This week’s Bloomberg Business Week magazine featured a phenomenal and very personal story of healthcare that actually captures many of the challenges around healthcare reform.  The author, Amanda Bennett, takes us on a journey that she has titled, “Lessons of a $618,616 Death.“  The true title, however, should have been, “How Do You Put A Price on 17 Months?”  In this article, Ms. Bennett takes us on the step-by-step, blow-by-blow journey that ended with her husband’s death.  She and a friend painfully reconstructed every page of his medical records, every dollar paid by her insurance companies, and every charge made by the various doctors and hospitals that treated him during the last years of his life.

Amanda Bennett and Terence Foley

She showed 1.) the grand total of charges, $618,616, 2.) the actual monies paid by the insurance companies to the hospitals after contractual negotiations, $254,176, and 3.) the total paid by her family, $9,468. In the article, she described the 30% overhead/administration costs, the costs of experimental drugs inside and outside of trials, and the 4,750 pages of medical records that were amassed during this time. For those of us who have “spent our time” trying to live within, cope with, and better understand America’s healthcare system, there were no surprises.  For those of us who have watched a loved one take this cancer journey with all of its mysterious unknowns, there were also no surprises. Ms. Bennett’s quote, “The system has a strong bias toward action,” was, I believe, the most poignant in the entire piece.

A few weeks ago, I had lunch with a very healthcare-savvy individual who, when I jokingly referred to death panels, almost came across the table at me.  She did not believe it was funny.  To say that she was passionate would miss the point.  Only the day before, I had spoken with another very intelligent healthcare reform advocate who indicated that the entire concept of death panels emanated from a payment code that reimbursed physicians for simply (or in some cases finally) talking to patients about their alternatives.  I had heard other explanations, but neither mattered.  What matters is that, in many instances, we are not discussing appropriate alternatives or revealing the quality-of-life issues often overlooked before beginning long courses of experimental drugs, or oncology drugs that may not have any positive impact on the health outcome of the individual.

Interestingly, Ms. Bennett did indicate that for all of the time, money, and pain invested in this journey, no one could confirm that her husband’s life was actually extended by these medical experiences.

Someone once described America’s healthcare system to me like this:  You walk into Nordstrom, order several three-thousand-dollar suits, a dozen shirts and some handmade, silk Italian ties, then turn to the person beside you and say to the clerk, ‘”He is paying for this.”  Our heroine Ms. Bennett did mention the fact that her husband would probably have questioned the use of all of these funds in this manner and the relationship that these expenditures might have had on all of the other people in the world who might have been helped by these dollars.

When healthcare reform is discussed, it is personal.  It is also deep, and it is costly, but the bottom line always comes back to this: “How do you put a price on 17 months?”  In my book Taking the Hell out of Healthcare, I discuss the journey that my father and our neighbor took together over about a 17 month period.  Both diagnosed with lung cancer, my father decided to go for it all.  He had surgery, chemo, radiation, more radiation, and more chemo.  My neighbor, a man without significant health insurance coverage, decided to spend his time with his family.  They both died on the same day.  My father died in a cold, tertiary care hospital where no clergy was present, his family members were not all able to be there with him, and it was over.  In contrast, our neighbor died peacefully in his home, surrounded by his entire family.

Ms. Bennett did say that she was glad that she was not a bureaucrat having to deal with these issues.  Frankly, I wish that she was!

As we begin to emerge from the bottom of a V-shaped recession, we all pray that it does not evolve into a W-shaped recession. Having been a witness for the majority of this economic challenge rather than an officer in charge, I’ve observed several significant issues that have impacted the hospital industry.  They have included the downgrading of bonds, a serious lack of access to capital financing, cutbacks in elective surgeries and elective donations to our health care foundations,  All of which has resulted in a deep degree of uncertainty as to when  all of this will be over.

The fact that many of the economic practices that got us into this mess have still not been discontinued or are being reshaped into the newest version of the scam du jour does not bring peace of mind to the vast majority of us, a deeply concerned citizenry.  Add to that the billions and now trillions that we are committed to repay over the next several generations, and one has to wonder about the ability of our current political system to respond appropriately to these challenges.

Warren Buffett’s annual letter to Berkshire Hathaway shareholders criticized Wall Street executives and board members in a way that most of us would liked to have expressed, but which only Buffet could articulate. This is because his comments are clearly supported by his business acumen and investment skills.  He broadsided the leadership of Wall Street for failing to control risk and for avoiding  what very clearly should have been the “severe” consequences of these failures.  He chastised the bankers in particular for designing and implementing their own industry’s doom and then piling the losses onto investors, while they themselves have managed to maintain lavish lifestyles.

