Hospital Impact

Why robot empathy won't go far

I'm insulted and you should be too.

I knew when I read this FierceHealthcare blurb that there was a blog lurking. But right after I read it I had to leave my desk for a doctor's appointment. Well that appointment sealed the deal.

When you arrive at your 2 p.m. appointment and are not seen until 3 p.m. that is an insult.

When you fly a certain airline and their idea of offering a better experience is to charge you thirty bucks to "upgrade" to, get this, "Economy Plus" that is an insult. (Sorry, I do a lot of flying in my consulting!)

And then this: The featured hospital in the FH blurb announces it will lay off 140 employees by the end of October, despite ending the fiscal year nearly $37 million in the black. And then for salt in the wounds, the hospital has leased 19 robots to fulfill a range of tasks, from delivering medication and food to taking out trash.

"Hiring as many humans to make deliveries would have cost the hospital more than $1 million a year," said the vice-president of facilities and support services. Leasing the robots from Aethon costs $350,000 a year. And this is all part of the hospital's "Accelerating Continuous Excellence" program.

I don't know about you but I am sick of people putting pretty names on what essentially are cost cutting or revenue enhancement programs. People see through this stuff. And as a marketer I am embarrassed. Because many times the brand my colleagues promise is not the brand that is delivered. The programs above have little to do with your better experience or mine.

Healthcare is just as much about human relations, empathy, comfort as it is about clinical care. I am sure robots are more efficient and cost less but what is the ultimate cost to the patient? I know MY experience would be enhanced when the robot is "speaking politely with workers and patients."

Patient experience. Everyone's talking about it but few do anything about it. How do you enhance care with an unsympathetic robot? How do you enhance care when a patient in my doctor's office (an orthopedic practice) is in pain and need to be lying down in a room but is told the doctor is running behind and you have to wait in the seating area?

Maybe the staff should ask themselves--"Would I be insulted by this behavior?"--and let that guide their actions. And please stop couching these programs as the best thing since Mother Teresa. The public is more intelligent than that.

Look, maybe I am just irked from a few isolated examples. You tell me.

But I am reminded of a television show from my youth called "Lost in Space." And I am beginning to believe that healthcare providers are lost in space given how they act sometimes. The robot in that movie was constantly shouting "that does not compute" and "Danger Will Robinson." Maybe it was on to something.

Anthony Cirillo, FACHE, ABC, is president of Fast Forward Consulting, which specializes in experience management and strategic marketing for healthcare facilities.

How to prevent your competition from stealing your health IT staff

by Gwen Darling

As hospitals continue to focus on demonstrating "meaningful use," one thing has become clear: The hunt for experienced Healthcare IT professionals is on, and the competition is fierce.

Fortunately many excellent educational programs are in full swing, working to produce the workforce of tomorrow. But in the meantime, any hospital employee who has played an integral part in a successful EMR implementation is one hot commodity. And if that employee happens to be certified in one or more key vendors' software modules? That employee isn't just hot, but on fire.

If you're a supervisor in a hospital with clinicians and/or IT personnel who have already been through an EMR overhaul, you need to realize that your employees are soon going to be approached by recruiters who are coming to take them away, my friends, if they haven't attempted to already.

Whether it's by phone, email, or through one of many social media channels, your experienced employees will soon be answering the question, "Are you happy where you are, or would you like to consider a fantastic new opportunity?" How do you think they will respond?

Here's a novel idea: Ask them before your competition does!

Don't wait until a formal performance review to initiate this process. Start a dialogue now. Let your key team members know that you recognize them as valuable assets, and ask what you can do to keep them engaged.

More often than not, it's not just about the money. Candidates tell me they are interested in finding an environment that endorses a healthy work/life balance, that allows them to contribute in a meaningful way, and that recognizes and rewards their contributions.

If you're not meeting those needs, it's much better to uncover this fact and work to bridge the gaps now than wait for a competitor to sweep them off their feet. And trust me, they're already on their way.

Conversely, if you nodded in agreement at the results of a recent survey reporting that nearly half of hospital employees were "distanced from or discontented with their current work," hold on a moment.

