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Running to a Hospital

June 13th, 2010

Periodically, it brings me comfort to return to my home base, and that is a place where not enough of my former peers have still journeyed.  One of my more spiritual friends always stops my conversations by saying, “Nick, you need to let go, and ask to be directed to the place where you can do the most good.”  She is talking about spirituality, believing in the universe, allowing destiny to present itself to you.  Truthfully, I spend a lot of my time being frustrated, wondering why others can’t see the light regarding such simple issues as: Transparency, Kindness, Patient and Employee-centeredness.

U.S. Veterans Affairs Secretary, Hon. Eric Shinseki

U.S. Veterans Affairs Secretary, Hon. Eric K. Shinseki

Interestingly, the largest public health system, the U.S. Veterans Administration (which has 17,272 beds and 153 hospitals) began their journey of “change” about five years ago when several of their administrators first approached Planetree.  I’ve been writing about, involved in, and literally living Planetree for decades now, and my passion for this philosophy of care has not waned.  It is about humanizing the healthcare experience, being transparent, centering your focus on employees, staff, and patients in ways that have not been considered even before the United States universities produced more attorneys than physicians.

Unfortunately, our business-minded organizations continue to look upon kindness as weakness, upon transparency as stupidity, upon patient and employee centered activities as pandering, and the price that we pay because of this archaic thinking is very high for all of us.

So, why would the VA get involved?  They “saw the light,” and the light was pretty darn bright.  When you look at the statistics regarding infections, lengths of stay, litigation, and patient and employee satisfaction, there  appears to be no decision.  Of course we can achieve several of these “dashboard” goals by producing human widgets, by treating people like objects, by taking over entire geographies and making sure that no one has a choice about anything, and we can continue to rack up profits in the billions, but are we really doing our  job?

Generations of Valor - WW II meets IraqThe VA thought not and started their journey, hospital by hospital, toward a kinder, gentler world.  Will they be successful with a culture bred out of military medicine?  Can they change a system that has long since been openly criticized as broken?  I think they can and they will, and with pending legislation that will permit our military and retired military personnel to “seek care where it is best delivered,” it will be interesting to see how well they do.

If you are in hospital administration and have little or no competition, ask yourself what would happen if your new competition allowed the patients to access their medical records; if  loved ones were invited to stay and become part of care giving teams; if there was 24 hour a day 7 day a week visiting hours; if employees were always treated with diginty; respected, rewarded, and recognized for their work;  if patients were always at the center of their own care?

Hopefully, someday, the masses will get it, and we will go from treating “organs” to treating people; we will focus on prevention not cleaning up train wrecks; we will embrace kindness, openness, transparency, healing and respect; and finally, we will acknowledge that the value of a human being is not based upon the value of his or her estate.  When that happens your patients will be “Running to a hospital” …your hospital.

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Posted in Hospital Administration, Hospitals, patient-centered care

Interesting Words to Think About

September 25th, 2009

The time has come to realize that the old habits, the old arguments, are irrelevant to the challenges faced by our people. They lead nations to act in opposition to the very goals that they claim to pursue — and to vote, often in this body, against the interests of their own people.  They build up walls between us and the future that our people seek, and the time has come for those walls to come down.  Together, we must build new coalitions that bridge old divides — coalitions of different faiths and creeds; of north and south, east, west, black, white, and brown.

The choice is ours.  We can be remembered as a generation that chose to drag the arguments of the 20th century into the 21st; that put off hard choices, refused to look ahead, failed to keep pace because we defined ourselves by what we were against instead of what we were for.  Or we can be a generation that chooses to see the shoreline beyond the rough waters ahead; that comes together to serve the common interests of human beings, and finally gives meaning to the promise embedded in the name given to this institution:  the United Nations. (President Barack Obama’s Speech to the United Nations)

Obama Speech UN 2009

Interestingly enough, there were 22 years in a row when I could have made the same speech (Okay, it would not have been rendered  as eloquently as the President’s, but the content would have been similar.)  The most disconcerting thing about this statement is that I was referring to the internal stakeholders of many hospitals.  One of my favorite statements during those years because of all of the infighting was that ”We are not the enemy.”

An enormous amount of energy is expended in almost every healthcare organization on internal power struggles.  In many cases these struggles revolve around issues relating to money.  Questions like “Should the radiologist or the cardiologist be permitted to perform one particular test?”  Turf battles over procedures always seem to be part of the equation.  Other struggles revolve around perceived power relating to whatever positions are held because someone wants more control of larger pieces of the budget.

