The structure of the not-for-profit arm of this project and the strategic direction of this new 501(c)3 corporation will be the Southwest Florida Global Research Institute.

The initial primary services outlined in this plan are to outfit and set up a tissue repository. From this hub, numerous spokes will emanate that will include opportunities for faculty-student involvement from the Florida Gulf Coast University and other Florida universities, as well as research opportunities for organizations that will eventually feed other related organizations such as an incubator and an accelerator.

It is our intent to focus on the various ideas, concepts, and programs that have been embraced by the leadership of all of the local organizations with whom we have interacted during this effort to include health systems, universities, the private and public pharmaceutical and research communities, environmental science, public health officials and political leaders.

In the financial summary of a business plan, it is evident that the revenue from programs, grants contributions, sponsorships and subsidies must initially be the fiscal drivers behind all of the suggested work at SFGRI with a clear goal of having financial streams in place by year four of the operation to allow the organization to not only survive but also to thrive. With all relevant guidelines, requirements, restrictions, and recommendations in mind, let us begin with an analysis of each suggested area of concentration.

The Southwest Florida Global Research Institute tissue repository is a key to growth for both research and biotech efforts in the region. Physician, faculty, staff and community involvement will all determine the degree of success that will ultimately emanate from this key research component, but the ultimate determinant for the success of this repository will come from professional guidance and initial oversight provided through the Clinical Breast Care Project’s Windber Research Institute Tissue Repository.

It is imperative that this program carries the most immediate gain for the overall success and future of the institute. The very essence of this initiative revolves around not only equipment and space, but also quality tissue derived through comprehensive protocols. In time, this effort could lead to an ongoing stream of funding that will help to meet the myriad fiscal needs of the other aspects of this project.

Equipment for setting up this program is relatively inexpensive, but expertise and recommendations for the actual business model are not and it is our recommendation that these efforts should be led through a consulting assignment with the Clinical Breast Care Project’s Windber Research Institute. In order to activate a comprehensive program such as this, highly skilled PhD’s and techs will be needed. Having contributed to the design of the numerous other programs and centers, we would recommend the researchers and employees at the Windber Research Institute as consultants to assist in this effort.  Under their direction, they have successfully put together and managed a similar program that has been identified by the National Cancer Institute as the only platinum quality tissue repository in the United States. They also have world-class experience in data management for the control of the tissue, as well as expertise in accounting, staffing, billing, and management systems that allow for the comprehensive management of the collected tissue.

The timeline for this program can be relatively immediate, but the overall effort must be seen as neutral and independent from all of the participating organizations. This tissue repository will contribute to biotech research which will enrich physician recruitment opportunities, for profit biotech spin-offs and training experiences for students in the schools of arts and science, business and public health at the local universities.`

In summary, the Southwest Florida Global Research Institute will be the centerpiece for what will become the vision of this region; care for aging, preventative medicine, auto-immune and diseases of the brain while spinning off companies to address all of these maladies and meeting these challenges. It will become part of a world-wide effort based in Southwest Florida with a singular goal —  to improve the health of humanity on many different levels.  That will be the mission of the Southwest Florida Global Research Institute.

Learn more:

• Clinical Breast Care program (Walter Reed Army Medical Center): CBCP.info
• Enterprise Florida on YouTube: Life Sciences Channel
• Florida Gulf Coast University: FGCU.edu
• Southwest Florida Economic Development Partnership:  ABrighterPlace.com – life-sciences
• Windber Research Institute: WRIWindber.org | Recent news: Windber Research Institute Adding Freezers to Tissue Bank

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Not everything that can be counted counts, and not everything that counts can be counted.
—Albert Einstein

At a recent conference I had the opportunity to learn about the Himalayan nation of Bhutan. Most of us had not heard of this country, but we should have, because they have done something that is reminiscent of the Broadway Musical “Camelot,” or possibly “Brigadoon.” Their King introduced a philosophy of living that is intended to shape all of the government’s activities. According to Mr. Kuenga Tshering, Director of the National Statistics Bureau of Bhutan, Gross National Happiness (GNH) was promulgated as Bhutan’s philosophy of economic and social development by the Fourth King of Bhutan as soon as he came to the throne in 1972.

