirement; compassion is many times interpreted as weakness. Instead, compassion needs to be a daily requirement. Do unto to others as you would have others do unto you.
by Nick Jacobs
From the 1976 movie “Network,” Howard Beale, the news anchor who was verging on a meltdown said: “I want you to get up right now, sit up, go to your windows, open them and stick your head out and yell - 'I'm as mad as hell and I'm not going to take this anymore!' Things have got to change.”
While recently visiting a friend at a nursing home, she looked up at me and said, “Why do you think the people who work here feel the need to come into my room at 5 AM, throw on the overhead lights and say, “It’s time to wake up!”
As a patient, I once asked a technician why she needed to take my blood at 2:30 A.M., she replied, “I have to because your physician comes to see you at 4 AM, and he gets very angry when he doesn’t have your blood tests and lab results.” When I asked her why the doctor makes rounds an hour before most musicians return home from their night time job, she smiled and said, “He doesn’t like to talk to the families, and they’re never here that early.”
If you’re a physician, your response is, “If I don’t make rounds early enough, I can’t see enough patients during the day to even begin to meet my financial obligations for staffing my office, for medical school loans or for my daily living,” but what about those docs who do come at a descent time? How do they do it? Here’s a better question. Do you avoid talking to the families?
Of course, if you work in the medical profession, your immediate knee jerk reaction to my other example is going to be, “We have to get them up and give them their medicine. We have a dozen patients and only so much time to get them ready for the day.” Yet, someone on that list has to be your first wake up and someone the last. What goes into that decision making process? Is it YOUR decision based on YOUR wants and needs?
There have been hundreds of cases of which I have been made aware in my health care career where the convenience to the patient was the very last priority on the list. The concept of Patient Centered Care is actually considered revolutionary in this field, and the fact that someone believes that you should focus on the patient, their needs, their convenience and their wants is revolutionary tells you how very upside down this system is.
When the radiologist takes an hour and a half for lunch while a patient languishes in an operating or waiting room waiting for the results of their tests; when the nurse, nurse’s aid or therapist builds their schedule around their breaks, and looks at the lighted call bell as an inconvenience, the system needs changed. Insensitivity toward the customer is rampant.
One of my favorite stories was of a local luminary who had joint replacement surgery. He rang the alert bell and began a two hour wait. Finally, he picked up the phone, called the outside number for the facility, asked the operator for the nurse’s station on the floor where he was a patient, and then said, “This is Mr. Blank. I’m a patient here on your floor. Could you please send someone to my room?” It was the only way he could get their attention.
This is not an indictment of the medical profession. It is an indictment of every profession. If you are a patient, a customer, a client or even a citizen interacting with a bureaucrat, remember one thing; without you, they have no business, no income. So, go to your window and yell, “I’m mad as hell, and I’m not going to take it anymore,” and then hand them a copy of the movie, “The Doctor,” it shows how uncomfortable the shoe can be on the other foot.
by Nick Jacobs
A few months ago in an article in the New York Times by Alex Berenson, he discussed the obviousness of the widening gap between those who have and those who do not have in our country. The Centers for Disease Control and Prevention reported that growing dental problems among U.S. citizens, untreated cavities, have reached a higher level than any time in the last 27 plus years. What does this have to do with health? Well, take one of those tests about how old you really are, and check NO when it asks if you floss regularly. Then do it again, and this time check YES. It’s creates a fairly dramatic difference in the years to live category.
Over 100 million Americans, nearly 30% of our population, do not have dental insurance and two children died of untreated cavities last year. Even though it was only two, it’s a very sad statistic. This represents a reversal of earlier trends in dental health in our country. Berenson additionally explored the trend of dental practices that do not accept Medicaid patients and have imposed significantly higher rates for their services. Of course, just like the primary care physicians who have pursued this same route, they are now enjoying booming financial times. Their professional organizations have also fought the use of dental hygienists and other allied health, non dentists to provide basic care.
This development leaves those uncovered individuals waiting in lengthy lines for access to public dental clinics. Sadly, clinics like this are not always available in many areas. The ones that are forced to use the clincs, however, have as much as a six month waiting time for patients to be treated.
