hospital impact

Just last week, Jim Collins published a monograph: Good to Great and the Social Sectors: Why Business Thinking is Not the Answer

(Taken from a review I wrote for amazon.com)
As a non-profit leader, I've been waiting for this monograph to be published for several months, and Collins did not disappoint.

In a lucid style that only Collins can deliver, he masterfully explains the subtle (but seismic) concepts of good to great for the social sector. Similar to his previous books, he effectively uses a broad array of real-life examples (e.g. the NYPD, a church, the Girl Scouts, the Cleveland Orchestra, a high school science dept), helpful graphics, and a very readable, conversational tone. Even though the monograph is only 31 pages, he contributes his clear thinking on numerous issues that will be very familiar to social sector leaders:
- how to measure success in non-$ metrics
- how to recruit and motivate a passionate (and poorly-paid or unpaid) staff
- how to think differently about "restricted funds"
- how to transcend systemic / external problems.

I particularly enjoyed his discussion on "legistative" leadership (versus "executive" leadership in the business world). Collins predicts a dramatic reversal - that one day non-profit leaders, who have mastered legistative leadership, will be wooed away to lead for-profit businesses. Also, he says that the true difference is not between for-profit vs. non-profit, but good vs. great - regardless of organization type.

This monograph does stand on its own. However, I think you would have to be fairly familiar with the concepts in Good to Great to fully appreciate the value of this monograph.

Regardless, I would recommend this to every hospital leader. For $9-10, you really can't go wrong.

This week's Grand Rounds are up at Diabetes Mine, maybe the best patient blog on the web.

Next week, Grand Rounds will be right here at hospital impact! Please email submissions to me at tony[at]hospitalimpact[dot]org by Monday night 11:59 EST, October 24.

Archives of previous Grand Rounds can be found here on Blogborygmi. For a list of submission guidelines, click here.

For those that are new, Grand Rounds is the weekly wrap-up of the best entries in the medical/healthcare blogosphere. Check out a few in the archive and you'll see a little bit of everything: patient stories (funny and scary), healthcare policy musings, health trends, patient/physician relationship mishaps and heroics, and the works.

Consumer Reports and Health Improvement Institute have launched a beta site for comparing consumer health websites: healthratings.org

Two things I find particularly impressive:
(1) The site provides strengths AND weaknesses for each site. For example, for WebMD, weaknesses mentioned include: "busy with distracting advertising; poor visual representation of pages."
(2) The site attempts to objective rank each website along 9 dimensions (e.g.identity, ease of use, design, coverage, etc). Maybe I'm just a sucker for harvey ball graphics.

By the way, the only hospital to make the top 20 is Mayo Clinic.

Is there a day coming when such a site would exist for hospital websites?

If you haven't already, check out MedScape's blog - numerous nurses tell their front line stories in the aftermath of Katrina. Some memorable quotes:

"The looks on some of the faces of these people will probably haunt me for the rest of my life. I already see these people in my dreams. The cries of the residents (and even some of the staff) when they are told they have nothing left to go back to and that we do not know if their families have made it, are sometimes too much to handle."

"Not one person I spoke to had on their own clothes; they were grateful for the donations. It was overwhelming and for the most part seemed unbearable, but every time I looked up to take a deep breath, the outpouring of love and humanity I witnessed gave me strength to move on to the next cot, holding the next person."

"My [8-year-old] daughter provided much-needed assistance by running paperwork back and forth to order medications or to bring me supplies. I watched her facial expressions as she gently placed stickers on the patients signaling that they had been seen by the nurse, always making eye contact and always with a smile. I knew that her life was changed forever, for the better."

Also, check out the story of this 113-bed mobile hospital.

Book Review: Healing Words by Dr. Michael Woods
(4 of out 5)
An impassioned and thoughtful plea from a doctor to doctors to say "I'm Sorry"

Given all that has been recently reported on physicians saying "I'm sorry," this short, straightforward book couldn't have come at a better time. Dr. Michael Woods has written a practical, motivational book directed at physicians on the why's, how's, and what's of apologizing to patients. Drawing from personal experience, stories from other doctors, examples from other industries, and research data, Dr. Woods does not hold back in making an impassioned plea for physicians to master this tricky part of the patient-doctor relationship.

At ~82 pages, you can probably read this book in one or two sittings (In fact, I read most of it in the waiting room as I waited to see my doctor. Luckily he didn't have to apologize for anything that day). Dr. Woods moves quickly from topic to topic, breaking down just about every psychological, cultural, and emotional aspect of "I'm sorry" - why it's so difficult for physicians in particular to apologize, what a meaningful apology entails, what the patient is thinking/feeling in apology-worthy situations, how to build more authentic relationships with patients, and even what exact words you could say in difficult situations. He even advises to apologize for: "(1) being late for a scheduled appointment; (2) receiving a patient complaint about poor service from hospital or office staff; and (3) Interrupting a patient who is speaking - even if you must take an emergency call."

