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Integrative Medicine

July 20th, 2018
Having served in healthcare senior leadership for over two decades, my tolerance level for various “healthcare norms,” that revolved around the sometimes-insensitive treatment and care of patients and their families had reached the breaking point.  Consequently, at the end of my 40th decade when I became a hospital CEO, I arrived in the position with a quiver full of change arrows that were sure to shake up the status quo, and it did.Because I had entered the healthcare field some twenty years after most of my senior leadership peers, my life experiences were much more varied and non-traditional. For ten years, I had been a band and orchestra director in both City and Urban school districts.  After that, I ran what became a successful arts organization in a rural area, and finally, served as the CEO of a convention and visitors bureau.  It was during those years that I went back to school for another Masters degree in public management/health systems management.

When this CEO opportunity presented itself, I realized how each and every one of my life experiences could help me run a hospital, but not just any hospital. It was my vision to create a hospital that embraced all modalities used in integrative medicine with the ambiance of a fine hotel and the amenities of a health spa.  We carefully scrutinized and then credentialed practitioners specializing in massage therapy, integrative nutritional counseling, acupuncture, osteopathic manipulation, pet and music therapy, reiki, and spirituality to name a few. These practices intermixed with traditional Western medicine became our new norm.

As the traditionalists who are reading this article begin to shake and scream about a lack of medical evidence, I can only point to the 19,000 papers written supporting the efficacy of acupuncture and the thousands of other medical papers written about the healing powers of music, massage, and such. In that same spirit, there is also the fact that the head is connected to the body and provides a mind-body connection that doesn’t fit neatly into the scientific “heal to the pill” mentality of our current system.As a non-clinician, non-scientist, it was easy for me to believe in things like “the Placebo effect” as well.  It really didn’t matter to me why people got better. It was our goal to create a healing environment where people would not be immersed in fear and trepidation, where their loved ones could comfortably stay with them, and where unnecessary paging, and middle of the night prodding, and wake-ups were avoided as much as humanly possible.

It seemed to me that by training our employees at Disney University, allowing them to learn from the Ritz Carlton, and exposing them to sensitivity and emotional quotient training, we could create a healing environment. Because my philosophy was that you could not change the human condition, but you could change the condition under which humans worked, we also embraced an anti-bullying environment where employees were cherished and recognized for their contributions to the welfare of our patients.

How did implementing all of these ideas change healthcare in our little slice of Camelot?  Our infection rate dropped to below 1% and stayed there for eleven years. (The national average is nine percent.) And I know we weren’t washing our hands more than they were at other hospitals. Of our peer hospitals, we had the lowest readmission rates, restraint rates, and lengths of stay, and when the naysayers saw these numbers, they said it was because we were not a large hospital. My belief was that we successfully had created a healing environment where our patient’s white blood cells were actually able to function to fight off infection.  We were transparent, nurturing, and caring. We were not a “Healthcare FACTORY” where the patients became widgets in an Industrial Revolution model of care.

Music was always used in healing ceremonies by an indigenous man. Acupuncture has been deemed effective for over 5000 years. Massage makes you feel better, and sometimes your spine gets out of alignment and needs to be corrected. This is neither rocket science nor brain surgery. It’s about love, kindness, and caring, wrapped up in good Western medicine. Oh, and one more thing.  Even with a palliative care unit, a hospice, we had the lowest death rate of our peer hospitals. I had always wanted to put up a billboard that said, “Come to our hospital . . . you’ll die less often.”
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Posted in Healthcare, Hospital Administration, Hospital Blog, Integrative Health, Leadership, Public Health, Uncategorized

Pittsburgh Post Gazette. Op-Ed

December 11th, 2017

Nick Jacobs, among his other affiliations, is an officer of the Integrative Health Policy Consortium, which represents more than 600,000 IHM practitioners; president of the Clinical and Translational Genome Research Institute, which he founded; and a consultant to the Department of Defense in breast cancer research.

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Pennsylvanians received good news recently when the Pennsylvania Health Care Cost Containment Council reported that hospital readmissions and mortality rates continue falling locally and statewide.

The report shows these rates declining for a number of common types of treatments. It gives much of the credit to a “commitment of PA hospitals to provide quality care” and to the Affordable Care Act, which ties reimbursements to that quality care. This, in turn, encourages health care facilities to strive for improved mortality rates because doing so helps keep government funds flowing through their doors.