Fifteen years ago I worked to help secure funding to provide health care through medical missions to the people of rural Honduras. Upon initial examination of the most pressings needs, we discovered that the single greatest medical crisis faced by the native Hondurans was the lack of potable water and proper dental care, and our teams of mission oriented medical people pulled hundreds of teeth on each visit. This work literally saved the lives of scores of people.
As the article stated, the right to have straight, white teeth in the United States among the middle class and above appears to be a God given expectation, but, once again, as we fall behind in care of our citizens in the industrialized world, we see the plight of those individuals who do not have their own advocates or financial safety nets falling deeper into a world of financial, physical and mental despair as they face more and more life threatening.
by Tony Chen
Check out this link for some examples of how hospitals are using the popular wii game console for their rehab/PT patients.
by Christopher Cornue
A continuing look at the Commonwealth Fund’s recent report, Bending the Curve: Options for Achieving Savings and Improving Value in US Healthcare Spending finds us reviewing their second area of focus – that of Promoting Health & Disease Prevention. By lowering the incidence of disease through increased public health initiatives and improved care, significant cost savings can be realized in our health care system. Chronic disease is their primary focus, making the assertion that prevention of continued dependence upon healthcare will curb costs significantly. Research conducted by the Centers for Disease Control & Prevention suggest that medical costs for individuals with chronic disease represents 75% of total health care expenditures. Their three primary areas of health promotion & disease prevention are:
• Reducing Tobacco Use
• Reducing Obesity
• Positive Incentives for Health
Reducing Tobacco Use – tobacco usage, including cigarette smoking, is arguably the single most avoidable cause of death in the US. Lung cancer, respiratory disease, heart disease and stroke have all been associated with tobacco usage. During the late 1990s, the CDC estimated that cigarette smoking led to $75 billion in health care expenditures and close to $100 billion in lost productivity. The Bending the Curve Report recommended the increase of the excise tax on cigarettes from $0.39 to $2.39. The additional revenue would be funneled to: 1) CDC’s national tobacco control programs; 2) development of grants to states for their own programs, providing they adhered to minimum tobacco control standards such as banning smoking in workplaces and enclosed locations.
Reducing Obesity – obesity has become an increasing problem in the US over the past several years, with the share of national health expenditures related to obesity falling in the 5-9% range. This presents a significant opportunity in reducing costs and combating this issue. The report recommends establishing a new tax on sugar-sweetened beverages at a rate of $0.01 per 12 ounce serving. These revenues would be used to create grants for states to develop individualized obesity prevention programs, providing they met specific minimum obesity control requirements. Additional suggestions offered in this report: 1) requiring restaurants to display nutritional information; 2) requiring schools to ban sugar-sweetened soft drinks; and 3) enforcing requirements for healthy meals in schools.
Positive Incentives for Health – it has been suggested that our own personal behavior (i.e., smoking, diet, physical activity, etc.) has a significant impact on our health and mortality. Therefore, if we take ownership and change these behaviors, our health can be improved and the costs related to treating disease can be reduced. Disease management and wellness programs which encourage individuals to embrace healthy behaviors are becoming increasingly present in our society. Federal grants to states to develop and promote these programs and encourage insurance companies to incentivize individuals to participate are examples of policies in Bending the Curve. Additionally, broadening the rules for Flexible Spending Accounts to allow for participation in programs to quit smoking or control weight would encourage participation.
On a side note, it’s important to state that these activities don’t need to wait for approval at the Federal or State levels. Action can be taken community by community. An example of this is a developing initiative in Chicago. I had the fortunate opportunity to attend a kick-off meeting this week, hosted by the American Medical Association and the Chicago Department of Public Health – “Building a Healthier Chicago.” Though in very early states, experts and concerned groups assembled for a day-long discussion about necessary efforts to create a healthier Chicago. Many of the initiatives and policies brought forth by the Bending the Curve report were discussed as plausible initiatives that a community can tackle. More information about this will be provided as it develops. Stay tuned …
by Tony Chen
No, it's not just retail clinics in drug stores. Check out this post on hospitalbusinessdevelopment on other potential retail opportunities that hospitals should be assessing.
by Nick Jacobs
Kathy's husband passed away about a year ago after a short run with cancer. Hence, her kids decided that she needed a complete physical, took her to a local hospital and found out that she had a blockage leading to her kidney.