The reason I’m writing about this is because I believe it is an amazing idea, a wonderful goal, and a step toward embracing  idealism.  Many of you have heard my thoughts on change, and know that I do not believe that there is only one route to follow on this journey through life.

Takstan Monastery, Bhutan (image credit: johnehrenfeld.com)

The Bhutanese philosophy of “living” refers to a set of social and economic interventions that evaluate societal change in terms of the collective happiness of people.  Further, these measures are also applied to the creation of policies that are aimed at that objective. Premised on the belief that all human beings aspire to happiness in one way or another, the concept promotes collective happiness of the society as the ultimate goal of development.  Now that would be a political platform!

The philosophy of Gross National Happiness considers economic growth as one of the means towards achieving happiness, but it also offers a holistic paradigm within which the mind receives equal attention. While GNH recognizes the importance of individual happiness, it emphasizes that happiness must be realized as a collective or societal goal and not be defined as an individualized or competitive good.

The philosophy should also not cause misery to future generations, other societies, or to other  beings, and it is important to the government of Bhutan that the efforts of this philosophy be distributed evenly across all sections of  the society.

They work at strengthening the institutions of family and community; the spirit of voluntarism, tolerance and cooperation; the virtues of compassion, altruism, honor and dignity, all of whose active promotion may be a contributing factor to Bhutan’s low crime rate.

Culture also provides a framework where an individual’s or society’s psychological and emotional needs are addressed. By preserving local, regional, and national festivals, the government attends to these needs and provides a forum for maintaining social networks and promoting the conviviality of public culture.

His Majesty, King Jigme Singye Wangchuck of Bhutan

Bhutan treasures the extended family network as the most sustainable form of social safety net. Aware of the possibilities of family disintegration or nuclearization, the government makes conscious efforts to revive and nourish the traditions and practices that bond families and keep communities resilient and thriving.

Their environmental policy is predicated on the perspective that human beings and nature not only live symbiotically but are inseparable from each other. According to this perspective, nature is a partner in existence; a provider of sustenance, comfort and beauty.

Environmental preservation, therefore, is a way of life in Bhutan. Currently, 72% of the country’s area is under forest cover, 26% of the area is declared as protected areas, and the state has decreed to maintain 60% of its area under forest cover for all times to come. Environmental cost is an essential ingredient of evaluating new development projects in  Bhutan.

Finally, Bhutan launched parliamentary democracy 2008, becoming the youngest democratic country in the world. All this was initiated by the country’s leader – His Majesty, King Jigme Singye Wangchuck, thus fostering people’s capacity to make choices.

Well, we have generally been making choices as a country for some time now that generally do not embrace nature, family, our fellow man, or the environment.  On a recent boat trip up the Caloosahatchee River, I expressed a dream, namely that mankind would embrace a philosophy of “National Happiness.”

Now wouldn’t that ROCK?

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Modern Healthcare Webinar Wednesday, July 14, 2010
8am pacific | 9am mountain | 10am central | 11am eastern | Register Now $79

Ever since a surge in cases of patient exposure to excess amounts of radiation during diagnostic procedures, pressure has been mounting for healthcare providers and equipment manufacturers. The FDA has already taken action, including a call for stepped-up training for practitioners and a more stringent approval process for radiation-emitting equipment.

Antique x-ray machine used to determine children's shoe sizes. Photo credit: desertsurvivor.blogspot.com

…I couldn’t stop thinking about it.  Overexposure to radiation is something I’ve thought about for many years.  In fact, I’m pretty sure that, short of cancer victims, I’d be the poster child for this for Boomers.  Let me count the ways.  Every time I went to my family doc as a kid for anything except a strain or a splinter, he’d zap me with the fluoroscope,  just for good measure.  Then, when we went shopping at Buster Brown’s, in order to determine my foot length and width,  I’d get my feet x-rayed.  After that, I played too much trumpet and had to have my lip radiated because of a blemish that wouldn’t go away.  There were at least seven radiation sessions with Dr. Jacob, a dermatologist who reminded me of Dr. Jekyll.  He zapped me because that’s what they did in “those days” for blemishes.  He would lay me on the table, cover me in lead, and zap my lip with radiation.  Thank goodness for the lead.