Regardless of the motivation, this is good news. But it’s not good enough.The mortality rate could be improved even more dramatically if more healthcare administrators and physicians would introduce integrative health and medicine practices into their services.

Integrative health and medicine (IHM), as defined by the American Board of Integrative Medicine and the Academic Consortium for Integrative Medicine & Health, recognizes the importance of the relationship between practitioner and patient. IHM focuses on the whole person, is evidenced-based and employs a wide range of appropriate therapies, healthcare professionals and disciplines to achieve optimal health and healing.

Integrative health practice includes treatments and therapies such as acupuncture; natural products; deep breathing; Tai chi and Qi Gong; meditation; massage; special anti-inflammatory diets; progressive relaxation; journaling; biofeedback; pet, music and dance therapies; hypnosis and guided imagery. When provided by a licensed or certified health care professional, IHM provides numerous benefits. It can decrease chronic pain, post-operative pain and the need for medications. It can improve patient satisfaction and shorten hospital stays. It can lower mortality rates. IHM methods also are relatively inexpensive.

Many places, including the Cleveland Clinic, have reported cost savings per patient, while also seeing reductions in patient anxiety, pain, and medications. During my tenure as CEO at Windber (Pa.) Medical Center, I worked with physicians, staff, and volunteers to create a healing environment by embracing all methods and therapies used in integrative medicine and combining them with the ambiance of a fine hotel and the amenities of a health spa. We carefully scrutinized and credentialed practitioners specializing in services such as aroma and massage therapy, integrative nutritional counseling, acupuncture, chiropractic manipulation, pet and music therapy, reiki and spirituality, to name a few.

In short, a healing environment permeated our facility.

Yes, we had our share of naysayers and opposition among physicians, allied health care professionals and others, but over time our infection rate dropped below 1 percent and stayed there for a decade. (The national average is 9 percent.) Of our peer hospitals, we had the lowest readmission rates, restraint rates and lengths of stay. Even with a palliative care unit to care for dying patients and their families, we had the lowest death rate among our peer hospitals.

For those who would say it was all coincidence because Windber is a small hospital, I would direct them to the 19,000 papers written supporting the efficacy of acupuncture alone, and then to the thousands of papers written about the healing power of music, massage and so many other treatments dismissed all too readily by traditional practitioners.

IHM practices are not at odds with traditional medical practices; rather, they enhance them. Yet in many hospitals and physicians’ offices, they are ignored, discouraged, even ridiculed. Such negative reactions result from ignorance, misinformation, prejudice and even greed — pharmaceutical companies, for instance, see no profit in promoting most IHM treatments, and some medical practices might earn less if, instead of scheduling patients for costly treatments or surgeries, they instead treated patients with acupuncture, spinal manipulation, massage therapy or even mindfulness.

Resistance to IHM is breaking down, but this shift in attitude needs to be accelerated. If you travel to Europe or Asia, you will see integrative medicine practices thriving because their value is acknowledged and embraced. In America, IHM beachheads are being established in health care systems and universities, thanks to such groups as the Family Medicine Education Consortium, Integrative Health Policy Consortium and the Academy of Integrative Health and Medicine, of which I am a co-founder. The academy includes among its member’s hundreds of licensed physicians who have successfully merged IHM with traditional medical practices.

Much remains to be done to more broadly spread the healing benefits of IHM, which will happen only when more patients take more responsibility for their health and demand IHM treatments, more physicians research and adopt them, and more insurance companies pay for them. When that day comes, there will be a lot more good news about mortality rates and other measures of medical care for Pennsylvanians and people all over the country to celebrate.

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Posted in Boomers, Children, Current Affairs, Diet, Family, Future, Healthcare, Hospital, Hospital Administration, Hospitals, Integrative Health, Leadership, Medicare, Military Medicine, Nutrition, Public Health

Four ways to improve access to Integrative Medicine Practices

November 13th, 2017

Licensure, regulation, medical evidence, and funding are four sure ways to speed up the process needed to allow integrative medicine practices to be embraced. If we begin with the assumption that money has a lot to do with everything medical in the United States, then we must look at the winners and losers and the WIFM’s?  (What’s in it for me?)  If you’re a practicing surgeon, and acupuncture or chiropractic care results in the patient not needing a surgery, that can be a financial threat to you. Let’s be fair, that probably doesn’t happen that often, but sometimes it does, and when it does, that’s money lost to your practice.

