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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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Posted in Healthcare, Hospital Administration, Integrative Health, Leadership

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Look, Up In The Sky…

October 7th, 2011

I have to admit that the 12-credit, continuing education course I signed up for was not supposed to be fun. In fact, I fully expected it to be two full days of classroom work, in a room with no windows, followed by exactly zero recreation time. I knew it would include a working breakfast, working lunch and a couple of bathroom breaks. I’ve done this before in places like Hawaii, Fort Lauderdale, Cape Cod; you name it. And,  because of my work schedule, I usually fly in, take (or teach) the course, sleep in some no-nonsense business hotel, then head home the following day. What have I been thinking about for all of these years?

Vintage New Mexico Postcard - Nick Jacobs, FACHE - HealingHospitals.comWhen I arrived in Albuquerque, New Mexico on Sunday and went to the rental car agency desk for my trip to Santa Fe, I should have guessed that something big was going on that week. The service representative told me that she could not rent me the compact car that I had ordered, but, in fact, had to rent me one of those black Secret Service type RV’s that hold eight people, a few rocket launchers and a small quad, but she’d cut me a break on the price. When I asked her about gas mileage, she put her head down and said something like, “Drill, Baby, drill.”  The helpful young lady informed me that the Albuquerque International Balloon Festival was taking place throughout the week, and there were virtually no rooms and very few rental cars available anywhere in the area.

Because I had run a visitors bureau in the 80’s, I had seen pictures of hundreds of hot air balloons floating over New Mexico and knew there was such an event, but didn’t realize it was, you know, this week.

My course was being offered by an organization called the American College of Healthcare Executives; the recipient of many thousands of my dollars over the last 25 years.  You see, they provide you with a credential that some hospital CEO’s have, and even when you’ve stopped running hospitals, it is important to keep paying them and taking courses in order to maintain the credential until at least six months after your death.

Albuquerque Baloon Festival - Humpty DumptyOne of the unusual things about this credential is that it is spelled FACHE.  My former assistant once asked me why I signed my name as Nick Jacobs, FACHE, but she pronounced it “fake.”  It actually means Fellow in the American College of Healthcare Executives, but, really, her pronunciation was more fun…and a great conversation starter, too.

The rain started during my 5:00 AM trip to Santa Fe and continued for two days.  So, because the balloons always fly very early in the morning, I never saw even one of them, but on my way to the airport this morning in the shuttle, I overheard a man and his wife discussing “the cow.” He went on and on about how big “the cow” was. It never dawned on me that he was talking about a cow balloon.  Finally, when he said, “Those were the biggest set of udders I’d ever seen,” I had to interrupt and question this discussion.  At that point he explained to me that the basket was in front of the udders, but I still didn’t get it until he laughed and said, “Heck, man, it was a hot air balloon the size of the Astrodome.”  Hence, the title of this post.

I’m glad New Mexico, the Land of Enchantment, isn’t wine country. Could you imagine finishing that 22nd sample of some great vintage, walking outside and seeing that colossal, airborne cow coming at you?

The course was great, the hotels were clean, and the people were nice, but missing that cow has me really upset.  I mean, how many chances do you have in your lifetime to see 600 hot air balloons flying overhead?  How many days in a lifetime provide a person with that type of visual opportunity?

It’s time to stop and smell some roses. From now on, I’m only going to go to courses that end at noon.

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Posted in Healthcare, Hospital Administration, Travel

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One in Six

September 28th, 2011

The U.S. poverty statistics came out a few weeks ago, and things haven’t been this bad since 1993. Look to your left; look to your right. About one in every six Americans is now considered to be living below the poverty level. In 1993, the average new house was $113,000, the average income was $31,230, the average car was $13K, and tuition at Harvard was at $23,500. By 2010, you could nearly double every one of those numbers except the average family income which rose only to $50,000, instead of the $62,500 it should have been.

African-American Senior Woman Wrapped in US FlagOne of my favorite comparisons has always been that of Harvard’s tuition, which hovered right around $40,000, and the cost to keep a prisoner in jan American jail for one year, by comparison: about $45,000.  Now, if you extrapolate the number of people in U.S. prisons based on the entire population of the United States, it works out to about one in every 31 adults. Between 2.3 and 2.4 million Americans are behind bars. America incarcerates nine times more people than Germany and 12 times more people than Japan. That adds up to nearly $104 billion dollars a year in U.S. prison costs alone.

The folks on Wall Street and in Washington D.C. who so cunningly helped to put us into this financial mess are, by and large, not in prison, and the percentage of inmates that are minorities is staggering. An estimated sixty-eight percent of prison inmates were members of racial or ethnic minority groups.  Are our prisons full because our minorities are bad people, or are they full because their jobless rate is 40% higher than that of Caucasians?

