It’s 5:33 PM on New Year’s Eve.  For some reason New Year’s Eve has become a significant contributor to some landmark memories for me, memories that will always be with me.  Maybe it’s because the day represents such finality.  Starting tomorrow, for example, 2009 better be the number that you write on the forms, checks, and documents because 2008 will be gone, gone, gone. 

One vivid and unique New Year’s Eve memory occurred back in 1985.  After making payroll 24 times a year for 59 consecutive months, success or failure all boiled down to the last day of December.  Truthfully, for the first time in five years, there was not enough cash to compete the payroll.  As I was closing down the office and preparing to leave for the night, the main door of the building opened and footsteps could be heard coming through the gallery.  My mind went immediately to the dark side.  Is someone coming here to rob or kill me?  Let’s be candid, this was a rural arts center, for goodness sake on New Year’s Eve.  Who in their right mind would be coming into the gallery five minutes before closing? 

As it turned out, the footsteps were coming from a donor who was there to present me with a check.  That check came to exactly the amount of money needed to complete payroll.  My immediate response was that the universe had, once again, taken care of the problem, but later, the concept of almost not making payroll put me over the edge and sent me on a job search for something that was just a little more secure. 

For two years after my father died, pneumonia became my New Year’s Eve visitor.  My kids were two years old and five months old, and my chest cold had gotten worse and worse until finally, the doc said, “It’s pneumonia.”  So, 1975 and 1976 were my pneumonia years.  The most memorable part of those two years was that pneumonia boy got to stay at home with the kids while the rest of the world partied.

Finally, the New Year’s Eve of Y2K holds a prominent spot in my brain as well.  The team of IT specialists, finance personnel, maintenance, and administrative leaders all gathered in the conference room to ensure that the the world would not come to an end.  Some of you have read the story before, but just as the ball began to drop on Times Square, one of our computer jocks accidentally leaned up against the light switch and al of the lights went off simultaneoulsy.  A wave of palpable fear swept through the room until one of the team members said, “Hey, the television isn’t off; we’re okay.”

Well, today was my last day of work as a hospital administrator and research institute executive, but the puropse of this New Year’s Eve blog is not to tell you about my pneumonia, about light switches going off, or even about making payroll.  It is to let you know that, in spite of the title and career change, we’re doing okay.  So, Happy New Year to all, and remember, the only bad New Year is no New Year.

For those of you who might have any interest in this topic, read on . . . for the rest of you, have a great holiday. 

With seven working days remaining until the name of this blog should be officially changed to Ask a Former Hospital President.com, I’d like to just make a short list of the areas in which I have been and will be working as the International Director for SunStone Consulting.

1.  Patient Centered Care. . . It is clear that this area of expertise will be my first and foremost focus, my passion.  How can any hospital succeed in this arena?  How do you become not only patient but also employee centered in such a significant way that your HCAHPS scores improve, your infection rates will go down, your length of stay will decrease, and the bottom line will improve significantly?  That’s the story that is burning inside me.  So far my new job has included significant keynote speeches, visits to hospitals seeking this guidance, and plenty of blogs and articles.  With organizations like Planetree, the Samueli Institute, and American Healthcare Solutions seeking to spread this word, this topic should consume a great portion of my time.

2.  Patient Advocacy. . . When the day is done, and my time is over, it is my very deep desire to have helped to change healthcare significantly, and patient advocacy is a very clear key to the success of this goal.  My book “Taking the Hell Out of Healthcare” was the first step toward telling the advocacy story. 

3.  Being Green . . . No matter what the pundits say, the world will only become a better place if we all work toward a common goal, to reduce the carbon footprint.  The investments made in this arena will result in a multi-fold financial and philosophical payback to any organization seeking to explore a green philosophy.  We have agreed to do Beta work in this area, and believe that every hospital will benefit financially from this initiative.  Pittsburgh Gateways is leading this initiative, and it is my commitment to work with them to bring to my CEO peers not only the how to but also the financial benefits that will make this work possible.