 

If you’ve spent four years in undergraduate school, four years in medical school, four or five years in a residency, and your educational debts amount to hundreds of thousands of dollars, the last thing you need is a clinical study demonstrating through medical evidence that thousands of patients won’t need your services, and your skills will become exponentially less in the demand.

 

On the other hand, if, like ophthalmologists who surround their practices with optometrists, orthopods did the same with chiropractors and acupuncturists, could that not create a steady stream of referrals for their practices?

 

Let’s face it, there is a role for all three of those professions, and there are skill levels in every profession and duties relegated to each that both overlap and potentially conflict. So, wouldn’t it be better to have the three practice as a team of professionals working together to help you?

 

“There’s not enough medical evidence”  has been the hue and cry of the uninformed for years. Ironically, once traditional medical evidence is thoroughly interrogated, it’s not unusual to find numerous flaws in even the most accepted medical practices. We’ve seen slanted reporting in even the furthermost prestigious journals where various drugs, procedures, and devices have been proven to be ineffective years later.

 

There are over 19,000 papers that have been written and submitted to medical journals in which acupuncture has been endorsed and proven to be effective, but there never seems to be enough medical evidence for the naysayers.

 

Credentialing is a very challenging area as well.  Not unlike the highly skilled surgeon with her medical degrees from the Sorbonne in Paris that is not permitted to practice medicine in the United States, there are sometimes economic and political reasons to limit the number of practitioners allowed in the United States. In my experience, by creating a hospital-based credentials committee that specializes in integrative medicine, the nay-sayers ability to discredit highly trained practitioners with different skills will become more limited.

 

Regulation may be the most difficult challenge in this discussion because, as we have come to know very well, political power can come from political contributions, and when it comes to regulations, those with the gold have more clout than those without. That is not to say that our politicians can be encouraged to be more flexible because they can.  All it takes is for hundreds of constituents to stand in front of a Congressional office to encourage change to occur.

 

So, what are we really dealing with here?  In 1910, the AMA put out a request for proposal to determine what should be taught in the medical schools of Canada and the United States and no physician would accept that assignment.  Consequently, a Ph.D., Abraham Flexner, did, and his approach was to eliminate everything that wasn’t already proven science.  From there we have evolved to a “heal to the pill” mentality where words like root cause and placebo have been dropped from the vernacular.

 

Finally, funding is the key. It has been proven time and again that integrative medicine practices can reduce health care costs exponentially. With that in mind, every bill that comes out of Washington ignores that fact, and funding for many of these well-documented practices is not present. There were over 5000 codes in the Affordable Care Act that were intended to fund such practices as acupuncture, but when the FAQ initially was released, it said, in essence, “Don’t worry about paying these codes.”

 

If you go almost anywhere in Europe and Asia and you will see integrative practitioners thriving because their value is acknowledged and embraced. Of course, we’re not professing that a massage therapist performs open heart surgery, but we do know that Integrative medicine can help to reduce costs across the board.

 

There are many good things that can come from Integrative medicine. You just need to be open-minded.

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Posted in Boomers, Communication, Current Affairs, Disability, Energy, Family, Future, Healthcare, Hospital, Hospital Administration, Hospital Blog, Hospitals, inspiration, Integrative Health, Leadership, Medicare, Partnerships, patient-centered care, Public Health, Public Policy, Science, Sports, Systems Medicine, Uncategorized

Memories of a new puppy and Pet Therapy

December 14th, 2016

It was a brisk, early, spring, weekend morning and Joanna, then a 16-year-old, now mother of four, said that we needed a transition dog. Tessie, our part-golden, part-black lab, part-border collie was getting long in the tooth, and it was our custom to always bring a replacement puppy into the house when the older dog was beginning to head toward the rainbow bridge.

So, at Jo’s insistence, we drove to a dog pound about 23 miles away. When we got there, it was closed, but she kept pushing hard for a new puppy.

We then headed for another sanctuary for abandoned dogs, a no kill shelter. That shelter was about 31 miles in the other direction. We arrived right before closing time and were directed to a room that was filled with a half dozen beautiful, little, white puppies.

The puppy that jumped the highest and yipped the most was not our choice. It was instead it’s little brother, the most loving and cuddly of the brood. The volunteer said that he was probably part sheep dog and part poodle, but we really didn’t care what he was because he was adorable.

