by Dr. Kenneth H. Cohn

Perhaps it is too early to know the impact of yesterday's elections. After all, the impact of conservative Democrats in the Senate remains to be seen, the Supreme Court has not weighed in on the constitutionality of requiring Americans to purchase healthcare insurance, and the president does not face reelection until 2012.

If healthcare remains a collaborative local effort among nurses, physicians, administrators, and allied healthcare professionals to care for patients and their families, what can we do in the aftermath of the election to show that we are listening to patients' concerns?

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Here is my four-step plan:

Continue to educate patients and their families that lifestyle decisions (for example, affecting diet, exercise, smoking, and seat belts) account for 40 percent of their quantity and quality of life, whereas healthcare interventions account for only 10 percent, as cited in Making Sense of Healthcare Reform.

Decrease readmissions: In Collaborate for Success, Waterbury Hospital decreased readmissions due to failure to take medications as prescribed from two patients per month to nearly zero, with one call to recently discharged patients. As Dr. Cusano summarized, "We realized that patients who were getting calls were close to 100 percent on doing the right things." A phone call within 48 hours of discharge and assessment shortly after admission of patients' likely discharge needs are at the top of Maureen Bisognano's ten-point checklist of What Can Be Done to Reduce Rehospitalization.

Improve recruitment and retention: Gaps in coverage are costly to practice administrators and patient outcomes. In the Lifelong Iterative Process of Physician Retention, a healthcare system improved its annual retention rate from 90 percent to 100 percent by teaching established physicians how to mentor recently hired physicians.

Foster healthy competition: In Better Communication for Better Care, the director of a cardiac catheterization laboratory brought the procedure times and outcomes for his six-person group to within one standard deviation in four months by telling physicians that if they could not come to consensus on how to limit variation and improve financial and clinical outcomes within six months, he would post the results for each cardiologist on a bulletin board in the catheterization lounge in full view of the entire staff. As a cardiologist explained, "None of us wanted to be an outlier except on the positive side."

Healthy competition is the antidote to "herding cats." People who pride themselves on patient care prefer being inspired rather than being supervised. If one must supervise, catch people doing their job well and celebrate their accomplishments.

As I mentioned in A Call to Action, Rabbi Jack Riemer noted that for leaves, birds and animals, turning comes instinctively--whether it's leaves turning colors, birds heading south, or animals storing food for the winter. Yet change for us does not come so easy. Not only does it mean breaking with old habits and perhaps losing face, "it means starting over again."

So life does start over again and yet there seem to be some constants. Just ask yourself this:
* Do patients and their families still come to us in need?
* Did we choose healthcare to make a difference in patients' lives?
* Do many aspects of healthcare remain local?

I welcome your input.

Ken is a practicing general surgeon/ MBA and CEO of HealthcareCollaboration.com, who works with organizations that want to engage physicians to improve clinical and financial performance.