Power, control, greed?  All of these traits are part of the human experience, but when an organization expends much of its energy on these issues, the result is wasted time, wasted resources, wasted anguish, and, in many cases, lower quality outcomes.

Watching old movies of workers in factories during World War II have always fascinated me because we, as a country, had found a common enemy toward which we could focus our angst.  The fact that health care never seemed to be able to embrace illness as the common enemy always created intrigue for me. Yes, we would rally and work together when emergencies hit, but the other daily activities became somewhat mundane and boring, and our instinct seemed to be to revert to power, control, and greed.

Maybe, just maybe, we could find a way to marshal the medical staff, employees, and administration, the volunteers, and patient families to work together every day in every way to create an actual healing environment where patients can be surrounded with the energy of love, kindness, respect, dignity, and healing.  Maybe this environment could be the goal of every hospital executive, and they could begin and end each day by focusing on setting the example for the creation of a healing environment.

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Posted in Healthcare, Hospital Administration, Leadership

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Non-traditional Thinking Pays Off

July 19th, 2009
health_montageWho would ever consider having 24-hour ’round-the-clock family visiting in a hospital; beds for loved ones to stay overnight; deli-style counters on the patient floors to serve hot meals to loved ones, patients, and staff; popcorn machines in the lobbies; bread baking in the hallways; live music, massage, aroma, pet, humor, and drumming therapy; decorative fountains; and special mammography gowns for modesty? We did, and that was over 12 years ago. Our patient population tripled through the emergency room. The budget tripled, and the number of employees almost tripled.

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

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

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

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

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

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

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

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Posted in Future, Healthcare, Hospital Administration, Leadership

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The Health Care Reality

May 15th, 2009

1979 was the year in Johnstown, Pennsylvania when I decided that it was time to leave teaching and transition into business.  For those of you who don’t remember that year, it was the beginning of some serious financial challenges for our country, but it was also two years after the Johnstown Flood of ’77, and there was an unemployment rate of 19.5% in Cambria County, PA.

1979 Rolling Stone cover Blues Brothers SNL Dan Ackroyd John BelushiIn 1980, when I accepted a job with a then bankrupt nonprofit organization in Somerset, PA, what had been a booming coal industry went into the skids. My house mortgage was about the same as the unemployment rate, 19%.  The job that I took was in the arts and Ronald Reagan was interested in cutting funding to the National Endowment for the Arts.

In 1985, my new job was with a tourism agency, and that was the year that then-PA Governor Casey cut funding to tourism.

In 1988, when I entered healthcare, it was clear that Johnstown could no longer support four hospitals, and the next decade and a half resulted in the closing of two (and almost three) of the four hospitals in that area.

Turn the clock forward to last October, when I announced my decision to become a healthcare consultant.  The stock market crashed, eight of every ten hospitals stopped, postponed, or scaled back needed capital projects, 58% of hospitals are now reporting  increases in uninsured patients using the emergency departments, 48% of hospitals have cut staff, and 80% have reported cutting expenses that include consultants.

As a consultant, the first thing I would tell anyone is that “No matter how bad things appear to be, you can do it.”

  • Our successes as a teacher continue to remain evident as former students ranging in age from 38 to 58 continue to remind me of great memories of our time together.
  • The arts organization became the largest and most successful rural arts organization east of the Mississippi.
  • The Convention Bureau went from almost closed to the fifth largest agency in the State, and most of you have tracked the successes that we experienced at Windber.

Not unlike the little engine that could, we focused on the positive, forgot about the negative, and never dealt with “Mr. In-between.”

roosevelt_action400

There are those who approach life cautiously, carefully, and very conservatively, and then there are those of us who drink from that same cup in big gulps and dream about how things could be rather than how they are.  There are those who are afraid of failure, and those of us who embrace failure because we know that it is getting us closer to more dramatic successes.

The only boundaries that we have are between our ears.

Because the future is a design function. Let me close this blog post with the ending from my commencement address to the graduate students of St. Francis University (with the help once again of Dr. Leland Kaiser):

  • Nothing has to be the way it is.
  • We can invent (or prevent) our future, because all limitations are self imposed.
  • We can empower ourselves to create a new world.
  • Reframe any limitations to become opportunities because…
  • Tremendous limitations breed success. They open doors.