We paid our fee, packed him up, jumped into the car and headed home to our older dog Tessie for what would become months of mothering, teaching and unconditional love and patience. Jo named him Brody, and it fit him perfectly.

Tessie taught him how and when to go to he bathroom and, she taught him to be terrified of thunder, to bark at the meter readers, to play with the cats as if they were his very best friends, and to beg from me at the table. While Brody reminded Tessie how to play, he became her adopted puppy.

One evening, a newly roasted turkey was placed on the stove to cool. While working on my computer, I heard some noise in the kitchen. The next thing I heard was puppy feet on the steps and then a thump, puppy feet and a thump, puppy feet and a thump. Then Brody, the puppy appeared at my chair, his belly was completely distended, and he smelled of turkey breath. He and Tessie had eaten the entire thing. Kind of like the Butkus dogs on “A Christmas Story.”

Well, Brody grew to be the best dog and best friend ever. In fact, when my mother visited, she would hold complete conversations with him as if he was a human being.

In her obituary I wrote that “She often scolded her sons for not talking enough to their animals.” Somehow the Pittsburgh newspaper accidentally changed that line to “She often scalded her sons for not talking enough to their animals.” Only those who knew my mom could have ever appreciated the absurdity of that printed mistake. So, when people said they were sorry and scanned my body for burn scars, I knew why.

It was about six years after he joined us that I went on a heart healthy diet that excluded all meat, and, since I was the only sucker in the family who would sneak him table scraps, he had to follow my diet. He became a vegetarian dog. In fact, with some of the new fat free products and make believe meats, I always made it a rulethat if Brody wouldn’t eat it, I wouldn’t eat it either. That diet extended both of our lives.

After Brody died my life became doggy less, and I’ve never gotten over that disconnect, but with my schedule and all of the traveling that I do, it would not be fair to either the dog or to me.

So, I always spend considerable petting time with my daughter’s dog, Chipper, and believe me when I tell you that when I’m around, he is completely spoiled in every way because I’m just a dog kinda guy.

And in Tessie’s memory I added pet therapy at the hospital while I was a CEO, and I’m still convinced that those dogs provided as much healing as many of the drugs.

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Posted in Healthcare, Hospital, Hospital Administration, Hospitals, Integrative Health, Mental Health, patient-centered care, Uncategorized

Random Thoughts About Things That Confuse ME

October 12th, 2015
 People have often asked me, “Where were you when Kennedy was shot?” In fact, I was in gym class. Six years after that, on April 4, 1968, I was in Pittsburgh when Martin Luther King was shot. I was back again in Pittsburgh on June 5, 1968 when Bobby Kennedy was killed. Finally, as a young teacher in Johnstown, on May 4, 1970, four students were killed and nine more were wounded by the Ohio National Guard at Kent State University. Between the riots and civil unrest that followed these events, I was pretty sure that our world was spinning out of control, and I had just graduated from college.

It was during that time of the Vietnam War, the escalation of the Cold War, the race riots and political rallies, that a chasm began to appear between those men who still had crew cuts and white socks, and conservative hippie kids like me with my wire-frame glasses, sideburns, and mustache.

In fact, at my very first job interview, the department head, a man who was still firmly planted in the 50’s, asked me if because I was my college class president, I’d ever been involved in a campus riot. Meanwhile, there had only ever been one small demonstration at my university, and I wasn’t even on campus when it happened. But his question offended me so much that I replied, “Only the one.” Needless to say that job went to someone with a crew cut and white socks.

Throughout my life I held profound optimism that because we were a country that embraced education, espoused Judeo-Christian love, and incorporated tolerance and diversity in our stated beliefs, our philosophies would prevail and the world would become a better place. Wrong.

Because I spend much of my time on the road, Facebook is often the way I keep in touch with my virtual and real families. It keeps me apprised of changes, challenges, and the daily activities of those I both care about and want to be connected to through this last quarter of my life.

Of course, Facebook is filled with puppies, kittens, babies, and opinions, and many of those opinions remind me of the Archie Bunker character who so famously dominated the airwaves in the All in the Family sitcom of the 1970’s. That series, along with MASH and The Jefferson’s attempted to challenge the way Americans dealt with race, war, and general closed-minded prejudices.