“It has not been shareholders who have botched the operations of some of our country’s largest financial institutions,” Buffett wrote. “Yet they have borne the burden, with 90% or more of the value of their holdings wiped out in most cases of failure. Collectively, they have lost more than $500 billion in just the four largest financial fiascos of the last two years. To say these owners have been ‘bailed-out’ is to make a mockery of the term.”

“The CEOs and directors of the failed companies, however, have largely gone unscathed…Their fortunes may have been diminished by the disasters they oversaw, but they still live in grand style. It is the behavior of these CEOs and directors that needs to be changed: If their institutions and the country are harmed by their recklessness, they should pay a heavy price – one not reimbursable by the companies they’ve damaged nor by insurance.”

With his sentiments firmly ensconced in my mind, I have to wonder about the current rounds of outrageous health insurance increases perpetrated upon the customers of many of our largest and most profitable insurance companies.  As a hospital CEO, I learned very early on that no matter how low we held our charges, those savings would not be passed on to the patients because the middle man controlled this aspect of the “business.”  Incentives are completely upside down in the system at many levels, and the political commitment to truly work toward meaningful change seems not only misguided but also seriously uninformed.

Bottom line?  We need to be heard.  We need to work toward systems that make sense: protection from catastrophic financial situations brought on by major illnesses or accidents, primary care that truly helps the patient manage their health challenges at a reasonable cost, and a complete change from a sickness-based to a wellness-based reimbursement system that is not dependent upon the insurance companies for the decision making proposition.

Sometimes right is truly black and white, and until we embrace palliative care, incentivize individuals for taking care of themselves, and deal with tort reform, progress will be only a delusion.

U.S. Health Care Reform Timeline: 1910-2010

Click image above to view full-size, interactive timeline. (Will open in a new web browser window.)

As the pulse is still an indicator of health in human beings and other animals, health care-related inflationary indices can be a measure of economic health, growth, and change in our business.  After perusing nearly six pages of single-spaced inflationary projections in an Amerinet-produced report, two jumped out at me, the two highest.  One was more significant than the other, but both tell their own story.

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.

The origin of the name of this blog, HealingHospitals.com came from decades of seeking a better way to transition an old model to a more meaningful, experiential approach to caring for people.  This would actually provide transformational experiences for the patients and their families in a more interactive and participatory way.  (HealingHospitals was named a top 50 hospital administration blog.)

In a recent conversation with a clinical psychologist, I learned that we generally become our habits or, in fact, our habits become us. Accordingly, to change, to grow, to transition and to flourish, we have to work very hard at changing those habits that are not benefiting us personally: over indulgence, negativity, low self-esteem, or whatever the issue(s) may be.

How does this apply to an organization?  Every organization that I have ever experienced has a distinct personality and, in its own way, habits, as well.  Sometimes the personality of the organization is imposed by its leaders, but usually there are layers and layers of practice that have become part of the culture of that organization; practices –for better or worse– that have accumulated over time.

My observations of numerous hospitals have also provided me with an understanding of the myriad of habits that no longer make sense in today’s world; habits still being embraced that literally produce negative results, and are not only insensitive to the needs of both the staff and the patients, but also are many times intellectually and emotionally caustic to all participants.  We’ve written several times about the disparaging nature of the “parent-to-child” management styles prevailing in many hospitals amongst staff, physicians, and administrators, but this is just the proverbial tip of this particular iceberg.

Many hospitals are wonderful examples of business models that flourished during the Industrial Revolution.  Employees still swipe time cards into time clocks, bells and pagers go off all day and all night; professionals poke and prod patients without any explanation.  How many times have you observed the 84-year-old being wheeled into a cold, uncarpeted hallway, parked near a wall with nothing to see, nothing to do, and no one to talk to for long stretches of time while waiting for tests about which he or she knows very little?

In many hospitals patients are referred to by staff members by their  body parts: the kidney in 101, the heart in 543, the stroke in 300.  It is also common that the procedures administered are at the total convenience of the staff and docs without much consideration for the patient.  Numerous hospitals still ask loved ones to leave promptly at 8:00 PM each night, and many times bad news is delivered via the phone.