So, as we design our future, remember that we should not work to create what people will like, but instead work to create what people will love!

…and we will know success beyond our wildest dreams.

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Posted in Healthcare, Hospital Administration, Leadership, Public Policy

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Focus on the Positive

April 29th, 2009

Okay, who wants to be the first one to have written about a pandemic?  Unfortunately, I know way too much about this stuff.  Guess it’s that old hospital CEO mindset.  Prepare for the worst, and expect it.  Well, let’s all pray that this thing settles down before more people die.  My friend, Dr. Matt Masiello wrote an E-mail today that could probably help a lot of people.  A public health message with a level of calm urgency.

Dr. Matt MasielloBased on the cumulative experience of the scientific and health promotion/disease prevention staff at WRI, we began a more active approach in  preparedness then what had been recommended by WHO/CDC and the local EMS. We feel that with WHO now raising the alert level to 5 our actions were appropriate. May I suggest the following.

1.    Prepare and distribute a letter to parents asking them to keep their children home if they have a cough, fever, headache. If someone in the family has the same signs and symptoms the children should also stay home until  the illness by the family member is confirmed not to be Swine flu.

2.    Place a small table with sanitizer bottles at the entrance ways of the school buildings.

3.    Encourage staff to carry on their person the small hand sanitizers.

4.     Instruct your teachers to review with the students advice on handwashing and use of the sanitizers. Teachers should remind students throughout the day of the importance of handwashing as well as keeping their hands away from their face and the importance of coughing into their sleeves. Wash/sanitize hands afterwards. I would encourage formal, scheduled trips to the BR to wash hands and when ever necessary.

5.    Place the attached sign in key locations and encourage staff and familes to take them and post at home as a reminder. Wash hands prior to and returning from work/school/play.

6.    Get plenty of rest, eat well and exercise.

7.    Open windows for better movement of air, when and if possible.

8.    Minimize social gatherings. The canceling of social events may come as  a formal recommendation via the CDC in the very near future.

Matt

So, that’s the official word from the United States’ representative to the World Health Organization.

Now, onto life.  Last night we completed a list of services that we are helping to provide to hospitals, schools, hotels, newspapers,  businesses and anyone else that might be interested.  Rather than list each business individually, let me list their services, products, and work, and, if you’re interested, give me a call.

  • Technology Solutions for Government
  • Sophisticated market research
  • Physician billing/Pre-certification and approval of payments for doc offices.
  • Telemedicine and medical device marketing analysis and launch
  • Food Services for hospitals and long term care centers
  • Education Programs and Leadership Solutions
  • Continuing Medical Education for physicans and nurses
  • State and Federal Lobbyists and Business Development Experts
  • Personal Healthcare and Corporate Wellness
  • Crisis Response Communications
  • Construction solutions (REIT)
  • HR and House Wide Quality System for Job Descriptions
  • Translation services (Contract pending)
  • Specialized Cancer Laboratory Services
  • Removal and disposal of hazardous waste, a green company
  • Economic Development and ECAP green initiative
  • The Doctors’ Doctor – Physician office mergers, acquisitions and general business operations consulting, and Hospital Physician strategic planning

Obviously, each line represents a company that we represent, and even more obviously, SunStone Consulting is your answer for all of the financial challenges that hospitals face.

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Posted in Current Affairs, Epidemics, Hospital Administration, Hospitals

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NickJacobs.org???

April 2nd, 2009

Let me open this blog with a little housekeeping chore. Because I’ve retired from being a hospital president (Yes, they replaced me with two great people, count ‘em, two.) , I’d like to change the name of this thing. It’s not that I’ve established a P-Diddy-type Twitter following where 100,000 human beings are waiting with baited breath to see what my next move will be, it just doesn’t seem right to keep calling myself a hospital president. We know who reads this thing, and we are grateful to our loyal, talented, and brilliant followers. We also know that we can link the old blog names to get you here. So, regardless of what you typed, or what gets Googled, our genius social media maven & webmaster, Michael Russell, can help to bring you home to this site.

Okay, so as a transformational advisor, a broker of sorts, most people with whom we have consulted have described me as a person who can fix things that are broken before they actually break. Maybe we should call it the “Break it if it’s not already fixed” blog. I’d love it if it was a name that would generate millions of hits and companies would fight to advertise on it.