It makes me sad when my friends, people that I love and most often respect, write posts that are passionately in support of social beliefs that embrace continued gun violence, racial prejudice, twisted religious beliefs, intolerance, greed and hatred. It would be easy to unfriend them, to write them off, and forget about them, but the teacher in me wants to try to educate them and to help them find their way. That never works because most of them are Archie Bunker’s age and older. All I’m asking is for tolerance, the embracing of diversity, and a non-violent philosophy of loving others. It’s the Golden Rule. Unfortunately, it’s often the Rule of Gold that seems to prevail.

I can tell you where I was on April 20, 1999, April 6, 2007, December 14, 2012: Columbine, Virginia Tech, and Sandyhook. Unfortunately, I can’t even tell you the name of the school or how many kids were killed on January 4, September 14, September 30 of this year. October 1, 2015, however, became more tangible because the hospital that cared for the wounded in Oregon is run by a friend, and Troy Polamalu’s cousin Brandon, a teacher at Umpqua Community College, was on campus at the time of the shooting.

Minimally, as a country, can’t we invest in behavioral health initiatives and enforce background checks.

Meathead really was the voice of reason on so many levels

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Posted in Boomers, Children, Healthcare, inspiration, Leadership, Public Health, Public Policy, Uncategorized

What is Real and What is NOT? The Truth, or Maybe NOT . . .

April 30th, 2012

Sixty two years ago, George Orwell wrote the novel, 1984.   He described a society controlled by government where the individual had no privacy, no real freedom, and was literally put into the equivalent of a drug induced state by the pabulum of mass media television.  It was an intimidating forecast.   But now the question; how much dumber can television get with shows like:  “My Big Fat, Obnoxious Boyfriend,” “Real Housewives of  Wherever,” and “Temptation Island?” 

It was Marshall McLuhan, the Canadian educator, philosopher and academician who came up with terms like, “the global village, “medium is the message,” and the concept of the “World Wide Web” almost thirty years before Al Gore said he invented it.  Marshall described the fact that the mass media was quickly taking over our ability to think independently as we rushed into the realities of Orwell’s  Big Brother.  He explained that we would be once again living in a world of tribal drums, total interdependence and superimposed terror as opposed to thought and feelings from rational analysis.  Can you say, “Weapons of Mass Destruction?” 

The World Wide Web has placed us in a type of tribal unity for which none of us were prepared.  Why do you think tattoos are more in now than any time before 1500 B.C.?  Piercings and tattoos make you “part of the tribe.”  Hey, the majority of presidential candidate debate issues revolved around turning the clock back to the 1950’s, no web. 

It appears that, because of this tribal unity, many very obvious changes have become accepted by our current culture.  For example, according to columnist Rex Huppke, the fact that someone of any political party can say something that is completely false and stand by it makes facts meaningless and thus, dead. He goes on to theorize that, rumor and innuendo along with emphatic assertion are also part of this new communications standard. 

Dartmouth political scientist, Brendan Nyhan professes that, “In journalism, in health and education, we tend to take the attitude that more information is better, and so there’s been an assumption that if we put the correct information out there, the facts will prevail.”Nyhan says that, “Unfortunately, that’s not always true.”   Facts don’t seem to matter, and those who expose bogus facts are often more highly criticized than the person who misrepresented the truth in the first place.

We all know that the spin can change the view on any subject matter.  In many cases, it’s the quality and persuasiveness of the argument, not the facts which becomes the issue.   If you are on the right side of the spin, or if enough information can be put out there, the mass audience will be distracted from the facts, and confusion will reign supreme. 

Fact:  The United States has one of the highest infant mortality rates in the industrialized

Fact: Legislation has recently been proposed to take away additional funding for prenatal care. 

Fact:  The United States has fallen to “average” in international education scores and our State austerity measures include the laying off of teachers. 

Fact:  The incarceration rate in the United States of America is the highest in the world with only five percent of the world’s population, one-quarter of the world’s inmates are incarcerated in the United States. 

Fact:  Average annual cost per student for a public school education $8500; average annual cost per prisoner, $23,000. 

See, many of you will not know if you should believe these facts.  Some of you will fact check them.  Others will say, so what?   Some of you will look for my prejudices regarding this list, or you may be overwhelmed and say, “I can’t change any of this anyway.”  Most, however, will not bother to read this far. 

Twitter has become the new novelette and everything is a sound bite.   As Jimmy Kimmel said, “What’s back and white and read all over? Nothing anymore.”

