Archive for the ‘Healthcare’ category

The Obligation is Real

September 21st, 2010

On Saturday night a group of people will gather at a restaurant  for a celebration of life since graduation from high school. I won’t be there. Neither will Joe, Butch, Tommy and half a dozen others,  but their absence is for a very different reason: they have passed away. I, on the other hand, will just be passing. So, why not go this year?

Nick Jacobs, FACHE at the beach with his grandchildrenWell, it’s a kid thing. You see, part of my birthday present to each of my kids was an overnight stay at a resort with their spouses, and, low and behold, there is no one to watch three of the grandkids and the brand new chocolate lab; no one, that is, but me. Why would I sacrifice the opportunity to hang with my old buddies for the chance to change diapers, mop up housebreaking accidents, and argue over bathing and bedtime issues?  Why?  Because it was part of the commitment, that kid commitment.  They will be my kids until either I die or they do, and with that come certain obligations that are real.

Why bother you with all of this personal blog stuff?  It’s about obligations.

The other day, a bright young man met with me at lunch to ask me questions about the American Healthcare System. Interestingly enough, I don’t believe that  my answers were what he had expected. You see, we have certain beliefs about our rights to generate, earn, and receive money in this country. What is missing, however, is a realistic reward system that aligns the appropriate reimbursements with the actual needs of the country. When he asked me how many hospitals would invest in purchasing his product, one that might help to eliminate hospital infections, my response was “Not many.”

You see, with obligatory bottom line orientations, many of the hospital CEO’s and CFO’s are not anxious to spend money on a  product that might work.  More importantly, with a lack of transparency, the public exposure that most organizations have relative to this infection problem is still somewhat limited.  It was easy to explain that if “St. Elsewhere” was exposed for having a 24% infection rate, not unlike a five star hotel having bed bugs, you can darn well bet that something would be done and done quickly, but the issue is not so pressing when it is under the basket.

Over the last few years, I have lost some wonderful friends who have had fantastic surgeries at highly respected hospitals.  These surgeries would have been impossible to have in a “normal” hospital, but, having said that, two of them died and one lingered near death for two years due to the infections they acquired there.

If this was widely publicized public knowledge, might he be able to sell more product?  The question was rhetorical and the answer is absolutely, positively, yes. So, back to obligations. Why is it that we must be exposed in order to become aggressive about serious problems in our systems?  The answer is simple: It costs money, and resource allocation is the number one challenge of most hospitals.  Hence my point about our financial incentives.  If we were reimbursed, rewarded and paid, not in an unconnected, cottage industry manner, our treatment regimes and protocols would change.  If we knew that it would be our financial responsibility to amputate limbs for advanced diabetes, would we be more eager to spend money on wellness initiatives?

Truthfully, it’s our obligation, and, as our fellow human beings suffer, we are currently seeing a movement toward political groups intent upon repealing reform measures. That is a backward view of an already complex challenge. It is our obligation to help our fellow man. “Do unto others …or pray you don’t lose your health insurance.”

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The Problem with Experience, Intellect and Self-Assurance

September 3rd, 2010

I received this quote from a friend today:

He who knows only his own side of the case knows little.
His reasons may be good, and no one may have been able to refute them.

But if he is equally unable to refute the reasons on the opposite side,

if he does not so much as know what they are,
he has no ground for preferring either opinion.”

–John Stuart Mill, British philosopher from his classic On Liberty, 1859

Man Looking in Mirror - Recursive - Nick Jacobs, FACHEMy new friend, Dan, has been helping me by holding up a rather small mirror, and suggesting that I explore me in that looking glass.  For the past two years, my patterns have not changed appreciably.  My work day starts very early and typically ends very late.  During those working hours, it has been my custom to continue to pursue those imaginative, creative inventions, ideas, and interventions that can help to change lives, businesses, and futures in a very positive way.  My enthusiasm for these discoveries, however, seems to get me into trouble, because I’m always trying to provide answers before anyone asks me questions.

Everywhere we go people are selling us something.  We are being inundated with opportunities to try something new, something different, something wonderful that will change our lives. We not only become callous to these approaches, we become cynical and sometimes very negative toward them.  Hence, when I try to explain that there really is plenty of money available to us to add those services and to create the type of environment that we know the Baby Boomers and their kids would love, the push back begins.

