Archive for November, 2009

Healing Hospitals: Get ready… Get set…

November 25th, 2009

One of Johnny Carson’s funniest ongoing “bits” (He was the guy who hosted The Tonight Show before Jay Leno) was that of Carnac the Magnificent.  Carnac was a psychic with a large elaborate turban and a plethora of envelopes, all of which were “hermetically sealed” and had been kept in “a mayonnaise jar on Funk and Wagnalls’ porch since noon” that day.  Johnny would hold each envelope up to his head and give the answer to the question that was sealed in the envelope.

Carnac’s answer: “Sis, boom, bah.”

The question: “What sound does a sheep make when it explodes?”

Well, here’s my version.

Carnac:  “The Baby Boomers will begin to speak more and more feverishly about their wants, likes, and dislikes relative to hospital care.”

The question would be: “What will eventually make you kiss your job good-bye?”

I’m sorry.  I know it wasn’t funny, but the point is that patient choice, patient transparency, patient dignity,  billing simplicity, and — most importantly — loving, nurturing patient care and improvements in every level of quality will become the demanded norm.  Remember, we Boomers have never been laid back.  Ours is a generation of demanding “I” driven professionals who have influenced the way blue jeans are made (i.e., to fit our pear-shaped butts).  We’ve invented levels of debt that were not even thought of before.  We have influenced drug use, stock market use; you name it.  What makes any of you think that you are out of the woods with us?

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It’s my further prediction that those hospitals that do not follow the path of creating healing hospitals will struggle and many may not survive.  We Boomers will contribute to more bankruptcies and closings than even the Balanced Budget Amendment.

We’ve been watching the hundreds of hospitals out there that are marching in lock step to the past re: patient care.  It’s like observing a physician who doesn’t even try to be nice to his patients.  A year or so into the practice, they come into the president’s office and say, “Why am I not making my financial goals?”   If things don’t become softer, more gentle, more humane, our patients will vote with their feet.

Oh, sure, you may have five or so years before the dominant players, the Boomers, take over, but, believe me when I tell you that the vast majority of businesses “on the financial bubble” right now are filled with employees who have either bad or no attitudes.  Those “It’s not my job” attitudes.

Now-closed Circuit City I have carefully observed organizations like Circuit City transition from model companies to bankrupt companies.  They changed their incentive methodologies for their employees, stopped listening to them, and stood back and watched as those same employees undermined their sales by saying things like, “I don’t care what you buy.  My check doesn’t change either way.”

Walk through your hospital, and take a good look at what is going on in each department.  Are your registration people friendly and kind?  Are they sensitive to the frail elderly, young, and frightened?  Are your techs polite, nurturing, caring?  Is the receptionist friendly on the phone, or do they throw everyone into voice mail hell?  How is your executive staff?  Are they parent-to-child leaders? Reality is what is happening; not what you think is happening.

Get yourself a secret shopper or two and let them work your system.  It can be a real eye opener, a  hard dose of reality.  Are your Press Ganey scores lower than a typical prison hospital?  Do your employee surveys reflect their love and respect for their fellow employees or for their job?  Are they proud to work at your facility?  Most importantly, would they recommend your hospital to their friends and families or would they recommend it as a place of employment for their peers?

If I haven’t captured your imagination yet, maybe you’re too hardened by the present.  I heard a PBS interview today where a Pakistani land owner said that when he tried to get his men to work together to carry larger quantities of dirt from one place to another, they refused and insisted that the bucket was the only way they had ever done it. They then told him that change is too dangerous.  Check your buckets.  Make sure they don’t end up empty.

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Thanksgiving and CHANGE…

November 21st, 2009

One of the sometimes-challenging realities of Thanksgiving is that it forces us to look into the microscope of our personal time here on earth and acknowledge the change that will always be a part of our humanity.  This week I received a phone call that should never have been necessary “in my lifetime.”  One of my former employees passed away. For those of you who have some knowledge of my past, you might scratch your head in confusion regarding my deep consternation and pain from the loss of one person, because there were literally thousands of employees with whom I have worked over the years. But, for the others of you who know me well, you will clearly understand.