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Posted in Communication, Current Affairs, Events, Future, Healthcare, Hospital Administration, Leadership, Public Policy

Living the Dream – Southwest Florida Global Research Institute

January 30th, 2012

Greetings From Florida - Southwest Florida Research Institute - Nick Jacobs, FACHEI’ve been on a blog hiatus — the longest since I began writing this back in 2005, but for good reason. Another former trumpet player, Kevin Taylor and I have been working on the creation of a research institute in Southwest Florida.  It will embrace an ambitious research mission, academic excellence and become the biotech engine of what could become the future of Southwest Florida’s clinical research, environmental, aging research, behavioral health and translational medicine efforts for the region.

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.

Southwest Florida Regional map - Nick Jacobs FACHE - HealingHospitals.comThe 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.

Windber Research Institute - Image by PlanetRussell.netThe 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:

Chico's in Lee County, near Ft. Myers, FL

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Posted in Future, Healthcare, Science

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The Patient-Physician Connection

November 28th, 2011

With age, one sometimes begins to accumulate wisdom, and, although I am not one to focus on the woulda, shoulda, coulda opportunities that have passed me by, one regret that I surely have is that I had not met Dr. David Rakel  until about three years ago. Dr. Rakel is the Director of the University of Wisconsin Integrative Medicine program.  He attended medical school at Baylor in Houston, Texas, and completed a family practice residency in Greeley, Colorado.  He is a doctor, a father, an academician, but most importantly, he is a healer.  Of all of the physicians that I have ever known – and there have literally been hundreds of them, Dr. Rakel embraces all that is good in the medical profession.

David P. Rakel, MD - Healing Hospitals - Nick Jacobs, FACHE

David P. Rakel, MD

In his presentation, “Placebo or NoCebo,” David outlined the ingredients present in a healing environment:  1. A relationship with a helping person, 2. A healing setting, 3. An explanation that gives a sense of control of a symptom.  4. A ritual procedure or plan that involves active participation of both parties – patient and clinician – that results in belief towards action.  He spoke passionately about the importance of touch, the intrinsic value of healing, and the fact that something was done with the ritual.  One of my favorite, tongue- in- cheek quotes that David had was from Voltaire: “ It is the physician’s duty to amuse the patient while nature cures the disease.”

Dr. Rakel talked about the intelligence of being positive while giving the prognosis, showing empathy, empowering the patient, and demonstrating the importance of having a connection between the physician and patient.  I’m sure that I’m not capturing all of the salient points that David carefully made, but I am sure that I understood his commitment to connection with the patient and the significance of using as many positive words as possible to convey that connection.

Once again, a great quote from Dr. Rakel revolved around the fact that you get better faster if you have unconditional love from your pet than a bad connection with your doc.  He and his research on the common cold both suggested that, “It is better to stay home and be licked by your dog, than to spend time  at a clinic with a grumpy doc!”

His recommendations to his residents and to all of the physicians to whom he lectures is that the physician needs to display empathy, compassion, patience and the ability to listen.  His counsel to meditate revolved around the need for us to get out of our chaos and influence self-healing mechanisms.  He described this journey from awareness to awakening to authenticity and finally to awe where the closer that we get to authenticity, the more beautiful our lives become.

Dr. Rakel then launched into numerous studies that evolved around the placebo effect such as the study where arthroscopic knee surgeries were “faked,” but resulted in positive outcomes.  By referring to obesity as working toward optimal weight; chronic pain as myofascial health, depression (and this is my favorite) as potentially happy, the patients are not labeled with negative implications, and we accomplish a shift in our intentions.  Not unlike what Newton, Einstein and Stephen Hawkins have done in physics, perceptions have been shifted by changing the manner in which we observe things.  He said, “How about if we tell the patient that they are potentially happy rather than clinically depressed?” Our intention is reflective of our future.

Finally, Dr. Rakel suggested that physicians protect time in their schedules, create space, create positive patient expectations, be fully present and listen to the patient, that they offer support and collaboration and create a plan by using words that heal rather than words that harm.

Right on. Thanks, Dr. Rakel.

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Posted in Healthcare, Integrative Health, Medicine, Mental Health

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Steve, Dean and Nick: Be “Insanely Great.”