In fact, Dan held up his hand and said, “Put your hand against mine.”  Within seconds we were pushing on each other’s hands.  It’s a natural thing.  We see the hand and begin to push back on it.  Our experiences, our intellectual capacity, and our self-assurance all work against us as we assume that “we have the answers,” and that no matter what is on the table, you have experience and knowledge that allows you to counter its winning characteristics.

Dan suggested that I begin to approach things differently. He suggested that I stop telling people all of the details of my incredible discoveries and allow them to tell me where their pain resides. Allow them to tell me what hurts. Then, suggest some of the marvelous potential cures that have been so much a part of my research over the past few years.  Maybe we should all listen to Dan?

As CEO’s (and former CEO’s), we all know a lot. We’ve experienced a lot, and if we weren’t fairly self-assured, we wouldn’t have gotten the job in the first place. So, maybe, just maybe, instead of always trying to fix everything before we really understand the details, maybe it would be good –really good to just listen for awhile.

Early aircraft listening device, Bolling AFB 1921

Early aircraft listening device, Bolling AFB, 1921

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A Speech to the Risk Managers at RM&PSI

August 27th, 2010

The RM&PSI is a national leader in clinical risk management practices and patient safety programs for health care institutions and providers.

RM&PSI, the Risk Management and Patient Safety Institute provided a forum for me to not only give a speech today on patient advocacy, but also to passionately press for its members to take up the cause of transparency, patient and patient family support, and healthcare quality.  Yes, the speech touched on Social Media tools as a means of reinforcing the message, but it was really all about patient adovcacy.  The RM&PSI is a national leader in clinical risk management practices and patient safety programs for health care institutions and providers.  It primarily focuses its efforts on clinical risk reduction strategies, quality patient outcomes and health care provider education.

Their conference was held in Traverse City, Michigan which functions as the major commercial area for a seven county area and is one of Northern Lower Michigan’s two anchor cities.  Tourism is a key industry and the area features freshwater beaches, vineyards, a National Lakeshore, downhill skiing areas, and numerous forests. But when you’re there to make a speech, it simply features nice people, a hotel room, and a conference room.  (So much for the sun, sand, golf and gambling.)

Nick Jacobs, FACHE - F. Nicholas Jacobs - Healing Hospitals - Sunstone Consulting

Nick Jacobs, FACHE

This opportunity was unusual for me because my typical speech-making effort includes a trip in, a speech, and a trip back out.  This time, however, they graciously invited me to attend both days of the two day event, and my eyes were opened even wider to the quality of the dedicated people who perform these “risk management” and quality assurance  jobs for our healthcare systems.  The people were absolutely delightful; warm, welcoming, open and honest, and it was a particular pleasure being the wrap-up speaker for the conference because I had been given the opportunity to listen to two days of presenters, to take notes, and literally to recraft my presentation to embrace the tenor and tone of their overall seminar.

The one thing that came out loud and clear for me is that our C’s (CEO’s, CFO’s, CMO’S, CNO’s, etc.) must carry the flag for our risk managers and quality assurance professionals. By being transparent; open, honest, caring and kind, we can make a real difference.  It is about taking care of our caregivers and taking care of managing the expectations of our patients and their families while supporting quality at all costs.

Thanks, RM&PSI for your invitation, your warm welcome and  your kind response to my work.  It is what I live my life to do.  It is what we need to be about.\

Free Resources from RM&PSI:

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And one more thing . . .

August 12th, 2010

These blog posts are supposed to be directed toward creating healing hospitals. That objective seems to be compromised from time to time as I post genuine opportunities for hospital CFO’s and CEO’s to trim monies from their budgets, to find money that their hospitals should have received, or to initiate new ventures that will create additional, positive economic yields for their facilities.  I’m sorry, but I just can’t help myself.

One of my “gifts” as a CEO was to always find ways to pay for the challenges that we faced so that new ideas, new modalities and  new healing techniques could be introduced to our healthcare environmentI even wrote a book about it. Interestingly, the biggest push back that I experience when presenting to my former peers is that bottom line, no nonsense question: “How the heck are we supposed to pay for this stuff?”

The Benefits of Healing Hospitals

View more presentations from Nick Jacobs.