Overall, doctors should apologize appropriately (and probably more often)- it's the right thing to do, it's the compassionate thing to do, and if that's not enough, it might even prevent some lawsuits.

Definitely this is a book written by a doctor for doctors. For the admin readers, something to read and then pass along to your clinical leadership (and risk management dept).

I'm just sorry that I didn't read this book sooner.

AHA launched a new site Hospital Relief Efforts - other hospitals around the nation can use this site to offer up personnal and supplies. (Hat tip: MSSP Nexus)

I was quite excited this week when I was contacted by Andrew Barna, a hospital executive over in San Jose, CA. He just started a hospital-admin focused blog, called healthcare tomorrow. He's off to a great start with an entries on HSAs, what's right on healthcare, and (my personal favorite) the long-term potential impact of JCAHO.

Andrew - welcome to the hospital admin blogosphere! Look forward to more insights now that the JCAHOites have left the building.

As a continuation to a previous series on community benefit, I thought this was a very thoughtful piece from an unique Chicago-based organization.

The Metropolitan Chicago Healthcare Council put together this very well-done economic impact report (pdf highlights or pdf full report) of Chicago hospitals on the community. Among the highlights:
- 400,000 primary and 2ndary jobs
- $23.7B in personal income for residents
- Better (and more sustainable) jobs with an average salary of $63k (~$20k more that region's average)
- $1.8B in capital spending, creating significant construction employment
- ~3,000 new hospital jobs per year through 2020.
- Every $1 in hospital wages creates $1.42 in non-hospital wages
- Every 1 hospital job creates 1.54 non-hospital jobs.

AHIP's new website, HSAdecisions.org, just published a consumer's guide to healthcare spending accounts: "what you need to know about HSAs, HRAs, FSAs, and MSAs." I work in healthcare and I still need help with this! thank you, AHIP.

Also HSADecisions site was recent news: as of 3/2005, 1,000,000+ people were covered by HSA/HDHP products. This is double from six months ago. Get ready for some more explosive growth.

yeah, this one's random - the folks at IBN have developed an urine test that is powered by a drop of urine.

What fun it was to get a comment from Carol Kovac, IBM Healthcare's GM. She's started a new blog called LifeLines. Among her first posts are predictions that EHR: (1) will NOT evolve into smart cards; and (2) will ultimately be paid for by employers and payors.

As I mentioned in a previous post, IBM Healthcare has grown from 2 employees to 1,500 under Carol's leadership. I guess Carol has a knack for growing things as she is an avid gardener as well.

Here's a good article on how not to treat your patients. Too often, in people's greatest time of need and sensitivity, they are treated like a #, an object, and/or a nuisance. Here's a story of one patient that was fed up:

"After one doctor slipped into the room unannounced and tried to give him an injection, Mr. Edwards decided that he had had enough, said his father, James (Red) Edwards Sr., in an interview. His son posted a sign on the outside of his door. It read:

'ATTENTION:
1) Please announce yourself when you come into my room (let me know your name and why you are here).

2) Please let me know what you're going to do and how it will feel before you touch me for any reason.

Thanks - Jim and Red'

The hospital where he was treated, at the University of North Carolina in Chapel Hill, has included Mr. Edwards's sign in a training video for its staff."

Judging by the comments on Matthew Holt's recent posting on hospital price gouging, this isn't exactly a popular topic for the masses: how to increase hospital profits.

Yes, there is some price gouging (intentional and unintentional) going on out there. Yes, some hospitals are overly-aggressive with their collections practices. And yes, lots of hospitals still need to get together a coherent pricing policy (as well as a community benefit stance).

Nonetheless, hospitals also get the shaft thanks to patients who can pay but don't and government agencies that don't even pay to cover costs. To top it all off, many hospitals shoot themselves in the foot with poor medical information technology, wrong coding, poor management etc. It's these controllable revenue cycle factors that this HFMA white paper focuses on - worth a read.

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The California Nurses Association has launched a blog to stop Arnold's "corporate takeover."

Dr. Mike Woods has started a very interesting blog with an unique/unusual focus: physician personal leadership. Some memorable quotes from his first week in the blogosphere:

"Medicine is a good example of an entire profession failing to commit to the obvious. The profession is filled with bright people, yet many have an almost infinite capacity to ignore basic truths that limit the achievement of excellence."

"While tort reform is a worthy endeavor, the profession conveniently ignores the fact that 80% of all claims are related to ineffective physician communication and inappropriate behavior in the course of caring for a patient."

"I do what I do because I became aware of my personal failings after I quit- yes, quit- medicine. I had become disgusted with the profession and the way physicians behaved and treated other people, including their colleagues. And a funny thing happened."