She went in for a stent and had a heart attack. A few weeks later she had open heart surgery, and the stitches leaked. Consequently, she had it again the very next day, and was then placed in a drug induced coma for about a week.
When she regained consciousness, her children had to tell her that she had a stroke during the second surgery causing her left leg and left arm to be weak. A few days later she was transferred to a specialty long stay hospital where she was diagnosed with C diff, an infection.
After about three weeks, she was transferred to a specialty care unit of a nursing home where she became less and less mobile until she could barely stand. She was nearly in a vegetative state from the fifteen different medications that her five different physicians had prescribed for her. Her weight dropped to 90 pounds. Although the MRI revealed that there were no signs of damage from the stroke she became more and more disabled.
After a series of phone calls with the children, none of whom lived near Kathy, followed by consultations with two pharmacists, two physicians and a social worker, all of whom were not directly involved with the case, Kathy was taken off seven of her fifteen meds, at least two of which were completely redundant and many directly conflicted with each other. One of the others, as noted in the literature, had severe side affects and, because two weeks into the prescription the patient was not exhibiting any signs of the progress that this drug might have produced, should have been discontinued months ago.
Today, the family is waiting and for their mother to walk again and eventually be able to leave the nursing home. The seven drugs had, according to physicians who advised in this case as friends of the family, gorked her out!
And today, I sit in my health care leadership chair, and wonder how often this scenario is repeated in the U.S. health care system.
She was not ever our patient. We were only involved as observers and friends, but we were involved. Short of being family, we tried everything to get the professionals involved to take notice of Kathy and her condition; her care givers, her physicians and the administrators. As an Insider it causes me much grief that this scenario has played out this way. Why were her medications not closely monitored? Why did her continued, non explainable deterioration not draw the attention of her care givers? How many people in our system of health care are without patient advocates and are destined to deteriorate and die prematurely due to a similar lack of interest?
by Christopher Cornue
Continuing from my earlier posting, The Commonwealth Fund recently published Bending the Curve – Options for Achieving Savings and Improving Value in US Health Spending. In it, they identified four areas of focus that, if implemented collectively and appropriately, could result in reducing national expenditures over the next decade while improving access, quality and population health. The first of these areas is to produce and use better information for health care decision-making. I believe that all of us in healthcare would agree that data & information are key to our ability to be effective in our respective roles – whether diagnosing patients, or trending our contribution margin. Similarly, I believe we’d all agree that access to this information is not easy, nor is it always complete or well coordinated. Next, translate these beliefs to our patients and other decision-makers in healthcare – how are they supposed to navigate our system and make informed decisions specific to health?
The policies recommended to “address information barriers that contribute to the inefficiency of our health system and undermine are outcomes” are grounded in three fundamental tactics:
• Promoting Health Information Technology
• Creating a Center for Medical Effectiveness and Health Care Decision-Making
• Patient Shared Decision-Making
Promoting Health Information Technology – the study focuses on the importance of widespread usage of information technology. This foundation is essential to ensuring our industry and consumers have an effective mechanism to support systemic efforts of improving health, coordinating care, and ultimately controlling costs. Among the details of the policies, they propose using 1% of Medicare expenditures in conjunction with a 1% tax on private insurance premiums to support activities to create effective healthcare technology. Additionally, they recommend federal matching funding (3:1 to help with healthcare adoption technology; and 15:1 to promote the development of Health Information Exchange Networks) for the states, with a high priority for safety net hospitals, rural providers and small practices. Examples include electronic medical records, process redesign efforts and health information exchange networks. Although the recommendation is for voluntary adoption, they suggest an alternative could be to require these efforts through Medicare’s condition of participation.
