hospital impact

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!

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 Nick Jacobs

If the Material's Management Director receives a favor in the form of a trip or a gift from a vendor, and that gift is beyond a limited value, that may be considered problematic for the organization. If a senior officer, though, is flown to a reception in the vendor's corporate jet, wined and dined, and then taken to a professional sporting event in an attempt to influence that officer into using that company's product, does that present the same problem? If a U.S. Congressman is flown at no cost by a lobbyist, that now is considered problematic, but if the lobbyist is from an academic institution, that is considered okay.

If a board member puts undue influence on an executive to do business with his company, how does that play out? Sarbanes-Oxley sends a very clear message that the business community is expected to do things differently than the way they have been done in the past, but I've already heard of cases in health care governance where specific board members have required the calculation of just how much business is too much business to be pushed to the extreme before the law kicks in for non profit corporations.

According to the Columbus Dispatch, in 2000, 13 of central Ohio’s corporate boards were dominated by insiders — company executives, consultants and lawyers. Some owned jets that they leased to their companies. Others owned office buildings that their companies rented. Still others were relatives of the CEO.

Bottom line? Corruption by any other name is often called doing business in many countries, and in some countries, it is truly considered an art form. Who do you know? How do you take care of your friends and the friends of your friends? What financial favors do they do for each other? Unfortunately, in many cases, if you don't play by the rules of the GOB's (Good Ole Boys), there can be a heavy price to pay, unemployment.

So, for all of you who are looking at a high powered future, study the rule books and stick to your guns, but, unless you work for an absolutely wonderful board, hold onto your hats because situational ethics can be very difficult to surmount.

Regarding ethics in the military, Robert Prentice, a professor of business law at the McCombs School, said, "Nobody up the line is taking responsibility. Everyone is trying to pin it on the little guys." Remember, that little guy could end up being YOU.

Final thought, putting on make-up or shaving in the morning usually requires one to look in the mirror, and that can become challenging for those who are better known as the players. Of course, that depends on the situation.

by Jeff McKune

Having attended a couple of Joe Tye’s seminars, I was eager to read The Healing Tree, a book he first published in 2005. The book is now in its second printing.

The story begins with an evening with Mark and Carrie Anne Murphy and the tragedy that enters their lives. Carrie Anne’s struggle towards recovery is one thread that is carried through the narrative. But a deeper and richer fabric is found in her personal awakening, guided initially by young Maggie, a fellow patient at the hospital who provides unique therapy to Carrie Anne and other patients. Carrie Anne’s despair eventually leads to her discovering a new path for her life, more meaningful and rewarding than anything she had previously imagined. The story alone touched me, and I found myself sometimes both uncomfortable and inquisitive with the introspection it created in me. That alone made the book worth the reading.

It was impossible for me to ignore the glimpses that Joe provides into the healing environment that was a part of the fictional Memorial Hospital. I wondered how some of the innovations Joe discussed would ever get past a Board of Directors. But clearly Memorial Hospital was a hospital focused on much more than physical healing. The hospital’s ongoing transformation was a result of visionary leadership. One phrase that I cannot forget is “the soul of the hospital.” What is the soul of your hospital? How do your efforts contribute to the development and sustaining of that soul?

Throughout the book, Joe also reveals some thoughtful insights into nursing and those that serve in caregiver roles. The bidirectional aspect of the nurse-patient relationship is developed in a discussion between Carrie Anne and Maggie. And toward the end of the book, the hospital CEO reminds us that patients are not the only ones that need healing. Joe is a strong advocate of nursing, and it is no surprise to see this emphasis in The Healing Tree.

I consider The Healing Tree to be one of those books that takes a hospital administrator beyond mechanics and methodology – it invites and encourages visionary and transformational leadership. A section containing discussion questions is included at the end of the book for the purpose of initiating dialog regarding that transformation. Also, there is a website for the book at www.healing-story.com where you can download the companion workbook Healing the Hospital, which I understand has been popular at caregiver and leadership retreats. If you want to spark discussions as to how your hospital can better serve both patients and staff, I invite you to read and share this compelling book.

by Nick Jacobs

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

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

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

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

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

by Jeff McKune

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

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

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

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

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

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

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

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

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

by Nick Jacobs

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

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

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

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

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

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

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

by Jeff McKune

My Dad and I were recently discussing healthcare issues, and he told me that he argued healthcare topics when he was on his high school debate team. In fact, in 1947 he was given the debate topic "Should the Federal government provide a system of complete medical care available to all people at public expense?" Sixty years later, the question of government's involvement in healthcare is still a hot topic, and it is one of the leading topics of the 2008 presidential race.

A little over a week ago, John Stossel hosted a 20/20 program titled "Sick in America: Whose Body Is It, Anyway?" One of the things I liked most about the program was the way that Stossel covered some challenging issues such as the linking healthcare insurance to employment, over utilization, and the profit motive. He also had a nice segment comparing the system in the United States with those in other countries, specifically Canada. I found the whole program to be refreshingly frank.