We’re also spending about $700 billion per year on our military. For reference, the rest of the entire world combined spends nearly that same number.  At $1.4 trillion a year, that adds up to $236 per capita worldwide on defense, and we still have 24,000 nuclear missiles lying around; enough to blow up the planet plenty of times.

According to the World Bank, over 1 billion people live in conditions of extreme poverty and 15-20 million people are starving every year.  I saw another set of figures today regarding food subsidies in the United States.  It wasn’t a figure indicating our generosity toward these one billion poor people, it was that between 1995 and 2010, our Congress voted to provide $260 billion to continue agricultural subsidies.  Okay, maybe some of that makes sense, but what about the $17 billion that is going to use the American people’s money to create artificial incentives to produce ingredients that eventually become hydrogenated fats?

We are an obese nation, yet we paradoxically continue to publicly subsidize high fructose corn syrup and hydrogenated fats, so that our obesity, diabetes and heart disease epidemics continue unabated. Sheer folly, or is this about some really big businesses, with some really good lobbyists?

Maybe it’s time to look at things a little differently. We all know that testosterone makes us physically strong, but it also makes us more aggressive and competitive. This testosterone overload has continued to result in war and violence being accepted as the normal way to settle things, and, except for the supposed economic benefits of war, we also know that war is just crazy. It kills and maims people, and diverts resources that might be otherwise be utilized elsewhere.

We’ve seen time after time that if you are brutal and retaliatory with people, they will learn to hate and fear you. However, if you give people love, compassion and respect they will eventually return the compliment. Maybe we should take a break from all of this running-the-world stuff, and focus on doing the best that we can for the human ace.  Maybe we should walk the talk of our religious leaders for a change.

We ran a hospital like that for over a decade and it prospered economically and grew. This concept is neither rocket science nor brain surgery.  It’s the most uncommon of things in our current culture, common sense.

We cannot change the human condition – but we can change the conditions under which humans live and work!

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Posted in Current Affairs, Hospital Administration, Public Policy

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ACO’s or SSP’s: “Change or Die”

September 6th, 2011

“Walk the Walk” author Alan Deutschman’s previous book kind of said it all in the title, “Change or Die.” In that book, Alan carefully lays out the statistical survivability matrix, and poses the question:

Alan Deutschman - Author of Change or Die and Walk the Walk - Nick Jacobs, HACHE - Healing Hospitals

Alan Deutschman

“What if you were given that choice? For real. What if it weren’t just the hyperbolic rhetoric that conflates corporate performance with life and death?…What if a well-informed, trusted authority figure said you had to make difficult and enduring changes in the way you think and act? If you didn’t, your time would end soon — a lot sooner than it had to. Could you change when change really mattered? When it mattered most? “

Then, he articulates the actual outcomes of studies. Talk about “tough love.”

“…The odds? You want the odds? Here are the odds that the experts are laying down, their scientifically studied odds: nine to one. That’s nine to one against you. How do you like those odds?”

So, as a nation, as healthcare leaders, as human beings in a country that is currently facing the realities of potential economic disintegration, we are faced with what can only be described as another enormous challenge: a financially unsustainable healthcare system. Regardless of your politics, regardless of your personal beliefs regarding the competency of the federal government and its ability or inability to fix anything, the law has been passed, the train is moving and it’s moving directly toward you and your hospital.

Over the past three years, we have repeatedly presented money-saving and money-making ideas to help begin to position your healthcare organization for the impending tsunami of change that has been launched. As a veteran of TQM, Six Sigma, Baldridge, and a half dozen other consultant-delivered “fixes,” I’m sure I can hear the words going round and round in your head, but, not unlike the clamor that arose from the HMO/PPO days of yesteryear, this ACO/SSP challenge has to be met and dealt with intelligently, and it has to be done in such a way as to not destroy your hospital or health system.

Let’s face it, we’re all pretty smart folks. We’ve all been in permanent white water for years, and the last thing that many of us want to take on is the ole captain of the ship without a rudder, during a hurricane while the lighthouses are being moved around on the shore.  But, once again, it’s here. It’s upon us, and we must deal with this challenge in an intelligent manner.

One possible alternative for smaller organizations is the SSP, a Shared Savings Program, the alternative put forth by CMS, the Center for Medicare and Medicaid Services, to a full-blown ACO, an Accountable Care Organization. Either way, however, SSP or ACO, the primary, overarching goal is to try to improve quality, decrease costs, and provide patient-centered care in a meaningful way. Not unlike the old HMO/PPO days, the effort requires infrastructure (and plenty of it…the average participant in the demonstrations spent about $1.7M on this one, single aspect of managing the healthcare new world order.)