Creating a Center for Medical Effectiveness and Health Care Decision-Making – recognizing that providers need data to lead their clinical decision-making efforts, the report suggested the development of a shared public & private sector “center” to coordinate this critical information and improve decision-making among various groups. Not only would this information support the provider, but it would also be used by payers (for coverage and payment decisions) and consumers (to provide further information as they make health care decisions). Based upon research that states education to patients and the usage of clinical pathways or protocols help to reduce costs, the development of streamlined information should prove valuable. According to the report, the center would “have a mandate to produce and publicize information that identifies and encourages the adoption of best practices and authority to establish certain incentives that are consistent with that objective.” I believe this effort is similar to the “Map of Medicine” concept in England and Wales that I wrote a posting about in Fall 2007 and the larger Healthcare Commission (a topic for a future posting) in England.
Patient Shared Decision-Making – allowing a well-informed patient to be key in their healthcare decisions in consultation with (not exclusive to) their physician is a primary driver for this strategy. The study suggests the creation of patient education aids (PtDAs) prior to having high-cost, sensitive procedures (i.e., coronary revascularization for angina, mastectomy for early breast cancer, prostatectomy for benign prostatic hypertrophy, medical stroke prevention therapy, etc.). These PtDAs would be required by the CMS for fee-for-service Medicare beneficiaries. The provider would be responsible for ensuring the patient receive these documents, as part of their decision-making process, prior to their procedure.
Next for our Bending the Curve report discussion is Promoting Health and Disease Prevention.
by Nick Jacobs
Last week in the New York Times, a very creative depiction of the Red Cross flag took it in three shots from a + (plus sign) to a - (minus) as it described the challenges faced by this prominent organization and its recent announcement of its $200+ M deficit. Interestingly, as the Chairman of a local Chapter of the American Red Cross, we have had the same challenges. As the public donates specifically to a disaster, and the monies flow past the operational needs of the organization and directly toward the actual disaster, there is no cash to pay salaries, overhead and operations. The article by Stehanie Strom, tells of the challenges of this leaderless organization that has been a revolving door for prominent CEO's since 9-11. She stresses the complaints generated by the tyranny of donors as they designate the target of their gifts. They are requiring the recipients of their gifts to spend their monies exactly where they want it spent.
As a former philanthropy executive for over 10 years, it is clear that this trend of giving only to the donor's designated project completely hamstrings the charity that is the pass through for the gift. Last year 92% of the 77,000 disasters to which the Red Cross responded were house fires, which, as quoted by the writer, were not exactly "the stuff of national headlines." The Red Cross is being held captive by their own policy called, "Donor Direct," which commits to sending funds only to the donor designated areas.
What's the point of this blog? We are about to enter the largest and greatest pass through of wealth ever conceived of in this country as the 78 M Boomers begin to make plans for their personal estates. It has been suggested that Donor Direct be replaced with donation limits, i.e., if the donation is less then one to five, the moneys will be used by the charity as needed.
Bottom line? "Nonprofits need to do a better job of educating their donors about the cost of running their organizations." For every $100 that we bring in from hospital operations, we sustain about $98.50 in overhead expenses. In our philanthropy department, for every $100 generated, we are faced with, on a bad day, approximately ten dollars in overhead. Clearly, philanthropy is certainly a piece of the possible solution to the enormous, unmet needs of our health system, but exclusively "Donor Direct" is a limiting solution that attacks the very fiber of the charity.
by Tony Chen
We've been talking a lot recently about hospital culture - what makes it work? how can we change it? Another way to look at it is to look at the hospitals that made this year's list of Top 100 Companies to Work For. A record-breaking 10 hospitals made the list this year with some surprises (9 hospitals made the list in 2007 and 2006). Here's the rundown:
#10: Methodist Hospital System
#18: OhioHealth
#45: Children's Healthcare of Atlanta
#49: Griffin Hospital (was in top 10 two years ago)
#59: Mayo Clinic (check out Fortune's video on Mayo)
#63: King's Daughter Medical Center
#75: Southern Ohio Medical Center
#76: Arkansas Children's Hospital
#85: Lehigh Valley Hospital & Health Network (employees get $500 "wellness" dollars)
#94: Baptist Health South Florida
(Aside: It's unclear exactly how Fortune tallies the list, even if they did survey 10,000 workers. Obviously, there is quite a bit of subjective judgment. Nonetheless, the key criteria seem to be things like: pay, turnover, benefits/perks, and % minorities/women.
