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.

by Christopher Cornue

Unfortunately, I cannot take credit for this very accurate description of leadership in healthcare at the moment. This was a resounding theme at a recent Health Care Advisory Board meeting I attended a few weeks ago. Supporting this assertion, the Advisory Board discussed changing reimbursement methodologies, revised DRG structure later this year, global competition for paying patients, increased costs, expected growth/volume decline, shift from inpatient to outpatient, proposed legislation forcing hospitals to absorb costs for adverse events that occur during a patient’s hospitalization, a more informed consumer, increased transparency of quality outcomes for hospitals, evolution of “retail clinics,” workforce challenges, etc. No need to go through the whole list – you get the point! While many of these issues have challenged hospital leaders for several years, it’s probably safe to say that a “perfect storm” type scenario is on the horizon, whereby all of these are impacting hospitals simultaneously. Which issue do we spent the majority of our time focusing on first? How do we manage this change going forward? Regardless of our focus, I just wanted to share this “Leading Through Disruptive Change” statement, as I think it’s a perfectly appropriate label for our efforts in healthcare at the moment.