As a young adult, my Internal Medicine doctor had his own x-ray equipment and used to say, “Okay, time for your chest x-ray.”  Problem was, he did it every single time I went to him.   Once, however, when I went there, there was no x-ray.  I asked the nurse why and she laughed and said, “Oh, that old piece of junk…it was zapping all of us with radiation.”   Later that week I heard on the radio that he had donated his unit to a small hospital.

As a teacher, chest x-rays were a requirement.  We would be invited to go onto an old x-ray bus every two years and they would light us up on a piece of x-ray equipment that probably put out more radiation than the bombs dropped at Nagasaki and Hiroshima. All in the name of TB checks.

Bronchitis visited me regularly over the past several decades, and chest x-rays were always part of those visits. So were dental x-rays, over and over and over again. The MRIs do things a little differently, but I’m sure there’s still some type of telltale exposure there, and I’ve had three or four of those. Annual physicals now include chest x-rays, thallium stress tests, et al, and visits to the bone docs required x-rays, too.  Oh yeah, and the heart caths?  They fill you with dye and then they light you up with the ol’ fluoroscope… did that three times.

And don’t forget the “new fangled invention that’s perfectly safe,” the heart screening on the 2, 16, 64 and then 128 slice PET/CTs. Did that three times, too.

BUT let’s get to the real exposure — playing in the sunshine, sans any type of sun tan lotion or sun screen.  Okay, I guess that’s an exaggeration.  We used to mix Merthiolate with baby oil, or sometimes just use baby oil to ensure a nice brown cooked look.  Every year I looked like a half Italian coffee bean.  It was more than a tan.  It was a deep fried, make your teeth look whiter than snow, fun in the sun, ain’t wearin’ no shirt, nature is good for you, sun tan with burns that preceded the tans every year.

So, when people tell me to eat organic, I smile and think, “Yep, that will erase all of those rads that filled me up like a Rocky Mountain boulder,” but I do what they say and just wait and pray that the radiation devil will not come my way.  If the sickness won’t kill you, the cure will, and that’s the truth.  At least you won’t ever need a night light.

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For years now I’ve written about the need to provide some type of safety valve for the uninsured, underinsured, and those struggling to make it from layoff at age 58 to Medicare at age 65.  Not unlike the Kennedy-Katzenbaum bill, (you know, that HIPAA bill that was just meant to provide health insurance portability), we have healthcare reform legislation.  The really challenging thing about this new bill is that it was primarily written by policy wonks fifty percent of whom will not be working in Washington D.C. in a few years, and worse than that, it will be interpreted by policy wonk lifers who will be there long after we are all dead.

So, the “Healthcare Oil Spill” has been addressed.  What will it mean?  What does it mean?  How will it impact all of us?  That remains to be seen.  The good news is that 30 million more people will finally have a safety net. The bad news is that there are still two wars going on that are draining our treasury.  There is still financial chaos among the countries lovingly referred to by the EU as the PIIGS (Portugal, Ireland, Italy, Greece, and Spain), and, along with this group,  spending in the United States  has been out of control for at least nine years.

What will happen is anyone’s guess.  How things will be interpreted is anyone’s guess.  How the law will be enforced is every one’s guess, but in  a recent round table discussion at the Mid-State HFMA meeting, we heard four CFOs discuss the challenges that they currently face and will continue to face as life becomes even more complex.  After that session, I’m thinking that lots of mud pushed in the head of the well might just be the cure!  Goodness knows there was enough mud thrown around during this last election cycle.  Maybe we could redirect it back to the source?  I do know for sure that one thing is clear: CHANGE is INEVITABLE, the train is back on the track, and it’s coming straight toward our physicians, hospitals, and nursing homes.