What do you need? Well, you need 5,000 patients, to start. Then:

  1. Decide if you will use Medicare only or other patient groups.
  2. Determine the exact service area that you will target.  How many square miles?
  3. Decide which reimbursement model will work for your organization, i.e., an SSP that is more risk-based, or capitated.
  4. Figure out which provider groups will be involved.
  5. Examine IT reporting capabilities and process improvement methodologies.
  6. Identify patient-related strategies such as enhanced experience for the patients or faster throughput as well as reduction in errors.
  7. Then, dig deep into the organizational strategies for improvement.

Infographic: Medicare Margins - Nick Jacobs, FACHE - SunStone ConsultingLet’s face it. From 2001 until 2008, total Medicare inpatient margins for acute care hospitals have decreased every single year.  (Source: Journal of Healthcare Management)   Reimbursements have decreased while your bad debt has increased.  So, regardless of your tolerance for risk or change, cost control simply must become the culture of every healthcare organization in the United States. We have seen the variances in costs based on geography in this country and treble charges in one area as opposed to another will not go on into the future. Joel Allison, CEO of Baylor Health has stated that this movement is “All about…focusing on wellness, on prevention.” (Arnst, 2010)

We need our primary care docs, we need physician participation to a far greater degree than we currently have, and, at the same time, the physicians must be partners in the effort.  Employing physicians is also a critical element.

SunStone Management Resources can assist you in this effort on numerous levels, but the time to act is now!

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Accountable Care Organizations

April 2nd, 2011

Avery Johnson of the Wall Street Journal wrote an excellent explanatory article this week about accountable care organizations – ACO’s. They’re a potential spin out from the Health Care Reform Act which are about to begin taking shape within the U.S. healthcare system.  The four hundred plus page proposal that was released this week is now being made available for comment, but those administrators and physicians who generally get the concept already are quietly pouring through the pages of this document to determine how it can become a part of their practices.

Donald Berwick, MD, Administrator of the Centers for Medicare and Medicaid Services stated that ACOs were brought into effect with three major aims which are better care for individuals, better health for populations, and slower growth in costs through improvements in care.

Proposed Measures for ACO Quality-Performance Standards.

Scheduled to begin in January 2012, the primary goal of the ACO concept, not unlike other previous historical steps, such as PPO’s and HMO’s, is intended to extract about a billion dollars in costs from the existing Medicare system.  Theoretically, this model is not without merit.  Because most healthcare in the United States is still literally “a cottage industry,” simply having patient advocates help co-ordinate the care of those mega-users, the 18 Club of patients with nine physicians with whom they interact annually and nine different drugs that they take daily, should benefit tremendously.  If these patients can be directed to avoid those unneeded duplications, millions could be saved.

The government outlined rules for how doctors and hospitals can organize into new businesses to reduce Medicare costs and improve care are at the heart of the accountable-care organizations.  The new partnerships that could/should evolve from ACO’s would be aimed at controlling these costs.   They would be structured to coordinate care and their reward would be to share financially in savings with the government if they could come in lower than expected.  There is an alternative universe, however, where they would risk being penalized financially if they go over the anticipated costs.

There is no question that better synchronization of care could help to reduce both hospital readmissions and medical errors which in turn would produce Medicare savings.  In line with this, one of the primary reasons that ACOs might not work is that some of the largest health insurers in the country, including Humana, United Healthcare and Cigna, already have announced plans to form their own ACOs. Insurers say they can play an important role in ACOs because they track and collect data on patients, which is critical for coordinating care and reporting on the results.  As Jenny Gold quoted in her NPR report, “This could just be HMO in drag.” These partnerships of primary-care and specialists doctors with hospitals and clinics might help to produce a model that, although directed toward Medicare, could also have a positive impact on all of U.S. health-care.

Obviously, both hospitals and physicians are worried about ACO’s because they represent CHANGE, but it is common knowledge that if something is NOT DONE, our health care system will crash and burn.   Think of this, providers would get paid more for keeping their patients healthy and out of the hospital. What a concept.

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Posted in Healthcare, Hospital Administration, patient-centered care

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Along the Way…Things Became Very Interesting

January 31st, 2011

Two years ago I began this new journey, but not until a few months ago did my work in consulting really begin to take shape in a way that could never have been predicted.