My first thought was to use nickjacobs in the title because there is a Nick Jacobs on Facebook who teaches Aboriginal people in Australia, and he seems popular. There is another Nick Jacobs who is a professional organist, and one who is an athlete. There’s a Nick Jacobs who is a consultant and another a paramedic in London, one who had a blog who is a yachtsman, there’s my son, the commercial real estate broker, and finally, there’s a Nick Jacobs who does pornographic movies who is not my son. Actually, that Nick Jacobs’ followers would probably be the most disappointed by this blog.

Since the .com version of nick jacobs was already taken by some guy in England, we captured nickjacobs.org, and that will work for right now.

If you have any ideas, however, that you think would really rock the blogspere, let us know and we’ll check with our domain registrar to see if it is available. In fact, if you are the winner of a Name Nick’s Blog Contest, I’d be happy to consult for free BY PHONE for at least one hour of brainstorming with you about the topic of your choice: music, healthcare, proteomics, teaching, PR/Marketing, the travel business, or even physician recruitment.

Remember, Hospital Impact is already taken, and, because my last three consulting jobs have been with a newspaper, a nonprofit arts oragnization, and a chain of hotels, we don’t want to think too restrictively. Gotta earn a little money, too.

When we ran the breast center, we found that the website got more hits than anyone could imagine. The problem was that the readers were mostly thirteen-year-old boys who probably weren’t too interested in running a hospital. After Miss America had visited us, the hits went up exponentially when those two searches were combined. Somehow, I don’t think that Nick Jacobs’ Breast Center for Miss America would probably get me the type of following I’m currently hoping to attract. On the other hand?

A very good friend recently asked me to write a brief bio about what my new life is like, and it struck me that it is very much like my old life but without any restrictions. This is what I wrote:

While teaching junior high school instrumental music in the early 1970’s, Nick Jacobs made an extraordinary discovery. He learned that, by empowering his students and surrounding them with positive influences, he no longer was providing a service or even an experience for them.

What this entirely unique teaching style resulted in was a method for helping to transform students. By providing with both passion and commitment the tools needed by them to undertake their journey, his involvement with the students became a means of dramatically helping them to make whatever positive life changes they were seeking.

It was during that early period in his career that he also discovered that this formula could work to positively change lives in almost any aspect of living as he ran an arts organization, a convention bureau, and finally a hospital and research institute.

Since that time he has dedicated his personal work to helping others make their lives better, and that is exactly what he is doing in his position as an international executive consultant with SunStone Consulting, LLC.

Maybe that will give you something to chew on? Okay, something on which to chew.

SunStone Consulting. With more than 20 years experience in executive hospital leadership, Nick has an acknowledged reputation for innovation and patient-centered care approaches to health and healing.

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Posted in Boomers, Breast Care, Communication, Current Affairs, Development, Healthcare, Healthcare Marketing, Hospital, Hospital Administration, Hospital Blog, Hospitals, Integrative Health, Leadership, Medicare, Medicine, Music, Music Education, Nutrition, Public Relations, Uncategorized, Wellness, marketing, patient-centered care

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The Marketing Enigma

February 15th, 2009

As the economy continues to present its myriad of challenges nationwide, hospital executives are embracing a variety of cost-cutting measures at a very high rate of implementation. Delays or discontinuation of capital projects, employee layoffs, and a variety of other broad-based measures are currently dominating the healthcare environment.

Departments without direct patient contact are usually perceived to be the easier layers to peel in these expense reduction activities. Areas such as marketing, community, and public relations often become prime targets as they are significantly scaled back or even disbanded.

Historically, hospitals have implemented fluctuating sequences from one extreme to another as they have decreased and increased marketing department sizes and budgets through the various economic cycles. Unmistakably, in challenging economic times, marketing is nearly always more important than ever. Without knowledge concerning the various services available, the patients will not be aware of the nuances of each and how they could impact their health and wellness.

Having said this, however, many hospital executives are not experts in this area, and consequently, they simply move in lockstep with those individuals who see these programs as non-patient expense centers that merely drain the organization of its valuable resources even further.

