by Tony Chen

Recently, TIME magazine (is it still an actual magazine?) came out with the 10 big ideas that are changing the world today. As I read through this mostly fantastic (and maybe fantastical-sounding?) list, I couldn't help but think about the impact on health care for six of those big ideas.

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by Tony Chen

If this didn't already start in your hospital three months ago, it will start soon enough. In order to survive the coming year or two of increasing bad debt, increasing charity care, other reimbursement cuts, declining elective surgery volumes, more complex delayed-care stuff showing up in the ER, and decreasing philanthropy, it is time for the serious business of cost-cutting.

What is your hospital planning? Where do you look first to cut costs? The real question is, where do you look that you haven't already?

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by Tony Chen

2006 was the year of consumer-driven health care. Two years ago was the year of retail clinics. Last year was the year of health IT (with Google and Microsoft making big splash entries). So, what will 2009 bring? Here are some predictions sure to go wrong:

1. The number of uninsured and underinsured will increase dramatically.

Think about it: Unemployment was once close to 5 percent. At some point in 2009, it could get up to 10 percent. Add to that the many businesses that will be cutting healthcare coverage for the sake of business survival, as well as the folks who will decide to forego buying individual health insurance to make ends meet.

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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.

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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.

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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.

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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 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

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

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!