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.

vs.

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."

In light of the recent discussion on hospital pricing, I thought this roundtable discussion on pricing (PDF) from HFMA was a helpful tool.

Two hospital CFOs, some consultants, and a lawyer talk it up. Among some of the interesting take-aways:
- Even the words "strategic pricing" has a negative connotation. Sounds like "pricing to make a lot of money." One participant preferred using "price transformation."
- To prevent backlash, set up an agreed set of criteria for pricing changes. Use these criteria consistently for all pricing decisions.
- Pricing is not just a "finance" issue.
- Good pricing starts with good tools: a clean chargemaster and a good market intelligence tool.
- No pricing policy is complete without a thoughtful charity care policy.

While we're at it, check out HFMA's White Paper (sponsored by 3M) of Strategic Price Setting (PDF, June 2004), where you'll find 11 pricing pitfalls to watch out for.

Book Review: If Disney Ran Your Hospital, by Fred Lee (5 out of 5)
This book is the "Space Mountain" of hospital management books

Many of you have been following my 8-part series on Fred Lee's book, If Disney Ran Your Hospital.

(adapted from the review I wrote on amazon.com)
Like many Disney rides, you have to wait a bit to get this book on amazon (I purchased mine directly from the publisher). But it's worth the wait. I attended the ACHE Conference in 3/2005 where the book was named the "2005 Book of the Year."

Fred Lee has written a fantastic book in "If Disney Ran Your Hospital." Not only is it a well-written book (Lee uses memorable examples, stories, and graphs to illustrate his points), but also he has chosen an outstanding topic. We need more books like this - learning from the best from other industries. Lee effectively builds the bridge, taking Disney corporate realities and turning them into approaches and strategies that hospital leaders can easily digest and apply in their hospitals.

Some of the concepts definitely stretch my current mindset on customer service (and after reading the book, you might even stop using that term). Lee talks about why perceptions are more important than reality, patient loyalty is more important than satisfaction, courtesy is more important than efficiency, and experience is more important than service. He also spends some time addressing the shortfalls of patient satisfaction surveys and competitive incentives for employees. All for the sake of his true focus of the book: to "bring out the best behaviors in workers and provide the best emotional experience for patients."

For those that are experts in services marketing or world-class hotel corporate culture, some of the concepts will be old news. Nonetheless, the way Lee specifically applies these concepts to the hospital setting is truly magical and novel.

Check out the Grand Rounds posting on Dr. Tony's blog. For the blogging newbies, this is kind of the "week in review" for the medical/hospital blogging community.

For those coming in from Dr. Tony's, welcome! Find out more about hospital impact.

(if only grand rounds could be held here instead of our hospital conference rooms)

also worthy of note today:

on hospitals
- this USATODAY article on hospital charity care lawsuits. The suits are being dismissed in federal courts, which is another way of saying "big legal showdown coming to a state courthouse near you."
- $13MM extra for 61 Indiana hospitals from BCBS pay-for-performance program
- Triad Hospitals performance beat estimates. Plus, smoother sailing ahead.

on blogs
- A Non-Stop Celebrity Megablog is born?
- Businessweek started a blog about blogs.

Thanks to Matthew Holt for linking to Ezra Klein's new series on how healthcare systems in other countries work. Too often, we compare our system to other countries without even having the slightest about what those systems are really like. I'm looking forward to Klein's lowdown. So far, he's already covered England and France.

Kevin MD has put up 13 postings in 48 hours on everything from obesity to patient compliance.

Also, check out Girl Scientist's grand rounds (highlights of medical blogs from the last week or so).

MedPundit also discovered a new way to make money blogging. One particularly proficient blogger, Darren Barefoot, offered up his blogging services on ebay and got 9 bids, with the winning bid at $2,000. The winning bidder? Check out the Cincinnati Healthcare News blog.

Since I've been covering the book "If Disney Ran Your Hospital" in the leadership blog, I thought I'd just bring up the fact that this blogger got kicked out of Disney for providing unofficial tours.

And while we're talking blogging, I couldn't resist this article about why celebrities blog. Not in the mood to face the harsh realities of hospital management today? Do some productive procrastination at these blogs...

Bruce Willis, David Duchovny, Pat Sajak, and Rosie O'Donnell blogging away.

Book Review: Winning by Jack Welch (4 out of 5)
this time Welch nails it

Many of you have been following my leadership series from Welch's new book, based on the Newsweek excerpt. Turns out the rest of the book is just as good as the excerpt on leadership that I covered in depth.

It appears that (after a couple of misfires) Jack Welch has finally written a book to match his legend. It probably also helps that his new wife Suzy (and co-author), a former editor at HBR, knows a thing or two about writing. No matter what you think of either Welch (to put it mildly, they're controversial), this book is worth the price of admission.