4.  Being Digital. . . As my current position comes to a close, we can openly declare that we will be completely digital before the end of the fiscal year.  One of our tasks has been to bring groups of hospitals together through fiber connections for work on tele-mental health, tele-pharmacy, and disaster recovery.  These are only three of the myriad of initiatives that fiber connectivity will permit.  Corathers Consulting will be working with me to help introduce various aspects of this somewhat complex initiative to hospitals throughout the United States.

From these four areas of expertise, dozens of additional projects, services, and opportunities will also be made available like arrows in a quiver.  We will continue to promote our knowledge regarding the use of genomics in the hospital setting.  We are also working with groups to introduce other services through our peers and partners that will help hospital CEO’s in their journey to fortify and grow their organizations.  Areas such as strategic facilities plans, construction and finance alternatives, physician strategic plans, physician office work, legal partnerships, food purveyors, insurance services, benefits management, case management, fund raising, marketing, as well as literally dozens of other growth and infrastructure opportunities will be on this menu.

SunStone is also working with me on the most important aspect of these initiatives and that is to help hospitals, practices, and senior leaders find the money to initiate every aspect of the programs needed to thrive.  Be it DRG Transfers, Workmen’s Comp initiatives, RAC preparation, and a myriad of other financial initiatives that will result in finding or reclaiming money, SunStone has that expertise to bring to these initiatives as well.   

So, as Bob Hope said so many times, ”Thanks for the Memories,” and thanks to everyone who has helped me through this very emotional transition.  Please don’t forget to “Ask A Hospital President.com” after the new year begins because being busy is my goal and helping you is my passion.

After nearly a dozen years, I attended my last board meeting as President/CEO of this hospital yesterday. I believe that I have missed only one meeting in all of those years. As I retire from the day to day operational aspects of health care and move into the next chapter of my life, it seems like a good time for reflection.

Looking back at the previous twenty plus years, my heart is filled with wonderful memories and the support of many friends, and it is also filled with the challenges and hurts that are almost always a part of senior leadership. A mentor once told me that, “The wind blows hard at the top of the pole.” I’ll never forget another suggestion that came to me from one of my former bosses when I informed him that I was thinking about becoming a hospital president. He said, “If you think you want to run a hospital, make sure you go somewhere where it is the only game in town, in the county, and preferably in the region.” Well, obviously, that was one more piece of advice that went by the wayside. We landed in a place where there were four hospitals all using the same media.

Having started as a musician and band and orchestra director, I have never moved very far from my education roots. It has always been about open communications, respect, dignity, encouragement, a spirit of co-operation, and positive mental attitude for me and those around me. In many ways, being a dad and a teacher was the best practice anyone could have had for running a hospital. Even though one of my favorite sayings was “I don’t want to be anyone’s parent here,” it seemed that there were numerous situations that were similar to the same types of issues that were regularly part of any family’s interactions.

Health care, however, is changing rather dramatically. As our economy and the Boomers both begin to shake, health care has to seek its own level. Will it be directed more toward wellness and prevention? Will it be rationed? (Rationing, of course, would indicated that everyone would get some of what is being offered. You know, similar to sugar rationing in World War II. They just wouldn’t get as much. The reality of our current system is that some get everything and others get NOTHING. Consequently, rationing may not be a great description of this process.)

My new charge is to help hospitals find their niche’, to help them find money and most importantly to find stability by becoming patient centered. We will be attempting to provide hospitals with the knowledge gained from over twenty years of experimentation into areas that had not been popular before we explored them. We will be helping hospitals to become patient-centered, digital, and green to name a few.

Some day, all of this will make sense to those of you who doubt. It was interesting when my career path went from teaching, to arts management, to tourism, to health care. The skeptics deeply questioned the transitions, but it all made sense. As I went from one discipline to the next, it all merged together in a meaningful way in health care management.

