Archive for the ‘patient-centered care’ category

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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Healing Hospitals: Get ready… Get set…

November 25th, 2009

One of Johnny Carson’s funniest ongoing “bits” (He was the guy who hosted The Tonight Show before Jay Leno) was that of Carnac the Magnificent.  Carnac was a psychic with a large elaborate turban and a plethora of envelopes, all of which were “hermetically sealed” and had been kept in “a mayonnaise jar on Funk and Wagnalls’ porch since noon” that day.  Johnny would hold each envelope up to his head and give the answer to the question that was sealed in the envelope.

Carnac’s answer: “Sis, boom, bah.”

The question: “What sound does a sheep make when it explodes?”

Well, here’s my version.

Carnac:  “The Baby Boomers will begin to speak more and more feverishly about their wants, likes, and dislikes relative to hospital care.”

The question would be: “What will eventually make you kiss your job good-bye?”

I’m sorry.  I know it wasn’t funny, but the point is that patient choice, patient transparency, patient dignity,  billing simplicity, and — most importantly — loving, nurturing patient care and improvements in every level of quality will become the demanded norm.  Remember, we Boomers have never been laid back.  Ours is a generation of demanding “I” driven professionals who have influenced the way blue jeans are made (i.e., to fit our pear-shaped butts).  We’ve invented levels of debt that were not even thought of before.  We have influenced drug use, stock market use; you name it.  What makes any of you think that you are out of the woods with us?

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It’s my further prediction that those hospitals that do not follow the path of creating healing hospitals will struggle and many may not survive.  We Boomers will contribute to more bankruptcies and closings than even the Balanced Budget Amendment.

We’ve been watching the hundreds of hospitals out there that are marching in lock step to the past re: patient care.  It’s like observing a physician who doesn’t even try to be nice to his patients.  A year or so into the practice, they come into the president’s office and say, “Why am I not making my financial goals?”   If things don’t become softer, more gentle, more humane, our patients will vote with their feet.

Oh, sure, you may have five or so years before the dominant players, the Boomers, take over, but, believe me when I tell you that the vast majority of businesses “on the financial bubble” right now are filled with employees who have either bad or no attitudes.  Those “It’s not my job” attitudes.

Now-closed Circuit City I have carefully observed organizations like Circuit City transition from model companies to bankrupt companies.  They changed their incentive methodologies for their employees, stopped listening to them, and stood back and watched as those same employees undermined their sales by saying things like, “I don’t care what you buy.  My check doesn’t change either way.”

Walk through your hospital, and take a good look at what is going on in each department.  Are your registration people friendly and kind?  Are they sensitive to the frail elderly, young, and frightened?  Are your techs polite, nurturing, caring?  Is the receptionist friendly on the phone, or do they throw everyone into voice mail hell?  How is your executive staff?  Are they parent-to-child leaders? Reality is what is happening; not what you think is happening.

Get yourself a secret shopper or two and let them work your system.  It can be a real eye opener, a  hard dose of reality.  Are your Press Ganey scores lower than a typical prison hospital?  Do your employee surveys reflect their love and respect for their fellow employees or for their job?  Are they proud to work at your facility?  Most importantly, would they recommend your hospital to their friends and families or would they recommend it as a place of employment for their peers?

If I haven’t captured your imagination yet, maybe you’re too hardened by the present.  I heard a PBS interview today where a Pakistani land owner said that when he tried to get his men to work together to carry larger quantities of dirt from one place to another, they refused and insisted that the bucket was the only way they had ever done it. They then told him that change is too dangerous.  Check your buckets.  Make sure they don’t end up empty.

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Healing Hospitals

October 18th, 2009

For the past several months, I have been searching for a new blog title. Nick’s Blog, NickJacobs.org, Ask a Hospital President, Taking the Hell out of Healthcare… none of them really told the story of my passion, my drive, my desire to change healthcare in a way that would be meaningful for every patient, every employee, and every physician.  Finally, the idea of what exactly I believe in, try to strive for, and teach hit me:  “Healing Hospitals.” Not only do I believe that we can make our hospitals healing places, I also believe that we can heal the hospitals themselves.

Nick Jacobs - HealingHospitals.com
Nick Jacobs, FACHE – HealingHospitals.com

For too many years, the Socratic style of teaching our docs has basically made many of them as tough as professional football players.  We have experienced “The Old Guard” in nursing, where, when new nurses come on board the older nurses are encouraged to “eat their young.”  We also know that the over-utilization of overhead paging, blood tests in the middle of the night, loud staff members, et al lead to what can only be described as a tense environment.

For the past 20  plus years, we have advocated a kinder, gentler hospital environment.  During that time we have introduced all types of non-traditional healing environments, integrative medicine, roving psychologists, drum circles, aroma, music, pet, and humor therapy as well as the elimination of bullies from the medical staff.

HCD-Cover-10_09These are just a few of the very effective mechanism that can be introduced to create healing environments in hospitals.  Healing gardens, labyrinyths, 24 hour visiting, double beds in the OB suites, and the beat goes on and on with decorative fountains, fireplaces, skylights, balconies, but most importantly dignity and respect amongst all staff and visitors toward patients.  So, “Healing Hospital” has multiple meanings. Healing will take place more quickly, thoroughly, and meaningfully in these facilities, and the entire staff will be charged with the promotion of healing by creating an overall healing environment.