The last part of the program focused on private solutions to healthcare problems versus government solutions, and the importance of competition and individual choice. Stossel gave a couple of examples where competition among healthcare providers has led to improved quality and lower prices, even during a time when most of the industry is experiencing higher prices. Those two examples were LASIK eye surgery and cosmetic surgery, both of which are usually not covered by insurance. LASIK prices have dropped 30%, and the quality has improved. Providers have to compete because patients are shopping around knowing they will pay for the procedure out of their own pocket.

When discussing healthcare challenges, we often focus on what does not work. But what does work? The things that work for healthcare are the things that have worked for our country in many other industries: Freedom of choice, competition, innovation, and the availability of information for potential buyers. If we know these things work, as hospital leaders, how can we best connect to these basic tenants?

by Craig Ahrens

I have not blogged in a long time and I apologize. As most of you know, I attempted to launch www.thebusinessofhealthcare.tv months ago and unfortunately had to pull back on the website official launch again until next month. Long story short, it is difficult to start any business – legally the loops you have to jump through are extreme especially when it comes to this type of business model. It has been an all consuming effort and fortunately I have partnered with individuals who are going to ensure a smooth startup. So, look for it again and I appreciate your support and welcome your ideas!

At the same time, I left the consulting world to work for one of my clients. They offered me the opportunity to work in one of the most competitive markets and service lines in the country – Indianapolis as a Neuroscience Service Line Executive Director. Normally, I would not have been interested in this position, but the chance to work in a non-CON, advanced specialty hospital, competitive market with an excellent health system was too enticing. I thought that it would be interesting to post my experiences working in a new role.

Service line executives are difficult roles to manage. They are difficult primarily because of three reasons:

1. Many of the relationships with operational staff are matrixed through Chief Nursing Executives.
2. Physicians and CEOs are used to negotiating business development opportunities minus a “middleman”.
3. Operationalizing plans and business development initiatives is difficult given the myriad of relationships to navigate.

How does one overcome these issues? In my opinion, the most important thing is for the CEO/executive team to visibly communicate to administrators and physicians that you are the go to person for the service line. Without this support, you are dead in the water with the matrixed relationships. Further, the physicians will continue to pursue the pattern of going straight to the CEO to discuss any opportunity. To some this may seem odd, but you need to market yourself internally and to be seen as the person who shepherds initiatives and gets them done through navigating the internal political hospital dynamic. I will continue with part II next week. Any comments?

Craig Ahrens, MHA, MBA, FACHE is the Executive Director of Neurosciences for St Vincent Health in Indianapolis, Indiana (part of Ascension Health System). He is also President of www.thebusinessofhealthcare.tv (due to launch in late 2007), which is the web’s first internet tv program dedicated to healthcare business news and interviews. He can be reached at info@thebusinessofhealthcare.tv

by Nick Jacobs

From MSN Money: "Patients in the highest-rated, five-star hospitals in the United States are at a 65 percent lower chance of dying than patients in the lowest-rated, one-star hospitals, according to a study released by HealthGrades, a health-care ratings company. If all hospitals included in the study performed at the five-star level, the lives of more than 273,000 Medicare patients could have potentially been saved over a two year period. Fifty percent of these potentially preventable deaths were associated with four diagnoses: heart failure, community acquired pneumonia, sepsis and respiratory failure."

From "Health Daily News:"

Today, some health care executives, insurers and physicians are . . . fully embracing disclosure and apologies, not only because they believe it will reduce malpractice claims, but also because it's ethically the right thing to do."

Larry Dossey, M.D. from "Reinventing Medicine," "For more than a century the profession of medicine has tried to become increasingly scientific and technical, because this is where we believed the future of healing lay. Now a monumental shift is occurring, empowered by the evidence that consciousness is a powerful factor in the world."

Finally, Dr. Karen Donelan, Senior Scientist in Health Policy, Massachusetts General Hospital, gave a wonderful description of her experience in the health care system. A dear member of her family received timely access when the pcp's answering service worked, the receptionist, technician and doctor all showed compassion and demonstrated their desire to be there for the family and the patient. At every step information and decisions were shared, so much so that the family felt part of the care team, and finally the doctors were highly trained and had all of the right tools. She described this as truly, significantly different care than they had ever observed with other family members. According to Dr. Donelan, "It was seamless, high quality , accessible, compassionate and expert with a fully disclosed price and plan of treatment."

It was the care that her dog, Rico was given by the vet. Surprised, don't be.

by Jeff McKune

This past week was certainly busy, and the last half of it was packed with our annual leadership retreat. My head is filled with tasks and action plans as a result of our leadership development sessions with the Advisory Board. Then Joe Tye challenged us with building the invisible architecture of our organization. I have so many action plans that I need to develop, that I may start with an action plan for my action plans!