Before you jump at the chance to walk away from it all and start anew (new culture, new co-workers, new challenges, new headaches), figure out what it would take to make you happy, and be the one to initiate a constructive dialogue with your supervisor.

Many hospitals have implemented some very innovative programs aimed at keeping employees engaged. Seattle Children's Hospital, for example, has an amazing employee commuting program in place. Programs such as this one not only keep existing employees happy; they also attract new ones. Double bonus! With an ongoing dialogue in place, and a little creativity, the possibilities are endless. So the question for you is: What employee retention programs do you enjoy or would you like to see considered?

Gwen Darling is the CEO of Healthcare IT Central, a career center for healthcare IT job seekers and employers. She's also the founder and editor of Healthcare IT Today, a blog about healthcare IT career development, and writes and blogs for Healthcare Informatics magazine. She can be reached at GwenDarling@HealthcareITCentral.com.

How to right size your purchasing and inventory practices when patient days drop

By John Cunningham

Colleagues across the country tell me that their patient volumes are soft which is driving their expenses out of line with expectations when adjusted for volume.

This is a growing issue as inpatient volumes continue to be flat or down for lower acuity patients while many hospitals are experiencing growth and stronger volumes in some of their more complex patient populations, who need implantable devices such as stents, pacemakers, and total joint replacements.

When the expense of high cost, complex volume is spread across a smaller base of adjusted patient days, the expenses are naturally inflated.

In times like these, supply chain executives and their teams have to be ever more diligent in helping end users right size their purchasing and inventory practices, and serve as a catalyst for improving these critical financial processes to ensure expenses are held in line or appropriately minimized.

Inventory in hospitals, outside of the central supply or storeroom, is largely unmanaged and can account for significant dollars on the balance sheet. The result is dollars that could otherwise be put to use in capital investments or accrue interest for the future are left on the shelf collecting dust.

Because the management of inventory in our high cost departments such as surgery, cardiac cath lab, and special/interventional radiology is often delegated to clinical staff, it is no wonder that there is disparity in utilization and inventory on hand. The same is true for ordering practices. Clinical staffs are primarily focused on the delivery of safe, quality care. Therefore the supply chain duties that they assume or demand for their own comfort and control are the last duties to get fulfilled and often are completed in haste at the end of the day/shift in order to "cover the unit" or in reaction to an event such as a stock-out.

Often clinical departments are not aware of the financial and operational implications of their ordering and inventory practices. For example, clinical departments will participate in "bulk/forward buying" to save on the line item cost but then expense the purchases in a single period rather than accrue them into future periods or account for the purchase as inventory or pre-paid.

Additionally, the ebb and flow of demand that results when inventory and ordering practices are inconsistent creates operational challenges for the suppliers fulfilling the order. Suppliers rely on standard and disciplined supply chain practices that include demand forecasting and thus are challenged when these spikes in demand occur.

To be of service, supply chain executives and their teams need to be more visible and helpful as ever. We must get out in the hospital/s and walk the inventory locations and procedure rooms with an eye for excess inventory, waste, and obsolescence. Discuss with our clinical department head colleagues the ordering practices of the unit and offering assistance and/or tools such as perpetual inventory technology, while underscoring the overarching need to reconcile purchases with use and charges (as appropriate).

There is an abundance of evidence that supports supply chain executives having oversight and accountability for the inventory and purchasing of all departments in the hospital.

To assign the responsibility to the clinical staff is much like a restaurant deciding that the mission critical role of the kitchen warrants the chef doing all the shopping and stocking of ingredients.

You might laugh but in reality it is what we in healthcare have done by bypassing the supply chain expertise of the company in deference to the sacred "red line."

Better performing supply chain departments as measured by expense management,inventory practices, standardization, customer satisfaction and contract management do not stop at the "red line" but in fact partner with the clinical departments with a shared sense of purpose and genuine interest in delivering results that are at a standard as equal to the quality of the care provided by the clinical department.