When I became the president of my former hospital, the waves of change had touched on it shores only briefly as it had attempted to avoid being consumed by neighboring health systems.  Because of this challenge of competition, we were given the authority to “try some new things” to attempt to preserve the facility as a community hospital.  To say that the road ahead was laced with hazards would be a serious understatement, but we did  navigate those sometimes treacherous waters successfully.

Carolyn "Winnie" Horner (1961-2009)As my tenure began in this difficult environment, a few people stepped forward who “got it.”  Winnie Horner was one of those people.  She “got it” from our first presentation about our dreams and plans.  Winnie was literally one of a handful of people who was willing to put herself out there to help the hospital establish new dreams, new ideals, new goals, and new caring philosophies.

Because a concept seems easier to embrace if it can be identified with others, we became a Planetree Hospital, the third in the United States and the first in Pennsylvania.  It was our goal to become a Healing Hospital.  It helped to jump start us into a new world of compassionate, healing, loving care that literally gave new life to the organization and helped it to remain not only open but also to succeed in ways that could never have been imagined.

Winnie not only “got on board,” for a long time she became the engineer of that train.  Her passion, her kind ways, her belief in spirituality, her amazing  voice, and her commitment to change was always obvious and appreciated.  She was a leader, a champion, the Joan of Arc of this effort, and I loved her for this.

Unfortunately, she will not get to read this because, at 48 years of age, she died this week.  Unbeknownst to her, she had been working with pneumonia, but, like Winnie always did, she kept giving of herself.  Who would have ever thought that it would have had this ending, and her three beautiful children are now without their mom this Thanksgiving.

So today, I write to you, Winnie.  You were a very important part of the soul of Windber Medical Center, and your presence will always be felt, but your absence will be felt even more deeply.

For me, Thanksgiving has always been a time of change, starting at a very young age as grandparents, uncles, aunts, and parents passed on.  The empty chairs at the table were always indicative of our own mortality, and the loss of those we love, be it permanent or just because of the sometimes-messy circumstances that are a part of living,  is a reality that we all must deal with throughout our time here on Earth.

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It’s ironic that, as commercial as our country has become, the tradition of Thanksgiving has remained virtually untouched in the essence of its meaning.  If you are alone for Thanksgiving, or with a cast of dozens, take a moment to reflect upon your life and your gifts.  Understand that nothing is permanent, and that, like Winnie Horner, we all have a chance to make a difference in thousands of lives, a positive, forever difference.

This year, Winnie and her passionate partners were able to achieve something that has only happened a handful of times in the world.  Through their work, Windber became a Planetree Designated Hospital, a model of care in the Planetree philosophy, my final Windber dream.  Thank you, Winnie, and if any of you don’t believe that you can make a difference, a real difference, take a page out of “Winnie’s Book.”  She was one of the best.

Planetree banner

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Another Day, Another “A”

November 12th, 2009

Straight-A Report Card One of my many college roommates, Mark, graduated with a perfect, straight-A GPA.  In those days the grade point average indicating perfection was a 4.0.  He worked harder than anyone I had ever known, and hardly took even a few minute break from studying.  For all intents and purposes, he had virtually NO social life, and, except for the occasional pinochle game and a coke-and-pizza break between study sessions, Mark was 100 percent committed to perfection in his grades.  As he became more and more sure of himself over the years, he would walk into our apartment and yell out, “Another day, another A!” and mean just that.

One of the greatest challenges of my life has been finding those measuring sticks that quantify our accomplishments.  In fact, the quest to solve just that ongoing problem has caused me plenty of sleepless nights.  I know, for example, that the infrastructure established for our research institute was so singularly unique, so perfect, so incredible that it should  become an international model.  In fact, when the National Cancer Institute evaluated just one aspect of the  institute, they indicated that the tissue repository was “The Only Platinum Quality Tissue Repository in the United States.”