Well, I’m sure if you type in nickjacobs.org or even Ask a Hospital President.com you’ll still get to us, but remember that our overall goal, our direction, our mission, our passion, and our job is to help you to create healing environments where infection rates drop, as will lengths of stay, readmision, restraint and mortality rates.  Call us at SunStone Consulting, LLC.  412-992-6197.

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Planetree or Bust!

October 4th, 2009

Those who have worked with me know that I have been unequivocally one of the most loyal supporters of the Planetree Philosophy of care in the world.

My former place of employment was the third Planetree hospital in the country, after Planetree’s headquarters moved to Griffin (Derby, CT.)  We were the first Planetree hospital in Pennsylvania, and that hospital, Windber Medical Center, is now one of the top ten Planetree-designated sites internationally.  After having served on the Board of Directors of Planetree for nearly eight years, having written literally dozens of blog posts and articles about Planetree,  having taught numerous online seminars for them, contributed a chapter to their latest book, and served on the Planetree Speaker’s Bureau for half a dozen years, I’m back once again with a presentation this Tuesday at the Planetree 2009 conference.  It’s called: Take Care of Your Employees and They Will Take Care of Your Patients.

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Although I was encouraged to retire from the board in order to give newer members their opportunity to participate, and am no longer a part of the Speaker’s Bureau, with no formal ties to the organization anymore, I want to assure you that my experience, passion, and commitment to humanizing healthcare, transparency, creating a nurturing environment for patients and their families could not be stronger.

Since my transition from formally running hospitals full time,  I have immersed myself deeply into the world of  helping hospitals through my consulting practice to achieve the patient, employee, and family satisfaction ratings that ensure top scores in HCHAPS which, in turn, will result in increased business, increased revenue, and increased growth for any organization.

Nick Jacobs, FACHE
Nick Jacobs, FACHE

I am including one of my lastest articles on Integrative Health written for Hospital News.  Remember, if I can help, just call, e-mail or or comment:

Integrative Medicine

Massage, Flower Essences, Spiritual Healing, Drumming, Reiki, Acupuncture, Music, Aroma, Humor, Pet, and Art Therapy; all of these healing practices were formerly referred to as Alternative or Complementary Medicine.  They deserve, however, to be referred to as Integrative Medicine. Because, when we integrate these various disciplines with other contemporary healing methodologies, the results can be amazing.

As a hospital CEO, it brought me great satisfaction to introduce all of these treatments to the healing environment of the hospital.  Many times they came amid intense resistance from both the medical staff, and some members of leadership.  In fact, after nearly 10 years of offering comprehensive exposure to Integrative Medicine, we still had a smattering of nonbelievers.  The only thing questionable about these therapies for a healthcare administrator is that the typical insurance companies don’t cover the costs of all of them and cash payments come into play.

The number of patients coming to our facility had tripled through the emergency room alone as did the overall budget of the entire organization during that time period.  Those “Forest for the Trees” practical leaders still could not bring themselves to give credit to one of the major contributing factors involved in that surge of the hospital’s popularity.  Yes, of course, we also encouraged 24 hour, seven day a week visiting, had guest beds in many patient’s rooms, and served meals to the families on the medical floor where their loved one was a patient. Did all of this combine to the create a healing environment?  Of course it did, but Integrative Medicine was the heart and soul of the difference.

Their skepticism seems to fit into the cycle of questioning the validity of wellness and prevention, two comprehensively established methodologies for improving general health and well-being, proven over centuries of unofficial clinical trials.  Wellness and Prevention works, but because the insurance companies have not yet fully embraced these philosophies, then some still say that they are not valid.  Treating sickness can be as comprehensive as ensuring wellness.  For whatever reason, some of our medical and administrative leaders often confuse reimbursements with healing, and forget to add new patients and additional income from related disciplines like PT and OT to the equation.

As a nonmedical, nonscientist, it was easy for me to understand why the various integrative arts worked so well for our patients and their families.  From the old song, “All You Need is Love,” you could easily enjoy the looks on the faces of those patients and family members who used these treatments to receive sorely needed relief from whatever pain or loneliness they were experiencing.  It doesn’t matter if you’re eighty minutes or eighty years old; touch, nurturing, and love all remain critical in our lives.  Have you seen the statistics on how much better people do with pets than without, or how many babies died in orphanages due to the “failure to thrive?”

None of these ancient arts were created because the scientific method produced FDA approved results in trials of 200,000 or more.  They evolved into centuries old healing arts because they provided relief and help in a time when leeches, bleedings, and a lack of hand washing were the accepted medical treatments.  The tribal shaman, medicine man, healers, and other spiritual leaders all knew what the subtle and not so subtle impact of their work meant to their fellow human beings.

We have casually observed the use of these healing modalities on patients who have experienced restored feelings to otherwise numb feet.