Over the years I’ve prepared charts, graphs, and narratives demonstrating the dramatic growth patterns, the huge economic surpluses, the wonderful bottom lines that were generated by embracing a “healing” philosophy, but those of you who have been lured by “snake oil salesmen” in your past lives are very leary that my passionate dialogue is simply that, dialogue. You have  no  reason to believe me when I say that improving your employee morale will improve your patient satisfaction scores. Of course it’s common sense, but if you’re too nice to your employees, they’ll think you’re a push over and they’ll take advantage of you, right?  Well, after 22 years of niceness, the one thing I can tell you is that niceness can be confused with weakness, and that needs clarification early on in your journey.

You see, my recent devotion to the economics of healthcare was prompted by the knowledge that you will be treating much larger quantities of patients for less reimbursement. Consequently, new streams of funding will be imperative. For example, the annual amount of discretionary healthcare dollars spent on integrative and holistic medicine is well into the double-digit billions of dollars.  Logic would tell you that at least a percentage of these dollars could be spent at your facilities.  The downside is that your patients have not been used to paying cash for anything except co-pays, but the reality is that “they will pay,” if the service is meaningful, helpful, and healing; money simply becomes a way to get them there.

Wellness Wheel - Image credit: Marquette UniversityIf you, however, don’t believe that massage is good for you, don’t believe that some people respond well to acupuncture or Reiki, don’t care that aroma therapy, floral essences, or pet, music and humor therapy have a place in “legitimate medicine,” that’s a problem, a personal problem.  Go on vacation to some place like Canyon Ranch, and let go for a few days.  Allow yourself to be open to new modalities.  The body and mind can work extremely well together . . . if you’ll just give them a chance.  More importantly, you can generate additional funds for your facilities that will result in additional growth in market share, in patient loyalty, and in patient and employee  satisfaction.

So, this week’s tip . . . financial transaction services: Over 1/4 of your facilities daily financial transactions are completed electronically.  We are currently providing the interface for your financial transactions that will reduce your costs of doing electronic business exponentially.  It is seamless, requires no interruption of your current banking relationships, and invisible to the patients and your staff, but why, for example, would you pay 4.5% if you could complete the same transaction for 2.5%?  It’s savings that can contribute to your bottom line to allow you to supplement your staff with those individuals who can add additional depth, healing activities, and peace of mind to your patients’ experiences.

It’s all good.

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Could We Do It Better?

August 8th, 2010

Several months ago, I met a white-haired gentleman of average stature at a meeting.  When I asked him what he did, he replied, “I’m a patient advocate.”  “So am I,” I said. “I even wrote a book, Taking the Hell out of Healthcare’ about it.  “Yes,” he continues, “but I found a way to make a living from doing this.”  His name is Harry and he is an actuary.  In those yin and yang posters, that would put us at opposite ends of the proverbial left brain/right brain spheres.  He had analyzed health care records for about thirty years and could prove what we all know, that between 5 and 7% of our employees use up about 80% of our healthcare dollars. That, my friends, is not rocket science.   All you need to do is hang around some sick people for a while, and you’ll realize that “our system” is set up to keep doing things to them over and over again.  Usually, it’s not to help them eliminate the problem, but to maintain their life in a chronically challenged situation.

Ryan Is An Actuary.  Look It Up. Flickr photo credit: evaxebra - © all rights reserved

Flickr photo credit: evaxebra © all rights reserved

So, I asked Harry what he does, and he indicated that he hires nurses, pays doctors and employs ”MANAGED CARE’S GREATEST HITS.”   Now every health insurance company in the world will claim the same thing, but everyone who has ever been turned down for anything by any health insurance company knows that: 1.) the bottom line reason was usually their bottom line, or: 2.) it’s a nurse against your doc, and your doc has not employed all of the verbal and intellectual tricks to convince him or her to allow you to have the test or take the drug that he thinks you need.

Harry went on to explain that these “5  percenters“  usually have anywhere from nine to fifteen docs with whom they interact on a yearly basis, and, not coincidentally, these physicians usually don’t do a great deal of interacting with each other, hence the need for patient advocates.  This is where Harry’s nurses come into the picture.  He assigns a nurse to each high-risk patient, allows the patient to pick their “favorite quarterback doc,” and then pays that physician to help hold down the duplication of unnecessary tests.  Makes sense, huh?  I can just hear my Internal Medicine physician saying, “Nick, you don’t need those 13 other chest x-rays this month, the first one will do fine for all of us.”