BusinessDictionary.com aptly describes marketing as the management process through which goods and services move from concept to customer. As a philosophy, it is based on thinking about the business in terms of the customer, or in healthcare, patient needs and their satisfaction. As a practice, it consists of the coordination of four elements:

  • identification, selection, and development of a product
  • determination of its cost
  • selection of a distribution channel to reach the patient, and…
  • development and implementation of a promotional strategy designed to reach these goals

In order to avoid erroneous decisions that could lead to disastrous business consequences for the organization, marketing evaluations might be performed by professional marketing assessment companies specializing in this arena. Some of these firms can provide this service in economically viable risk-reward agreements that do not further complicate the financial challenges being addressed. They specialize in the evaluation of services that detail which marketing functions need to be continued and which functions should be restructured, and/or outsourced. The goal of these marketing evaluation firms is to:

  • help preserve the existing positive effects created by marketing
  • build better marketing practices, and…
  • cut the unnecessary associated costs

In two decades of observing the yo-yo phenomena described above, we have worked with numerous individuals and firms along the way, but none have been more valuable than the firms that specialize specifically in this area of marketing department analysis.

Firms that provide this specific service can be found through the American Association of Healthcare Consultants, The American Marketing Association, and the Society for Professional Marketing Services.

In our work, however, we have found at least one company that has continuously provided the necessary analytic and evaluation components required to complete this sensitive task. Corathers Health Consulting is a unique organization because it utilizes luminaries and unique specialty consultants through a team approach for most of their highly customized projects. What we observed when we worked with Corathers was that their distinguished consultation supplied an unparalleled differentiating factor over the other consulting companies with whom we had previously worked, but they are one of many such firms.

Regardless of the organization chosen, the concept is the key, and that is that you owe it to yourself and to your organization to understand exactly what can or should be eliminated or outsourced before the cuts are irreversibly implemented. The future of your organization may lie directly under that hatchet, and once the decision has been made, reverse is a costly gear to find on a very bumpy road of lost business, missing publicity, and absent advertising. The answer lies in cutting wisely and appropriately as you attempt to keep patients informed and to grow your business.

Linking a patient-Centered Approach to Quality Improvement & HCAPS

Nick Jacobs, FACHE addresses the 2008 Healthcare CEO Summit, co-sponsored by the Picker Institute and Planetree. Chicago, IL USA – Fall, 2008

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Posted in Healthcare, Healthcare Marketing, Hospital Administration, Hospitals

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The Coming HIPAAcalypse?

November 14th, 2008

Mayan CalendarThere was a television show on at about 3:00 AM the other morning that, once again, predicted the end of the world. This time, it was the manifestation of predictions from two ends of the earth: both the ancient Chinese and the Mayan Indians concluded 5,000 years ago that the world would end on December 21, 2012. (I think that Merlin the Magician was involved too, but he would have been just a kid 5,000 years ago!) Both predictions were written at nearly the same time, and both predicted the same date, but I believe that I have discovered what may contribute to this major catastrophe:

It is my prediction that the collapse of the planet as we know it will come from HIPAA.

According to Wikipedia,

“The Health Insurance Portability and Accountability Act was enacted by the U.S. Congress in 1996. The Centers for Medicare and Medicaid Services explain that Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Title II of HIPAA, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers.”

Sounds pretty reasonable, doesn’t it? Just hire a full time security person for your electronic medical records, oh and don’t forget to spend millions to create the medical records in the first place. After that, life will be just fine? Right? Wrong.

If you have had little training in what the term oxymoron means, this would be a classic example; “The Administrative Simplification provision.” This provision was intended to deal with the privacy and security of health data. That is also a very noble idea. If two patients are in the same room, and someone is discussing the status of either patient, there should be a sound proof curtain between them. Soundproof curtains would also qualify as an oxymoron. For those of us who have lived this nightmare called HIPAA, Senator Kennedy has often been quoted regarding the fact that his intentions when designing this act have become grossly bureaucratic in their implementation.

Here’s the totally mystifying, Merlin-type description; the standards are meant to improve the effectiveness of our health care system by encouraging the extensive use of electronic data interchange in the U.S. health care system. Seriously, all of this sounds good. The problem comes when hundreds or thousands of government bureaucratic health care wonks and healthcare attorneys are introduced into the equation.

Well, a few weeks ago, according to Managed Healthcare Executive Magazine, the department of Health and Human Services, Office of Civil Rights (OCR) and the Centers for Medicare and Medicaid (CMS) and Providence Health Services, Providence Health System, and Providence Hospice and Home Care entered into the first case where a monetary settlement was paid to resolve a potential violation of the HIPAA privacy and security standards.

Providence agreed, without admission of liability, to pay $100,000 to the government over a data breach. This case did not involve a single egregious violation. So, it appears that, HHS may believe that enforcement time has come as they become more aggressive in their investigations and enforcement of these laws. Hence, the end of the world may be approaching. If all of the hospitals are fined into closure, and then the avian flu hits, the most often heard phrase will be “Hasta la vista, Baby.”