Consequently, the blog name, HealingHospitals.com which may seem almost like an oxymoron, is intended to help us all to create environments for healing. For the most part, we can probably agree that it would be great if hospitals were places where you could go to begin that healing process.  We might even agree that it would be wonderful if we could be nurtured there, to be helped to find the road to recovery through healing, and even more dramatically, to have a transformational experience that would help us break or modify those habits that keep bringing us back.

It would also be fantastic if, at the end of life, our loved ones could be admitted to control pain, or if the family could have respite.  More importantly, it would be amazing if relationships could be healed before the transition to the other side.

In the late eighties, when I entered healthcare administration, it was my passion to make hospitals more like hotels and spas. But, most importantly, it was all about making the hospitals healing places where patients would have a chance to change their lives in a meaningful way; mentally, physically, and spiritually, via a transformational center of caring.  Let me certify that we did just that, and it is going on to this day. The point is that “you can, too.”

Each year I put up the tree and begin to believe that it is magic. The room feels and looks warmer. Often, I’ve considered leaving it up all year as a symbol of joy, love, and happiness, but when I returned home last evening it hit me that it was not the tree as much as it was the carefully wrapped packages beneath it. Once they were gone, the room seemed void of its magic.

It hit me that those packages represented anticipation, love, and sharing in ways that truly touch your soul. Those acts of love represent the essence of that entire experience, price or cost don’t really matter.  It’s the giving.

I try to end every night by reading CarePages from a local children’s hospital website; stories of young children that have many times reached the end of effective treatment and are waiting to meet their destiny decades before their time might have been.  The outpouring of the deep, soulful hurt that their parents, siblings, and grandparents are experiencing from this journey is always profoundly moving to me.  In many of these instances, the only gifts that we have left to give them are our  love and support.  That, however, is not the case for the majority of our fellow men in this country.

It won’t be long until the final product of the healthcare reform effort will appear.  We all know by now that it will be a patchwork quilt of sometimes horrendous compromise.  We can also count on the fact that the negative rhetoric will reach decibel levels typically heard only when standing in close proximity to a jet engine.  The pundits will parade up and down the isles of righteousness, and they will be spouting off their theories regarding what should have happened.  At the end of the day, however, when we approach our bathroom and bedroom mirrors for that last inevitable look, we must all dig into our humanity and ask one very real question: “Will it be better for the uninsured than it had previously?”

As a former hospital CEO, it became evident to me in the first six months of my administrative training that only those without insurance were destroyed by the system.  Only those who were not under Medicaid or an other insurance were hit with the awful burden of paying for everything at the full, retail price.  The fallout was clear.  Due to the risk of having to pay full costs to the hospital, they either were too frightened to go for treatment until it was too late, or they lost what little they had; their homes, their savings, and their possessions.

In a country with such unbelievable abundance, where not just the number but also the quality of the cars, clothes, and even pets that we own are held up as barometers of success, we have often allowed our fellow man to suffer and die for economic reasons.

That fact is no more obvious than at any children’s hospital in Pennsylvania, where you’ll see parents from conservative states where childhood transplantation surgeries were always denied, so as to avoid increased taxes.  You’ll see these parents waiting in line to establish residency here so that they can at least have a chance to save their child’s life.

Regardless of your politics, regardless of the dysfunctional (mal-)functioning of our government, in which some of our representatives and senators have taken us to the brink of collapse due to their inability to co-operate; regardless of these issues, we are looking at the beginning of health care reform.  I just pray that we don’t revert to the inhuman practices of our recent past.

It’s time for a human win.

Last year at this time, as word of the global economic meltdown was beginning to take hold, we saw the beginning of a decline in all aspects of purchasing, including the  optional surgeries and tests in our hospitals.  At the same time, as a member of several volunteer boards, we began to see declines in ticket sales that went as high as 20%.  Later, we met with restaurateurs who indicated that their business was down between 10 and 20%, an amount that proved to be terminal for numerous marginal companies.

As the year proceeded, we saw  hospitals make extensive cutbacks in employee  education, travel, and marketing.  This trend became the norm in the industry.  The healthcare-related industries that seemed to hurt the most were those involved in construction and new equipment acquisition.  One type of firm that did well was financial consulting groups, like SunStone Consulting, LLC , organizations that specialized in finding money that hospitals had already earned, but had either not been staffed deeply enough to pursue or that did not know the processes necessary to generate these funds.