Interestingly enough, this system WORKS, and it works pretty darn well because it’s not about saving money for the insurance company;  it’s not about depriving the patient of needed tests;  it’s not about controlling the patient, or preventing him or her from having what they need, but it is about eliminating wholly unnecessary tests, meds, and procedures.  Harry had letter after letter from grateful patients, families, and employers thanking his people for helping them navigate their way through the maze of this very complex, sometimes-disconnected, procedure-oriented system.

The other interesting thing is that Harry likes to go to a town and start first with the hospitals, because their employees are the most comfortable with using everything, and have the easiest access to the most doctors.  It’s a great way to prove  the system works.  From that point on, he then works to bring all of the major employers into the fold, and ties them into the primary hospitals.  It’s something that only an actuary could have accomplished, because, as Harry readily states, “It’s taken me about 30 years to perfect this system.”  The patient is protected from being over-tested in an indiscriminate manner; the hospitals or businesses save a considerable amount of money, thus limiting reases in their annual healthcare costs, and the savings are cumulative over the years.  So, why not try something that will improve the employee morale, patient satisfaction, and quality?

If you are interested in learning more about this program, give me a call.

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Modern Healthcare’s “Don’t Ask, Don’t tell”

August 1st, 2010

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The July 19th edition of Modern Healthcare had a very revealing article by Melanie Evans entitled “Don’t ask, don’t tell.” The cut line under that title was “A third of physicians in a  study don’t feel obligated to report impaired [fellow] docs.”  Ms. Evans went on to describe the fact that the word impaired refers to drugs, alcohol or mental illness.  The study was from the Journal of the American Medical Association and it queried nearly 1,900 physicians.  Having been involved with the management of hospitals for over two decades, the results of this study shocked me.  Not because I didn’t believe it was possible; not because I didn’t believe there could be a problem but because it was clearly not my experience.  Yes, there were impaired physicians, administrators and staff members, but the programs available to them were comprehensive, thorough and unending.

If the question was posed, “Is there a problem with drugs, alcohol, and mental illness among physicians?,” my answer would have been  yes.  The same, however, is true of administrators, staff and employees.  None of those exposed to an environment that intersects with life and death issues on a daily basis and that requires the incredibly long hours necessary to keep the  proverbial “wheels on the bus” is without risk of these problems.  Add to that the relative ease of going  from one “friend” to another to get the prescription that is needed, and we have created a potential formula for disaster.

The seriousness of the outcomes derived from this series of questions is not something that any of us “in the business” is in any way ignoring.  It is real.  It definitely could result in injury andor death through medical errors.  So, the question becomes one of management, monitoring and self-policing.  The airline industry pays very close attention to the impairment of their pilots. Why?  Their crashes are typically not between one pilot and one passenger.  They are large, emotional events that impact literally thousands of lives.

When will the medical community begin to embrace the same standards as the airline industry?  It seems to me that we are currently “on  the move toward that objective now,” and as the public and government put more and more pressure on the healthcare industry to be transparent, it will become harder and harder to hide those shadow surgeries that went wrong  or those mis-diagnosed cases that could be traced back to impaired professionals.

Image credit: Edie Falco as Nurse Jackie - (c) Showtime Networks

The Modern Healthcare article ended with the statement that doctors “need more education on programs that evaluate and manage treatment and monitoring for impaired doctors.”  I agree . . . in this case, more is better, but how many “Nurse Jackies” (i.e., the hypothetical impaired employees) do we have flying low throughout our facilities as well?  The healthcare industry needs to pay attention to all of its impaired at all levels.

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Overexposure to Radiation

July 12th, 2010

When I saw this…

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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 shoe size

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.

HealingHospitals.com - Overexposure to Radiation - Nick Jacobs, FACHE

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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Settling into what?

July 3rd, 2010

Healthcare reform will be phased in over the next several years, and when you ask the experts what their opinions are regarding this new legislation, the universal answer that I’ve received is, “I don’t know.”  There is one very fundamental reason that leads to this answer, bureaucracy.   Much like HIPAA, the law was actually written by young health policy scholars, 50% of whom will not be in their current positions two or three years from now.  In fact, many of them will no longer be in the Metropolitan Washington D.C. area.  Consequently, the policy wonks will take over and the fundamental premises upon which the program was built will be left for in-depth interpretation by the “bureaucrat du jour.” 