Supply chain is the fuel within the monstrous hospital ship and the supply chain team has to step up and cross the "red line" to ensure the basic principles of supply chain management are deployed and add value to the organization's bottom line. Volume, case mix, and reimbursement are well beyond the supply chain executive's scope but leadership in deploying supply chain best practices during these difficult times is an imperative and basic expectation.

John Cunningham is VP, acute division, supply chain operations at Universal Health Services, Inc. He has extensive experience turning around and leading hospital supply chain operations in some of the nation's leading academic medical centers and large integrated delivery networks. In addition to his current position with UHS, John is also a member of the adjunct faculty in the Drexel University School of Nursing and Health Professions and served in the United States Navy.

A push for patient-specific preventive medicine to fight obesity

by Thomas Dahlborg

It's no secret that Americans are getting fatter and that more Americans can expect to get sick and die from obesity-related complications, such as heart disease, stroke, and diabetes.

But while it is great news that people are universally acknowledging that obesity is a huge health issue, the current healthcare system does not position physicians (and other practitioners) to best leverage their skills, wisdom, heart and energy to help individual patients understand and address the root causes of their obesity.

In an editorial in the journal American Family Physician, Dr. George A. Bray of the Pennington Biomedical Research Center in Baton Rouge, La., says physicians should teach their patients who need to lose weight about caloric restriction, meal replacements, and pharmaceuticals.

Is it any surprise that most past and current efforts and investments to prevent and control obesity have been inadequate? Just take a look at how our workstyle limits our ability to give our patients the best care possible:

*A typical family physician does not have time to truly develop a relationship, trust and understanding with each patient, because he is required to meet specific productivity (e.g., 30 relative value units) requirements per day.

*A typical family physician does not have the time to truly assess and understand an individual patient's situation and drivers of obesity, because he is triple booked every 15 minutes.

*Fragmentation of the U.S. healthcare "system" means behavioral health is typically "turfed" or tossed aside, rather than becoming part of the patient's entire story. Yet how can a comprehensive solution be based on only a small component of the full patient's story?

Could the U.S. philosophy toward preventive care and funding also be holding us back? Wisegeek.com notes that in contrast to Eastern medicine, many doctors in the West do not practice individual preventive medicine. One reason: Insurance companies regard it as too pricey and time consuming.

How can we begin to adapt and change the entire health system to truly make a positive impact in our fight against obesity?

We could start by addressing some of the critical aspects of healing required to bring about positive change. Reimbursement should be tied extensively to health outcomes (not productivity and not only via small pay-for-performance payments that do not significantly influence physician behavior).

Time, relationship, trust, root-cause analysis in healing; cutting-edge chronic disease management; integration of physical, mental, emotional, spiritual, environmental, financial, and other aspects of an individual's life should be understood and incorporated as part of co-created healing solution plans.

We should insist on unbiased evidenced-based and patient-specific treatments, and access to this type of care should be available to all while we also ensure each patient's dignity and self esteem is maintained.

We can't wait for the system to catch up to preventive medicine's call to action. With more hospitals owning physician practices, the time is at hand for hospital and physician leaders along with other key stakeholders to collaborate, adapt and spur the change we need to address this obesity challenge. Let's get moving.

Thomas H. Dahlborg, M.S.M., is executive director of the physician practice True North Health Center, where he focuses on improving growth while ensuring access for the uninsured and the elderly. He has 21 years of experience creating competitive advantages, analyzing customer expectations, and developing and implementing focused and aligned strategic deployment plans. Formerly he served as the chief business strategy officer at Network Health, a comprehensive Medicaid health plan based in Cambridge, Mass.; and was COO of the U.S. Family Health Plan at Martin's Point Health Care in Portland, Maine.

Is your back office on the back burner?

Back-office automation and process improvements have rarely been a high priority for U.S. hospitals, writes Jim McDowell, senior director for healthcare insight and industry strategy at Oracle Corp. in Phoenix.

Over the past dozen years alone, hospitals and integrated delivery networks (IDNs) have focused on everything from the Y2K problem to primary medical records system overhauls, and now the push for health information exchanges and meaningful use threatens to keep back-office systems squarely on the back burner. FierceHealthFinance