hospital impact

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.