How do we cope with that change?  Make sure that every ounce of fat is cut from the system.  Take a look at the list below and contact SunStone Consulting for the next steps:

• Charge Process (CDM)
• Compliance
• Documentation Accuracy Program
• Inpatient Coding and Compliance
• Outpatient Claim Analysis
• Pharmacy Revenue Cycle
• Pricing
• RAC Assessment
• Reimbursement & Financial Analysis
• Revenue Cycle
• Transfer MS-DRG Review
• Workers’ Compensation Recovery
• Employee Health Insurance Advocacy

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Ice-covered Orange Tree Photo credit: Eric Zamora - University of Florida IFAS

The first was coffee/juice, and the projected costs for these two items are up 10 percent. At first my curiosity was piqued by this, but then I saw the explanation further over on the page.  It said that these increases were based on the recent freezes in Florida, which will have a significant impact on juice pricing.  I guess that makes sense.  The trees and oranges froze and were ruined, but it was interesting to me that every other orange-growing country in the world hadn’t jumped into the market and taken advantage of this shortage situation.

The even more difficult quandary created by this coffee/juice category, however, was that the coffee wasn’t explained.  Surely, everyone knows by looking at a world map in Starbucks that coffee comes from places that are not Florida. Maybe it’s just a “calf path” item. You know, some ancient, primeval calf made a trail in the woods named “coffee/juice” and we still follow that path today.

I’m sure that many of you are now wondering what the second category is, the second highest predicted commodity increase for health care, and, honestly, I can’t wait to tell you.  Why am I excited about this one?  It’s because, you see, it is a NIGYSOG (Now I’ve Got You, You Son of a Gun) moment.  For nearly five years, I’ve been predicting some very obvious changes that are about to sweep through the healthcare delivery system.  Our blogs, newspaper columns, and speeches have all directed you toward these changes, and over and over, the vast majority of healthcare management professionals have either ignored or rejected these pronouncements; sometimes out of fear and sometimes out of a “wake me when it gets here” mindset.  Honestly, when it comes to prognosticating, it made me feel like Punxsutawney Phil.  (Oh, and what was that advertisement I read today?  “You have just survived the worst snow storm in this area in the past 100 years.”)

The second most highly inflationary bell ringer from the Amerinet report is one that spot-on supports our predictions completely.  (Drum roll, please.)  It is biotech products.  The prediction is that the cost of biotech products will increase an average of about nine percent.  Upon examining the comment section beside this category, the following sentence appears:  “Increased demand will drive these price increases.”

Many of you may still be scratching your collective heads in wonderment.  “What are ‘biotech products,’ and why should I care about them?,” you may be asking.  Let’s take a quick historic look at life in the biotech lane.  In 2001, when we co-founded a research institute that had specialty areas in biomedical informatics, tissue banking, proteomics, and genomics, it cost approximately $100,000,000 (that’s 100 million) to map ONE human genome. This year, that number will fall to below $500. If you take that ratio of product-to-cost and project it forward, it doesn’t take too much imagination to conclude that not so many years or months from now, your physician will potentially have (or want to have) access to your molecular profile.  It will provide insights into your personal health that were heretofore unavailable, even unimaginable.

Once issues involving insurance coverage, confidentiality, and ethics are resolved satisfactorily, these tests will become a routine part of your annual physical.  Complete Blood Counts, lipid profiles, prostate or breast testing, and genomic and proteomic analysis will provide your caregiver with answers that make the practice of medicine until now seem hit-or-miss by comparison.

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At a lecture I once attended, Dr. Leland Kaiser said, “Give me the creative leader every time. They will always win over the traditional one.”

Well, yesterday, I met a creative leader. This young business entrepreneur was only about 34 years old. He owned a construction business that specialized in concrete. You know, poured basements, slabs, sidewalks, and driveways. When we discussed the current business climate, he smiled and said, “I’ve done okay.” Well, we all know that the construction business is literally on the skids right now and has been since the crash last year. NPR news ran a segment on Thursday about the 12,000 new government jobs being created in the Washington DC/Northern VA area. Seemed like good news until they said that these jobs represented only about a third of the more than 30,000 construction jobs that had been lost to date there.