There is a strong sense of being equipped that comes out of a retreat. With all of the collective enthusiasm that accompanies that sense, I have to wonder how much will survive the onslaught of the reality of daily operations at the hospital. There has to be more than just "retreat-speak" that follows me back to the job. Certainly there are a myriad of projects that I could attempt to tackle. However, I know that time and energy are not unlimited, and that I still have to maintain some sense of balance in my life - time for family, friends, and self (exercise, reflection, and spiritual growth).

So now that I am armed, to which efforts can I fully commit? First, I will renew my commitment to formally developing my own leadership skills. If my dream is to help build a better hospital, to have a positive impact on healthcare, I have to start with building a better Jeff. That will mean taking a critical and introspective look at my skill set, determining where the opportunities for growth are, and committing time each week to addressing those gaps. My second commitment will be to focus on bringing out the very best in each member of my staff. What are their dreams? What baggage are they carrying that I can help them overcome? What would it take to make them feel like this is the greatest place on the planet to work?

Maybe armed and dangerous is not the right phrase: How about aimed and determined!

Did you recently return from a leadership retreat or similar experience? What initiatives were you able to take back to your organizations?

by Christopher Cornue

Our organization just went through another “re-organization” and the phrase “Physician Integration” was added to my title in a slightly revised role in the Table of Organization. By raising the question of what this means, I’m being somewhat facetious (I had better be clear about it, since it is in my title after all) … but shouldn’t we all have “Physician Integration” formally, or informally, after our titles? Since we are leaders in healthcare, aren’t we all expected to integrate physicians into what we do on a day-to-day basis? So, instead of Chief Operating Officer or Vice President for Strategic Planning … the roles should read Chief Operating Office & Physician Integration or Vice President for Strategic Planning & Physician Integration. These revised titles speak more to a “matrix” style Table of Organization emphasizing the role of physicians in everything we do.

Let’s not make light of this – it is key that physicians are part of our operations meetings, service line discussions, marketing/planning, nursing leadership, etc. Too often I have heard physicians separate leadership between “physicians” and “administration.” Quite frankly, I get a little frustrated when I hear this stated … I truly believe we’ve moved beyond this “old school” style of thinking of separate accountabilities and we really need to marry physician and administrative leadership as supportive, not exclusive managing styles. Another one of my soapboxes, I guess.

While it might not be necessary to specifically identify the term “Physician Integration” in each of our titles, it is important that we remember, recognize and reinforce the importance that physicians play in everything we do. This is the true nature of a dynamic, progressive and successful organization and a moniker I am proud to attach to my new title, and any other title I hold in my future care in healthcare.

by Nick Jacobs

On my hospital blog (Windberblog.typepad.com), my entry this week was about twisted truths, not ours, but others. As the art of spin has become more and more refined, we begin to reach a point in communications where reality is whatever the loudest voiced pundit can emphasis the longest and the most intently. This practice has become true in health care as well. Especially in areas of high competition.

Last year I wrote another blog about an author by the name of S. I. Hayakawa and his book, Language in Thought and Action. As a freshmen college student my impression of the book was that it was about thought and mind control through the use of disinformation.

"The original version of this book, published in 1941, was in many respects a response to the dangers of propaganda, especially as exemplified in Hitler's success in persuading millions to share his maniacal and destructive views. It was the writer's conviction . . . that everyone needs to have a habitually critical attitude towards language — his own as well as that of others — both for the sake of his personal well-being and for his adequate functioning as a citizen.

The reality now, however, is that this art has evolved into a science, and the science has become an accepted part of our world. It is fascinating to observe the use of disinformation as a means to attract patients, to see the truth twisted just enough to confuse the public so as to appeal to their lack of technical and medical knowledge through misrepresentations that lead to business.

A few weeks ago, one of our visiting sub specialists told a patient that they had to be transferred from our facility because we didn't have the necessary equipment for his surgery. As it turned out, the piece of equipment was an orthopedic nail that, had we not had cases of them, could have been delivered almost instantly by a local sales rep. The reality is that a competitor requires each surgeon to do a certain number of surgeries each day that they have scheduled. If they do not, they will have a decreased number of slots to work from in the future that are exclusively designated for their use.

What is the definition of an Open MRI? It is not a larger bore device, it is, indeed, open. Who cares? A facility that has purchased a larger bore device cares. Say that it is OPEN, confuse the public, and take business away from the facilities who purchased the OPEN MRI. A nuance, you say? A tiny twist, you think? Well, if you have a $34,000 a month payment to make, it is just good business, right? Twist to sell.

Finally, we hear, everyday, the little whispers about skill level. Perception is reality, and unless or until total and complete transparency becomes the guiding light of health care, we will be in the same boat that we were in before "Consumer Reports."

Buy our gasoline, "It will put a tiger in your tank!" It wasn't that long ago when we believed that there was a huge difference between the quality of different brands in that business as well, at least we believed that until we were informed that all of the gas was coming from the same refinery or, in some cases, all of the stations were being fed from the same truck!

Bring on open communication, just don't let some of the major, existing evaluators take the lead. They are from a different paradigm, a world where, many times the twisted, interpreted detail is the basis for a pronouncement that has no bearing on the reality of the care.