A few observations to make:
- I think employees know the difference between employers that really care versus employers that just try to appease / buy their loyalty. It takes real thoughtfulness and understanding of your employees (and the willingness to invest the $$$) to offer the types of benefits being offered to the employees on this Top 100 list. Just take a peek at some unusual perks here - everything from $ for buying hybrids to dollar-for-dollar matching of charitable contributions to 18 weeks paid maternity leave (7 for dads).
- I have to wonder whether the % women/minorities factor in Fortune's criteria gives hospitals an unfair advantage? Maybe that's why so many hospitals are on this list? Then again, maybe it's because many people in hospitals do view their jobs as truly meaningful work.
- Speaking of meaningful work, this is partly why Google is #1. Sure, it's nice to have great perks, financial security, lots of mobility, and a great campus. But Google gives employees 20% of their time (1 day/week) to work on anything they want.
- Mayo does seem serious when they say they want to "hire for life," but it does beg the question - where are the other prestigious hospitals?
- In my book, the true A-listers are those on this list AND the Magnet Status list: Mayo, Lehigh, Southern Ohio, and Baptist Health Florida. I know people have different views on the true value of Magnet, but irregardless, it does represent an organizational commitment to really invest in the nursing staff.
by Tony Chen
Over at the hospital impact social network, there have been a few very insightful comments about hospital culture:
Mike said: "Hospital cultures are very segmented as well. Not only are they segmented by profession i.e. nursing, medicine, ancillary services etc. but also intra-professionally within in each discipline i.e. Nursing - ER, ICU, Med/Surg; Medicine - Surgery, ER, Attendings Residents and the list goes on. Each group has their own expertise they bring to the table and each are jocking for position on many issues depending on the impact. Bottom line hospitals have very dynamic cultures."
Isn't it this type of culture that breeds the "not my job" type of attitude? And when the "not my job" is running point for a patient's care, devastating things happen.
Jane had an interesting solution for this particular problem:
One of my answers is..return the role of "head nurse" to its original purpose. That is, overseeing the care given to all patients on a unit, teaching nurses how to improve their practice, engaging other members of the care team in true care planning, making rounds with physicians and talking with families. Not managing a budget, finding staff, sitting on innumerable committees and spending almost no time actually on the unit.
This comes down to investing in additional resources to the head nurse with the many administrative tasks. While I like this idea, I think there are some administrative/strategic initiatives that only the "head nurse" who knows what's going on could really implement.
Speaking more generically about hospital culture, I saw this very interesting insight from Denny:
"For leaders, the most critical thing they can do to shift a "culture" is find out what the conversations are that their people are having. Not only is it important to know what people are saying to each other, but also what are they saying to themselves about the way things are. When a leader knows what people are saying about "the way it is around here," the leader then has an opportunity to address the issues and make a difference."
I like this explanation because everyone can grasp this. Hospital culture isn't some warm fuzzy thing that only consultants talk about - it is the unwritten norms of behavior and the frank conversations. Of course, this means that the people trust the leader enough to share!
by Tony Chen
Go check out this great post on the World Health Care Blog for a good wrap-up of what Deloitte, Brailer, PWC, Forrester, et al are saying about healthcare in 2008.
To summarize, here are 8 things that will increase in '08: IT investments, MDs using the internet, telemedicine, healthcare costs, employers not providing healthcare, individual health insurance, retail clinics, and hospital/physician tension. Are we having fun yet?
by Nick Jacobs
Giving people permission to care in the health care environment may be one solution to positively changing the manner in which we run our hospitals, nursing homes, clinics and ambulatory centers. If we carefully examine what the current behaviors are and how the stakeholders are punished and rewarded, it’s an eye opener. Having worked in this field for over 20 year, I know that profound caring is just beneath the surface and relatively small changes can begin a process of managing and changing expectations and behaviors.
How is this accomplished? Our first step was to provide enough information and education to every employee, physician and administrative leader so that they had no questions what-so-ever regarding the organization’s goals. We did this by offering open meetings over all shifts to every stakeholder. We then offered classes and workshops in Emotional Quotient (EQ), Disney, Planetree, and general Sensitivity training. We paid for a week-end visit to the Ritz Carlton for the head of housekeeping and maintenance, and sent four employees to Disney University.