When I asked our young rock star how he did it, he smiled and said, “I got this idea.” The number of times that those words have come out of my mouth is virtually immeasurable. Yet someone else has later described the related actions as an accidentally brilliant strategy. My response to him was, “So, what was the idea?” He smiled and said, “As soon as I got a bill, I paid it, that day, that minute, that instant.” As an employee of an accounting-type firm, my mind began to race with the traditional thoughts of “Oh, my gosh, how foolish. He could be getting interest on his money for 30, 60, or even 90 days, and he is paying his bills when they arrive?,” I thought to myself.

He then began to explain the outcome of his decision. “My suppliers love me, and because they don’t have to add in late fees, collection costs, lost interest, or simply lost money from late or uncollectable accounts receivable, this practice got their attention. Because they, in his words, “loved him,” he was able to negotiate better pick-up times for the concrete. This made him more flexible and productive as the trucks arrived at 8:00 AM with the morning’s first load of cement. The suppliers were also willing to negotiate lower prices for him than they could for the other contractors with whom he competed. Why? Because he paid them promptly every time.

He then went on to say that because his costs were lower than the other contractors, he could lower his prices to the builders with whom he wanted to do serious business, and, instead of the six or eight regulars that kept him going in the good times, he was now able to attract about 28 builders who wanted to work with him because he was on time, did good work, and, of course, was less expensive.

So, when he told me that he was doing okay, it meant that none of his employees had lost their jobs, his income had not gone down, and his business was virtually booming in an economy that has meant bankruptcy for more traditional construction oriented businesses. The really great news, however, is that this guy is a long lost, distant cousin about whom I had never known until just a month ago. So, I guess creativity runs in the family. Oh, yeah, and he’s a heck of a musician, too. Seems like Leland was right.

A Blueprint for Transformational Change: Nick Jacobs’ 2009 Graduate School address at St. Francis University’s 2009 commencement ceremonies

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Then, during lunch today, the Pittsburgh Post Gazette reached out and grabbed me with this headline:  “The End of Male Rule.” The reason that this headline was so moving to me stems back to the Saturday of the week-end before 911 when Dr. Wayne London, an old metaphysical theorist friend of mine told me that:  1.) The American financial system as we know it would collapse.  2.) The center of the U.S. Military would come under attack, as would 3.) the patriarchally-controlled Catholic Church.  He then said, “All of this will happen as Mary Energy begins to lead toward the change, and women will take control of the world again.”  He went on to explain that this woman control is not a new phenomena, just one that has not been around for quite some time.

Pentagon 9/11 memorial service, September 11, 2008 – Photo credit: UPI

Well, after the Twin Towers were hit, our own American citizens did much more damage than anyone could have ever imagined possible to our financial system by setting up the elaborate mortgage and derivative schemes that nearly caused the entire U.S. financial system to collapse.

Of course we all remember the horrible hit that the Pentagon endured on 911, and now we face the huge financial burdens of continuing two wars and trying to rebuild a completely exhausted military that has been over-stretched and nearly wiped out emotionally by the last several years of redeploying both our all-volunteer army and their equipment over and over again.  When you begin to see more suicides than casualties of war, something is obviously very wrong with the System.

The Church went through what has come to be recognized minimally as a very difficult time with millions and millions of dollars in lawsuits and structural challenges over sexual abuse issues that had been closeted by numerous U.S. Bishops for years and years.  The celibacy thing seemed to have been much more destructive for the men of the Church than the women.

So, what was Reihan’s interpretation of this metamorphosis, this change in traditional male dominance?

PTA President Charles J. “Chuck” Saylors

Before we go there, on NPR this evening, I heard about Chuck Saylors, the first male president of the National Parent Teacher’s Association since its inception in the late 1800′s, and it all started to make even more sense, a guy in a predominantly female organization deserving to become president because so many men have assumed more house dad roles.