I don’t mean to make light of such an important topic as patient confidentiality or the potential portability of health insurance, but, if any of us mere mortals could objectively step back and witness the chaos, expense, and outright insanity created by the current implementation of these statutes, the only objective phrase that could eventually emit from that experience would be, “Holy, $%#@&!”

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Posted in Healthcare, Hospital Administration

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Something’s Gotta Give, Something’s Gotta Give, Something’s Gotta Give!

November 1st, 2008

My Facebook friend, Anne Zieger, editor of Fierce Health Finance, wrote a compelling piece the other day regarding the potential demise of hundreds of hospitals. Her prediction is based upon some very valid financial realities, and we are witnessing them locally as well as nationally. Not unlike the little banks in our area that seemed to have been insulated from Wall Street’s collapse, some of these national problems seem to be washing over some of the smaller hospitals with relatively minimal damage. Yes, many of us have seen as much as a 10% decrease in elective, outpatient procedures.

In fact, while visiting a really upscale mall for a photo session with my two year old granddaughter, Lucy, an employee engaged me in a conversation about the rotten economy. About five minutes into the conversation, she indicated that there are currently 150 stores in the chain for which she works, and that only five percent of them made budget last month. Portrait pictures must fall into the category of a luxury as their business is severely impacted by this economy. More directly, however, she indicated that she needed stitches removed the other day, and that, “she did it herself” rather than spend the $20 co-pay.

So, are we seeing decreases in important tests? Are we seeing patients avoiding emergency room visits? Are we seeing patients cutting their prescriptions in half? Yes, to all of these questions. Anne, however, seemed to be talking about the “big boys,” where their millions or billions in investments have recently tanked. If you are so big that your income from running the hospital is not a major source of protection, and your income from your investments is propping you up, then the problems begin to manifest themselves exponentially.

“Some hospitals are responding by digging into their investment income more deeply than usual, using it to finance capital projects, or even meet operational needs. Others are issuing bonds with the scary codicil that they’ll buy them back if finicky investors want to dump them,” states Zieger in her column.

She further goes on to explain that “both of these situations put a huge squeeze on hospitals’ long-term viability. One robs from their long-term assets to solve medium-term problems, while the other puts the hospitals at risk of being bled dry by investors who get spooked.”

Well, wouldn’t ya know? Yes, we are seeing a few challenges due to decreased electives, but not because we were living off of our investments. The other good news is that, because we froze our fixed pensions several years ago, we are seeing very little impact upon them from the huge drop in those investments as well. Unlike many of our larger peers, neither of these issues is similar. Between the drops in the market, the loss of pension funds, the decrease in electives, and the down-grading of their viability by the bond markets, their challenges look galactic in size compared to ours.

Sometimes smaller is just safer.

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Posted in Healthcare, Hospital, Hospital Administration, Hospital Blog, Hospitals, Integrative Health, Leadership

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As Close to Home As You Can Get

October 15th, 2008

Yesterday afternoon the realities of humanism, mortality, and fear attempted to take me out for about the one millionth time in my life. A phone call came from a loved one casually explaining that the doctor had potentially discovered a problem that needed further examination. When the office called for an appointment to have the scan done, they were told that it would be approximately a week before there was an opening in the schedule.

As an insider, I knew that a certain number of slots were held each day for emergency or unscheduled procedures. Not unlike the hotel that holds back a room or two from the 1-800 reservation list, just in case a preferred guest or luminary comes through the doors, flexibility is something that hospitals have to embrace at some level.

Taking the Hell out of Healthcare by Nick JacobsOnce again, as an insider, a call to the department resulted in an immediate invitation to come in for the test the very next day.

My route to health care management was a particularly unique and circuitous route, and it left me asking the question, “why does it have to be this way?” I’ve personally done everything that I can to make it humane, patient centered, and sensitive.

If you or your loved one wants to know the inside story on how hospitals work, take a look at my new book, “Taking the Hell out of Healthcare.” It really can help. It is a simple “how to” book aimed at the everyday person who is having to deal with this complex and sometimes difficult world of health care.

My passion and personal commitment has always been to patient advocacy, transparency, and human kindness. Find out how to make the system work for you.

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Posted in Hospital, Hospital Administration, Hospitals, Medicine

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