By the second year, we had built a comprehensive evaluation matrix for patient satisfaction and patient responsiveness into our employee’s annual appraisals. We then created an opportunity for about 10 percent of the employees (including our senior leadership), to find employment elsewhere. Although this was a difficult time, it was clear that these individuals had no interest in providing the type of compassionate care expected in our organization.
Finally, each and every year for the last nine years, we have continued to enforce our commitment to the philosophy of transparency, patient and peer compassion, and spiritual openness. Integrative health, access to clergy, 24 hour visiting, and a commitment to creating an environment that encourages a nurturing attitude have contributed to making our facility a true center for healing.
by Christopher Cornue
Our friends at the Commonwealth Fund have provided us with a wonderful New Year’s present – “Bending The Curve: Options for Achieving Savings and Improving Value in US Health Spending”.
Built upon established facts that US health spending is expected to increase from 16% ($2 trillion) of the GDP in 2006 to 20% ($4 trillion) of the GDP in 2016, the authors of this detailed and unique report offer options that have the potential to “bend the curve” of this increase and keep our spending from increasing so rapidly. The options they present are in some cases radical changes in our thinking and rely heavily on changes in governmental policies; however, overall, they are plausible solutions providing an opportunity to control our healthcare spending. They assert that over the next decade, it would be possible to reduce national expenditures while simultaneously improving access, quality and population health.
The report is focused on a combination of policies that address different aspects of the healthcare industry:
• Production and use of better information for health care decision-making;
• Promotion of health & disease prevention efforts;
• Alignment of financial incentives with health quality & efficiency;
• Correction of price signals in health care markets.
Through forthcoming postings, we’ll try to examine each of these areas and policies identified by the report.
As is always the case with The Commonwealth Fund, much of their efforts are focused on promoting a national discussion around issues and solutions. They’ve accomplished this once again and over the next several postings, we’ll do the same.
by Christopher Cornue
As many of our readers know, I’m usually not short on words, but this posting is very direct and few words are needed. We spend a great deal of time discussing ways to make our healthcare system better in the States and this is an absolutely essential discussion that needs to occur, and it will continue. However, I do want to take a step back, prompted (I’m sure) by a recent hospital stay in November and other recent activities. Medicine is so amazing and our society is able to do so much to improve the health of individuals. The progress made over the past few decades (and centuries, for that matter) is remarkable and our possibilities to improve are endless. The ability to affect the lives of individuals, whether you are a front-line caregiver, physician, administrator, office worker, etc. is a rewarding and awesome responsibility. I’m so proud to be a part of this industry and to be an active contributor to these efforts.
So, with that brief pause and reflection on our industry, I look forward to our future discussions, collaboration and solutions to, as Tony puts it, make “our hospitals the best run organizations on the face of the planet” and improve the delivery of healthcare!
by Tony Chen
Straight from CNN's frontpage in the last 24 hours:
- Glenn Beck: Put the "care" back in health care. This CNN reporter experienced first-hand the lack of compassion at his hospital bed. Funny, Nick just posted on the power of empathy earlier this week.
- Should I sue my doctor? A heads-up to all risk management folks - this article recommends patients to come see you for compensation.
- Dennis Quaid, wife lash out at hospital. Movie Stars! Medical errors! A conspiracy? What more could you ask for? Coming to a theater near you: Secrets No More
A few implications for hospitals come to mind:
- As social media becomes more and more rampant, is your hospital ready for more of patients youtubing and blogging from their hospital bed?
- Do movie stars or other influential people get "better" treatment? We aren't comfortable with this 'tiering' of healthcare, but it's happening already.
- While I don't know the real story behind the Quaid's experience, I am reminded of one thing: transparency is more than providing regular metrics, it's a culture.
- Where are the touching/inspirational stories of the 100s of amazing miracles that have happened in our hospitals in just the time you read this post?
by Tony Chen
Go over to Kellogg Insight to read a research article on whether hospitals "act strategically" in a competitive market. This particular economics professor focused on EP procedures. It's very rare that I see business strategy empirical studies on hospitals. So if you enjoy economics and/or strategy, definitely read it. The conclusion (written like a true economist):
“Recognizing that hospitals, insurance companies, and doctors are economic agents reacting to the economic conditions they face would go a long way to understanding healthcare,” Dafny concludes. “This paper contributes to the mounting evidence that the Hippocratic oath does not suffice to protect patients from undergoing unnecessary but profitable treatments.”
by Tony Chen
If we really aim for hospitals that are world-class organizations, then we must aim for world-class organizational cultures. Join the discussion on how to do that at our online community forum here.