As the challenges of our present economic times have become increasingly daunting, my personal and professional journey has become even more dedicated to innovation and creativity. One goal has been to provide new alternatives to past practices that will create value for patients. This means making a contribution to saving and transforming lives, while producing cost savings and financial stability, and developing new markets to enable provider growth in their missions.

Olympic National Park, Port Angeles, WA - Nick Jacobs, FACHE - Healing Hospitals - SunStone Consulting

The driving force behind my exploration began with asking how we can begin to control those out of control expenses that are currently blurring the lines between continued care for our population, and rationing or elimination of services?  But, the answer(s) must enable us to continue to add healing opportunities for our patients at every turn.

Because my creative energies have always been focused on producing more ways to generate new monies for whatever organizations I have personally represented,  it seemed somewhat foreign to me to spend more time on fiscal issues than creative alternatives.  However, with literally millions of Baby Boomers coming of age each year, it was obvious that our entire culture is at risk both fiscally and socially. Consequently, after listening carefully to my peers, several opportunities presented themselves that would address all levels of these concerns.

Through the combination of their proprietary software and dozens of years of combined knowledge in the healthcare finance field, SunStone Consulting, LLC, spends each and every working day addressing the challenges of finding monies that should already have been captured by hospitals and physician practices, while also creating new opportunities that have heretofore not been explored. That’s where SunStone Management Resources comes into play.

SunStone Consulting - Nick Jacobs, FACHE

We have identified new companies, new entrepreneurs and new creatives who can not only improve healthcare, but also significantly improve the bottom line of those organizations willing to embrace their programs. One such company with whom we are partnering can increase Emergency Room productivity by as much as 35 to 50%.  They can also help do the same for cancer centers and operating rooms. They utilize robotic systems that communicate patient needs and simultaneously seek out the appropriate medical services required as soon as the patient is triaged. The patient’s condition and potential requirements are communicated to every individual who will or should have contact with them throughout their hospital stay.

We have also identified what I refer to as “no brainer” opportunities. By making otherwise locked fiscal percentages  a commodity, even small and medium sized organizations can save huge dollar amounts. How? By changing out only the electronic reading devices used hospital-wide. This simple change has resulted in huge fiscal savings for clients.

Add to examples like those above the introduction of  a new invention that, in the right hands, can help to extend some types of Stage 3B and Stage IV cancer patients’ lives from months to years through a relatively simple post-surgical procedure. Also consider the invention of new materials that would support bone growth, while virtually eliminating the need for casts or even slings. Imagine a series of protocols that have brought over 40 people out of deep, irreversible comas. Then, on a completely different path, consider having access to  the cumulative knowledge garnered from over a hundred million dollar investment in breast cancer care.  (This is about to be made available to small and medium sized hospitals across the world.)

These are but a sampling of  just some of the opportunities currently driving my passion in this new healthcare world order.

You may want to make a simple inquiry into what’s behind the innovative, practical, and incredible creations of the brilliant people doing this work.  It’s not just so many words on a page.  It is the future, and the future for you and your organization could be now.

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Posted in Boomers, Healthcare, Hospital Administration

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Finding the Cure…for Bullying

January 21st, 2011

No workplace bullying - Nick Jacobs - healinghospitals.comThis week, NBC’s Today Show featured another story about bullying. As I have have mentioned in previous posts here and elsewhere, I believe that bullying is the quintessential cancer on our lives in places of business, in the military, politics, and relationships of all types.  The good news – actually the very good news –  is that there has been some incredible work being performed on this topic through the efforts of Dr. Matt Masiello at my former place of employment, the Windber Research Institute in Windber, PA.  Grants through the Highmark Blue Cross Foundation of Pittsburgh have fueled this initial effort and the academic and quantitative analysis being done by Clemson University has documented this work.  I believe that this joint effort is a magnificent  example of what can be done to change the future course of events currently being controlled by bullies.

The Today Show story that I saw featured the Massachusetts school where, due to cyber-bullying, a young girl committed suicide last year.  Apparently, another girl is now having the same experience at the same school. With the help of programs like this comprehensive anti-bullying program, the former Secretary of Education from PA, Jerry Zahorchak, (now Superintendent of the Allentown PA school system), embraced the effort to quell and discourage this type of destructive behavior.  And the program, under the direction of Dr. Matt Masiello has successfully been introduced across the  entire State of PA. (Matt had started the Allegheny County’s Goods for Guns program in 1994, when he was the head of pediatric intensive care at Allegheny General Hospital. To date, this program is responsible for collecting more than 11,000 illegal guns from the streets of Pittsburgh.) Matt has had the same success with this anti-bullying program. Now, both Massachusetts and Maryland are looking into embracing this effort.

