by Nick Jacobs

The book, Change or Die by Alan Deutschman, tells a story of three very different situations that prove that the title can, but rarely does happen. The author quotes the fact that, although we may be faced with the alternative of changing or dying, we are plagued with the reality that only about 10% of us are truly ever able to personally make that change. Mr. Deutschman takes us through three examples of an organization, a leader, and a physician who have helped hundreds of us beat those odds: Heart Patients, Criminals and Workers.

He examines the patients of Dr. Dean Ornish's Coronary Artery Disease Reversal Program (which has been in place at Windber Medical Center since 1999), the criminals who are participating in an effort to rehabilitate themselves under the guiding principles established by Dr. Mimi Silbert at Delancey Street in San Francisco, and the members of the United Auto Workers who were employed at a GMC plant at Fremont that was so hopeless mired in its own controversy that it was closed by GM. It was later re-opened by Toyota as a successful manufacturing plant equipped with the same basic tools and machines and 50% fewer employees, but the vast majority of them were exactly the same union employees who worked in that same failed factory for GM.

It's an interesting journey into human nature, the circle of failure and hopelessness, and the promise of hope that has always been a part of achievement and growth, of success and positive persistence, of debunking old myths and replacing them with empowerment. He embraces the three keys of relate, repeat and re frame to help us make positive changes in our lives.

If, like me, you are a little overweight, have high blood pressure, high cholesterol, a lousy set of genes and are a mouse potato (sit around too much with your computer), you might want to read this book and then, like the journey that I began in 1997 under Dr. Ornish's direction either "Change or DIE."

by Nick Jacobs

Demming, Crosby, Baldrige, 6 Sigma . . .

In the past twenty years, my bosses have exposed me to plenty of systems intended to improve quality and patient care: Demming, Crosby, 6 Sigma. My depth of knowledge regarding the Malcolm Baldrige Award program, however, rose to dramatic new heights this week while attending the kick-off session of the Journey to Baldridge.

For those of you who are not too familiar with this program, it was started in 1989 during the last year of President Ronald Reagan's presidency as a symbolic endorsement of producing quality corporations in the United States to compete with Japan.

Malcolm Baldridge was Reagan's Secretary of Commerce, and was a great believer in quality. The award was named in his honor after his untimely death in a rodeo accident.

The Baldridge is the highest award you can receive in this nation for business excellence, and only about 62 companies have received this prestigious recognition since its beginning. The award comes from the U.S. Commerce Department and NIST, U.S. National Quality Institute of Standards and Technology. The actual award is given by the President of the United States and examines leadership, strategic planning, customer and market focus, measurement, analysis and knowledge management, human resources focus, process management and business results.

The program is not about winning the award, but as the presenter stated, "It is about deserving to win."

As an outside observer, it seems to me that the program embraces the old idea that "what you focus on is what gets accomplished."

So, take a look at the Baldrige program.

It's not the quest to meet minimum standards like the Joint Commission on Hospital Accreditation. Baldrige is the quest to actually "Be the BEST."

For the record, this was not a paid political announcement for Baldrige. We just thought that, if you weren't real familiar with the program, you might just like to know.

By: Craig Allan Ahrens
The Business of Healthcare
A talk show and discussion forum dedicated to the strategic issues impacting the business of healthcare

It is like "Back to the Future" all over again...by the way who said that quote because I have been using that a lot lately. Anyway, physician employment is getting really, really hot again as a strategy for health systems. It is interesting because many of the lemmings that jumped into employment in the 90s jumped back out. However, for the lemmings that I know who didn't leap off the mountain after taking the first plunge, some have gotten very good at managing the employment of physicians. What is even more interesting is that the organizations that I am aware of who have pulled physician employment off well have for the most part solidified their strategic positions in their respective markets. Well, if you employ your distribution channel and run it effectively, then it is pretty hard to crack. Right?

Believe me I am not waving the flag of employment for everyone. More than most, I am intimately aware that each market has its individual quirks. The competitive pressures that led to physician employment by hospitals are different today than in the 90s. Back in the good old 90s, everyone thought managed care was coming and the chickens listened to chicken little and started the massive primary care employment trend. The providers that did a good job of managing those physicians have realized advantages against today's competitive pressures that many did not anticipate years ago.

Today, the competitive pressure are not a "coming soon" fear like in the 90s; rather they are a reality forcing systems to strongly pursue employment. Some examples include:

1. Declining physician reimbursement by the government.
2. Increased outpatient competition by physicians.
3. High cost of malpractice insurance.
4. Physicians' desire to "have a life".
5. Severe shortages in key specialties.

I'm sure there are a multitude of other reasons and I look forward to your thoughts. Maybe hospitals should start putting a line item in their financials called physician capital expense?