Having spent a decade working in a government related, subcontract situation, this fact alone sends cold chills down my spine at the rate of thousands per second.  Recently, it was my distinct displeasure to sit across from two of these individuals, detail splitters, at a meeting on Capitol Hill.  Prior to the “opening bell,” they had formulated their opinions regarding their preferred outcome of the meeting, and they had dug in to ensure that none of the facts presented by the opposing side would be considered relevant.  They had made up their minds that the greater good would be served by their pre-meeting decision making.  Interestingly enough, their decisions in fact would result in hundreds of families being destroyed as their loved ones were forced to languish so that studies of the studies could be performed over the next several years. 

In HIPAA,  the Health Care  Insurance Portability and Accountability Act, the “wonks” took its well-intended core values and distorted them into a nightmare of implementation that forever changed health care in the United States, and, after literally billions of dollars of required implementation changes for thousands of hospitals, doctors, and health professionals, all one has to do to experience the absurdity of most of these privacy attempts is stand on the other side of a curtain in a surgi-center, a semi-private room, an emergency room, or even a registration area and listen.  What you will hear is hundreds of facts about the person beside you; condition upon admission, detailed diagnosis, phone numbers, et al, at which point you can lean back, smile and say, “HIPAA my A**. ”

So, conceptually, is healthcare reform what needed to be done?  The answer is an unequivocal, “Yes.”  Was it the right thing to do to reach out to the uninsured?  Absolutely.  Should we as a country move toward electronic medical records?  Yes.  Does it make more sense to bundle payments so as to encourage physicians and hospitals to work together more closely?  No question.  Finally, was the system broken?  Beyond a doubt. It was completely broken. 

As a country we have slipped out of first place now in so many categories that it is embarrassing to delineate those statistical changes, but healthcare should improve now that this legislation has passed.  You may have detected that the operative word is SHOULD.  Will it?  On PBS’s Nova last evening I watched the day by day analysis of why we were not ready for the attacks on 911.  It was because of the bureaucracy.  It was because the NSA (which now has about 35,000 employees and has a budget well over $20B annually.) was NOT willing to share the information that they were obtaining with the FBI, and the FBI was not working with the CIA, and the CIA was not working with the FAA, and the FAA was . . .  Well, you get the picture. 

Healthcare reform?  We’ll see.

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Moving Through Healthcare’s Version of the BP Oil Spill

May 27th, 2010

Who could have ever guessed that the United States of America would fall so far behind in education, childhood death statisticsscientific research, manufacturing jobs, and even overall, general healthcare?  Yes, of course, we are still a wonderful, strong country with incredible resources, but somewhere along the line, the train seems to have jumped off the track just a little, or is that like being a little pregnant?  No one would ever have conceived that a spark plug would be worth more than GM stock, but that’s exactly what happened last year.  Or how about the fact that large investment banks responding to the mandate to increase home sales by spreading the risk internationally could have helped put this entire world on the verge of a national depression?

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:

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Speaking This Year

May 20th, 2010
Nick Jacobs, FACHE - F. Nicholas Jacobs - Healing Hospitals - Sunstone Consulting

Nick Jacobs, FACHE

As some of you may have noticed, last year was a tough year for education, travel, and some forms of consulting. It was “the economy, stupid.” A number of our major public speaking engagements were canceled or postponed, because hospitals stopped sending employees to educational conferences. In fact, at one of the leadership conferences where we spoke last year, there were only 90 people in attendance. The previous year, there had been nearly 500.

Well, thank goodness, things have picked up a bit, and we will be speaking a few more times over the next several months. The following is an up-to-date list of locations, dates, and topics currently scheduled:

  1. Lake Erie Regional Cooperative/Amerinet Conference, Toledo, OH, May 7th, 2010
    “Redesigning the Patient Experience”
  2. Risk Management and Patient Safety Institute, Lansing, Michigan, August 27, 2010
    “Blogging and Transparency -Increasing Patient Satisfaction through Web 2.0″
  3. Planetree Conference, Denver, Colorado, October 8th, 2010
    “Navigating the challenges faced while transitioning to the Planetree model of care”
  4. Central Peninsula Hospital, Soldotna Alaska, October 14, 15th
    “Planetree”
  5. Waverly Health Center, Waverly, Iowa, October 20-22,
    Topic: To be announced
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