For those of us in administrative consulting, the year has been interesting.  Decision makers stepped back a little and waited to see where Obamacare was heading, to collect more cash in a society where “cash was definitely king,” and to cut back on new initiatives until things had settled down economically.  These leaders watched the markets, looked at investment activities, counted revenue versus expense results, and generally became more conservative in their leadership approaches.

What’s on the horizon:  There is an old saying that “He who looks into a crystal ball to predict the future will get crystal in his eye,” that is not far from truth.  Are we completely out of the woods?  Not by a long shot.  Will there be additional taxes, additional expenditures that are not budgeted nationally?  Yes, most assuredly, there will be, but are we certainly seeing more positive signs in virtually every economic indicator that would predict at least a somewhat more optimistic overall outlook.

Wall Street Journal: Pointing to renewed signs that the global slump is bottoming out, the International Monetary Fund on Wednesday upgraded its outlook for 2010 while slightly trimming this year’s forecast.

The overleveraged global financial system continues to cast a shadow over the economic outlook, however, and the fund urged policymakers not to become complacent about recent market improvements.

“Financial conditions have improved, as unprecedented policy intervention has reduced the risk of systemic collapse and expectations of economic recovery have risen,” the IMF said in its updating its outlook for the world economy and financial system. “Nonetheless, vulnerabilities remain and complacency…

So, if we embrace those little rays of hope as a means of restarting the economic engines, if we visualize a better future for all of us, if we focus on the positive, at the very least we most likely will find a better parking space at the Mall!

Happy Holidays and here’s knowing that 2010 will be a better year for everyone.  (It wouldn’t take much!)

“Extraordinary claims require extraordinary evidence.”
Cosmos – Carl Sagan (1934-1996)

Over the last several years, we have made extraordinary claims in our blogs, our speeches, and our consulting.  We have made claims that have been questioned, sometimes scoffed at, and generally ignored by the masses who believe that their way is the only way.  It is almost as if these claims are so seemingly “out there,” that many believe they could not possibly be true.

• less than 1% infection rates
• lowest restraint rates
• lowest re-admission rates
• lowest mortality rates
• 99% patient approval rates
• 97% employee approval rates

In hindsight,  should we have just kept these claims “under the basket” because too many believe they look too good to be true?

When we claimed a bottom line that was over $2.5 M in a hospital with fewer beds than an average wing of most hospitals, you could see the frowns of disbelief on the faces of financial officers.  When we claimed those approval rates, the CEO’s of other hospitals simply smiled and probably thought to themselves, “…maybe in your little hospital, but NEVER in mine.”

Now that I am no longer affiliated with my previous employer, let me throw down the gauntlet to you.  It is my complete and sincere belief that these results, with your total support and endorsement, can happen in your facilities. It is my further belief that I can help deliver those results for you, so that instead of laying people off, you too can double or triple in size. I believe that you can take your everyday challenges and turn them into unbelievable successes.  How?  Take the pages from my book on hospital management.  (The one that’s not published yet, but firmly planted in my heart and head.) In the interim, get yourself a copy of my first healthcare book that has been published, Taking the Hell Out of Healthcare.

• If you are a genuinely kind person, that will show through in your management style.  Kindness is not weakness.
• If you care about your staff, they will care about not only you but also about your patients.
• If you treat people with dignity at all levels of the organization, your organizational culture can change.
• If you help the 10 percent or so of your employees, physicians, and others who do not support this philosophy to find work at neighboring institutions, they will be the gift that keeps on giving as they run rampant over patients at those hospitals and drive those patients to your doors.

These are not difficult assignments.  They require only that you stick to your resolve, that you always try to do what is right, and that you do not stop until all of the necessary changes have been made.  Healing organizations start with YOU.  Healing organizations embrace their human resources.  They embrace patient families.  They DO NOT function like cold, corporate America.  They function like patient-centered America.  Kindness in the workplace is not a gimmick, not a fleeting idea, not a once or twice a year thing, it is a complete commitment to a change in culture that reaches out to patients, employees, and medical staff.

The cost?  In the big picture, the cost is not even a consideration. Your investment now is less  than you can imagine, as your facilities grow, expand, and thrive. Besides:

What does it cost to be nice?

What does it cost to be civil?

What does it cost to be kind?

Healing Hospitals are a way of life.  Make sure that your hospital becomes just that, a place for healing.

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?

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.

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.

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.

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.

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.

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.

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.