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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 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.

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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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?

The 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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It is more than a cultural change, it is a humanity change.  The key to both, however, is the word change. Those who have wonderful, sustainable, well-financed lives with adequate health insurance are concerned that their hard-earned dollars will go to support an inefficient welfare sate.  Interestingly, many of these people clearly may benefit tremendously by these changes, but  they are unsure as to what that change will represent to them personally.

When Medicare passed, those who did not or could not embrace it quickly enough did have significant life changes.  On the other hand, those who could ended up doing better than they could have ever dreamed.  The same was true of the managed care movement of a dozen years ago. The real question here seems to be one of  “The Greater Good.”  Will it be worth it to help our fellow man?

The bigger issue in my mind is the question of our ability to shift from sickness to wellness care. Wellness and prevention, Tort Reform, Big Insurance, Big Pharma, were all part of the dance.  What will their involvement be in this new healthcare plan?  My insurance friends are predicting the end of their world. Will it be the end or just a different model?

What do we need to do to make it work?  We need to end two wars, decrease the DoD spending accordingly, and monitor those who abuse the system.  We still need Tort Reform. We need to reimburse our physicians for counseling their patients about wellness and prevention as well as for end of  life choices and options.

In a recent article in the Harvard Business Review by Gardiner Morse, The Ten Innovations that will Transform Medicine, we see a stimulating list of opportunities that could make this all work better:

1. Evidence Based Decision Making
2. Payment Innovation (based on outcomes and volumes)
3.  Patient Portals for access to personal health information
4.  Behaviorial Economics
5.  Protocols that work for specific treatments
6. Accountable Care
7. Regenerative Medicine (incl. adult stem cells)
8. Virtual Visits  (telemedicine)
9.  Genetics
10.  Robotics

Regardless of your personal view of healthcare reform, it was clear that the system has been broken for a very long time, and whatever religion or spiritual belief you embrace, it has to be supportive of an effort that will potentially stop destroying the lives of others due to either a lack of available healthcare or a lack of finances.  Stay Tuned.

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Amanda Bennett and Terence Foley

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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In 1969, business communication consisted largely of yellow legal tablets, Bic pens, daily reminder calendars, newsletters that were pasted-up by hand, then run off on the mimeograph or ditto machine, and an occasional public meeting for the employees.

I remember one hospital whose philosophy was “We’re the biggest and the best, and if you don’t come here, you’re stupid and will probably die.”  Their CEO was totally against press releases, advertising, or public outreach of any kind. He would say, “If they don’t know us well enough from our work, we need to do better work.”

News coverage was pretty simple at that time, too.  You sent your news release to the local paper(s), local radio, and, if available, local television stations.  Grand slam home runs in communications in that era would consist of a story that hit the wires or made either the New York Times or Wall Street Journal. Not unlike scenes from Ozzie and Harriet or Leave it to Beaver, things were formal and “normal.”

The interesting thing about today’s world, is that just the description of  “how to communicate” from a business perspective would take thousands of words.  Without beating all of those digital horses to death, we now have hundreds of television cable choices, Satellite radio, dozens of specialty publications, 24 hour/real-time web-based everything, and so much spin that even the late S.I. Hiyakawa would be flabbergasted.

So, the question becomes, “What’s the ticket?”  “How do we get the word out about our work, our facility, our philosophy?”  To that end, it is important to understand that the entire vision of healing hospitals is a wholesome, caring, loving, nurturing philosophy that is profoundly newsworthy. How do you capture the hearts and minds of current patients, their families, their neighbors, and their neighbor’s neighbors?   Interestingly enough, the first approach and my initial recommendation is education for your employees.

Many employees have not yet made the connection between this type of unique care and publicity.  Obviously, not unlike the old CEO quoted above, it is the power of “word of mouth” that can carry the day locally, but –not unlike my last CEO experience, if there is not enough population to produce growth, then you need to reach beyond the local geographic boarders. By doing so, we tripled in size over a decade of population decline.

There is an old saying that “anyone who is 50 miles from home can become an expert.” For the most part, most people are not aware of your quality care, your commitment to humankind, your nurturing attitude even 30 miles away.  Consequently, media is the key.  What I have found is that national media can bring a halo of credibility to an organization that years of local media could never bring.  Unfortunately, unless you have done something wrong or a meteor drops onto your grounds, national media is not that easy to attract.

We were fortunate in that we had the Wall Street Journal, USA Today (four times), the New York Times, the Today Show, the Philadelphia Inquirer, Oncology International, Forbes, Fortune, and several stories in Reuters releases and at least three placed with the Associated Press that were picked up internationally.  How did we do it you might ask?  We often times did it by linking local stories to national topics. It takes creativity, persistence, and a strong desire.

You need to do news releases to just about everyone. Pick topics that are timely, informative, and have a unique angle, and then work at it constantly.  The other way that we promoted our organizations was through social media and Web 2.0.   My original blog, Nick’s Blog at the time – started in 2005, now HealingHospitals.com (i.e., this blog), was the first hospital CEO blog in the world, and that brought a tremendous amount of new traffic to our organization.  We also became active on You Tube, Twitter, and Facebook long before many others in (and outside) the healthcare community accepted these phenomena.

Bottom line?  It can be done cost-effectively with great success, and we’re here to help.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What does it cost to be nice?

What does it cost to be civil?

What does it cost to be kind?

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

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