Reihan’s article started with the line:  “The era of male dominance is coming to an end.  Seriously.”   He went on to describe the fact that the Great Recession has turned what was a quiet evolution into a revolution…a mortal blow to the macho men’s club.  He quotes the fact that 80% of job losses or over 7 million jobs have been lost by men in this recent massacre, and the predicted number of male jobs lost by the end of 2009 is estimated to be around 28 million worldwide.  He adds to the fact that soon there will be three women for every two male college graduates in the U.S.

One of his most interesting revelations was that Iceland threw out the entire men’s club in their last election, as did Lithuania.  Could this be the beginning of a trend?

Of course the article went into much more depth, had numerous other examples to support these claims, and was compelling in its support of Dr. London’s theme.  The bottom line, however, is not easily denied.  We macho, risk-taking, aggressive guys have done a lot of damage over the years, and it will be fun watching this predicted shift in the next decades.

I’ve always felt that a world run by women might have a little better chance of having less warfare. Let’s hope that the female leaders of our future will have the attributes that will make them better than the men that they are replacing, and the world will be a better place.

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While spending an absolutely delightful weekend a few months ago with several people who were creative, inventive, entrepreneurial, and fun, one of the most highly respected innovators in the world turned to me and said, “You should be on the agenda at TED.” You may wonder what qualifies one to be considered to be one of the most highly respected innovators in the world, but take my word for it, he is. He’s on the faculty of about eight universities, has offices in a couple of dozen countries, and is one of the most sought after creators of innovation anywhere.

Well, little did he know how much that comment meant to me. It shook me up, inspired me, and filled me with excitement. Why? Read that line above again, “an invitation-only event where the world’s leading thinkers and doers gather to find inspiration.” Okay, I’ve been called a futurist, a creative, a right-brained whatever, and several of the things that we’ve done over the years have literally rocked the house (like this blog), but . . . in the world? It always seemed to me that my primary claim to fame was my ability to keep trying when some people not only wanted us to fail, but would probably have like to have seen me personally run over by a cement truck. I was persistent.

I’m not sure where I would fall into that description of the world’s leading anything, but it surely was flattering to have someone of that caliber say that to me. It’s funny, because every time I begin to allow the little ghosts come out of the sewers to pull at my pants cuffs with their negativity, I simply smile and think about our collective accomplishments.

This week alone, our consulting practice has taken me to a publishing company to help their employees begin to create what they would like to have for their future; then to a chain of hotels in New York City where the owner fully comprehends the merits of wellness for his employees; to a biomedical informatics startup company specializing in neuroscience; a nonprofit music group struggling to re-invent itself; and finally to an executive recruitment firm seeking a new business niche.

So, back to TED. If you have ANY interest at all in what goes on there, what gets said there, who speaks there, you probably would be surprised, or not. People like Dr. Dean Ornish, Bono, Bill Gates, Jane Goodal, and former President Bill Clinton have spoken there, but so too has Dr. Alan Russell from the University of Pittsburgh and a hundred other people who have simply made a difference –with extraordinary results. The good news is that, should you have any interest in seeing and hearing any of these speakers, just go to TED Talks on the web, and they’re all there for your inspiration.

For example, in a presentation by Scott McCloud, the cartoonist and comic book artist, we heard: “Learn from everyone. Follow no one. Watch for patterns. And “Work like hell.” Stefen Sagmeister has made his mark by creating public art with sayings displayed in public places like, “Everybody thinks they’re right,” and “Money does not make me happy.” My favorite, however, is “Complaining is silly. Either act or forget it.”

Jill Tarter, astronomer and a world-renowned expert on extraterrestrial life made this comment, “If we are alone, it is an awful waste of space.”

Seriously, take a look at TED and its companion, TEDMED, dedicated exclusively to healthcare innovation. Maybe, in my dreams, I’ll be giving my speech on kindness in the workplace, my 18 minute presentation on life, love, and a kinder more co-operative future.

Hey, we all need a dream. And I, too, have a dream.

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