We have seen them relieved from debilitating back pain, healed from hopeless wounds, saved from surgeries due to the opening of blocked intestines through acupuncture.  We have observed psychological breakthroughs from drumming that had never been reached by traditional therapy.  Truthfully, I didn’t care exactly what made our patients better, just that they were better, and the results were dramatic, with an infection rate of 1% or less, a 3.4 day length of stay, a low readmission rate, and the lowest mortality rate for adjusted morbidity in the region.

Remember, “All You Need is Love.”

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Healthcare Reform? Blow it up, and Start from Scratch!

June 20th, 2009

Healthcare Reform? The premise and the incentives are wrong.  We treat sickness (which can be a good thing), however, we do it to the almost total exclusion of encouraging and incenting wellness. While in the Netherlands a few years ago, I asked a very comfortably-situated business person why she and her entire family all rode bikes. She smiled and explained that the millions of bikes in the Netherlands are a way of life because they keep people healthy.  Of course, we don’t have to ride bikes, but why not?  “It is much less costly.  It gets us where we want to go, and it is so much better for our bodies,” she said.

Photo credit: Amsterdamize
Photo credit: Amsterdamize

After going to doctor after doctor in my early thirties and then again in my early forties for a recurring and seriously painful back problem, someone suggested a Chicago-trained chiropractor.  After a very quick, one time manipulation, he said, “Follow me, please.”  When we descended the stars of his office, in front of me was literally an entire homemade work out facility.  This particular center seemed to emphasize strength training.   The Doc walked me over to a row of three machines and said, “If you use these three machine or their equivalent, just the way I show you, you will never have to come back here again.”  Then he said, “Oh, and if you drop fifteen pounds, you may be able to get off those blood pressure pills, stop taking that stomach medicine, and feel better about yourself in the process.”

The Dr. Dean Ornish Coronary Artery Disease Reversal Program is completely about health and prevention.  It is about wellness; treating yourself with the love and respect that you deserve, being kind to yourself, yet being disciplined enough to get you where you need to be in order to enjoy a healthy, pain free life.

We spend only 4% of our health care dollars on prevention.  That may sound like a lot to some of you, but do the math.  Take 4% and multiple it times $2.2 trillion …or possibly soon $3 or $4.0 trillion.  Every physician should endorse a workout facility and work to send you there, and every physician should receive bonuses for having you use it.  A primary care physician in Britain can make about $320K a year, which includes incentives directed toward encouraging healthy living for their patients.  Our primary care docs make, what, $130,000, $150,000, $180,00 in comparison?   Would you really care if your physician could make almost twice as much if you were living a wonderful, healthful, reduced stress life?

There is absolutely NO DOUBT in my mind that the reason I’m typing this here today and not deceased at age 58, like my father, is because of the work of people like Drs. Ornish, Benson, Jonas, and Weil.   It is not because of my old donut shop, the nachos and cheese, the automobiles, my Lazy Boy, or the grueling work habits that we Americans think of as normal.

And what about death?  I have to tell you that death happens to all of us.  (Sorry.)  When it happens may depend a great deal upon our recognition of that fact, but it is not avoidable.  So, why is it that we, as a society, reject death as evil, and ignore its possible existence?  How could we cut billions and billions of wasted healthcare dollars?  Hospice is the answer.  Don’t commission oncologists for drug use when there is absolutely no hope that the patient will live.  Don’t pay radiologists for radiation treatments that will not work in preventing death.  Don’t reward hospitals financially for readmission after readmission for people who should have been told to mark  their DNR’s months earlier.  Face death as part of life.

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Finally, look at the food and restaurant industry.   For every restaurant or food company that pulls a killer food and replaces it with the reasonable alternatives, reward them through the $3 or $4 trillion health budget.  You can buy veggie hot dogs on the streets of Toronto.  (Try Morning Star Farms brand veggie hot dogs.  They rock.)

In closing; diet, exercise, stress management, balanced lives, less capitalistic rewarding of killer diets, higher reimbursements in healthcare for the “right stuff,” and acknowledgement that this will eventually end, can make it all work so much better, so much cheaper, so much easier.  Did you have your pneumonia shot yet?  Well, actually, you may not need one if you start taking care of yourself.  I’m going downstairs to workout now.

Next time?  Tort reform.

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Healing and the Mind Revisited

April 8th, 2009

I’m working in Chicago right now, feeling a little overwhelmed by a phone call that I had from one of my very dearest friends about his impending future, about my son-in-law in Baghdad and his family who are living without him at home, and also about the challenges that we individually and collectively face both nationally and internationally during this time of economic crisis and overall unrest. During the midst of my thoughtful contemplation, I received an E-mail from a very dear friend, Savery, with a link to open. I was so moved by it that I decided to post the link on Facebook.

Almost immediately after it went out, my friend, Dr. Dean Ornish, sent me this follow up link from Bill Moyer’s show. For those of you who don’t know this about me, the Bill Moyers series, “Healing and the Mind” was my inspiration for the Planetree Philosophy that we implemented at Windber all those years ago. For some reason, he and I keep intersecting, and here we are again.

So, thanks, Savery, Dean, and Bill, but most of all, thanks to the amazing man who created this wonderful experience that you are all about to have.

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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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