October 25th, 2011

Steve Jobs - HealingHospitals.com - Nick Jacobs, FACHE
During this time of economic uncertainty, the recent loss of creative, innovative leaders like Steve Jobs and Dr. Lee Lipsenthal adds to a collective national and personal concern over what seems like a serious lack of truly inventive and ethical leadership. Who will represent the next wave of 50-something leaders, and how will their personal characters influence upcoming generations?

One hope that I have for the future is Dr. Dean Ornish, a man who has been a personal friend, mentor and physician to both Mr. Jobs and Dr. Lipsenthal. To describe Dr. Ornish as a man of character, knowledge and creative medical vision would be akin to calling Winston Churchill a “good dinner speaker.”

Dr. Ornish and I have a long history of friendship, respect and support for each other’s work. Years ago, wanting to avoid being a heart surgery patient, I began to explore alternatives to legacy procedures and regimens. And, not unlike Steve Jobs, whose initial interest was also to avoid having his body violated by surgery, my research led me to the work of a young Dr. Dean Ornish. As soon as I learned more about his extraordinary program for coronary artery disease reversal, it was a simple decision to invest my own personal funds in one of his intensive workshops, held near his home in California.

Dean Ornish at PopTech (2009) - Camden, Maine - Nick Jacobs, FACHE - HealingHospitals.com

Dean Ornish at PopTech, Camden, Maine (2009)

 

As providence would have it, my own work resulted in what became a steady stream of research grants, and my subsequent personal decision to include Dr. Ornish in our appropriations for the next half-dozen years at the hospital and research institute where I previously served as President and CEO. Each year, I fought to have at least one million dollars invested in the Preventative Medicine Research Institute in California so that Drs. Ornish and Lipsenthal could continue to move forward in their research, as well.

Once, Dr. Ornish asked me, “Nick, what do you really want from our work together?” Without a moment’s hesitation, I replied, “Dean, I want to lose the question mark after the name of the town, ‘Windber.’  Whenever I tell people where we’re based,  they usually respond, ‘Windber?’…’You mean Windber, PA… the old coal mining town?'” Some history here: I had been hired by the board of rural 102-bed, acute care hospital in that historic, rural community to either radically turn it around, or shut it down. For me, the latter option was never a consideration.

Among the many transformational changes we made as part of the turnaround was to be among the first hospitals — and most probably the first rural hospital — in America to implement Dr. Ornish’s evidence-based program that arrests (and can even reverse) the effects of coronary artery disease. The results — with patients of broadly diverse ethnic backgrounds — were so successful, that we were asked to present to the World Congress on Cardiology in Belgrade, Serbia in 2007 on our outcomes and research discoveries, garnered from our experience implementing the Ornish program.

We were also instrumental in introducing the program at other sites for Highmark Blue Cross, as well as a host of other innovations and reforms at our own hospital; from live music playing, to fountains, delicious, nutritious food, cooked by classically-trained chefs, 24-hour family visitation and… wait for it… pajama bottoms for the comfort, dignity and modesty of our patients.

The goal: an environment entirely dedicated to the healing of body, mind and spirit.

The result: among other verified successes, one of the lowest hospital acquired (i.e., nosocomial) infection rates – less than 1%) in the U.S., where the national average is around 9%.

And, yes, we were profitable. Consistently profitable, quarter over quarter.

On one flight in a private plane with my board chairman and me from Cincinnati, Dr. Ornish and I had mutually planned to spend some “quality time” together – collaborating, planning and just trading stories about our experiences. Instead, he wound up honoring an emergent commitment as a personal health advisor and consultant to the leader of an Asian nation, and spent the majority of our flight in direct, one-on-one communication with this person. Awesome? That’s just the kind of guy he is.

My personal hope is that Dean Ornish will take up the mantle for both Jobs and Lipsenthal, as he takes his wellness programs to new levels through mobile apps and enterprise solutions using  iPhones and other mobile devices, and iPads and other tablets, making innovative use of social media technology. (Talk to my friend Mike Russell about that.) My further hope is that  Dr. Ornish’s success as an agent of influence and change will continue to be used in a powerful way, to not only help improve the health of the world, but to continue to positively influence public policy in the United States, as well.