As my time away from the hospital and research institute quickly approaches twelve months, my passion for the accomplishments that we experienced there has become even more clear to me, but where is Judge Simon when you need him?  How do you grade them?  Worse yet, how does one convince his former peers that the design that grew out of the ideas that became the philosophy of our hospital should be treasured as a new way to achieve perfection on multiple levels? …Another Day.  Another A.

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Having an infection rate that never went above 1 percent; an extremely low length of stay (3.2 days); low readmission rates, low restraint rates, unbelievably low litigation rates that almost didn’t register on the charts at all.

If your CFO is reading this, simply add the following to each one of those accomplishments . . . $$$.  How does a small hospital in Western PA with one major health care plan produce a bottom line in excess of $2M?  More importantly, why wouldn’t every hospital administrator want to adopt these approaches?

So what’s the “secret sauce?” We did this by working endlessly to create a truly healing environment, not to be confused with simply doing our jobs well . . . that was a given. We all had to do our jobs well, AND create an environment that fostered a healing atmosphere.

People actually got a chance to begin the healing process.  By eliminating overhead paging, permitting loved ones to stay over with 24 hour visiting, as well as pet, aroma, music, and humor  therapies, integrative medicine, kindness, a commitment to nurturing, patient centered care and a total commitment to the creation of an optimal healing environment, we began to see outcomes that were previously thought to be literally unthinkable.

Another day.  Another A.

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Creating Functional Healing Hospitals

November 8th, 2009

Why Healing Hospitals?  Transparency.  Human Dignity.  Patient Advocacy. All of these represent a new way of administering health care in this country.  Our industrialized model of care in the mirror image of factory-like settings is no longer acceptable, viable, or an alternative.  We, as a country, as a society –as a culture, need to step up and do what is right.  Love, kindness, nurturing, and a commitment to patient advocacy are the correct ways to interact with our patients.

healing_mosaicMany organizations who embrace the various human dignity monikers such as Planetree and Eden Alternative do so for marketing clout, for positive press, or for hoped-for financial gains.  Upon meeting some of these leaders, transparency becomes a very recognizable trait because they themselves are transparent –and not in the good  sense.  Rather, they are transparently “takers” in an environment that is much better served by “givers.”

For a country that is so obsessed with standardized tests, our healthcare delivery scores are abysmal, astonishing, and asinine. Not unlike our appetite for Biggie fast food meals and Biggie drinks, our appetite for beautiful trappings without substance, for corporate jets, for the power of millions and in some cases billions of dollars in reserves has resulted in a dysfunctional health delivery system that looks at patients as widgets.

Nicholas D. Kristof - NYT photo Nicholas D. Kristof  NYT photo

Nicholas Kristof, New York Times Op-Ed columnist has written another compelling article about the  U.S. health system, in which he quotes the latest World Health Organization figures. (Download the .pdf file.) According to the WHO report, the United States ranks 37th in infant mortality (partly because of many premature births) and 34th in maternal mortality. A child in the U.S. is two-and-a-half times as likely to die by age 5 as in Singapore or Sweden, and an American woman is 11 times as likely to die in childbirth as a woman in Ireland. He then quoted another study, a recent report by the Robert Wood Johnson Foundation and the Urban Institute that looked at how well 19 developed countries succeeded in avoiding “preventable deaths,” such as those where a disease could be cured or forestalled. The U.S. ranked in last place. Dead last.

He did find one health statistic that is strikingly above average: life expectancy for Americans who have already reached the age of 65. At that point, they can expect to live longer than the average in industrialized countries. That’s because Americans above age 65 actually have universal health care coverage: Medicare, he writes. Suddenly, a diverse population with pockets of poverty is no longer such a drawback.

Learning how to convert your hospital to the standards of  Healing Hospitals is not rocket science.  It is, however, not without tough decisions, aggressive doses of nonconformity, a passion and commitment to patient advocacy, and a strong desire to improve infection, readmission, restraint, and mortality rates.  It can be done, but it takes guts, a break from the conventional, unconventional wisdom, and a willingness to do what is not only right …but also what is very, very smart.

WHO Report – Primary Health Care: Now More Than Ever

View more documents from Nick Jacobs.

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