My old boss used to say - we as managers are really only responsible for two things - structure and culture. And structure is the easy part.
by Nick Jacobs
Denise Grady wrote a great Op Ed for the New York Times today about her sister's fight with cancer. In this opinion column she discusses empathy toward vulnerability. Interestingly, she quotes Dr. James A. Tulsky, director of the Center for Palliative Care at Duke University Medical Center whose study published in the Journal of Clinical Oncology found that doctors and patients weren't communicating all that well about emotions. She quoted the study as having revealed that male doctors were less than 50% as empathetic as female doctors in their responses to patients.
Ms. Grady made a point of indicating that it was not necessarily critical for the physicians to engage in long dialogue with the patients where they became psychological counselors. In fact, according to Tulsky, "Brief, empathetic responses will suffice."
A few days ago, I ended a post by quoting Maya Angelou who said, "I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel."
So much of our life is spent looking for emotional support in some way, shape or form. The management schools teach us that "It's not all about the money." The attorneys tell us that "If we are kind and explain ourselves to the patients, our chances of being sued drop exponentially."
This morning we dealt with an employee complaint. It wasn't about time, money, or benefits. The complaint was that the employee was not treated with compassion, respect or dignity. It was about how one of her peers made her feel.
There are very difficult emotional challenges that come with being a chemotherapy or, for that matter, any type of cancer patient. After all, this disease can very clearly make us deal with our own mortality in a very direct, uncaring, matter of fact way. It is or it isn't. We are or we aren't; and one of the examples that we use is that "It may be your 543 rd Leukemia or melanoma or lymphoma, but it is the patient's first."
We are not indicating that our world must be one of mamby pamby, warm fuzzies that never deal with the truth. We are indicating that the people with whom we deal are human beings. I heard a comedian say last night that he had just gone through a tough divorce and lost weight. He then said, "I think I lost about 30 pounds. That's how much a soul weighs, right?"
So, as we move about in our world every day, remember Denise Grady, remember her sister, and remember that warmth, concern, compassion, and empathy are NOT bad things. The day that we found out that my father's cancer had metastasized, the doc told him not to worry. He told him that everything was okay. Then he turned to my mother and winked. That day will forever be burned in my memory. His was the wink of death.
Just remember that, "Wherever there is a human being, there is an opportunity for kindness."
by Nick Jacobs
My life has taken me to different countries, different continents, different cultures: Italy, Bosnia, Serbia, England, Nigeria, The Netherlands et al. During those travels, it is always exciting to me when my view of life is shaken by fundamental realizations that challenge my day to day beliefs.
For example, during my first trip to Europe, we crossed so many borders into so many different countries pre Euro, that money became so confusing to me that my mind locked up. 123,000 Lire, 5 Francs, £3 Sterling? What did it mean? It was during those multiple country, multiple currency visits that it hit me, at the tender age of 22, that money was just one way to get what you needed.
Nearly twenty years later, as we deplaned at the airport in Rome, we were swamped by Italians leaving for their month long holiday, and, of course, for those businesses that remained open, there will always be the break from 3:00 to 5:00 PM and those leisurely, wonderful, evening meals.
What struck me is that we, as Americans, too often see the things that happen to us on our way to our next meeting or destination as an unessential distraction. While, to those Europeans, be it in Serbia, Bosnia, France, Italy or Spain, those interruptions are life. They stop and talk. They enjoy the trip. Because the journey, not the destination, is life.
A friend of mine recently forwarded me a letter from a business associate that described the secret to being a successful leader. To paraphrase his thoughts: a successful leader has the uncanny ability to embrace both philosophies. Great leaders most often have disciplined themselves to get huge amounts of work done in very short amount of time.