Newsweek cover - Dr. Dean Ornish - Healing Hospitals - Nick Jacobs, FACHEDean Ornish has long been recognized as a leader, a man of character and a visionary, but with the loss of two of his closest friends, the pressure to perform grows exponentially greater. So, my best to you Dr. Ornish. Thanks for your confidence in my work. Keep the faith, and keep up the good fight to make a phenomenal difference in this world, thinking in insightful new ways and never resting on your laurels. As your friend  Steve Jobs famously said at his Stanford commencement address, “Stay hungry. Stay foolish”…but especially the phrase he immortalized early in his career: be “insanely great.”

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Going “Rogue” – An Open Letter to Healthcare CEOs

October 17th, 2011

For the past three years, I have had a chance to dig heavily into the future, and I’m pretty convinced that the old saying, “Necessity is the mother of invention,” has never been more true than in today’s healthcare environment.  What was a given before in healthcare management may no longer be so in the future, and since most hospitals only Chief Innovation Officer is the President him or herself, their tasks of visualizing, understanding, deciding and directing the future of the organization will be shifting even more heavily from quantitative deciding-and-directing to the more qualitative visualizing-and-understanding side of this leadership equation.

Although I understand the reluctance of most CEO’s to be on the bleeding edge of creativity, my experiences at my former positions can significantly reduce or mitigate the majority of risk from any decision regarding innovation.

Our new competitive environment has an insatiable appetite for information, access and connectivity and it’s a well known fact that a periodic injection of chaos fosters creativity and forces your co-workers to leverage technology.   Because most organizations already have an environment that is built on trust and collaboration, injecting a little creativity can put their CEOs in more of a position to be the orchestrator and the inspirer.

That Used to be Us That Used to be Us is the new book by Thomas Friedman and Michael Mandelbaum in which they analyze four specific challenges Americans face as a nation—globalization, the revolution in information technology, the nation’s chronic deficits, and our pattern of excessive energy consumption—and spell out what they believe needs to be done to sustain the American dream, and achieve true supremacy based on innovation and excellence.

As an innovator and futurist,  several sections of this book captured my imagination and brought closure to a myriad of beliefs that I have instinctively embraced over the past few decades.  When my responsibilities revolved around the CEO position, I always saw my job as being a contributor to an environment where creative decisions were embraced allowed to happen and then those innovators were rewarded and inspired to keep going.

As the co-founder of a Research Institute, one issue that continually resonates with me is that  “We don’t have enough ‘rogue’ CEO’s in healthcare administration to take risks so that the rest can benefit from both their successes and knowledge.”

Well, fortunately, I’m your guy.

For the last several years I have been out there implementing unusual things, and many of these disruptive ideas are coming to pass in a big way.  I was the first hospital CEO to blog, starting in 2005 (HealingHospitals.com), was an early Planetree board member, created the first breast cancer research center dedicated to the Department of Defense, and filled my hospital with Integrative Medicine, hotel amenities, and music.

Below, I’ve listed thirteen new examples of areas of innovation, in which we’ve been working for the past three years, as well as numerous ways to pay for these initiatives.

 Thirteen Examples of Disruptive Technologies and Practices That Hospitals Need to Understand 

  1. Robotic algorithmic software that improves emergency room flow by 37 to 50 percent.
  2. Financial transaction software that reduces electronic transfer fees exponentially (25% of health care income is from electronic transfers.)
  3. Utilization of nurses and actuaries as patient advocates to significantly reduce your employee health costs.
  4. Preventative medicine reimbursements that can double a physician’s income and add bottom line profits to hospitals.
  5. Treble growth potential of your organization through adding Integrative Medicine
  6. Diabetic retinopathy telemedicine for Family and Internal Medicine docs.
  7. Proteomic and genomic testing creating new “hospital income.”
  8. Peritoneal lavage that extends Stage 4 cancer patients from three months to five years or more.
  9. Bone scaffolding that supports bone growth and virtually eliminates bone infection.
  10. Special bandages that protect and stem cell cocktail sprays that heal burn wounds
  11.  Access to a cancer consortium that allows small and medium hospitals to become Certified Cancer Centers
  12. Hospitals paid “not to play” during an energy crisis as a back-up to the power grid.
  13. Green hazardous waste disposal costing 25% less than traditional methods

If you’d like to learn more about any adopting any of the concepts above, or receive a leadership presentation that will enable your staff to see the opportunities (rather than just the threats) in our current, uncertain environment, here’s where to find me.

Why Are Hospitals The Way They Are? from Nick Jacobs, FACHE on Vimeo.

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