This anti-bullying program is based on a European program with which Dr. Masiello had become familiar.  This is a school system-wide effort that is very well documented and results in tremendous awareness and reduction of bullying at all grade levels.

The trainers bring a group of teachers and administrators together in the school system, and then “train the trainers” as to how this effort can become part of the philosophy of the school.  They start the training in the spring, typically launch the school wide effort in the fall and run it for at least a year. During that time, detailed records are kept measuring outcomes.

Matt Masiello, MD - Windber Research Institute - Nick Jacobs - Taking the Hell OUt of Healthcare

Matt Masiello, MD

Matt is a wonderful physician, a truly giving person and a saint of a man who is the only U.S. representative on the board of the World Health Organization’s Health Promoting Hospitals program. I hired him before I left Windber Research Institute, and he has worked tirelessly to address both this problem and the problems of childhood obesity.

The Olweus Bullying Prevention Program (Olweus.org on the web, @Olweus on Twitter) has impacted more than 400 school districts and 20% of all school-aged children in Pennsylvania. It has also had up to a 50% reduction in student reports of bullying …and bullying others.

For more information, please contact me or Dr. Matthew Masiello at the Windber Research Institute.

Michael & Marisa’s anti-bullying song – “The Same”

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Posted in Current Affairs, Healthcare, Hospital Administration, Hospitals, Leadership

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Wikileaks and Transparency

December 9th, 2010

LONDON (Dec. 8th) —Held without bail in Wandsworth prison, Julian Assange has been deprived of his trusty laptop, so the WikiLeaks founder can’t supply an inside scoop on life behind bars. But if the pro-transparency campaigner could leak just one word about conditions in Britain’s biggest jail, he would probably settle for “cramped.”   (via AOL NEWS)

Wikileaks' Julian Assange at TED - Nick Jacobs, FACHE

At my last CEO position, there were about 650 employees on the hospital side and another 50 at the research institute, but in the position that I held as the Chief Communications officer immediately before that,  there were over 4,500 employees.  Any one of those employees could  potentially have become PFC Bradley Manning.  Manning is the young man being accused of leaking millions of pieces of information to Assange’s Wikileaks. Every disgruntled, well-intentioned and sometimes naive employee who either had an “axe to grind” or who simply embraced a philosophy of openness would have potentially presented a major problem to any organization that was built around secrecy at all costs.

In my 20+ years as a hospital administrator, there were hundreds — no, thousands — of incidents that could have been “leaked” to family, friends and the media regarding incidents that may or may not have been problematic.  My memory goes immediately to an online discussion forum where the death of Congressman John P. Murtha was being dissected by a group of Bethesda Residents;  specifically, young U.S. Navy physicians who were venting and expressing their fears regarding their “being held responsible for the death of this powerful Congressman.”  The amazing thing to me was the it was a running dialogue that was, yes, online. The discussion topic thread was etitled Did we kill Congressman Murtha? The anonymous user names went through case-by-case analysis of other undeserving patients who did not emerge with their lives from surgeries at the hospital over the previous weeks and months.  These were individuals who, according to their estimations, should have. Imagine my shock when I came upon the casual page which, at minimum represented a potential HIPAA violation.

Well, it’s all about transparency, my friends, and this movement is only the beginning.  Unlike Kevorkian’s efforts which were almost single-handed, this is a movement, a viral, well-funded, philosophical movement that feels like “Damn the torpedoes, full speed ahead.” And it’s “coming to a theater near you.”   Not unlike the content of the sensitive documents that have been appearing online recently where peoples’ lives are at stake,  hospitals and physician offices face many of the same realities every day.  How many people, like PFC Manning, may not be truly insane or wish to destroy the government, but simply believe that their assistance in exposing the truth will “set us free?”

Transparent Butterfly - Nick Jacobs, FACHE - Healing HospitalsAs business leaders not many decades ago, we were urged to treat every e-mail and every comment as if it was being reported by Mike Wallace on 60 Minutes.  Of course, not many of us did, nor could we stick to that difficult rule of communicating, but think of the potential ramifications if Mr. Wallace had been as potentially ever-present as Mr. Assange.

What is my formula for success?  It’s always been the same.  Be as transparent as you can possibly be. Seems simple, but try it sometime. Don’t break the law. Don’t give out information that is inappropriate as in personally destructive regarding individuals, but be as open about your operation as you can possibly be.  Encourage an environment of openness when it comes to issues, mistakes, etc. and the frustration levels will go down, down, down…sometimes to the point of having employees telling you, “I wish I didn’t know so much.  Life was easier when I was in the dark.”  That’s when you’ll know you are beginning to provide a truly transparent business environment.

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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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