Tony, thanks for opening this topic.

I would love to start a topic area called RETHINKING HOSPITALS- The shape and substance of social networking in medicine.

Since social networking is an area of my expertise and key to building health communities, I think it is very important to begin to think about this in the context of the architectural structure of a hospital.

Last year, I taught a course through Boston Architectural Center to 50 experience Architects. 6 of the spoke up as architects specializing in health care and I on my feet designed an experiential exercise/case study for health care. This exercise was exceptionally valuable both to the architects and me (who has years of health care systems background, HIT, and patient delivery in roles focused in health care systems, finance, clinical unit management, pay for performance and professional development and program management that factors in changes in technology and culture.

If anyone here is interested in looking at this method of integral methodology, I would be happy to author a few pieces of thought as a guest blogger to launch this kind of thinking and conversation over the next 6-12 months. Life does manage to happen separate from visiting this wonderful blog and reading.

I may be able to get Max Goldman or thers from www.SucessFactors.com to visit here for conversation on the pay for performance aspects of this as well. Success Factors is very unusual from other HRM Systems companies, in that Lars Dalgaard, CEO was a career BioPharm person prior to joining SF and their entire system has been adopted for hospitals to integrate with JCAHO regulation.

Creating culture and change in hospitals does have to build a thought and practice leadership with respect to pay for performance, professional development and budget management. I am certain Nick Jacobs thinks a lot about this one as well.

Cheers,
Lavinia

what a great idea - "rethinking hospitals." I also like the notion of leveraging hospital architecture/design to create more productive social networks/workflows and more patient-centric care.

Tony,

What about retail medicine? We're moving beyond massage therapy and chiropractors into private pay only advanced imaging centers for pregnant mothers and telemonitoring systems for our elderly. It has come to a point where the "haves" are beginning to splurge on health care "extras" and hospitals may be at a disadvantage if they do not also consider entering this market.

hmmm... the have-a-lot's and have-not's... the gap is widening every day.

What is interesting here is no one has yet commented on the perspective of what hospitals are today and where we need to reexamine them in the context of CULTURE AND CHANGE.

www.strategy-business.com regularly features an examinaton of thought leadership and practice leadership in the context of culture and change.
Real focus on the types of change that can occur in health care include numerous intelligent stories at the www.bah.com website which has a section dedicated to heatlh care. I recommend this site for any health care leader to examine change by community (relevant focus, e.g. AIDS./HIV) or from the perspective of specific industries within health care, e.g. BioPharm, Hospitals, Government or from the perspective of the payor systems.

Years ago, it's editor, Art Kleiner, authored a book called the AGE of HERETIC. In this book, Art tracked the story of the development of the field of change and how it often took a Court Jestor, e.g. a heretic to inspire and lead change.

Art is a remarkable thought leader in his own right and helped me launch WorkEcology as a community of practice. This grew from the dialogue that I launched wanting to examine how change can be a strategy that is actually invested in, whether by VC or Philanthropists. I truly believe that the culture of health care (hospitals specifically) cannot change if we do not organize ourselves into community of multiple expert leaders and that one heretic cannot lead the kind of change that is needed now from an institutional (only) basis. Carly Fiorina's failure at HP is a good exampe of why change cannot simply come from the one expectation that one person can do it all.

I think health care over all and hospitals is at a new frontier of culture and change and ready for a new formation of investment strategy that is not about leading as a heretic.

Alot of what has been suggested here is reads like starting a new business with roi for a specific product rather than outcomes.

This past week, I received announcements on the Heinz Awards. Two remarkable men received awards that reflect changing culture.

1. Human Condition: William Thomas, M.D., for impacting the human condition, physician and founder and director of the Eden Alternative from Sherburne, New York

2. Chairman’s Medal: Elma Holder, founder, National Citizens’ Coalition for Nursing Home Reform for leading a change in culture that goes back to 1986, when the abuse and impact of elder conditions in nursing homes began to become more commonly known by the public.

While Bill and Elma are individuals, what is unique to both of them is how they lead change and how they empowered change through a community in a form of energy that was more pull than typical of the archetype of the heroic leader. These type of leaders learn to live with the pain of leading and not be swept away by the difficulty or hurdles by destroying their own health or living a life without balance. These leaders----share their heart at work and take care of their heart by forming communities and letting other leaders step out to really make a difference and own their portion of the change initiative. They gain the respect of a few walking and working quietly and then the "big bank" grows out of thoughtful dialouge that builds trust and forms a social network across many organizaitons, institutions and sectors to make a difference and build lasting social impact.

I think it is important as we talk about hospitals we begin to think about what outcomes we want to create in health and what the hospital's role is in that and how a group of people managing a hospital can impact that.

Nick Jacobs leads in this way. I took a great chuckle in talking to Nick person to person about how the hospital in which he leads change reduced its infection rate to less than 1% and how people still wanted to complain and find problems rather than focus on learning how this outcome grew, out of what actions and conversations and how it has benefitted more importantly the patients who come to this hospital for care.

I think in this era of health care where we continue to talk about the difficult nature of health care as a beast, it is time to cultivate new conversations built around thought leadership, practice and impact.

As Don Berwick wrote in his book, speak to any health care executive, physician or leader who has had a bad hospital experience or experience with health care in general and you will find yourself a change agent.

I think the question now is how can we awaken our hearts in balance with sound financial practices, (investment and maintenance) to lead for change and what could be the role of Philanthropy with the projected $41 (+) Trillion of available philanthropy investment available to impact this change rather than struggle with bottom line issues that gain the focus of time and attention and dominate our day and can only reenforce a struggle rather than lead a change.

What are the tools of stopping the struggle and leading change?

I'm so happy to read this post because it has identified the most important aspects of hospitals that are neglected usually. Especially the miracles and stories of motivation that should be written and ciculated. Quantum healing is a major discovery in the world of healing and medicines and more research needs to be done on it.

patient is the most important person in the hospital