They also, however, have learned to hold onto the moment, to remain receptive to those with whom they have come in contact, to keep their minds open for positive interaction and to take advantage of the serendipity that surrounds each and every one of us every day. It has been my experience that by keeping open to every possibility, we often times find solutions to our most challenging problems. So, carpe diem. As Maya Angelou said, "I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel."
by Tony Chen
Has anyone else seen this article in the Atlantic? It claims that too many doctors lead to lower quality because the "coordination costs" outweigh the benefits. When every doc is responsible for one aspect of care, sometimes it gets unclear who is responsible for what (or at least, that's the theory)
From the article:
“Why would more doctors lead to worse care, and fewer doctors to better care? More tests and procedures always entail more risk, and for care that’s unnecessary, the ratio of benefit to risk is zero. What’s more, where numerous doctors, particularly specialists, are routinely involved in a patient’s case, the potential for miscommunication and confusion multiplies (bold mine). Modern medicine should be a team sport, but it is often practiced as if everybody is running a different play. Different doctors order duplicative tests, prescribe drugs that interact poorly with what the patient is already taking, and assume another physician will attend to a critical aspect of a patient’s care. A cardiologist can be a virtuoso at slipping a stent into the coronary artery of a patient in the throes of a heart attack, but if she leaves it to another physician to prescribe aspirin to her patient—one of the most effective treatments for preventing a second heart attack—that prescription might fall through the cracks.
“This is what appears to be happening in many hospitals, where the ratio of specialists to primary-care physicians is especially high. In one recent study, two Harvard economists—Katherine Baicker, of the School of Public Health, and Amitabh Chandra, of the Kennedy School of Government—examined how the quality of care in different states varied as the proportion of specialists rose. They found that measures of quality, like the percentage of heart-attack patients who received a prescription for aspirin, tended to fall in direct proportion to a rising ratio of specialists. The point, says Chandra, “is not that the specialist is inferior, but that the system is not accounting for the ‘coordination cost’ specialists are imposing.”
It's not hard to believe that this coordination isn't always done well. But it is hard to believe that this lack of coordination could outweigh the benefits of the tremendous expertise and advanced care provided by specialists.
I need to see more on this, but nonetheless, this further reinforces the notion that your hospital's organizational culture may be just as important as the organizational structure & processes.
by Nick Jacobs
The book, Birth of the Chaordic Age by Dee Hock, Founder and CEO Emeritus of VISA was recommended to me, and actually sent to me by a very brilliant guy a few months after I had attempted to explain my philosophy of management to him.
If you are a student of management, or a front line manager, you will see that there is hope. At least one CEO in the country gets it.
Dee Hock is currently founder and CEO of the Chaordic Alliance, a nonprofit committed to the formation of practical, innovative, organizations that blend competition and cooperation to address critical societal issues, and to the development of new organizational concepts that more equitably distribute power and wealth and are more compatible with the human spirit and biosphere.
Dee says plenty of things are right on target for me. "Forming a chaordic organization begins with an intensive search for PURPOSE, then proceeds to PRINCIPLES, PEOPLE and CONCEPT and only then to STRUCTURE and PRACTICE."
One of my favorite sections involves the reality quoted earlier:
"The Industrial Age, hierarchical, command-and-control institutions that, over the past four hundred years, have grown to dominate our commercial, political and social lives are increasingly irrelevant . . . They are failing . . .organizations increasingly unable to achieve the purpose for which they were created, yet continuing to expand as they devour resources, decimate the earth and demean humanity."
Willis Harman, former President, Institute of Noetic Sciences, writes: "Dee Hock describes a new organizational culture that might well spell the difference between a smooth, orderly transition to a more salubrious, sustainable society and the chaos and anarchy that some see in our near-term future."
So, as Paul Harvey says on his radio program, "And now for the rest of the story."
My entire professional career has been dedicated to attempting to create an environment that was not like the typical hierarchical organization. Unfortunately, the bullies live on, and the world is under attack in every way by their greed and their egos.
So, think about reading Birth of the Chaordic Age. For some of you, life may change. For others of you, there may be a rebirth of your spirit, and for the rest of you, understand that there is a movement to unseat your archaic beliefs, those beliefs that currently feed our wars, our pollution and our failed systems. So, hold onto your hats because change is coming.
Read more!