Put "Winning" on the top shelf next to "Good to Great" and "Built to Last." In fact, Welch's "Winning" is the perfect complement to Jim Collins' two-some. Collins' work is dramatically research-based, Welch's is utterly life-based. In particular, I enjoyed his 8 leadership principles that balance soft skills (communicating vision, building trust, motivating others) and character attributes (making the tough call, being positive, being nurturing to the core). I also enjoyed how Welch answers his critics on the infamous 20-70-10 rule and his hiring frameworks.

One strength of "Winning" is in the breadth of topics covered - both in the realm of organizational leadership as well as career development. Lots of books do one well, but Welch manages to excel in both without being superficial or glossying-over (though most other books aren't 350+ pages!).

Make no mistake about it - the ideas presented are not new. For example, two of Welch's leadership principles: "exude positive energy" and "push and probe with a curiousity that borders on skepticism" sound a lot like Collins' "confront the brutal facts, yet never lose faith" principle. But it's Welch's down-to-earth writing style that helps you understand these timeless principles in a fresh way. As you're reading, you can almost picture him speaking the words in some business school auditorium or some Fortune 100 management retreat. The words are deceptively simplistic, but it's Welch's wisdom at its best - boiled down to the very essence from four decades of rough-and-tumble managerial experience.

Book Review: Hardwiring Excellence by Quint Studer(5 out of 5)
Clear, Inspirational, and Thought-Provoking

Quint Studer ain't your ordinary hospital consultant. In fact, he probably wouldn't call himself a consultant at all; he's a "Fire Starter" and a "Coach." From a high school GPA of 1.3 to Special Ed teacher to hospital President to Founder of the Studer Group, this man has a genuine passion to make a difference in healthcare and on society. In his first COO role at Holy Cross Hospital, he took his hospital's patient sat scores from 5% to 94% in one year. At his first Administrator position in Baptist Hospital, he decreased employee turnover from 30% to 12% and also founded the Baptist Leadership Institute. It's hard to argue with results like that.

The basis of his book and his work is this flywheel:

which is essentially a much more thoughtful way of saying "success breeds success." Start with passion - a passion for what you do, a passion for making people's lives better (lots of folks take this step for granted). Then implement their 9 principles (the book dedicates one chapter for each principle). And these principles lead to results in the most important areas - the pillars: people, service, quality, finance, and growth (can anyone say "balanced scorecard?"). This in turn leads to more passion, and momentum starts kickin' in. And all of this is founded on the fact that when people are given a worthwhile purpose, watch out what they can do.

In my view, this book is well-balanced between motivation and practical to-do's. In fact, I think the magic of this book is how well Quint covers both issues: the heart (the emotions/psychology, human nature) and the mind (hard-nosed focus on hard-core results). I think most hospital leaders could pick up this book and actually put some or all of the principles into practice, even in difficult working environments. And that is exactly Quint's intent.

Okay, I'll give you some clues:
- 554 beds
- 2,000+ employees
- 850,000 patients per year
- Patients come from 150+ countries
- JCAHO accredited in 2002
- Patient volumes up 23% in 2004
- 16% profit margin in 2003
- $112MM in profit in 2003

Allow me to introduce to you Bumrungrad Hospital in Bangkok, Thailand

Okay, maybe they aren't the BEST, per se, but...

Not only do they have a world-renown heart center...

Americans, Europeans, and Australians alike are flocking to their plastic surgery center because it's the same quality at a better price.

(smart branding move: check out their website - they are creating a distinct brand just for plastic surgery center to cater to the different market segment)

Is healthcare becoming a global marketplace? Will a well-off couple take a flight to Thailand for a nip, a tuck, some curry noodles, and some sun? According to McKinsey, "Medical tourism" will hit $2B in 2012. Of course, acute care is not on the chopping block for obvious reasons, but elective surgery and check-ups? It's already happening.

Check out Bumrungrad pricing and promotions (exchange rate: $1 to 40 bahts). You can get a comprehensive check-up for ~$60.

By the way, Bumrungrad is expanding into the Phillipines, Malaysia, and maybe even China. They just shelled out $9.2MM for a 40% stake in Asian Hospital in Manila.

Gotta give props to those who have gone before me. There ain't too many hospital-related blogs out there, but check these out.

Matthew Holt - maybe one of the "grandfathers" of healthcare blogs as he started his blog 18 months ago (that's 18 years in blog-years). healthcare, pharma, managed care news and observations, updated almost every workday.

Joe Paduda - "Managed Care Matters" for news, observations, and insights into anything managed care, updated almost every workday.

Healthcare Renewal - a team of academics tackle the dyfunctionalities of healthcare, updated daily (sometimes more than once!)

Clinical IT - Healthcare IT may be more important than ever. updated several times a month.

Telemedicine - overcoming distance in healthcare, another take on healthcare IT written by seasoned healthcare practitioners. updated several times a month.

Healthcare Blogs - an eclectic aggregation of 100+ blogs in the healthcare world - students, pharmacists, house staff, MDs, etc.