By the way, look for the next podcast on the "The Business of Healthcare" website or on the Itunes store under the Business of Healthcare. Our guest will be Parveen Chand, who is a facilities and business development planning executive for BJC Health System's Barnes Jewish St. Peter's hospital in St. Louis, Missouri. We will be discussing their innovative approach to facilities planning and budgeting. It should be uploaded by Wednesday October 11th, 2006.

If any of you have any ideas, people, or topics that you think that would be interesting for the "The Business of Healthcare" podcast, please email me at info@thebusinessofhealthcare.com.

Thank you.

If you have Itunes on your computer, click here
If you don't have Itunes, go straight to "The Business of Healthcare" blog

Most recent podcasts:

Show 7: Roundtable Discussion with Three Healthcare Leaders: Strategic Issues - A Midwest, East Coast and West Coast Perspective
Show 6: Service Line Success and the Strategic Impact of the Rebasing of DRGs
Show 5: Orthopedic Service Line Planning
Show 4: Neurosciences Planning for Healthcare Institutions
Show 3: Human Resources as the Critical Hospital Strategic Partner?
Show 2:Patient Satisfaction and Customer Service as a Hospital's Strategic Priority
Show 1: Surviving and Thriving as an Independent Hospital in a Competitive Market

Mr. Ahrens is a healthcare strategy consultant at ECG Healthcare's Midwest office with expertise in general hospital strategic planning, operational turn-arounds, physician business development, and service line planning. You can reach him at info@thebusinessofhealthcare.com.

by Nick Jacobs

"The feasibility study would probably not result in the quantitative answers necessary to achieve the goal . . . but then no feasibility study ever has for me."

That is what I said about our most recent project, and every project, personal or business, with which I have been involved during the past 30 years.

Feasibility studies and business plans are works of logic. They are carefully weighted business analysis tools that are typically void of passion, imagination, intuition, drive and EGO.

So, when you need the project to fly only because it is viable from a business prospective, it will be conservative. It will be cautious. It will be smaller, and, for the most part, it will be modestly successful. To quote Tom Peters, "one mediocre success after another. Incrementalism ad nauseam, JAMS, Just Another Mediocre Success."

When it comes to Big Hairy Audacious Goals, when it is far reaching, when it is a total stretch, and when that stretch is compounded with passion, ego, determination, or a desire to save mankind, then the feasibility study becomes MOOT, or, in our case, unessential.

That is MY BELIEF. People want to be associated with winners. People love imagination, passion, personality, and dreams. People love to be excited by excitement. It is the leader's job to provide the vision and to inspire the stakeholders with our passion. It is our job to attract them to become part of a memorable goal that is meaningful, sincere and intense.

Sometimes, it means getting out ahead of your headlights . . . which makes the trip even more interesting.

We will succeed because they will be touched by that spirit, moved by that vision and attracted by our sincerity . . . not because we did a feasibility study or have a business plan.

The bottom line? A quote from Donald Trump, "We all have instincts. The important thing is to know how to use them. You may have superb academic credentials, but if you don't use your instincts you might have a hard time getting to and staying at the top."

If you look at windbercare.com or wriwindber.org, you will see pages of projects that had no business plans, a thoughtful beginning and hopefully, no end. And a final quote and peak into my own personal belief system, "The goal must be for all the right reasons."

by Nick Jacobs

What's happening in U.S. hospitals?

HFO, hold for observation is a term that strikes fear into the heart of any good hospital chief financial officer. Simply put, it's an insurance company phrase that means "do everything that you can for the patient." We (the insurance company) will wait for up to three days to see if anything is really going on with the medical diagnosis, you (the hospital) can threat the patient exactly the same as any other inpatient, and we (the insurance company) will pay you only for the outpatient tests."

Last year, clearly 50% of our inpatient census fell into this HFO status. This decision support tool for the insurance company literally strips millions of dollars from the bottom line of the hospital, and the insurance company can reward their stock holders or stake holders accordingly.

Another trend that seems to be growing exponentially is the emergency departments' philosophy of "treat em and street em." Get the patient in, stabilize them, treat them, and send them back out the door. Once again, at our facility, a 40% increase in Emergency Department visits and a decline in overall admissions to the hospital?

Finally, in the last ten years, the newer drugs have resulted in significant improvements to overall patient health and stability which has also contributed to, not unlike what has occurred in pediatrics, less admissions to the hospital.

If any of you are still following this line of thought, it means that primary acute care hospitals could see less and less inpatients on a daily basis. Is this good or bad?

Probably this same blog could have been about fossil fuels and the decline in the use of gasoline engines. To which your response might also be, good.

Consequently, the topic should really be "Who Moved My Cheese?" The cheese is moving. Maybe not in all of our hospitals, but it's moving, and we, collectively need to understand that the paradigm is shifting, the flow is being altered, and the current system, not unlike the Industrial Era, is coming to an end.

So, move on to the new model. or better still, help INVENT IT.