Now, we are launching into one more area of expertise, but this time, we have 40 years of experience, and deep knowledge regarding not only life, but marketing, communications, Web 2.0, patient centered care, construction, carbon credits, ambiance, Planetree, Optimal Healing Environments, employee centered care, recruitment, data mining, proteomic and genomic research, wellness centers, hospice, behaviorial modification, food services, fund raising, integrative medicine, and digital radiology equipment. So, if anyone needs a motivational speaker, some advice on OC48 lines, 3TMRI breast coils, micro turbines, public relations campaigns, or anything from the list above, remember me. My web address contact information will be nickjacobs@sunstoneconsulting.com.

This week we are off to Charleston, South Carolina to present a keynote speech for the Carolina’s Healthcare Public Relations and Marketing Society Fall Conference. The primary theme of the presentation will be directed toward creating a market niche through instituting an Optimal Healing or Planetree Environment and then promoting that niche through Web 2.0 techniques. Truthfully, the art (not the science) of marketing and public relations has been a dominant driver in my career, and this presentation will be coming directly from the heart, as I combine my two greatest work passions for a single presentation.

After the Carolina blitz, we are off to the Clinical Breast Care Project off-site with Walter Reed Army Medical Center in Hershey. This year we will celebrate over a decade of amazing progress, advancements, and scientific growth.

COL Craig D Shriver, MD

We will also celebrate our Principal Investigator’s mile-stone birthday, a significant birthday that brings him closer to the age of “Yoda” wisdom. When we began this journey together Dr. Craig Shriver was a young Lieutenant Colonel and I was, well, I was the age that he just embraced at this birthday. Time flies as we work diligently to find breakthroughs and eventual cures for breast cancer. Dr. Shriver has been an amazing partner and friend, and I can only hope that we will have opportunities to continue our work together in some significant ways in the future.

So, what else has been happening? With SunStone Consulting we have been working with Corathers Consulting and numerous regional hospitals to begin serious fiber networking and telemedicine technology for telepsychiatry. How did this come about? A funny thing happened on the way to an economic bailout. Inserted in the $700+ B bailout was parity for mental health coverage and included in that parity is the ability to compensate psychiatrists for their work in telemedicine. Let the networking begin.

Intelli-Surge is doing a tremendous amount of work in the region to assist several local hospitals in their efforts to construct new buildings. The uniqueness of their approach is that hospitals will be able to build thier facilities without necessarily having to come up with the enormous amounts of cash typically required for this work.

Finally, Pittsburgh Gateways is helping several of us to come together for economic development gains for the Greater Pittsburgh region. With their guidance and connectivity we are hopeful that the future will be filled with opportunities for economic stability for many of the start-up companies in our area.

So, off for another round of busy . . . as we do our thing in the air and on the ground.

There is a very popular book, DVD, and pop culture hit entitled “The Secret.”  Only two days ago I made a 12 hour round trip to Syracuse, New York to speak to a group of Human Resource professionals from New York State.  (It was faster than flying from Pittsburgh to Philadelphia to Syracuse.)  It struck me that my presentation could have been called The Secret.  It could be, but truthfully it really is no secret at all.  Most probably it would have been better to have named it “Common Sense.”  

The speech was all about treating  employees as well as the patients.  Employee empowerment,  physical wellness, communications, emotional health, the use of integrative health techniques, employee personal growth, dedication to fun, and, most importantly, the elimination of bullies from the workplace are just a few of the major topics that we discussed with our audience.

Interestingly enough, the outcomes generated from these actions are not only remarkable, they are, in fact, predictable.  Exceptional stability in the workplace with barely a 10% turnover rate; impressive HCHAPS scores,  high employee satisfaction ratings, low infection rates, extremely low settlement rates from lawsuits of any kind, and high profitability created from a word of mouth chain of endorsements that results in enormous increases in the patient count. 

So, it is all about common sense. If you treat your employees with respect, and love, they will do the same for the patients.  If you nurture them, care about them, assist them, pay attention to them, and are open and honest with them, they will do the same for you and for the patients. 

Wanna know more about this revolutionary new way of caring for employees, just give us a call.

Not long after the attacks of 9/11, the pundits began to attempt to discern their impact on our every day lives. No one fully understood the domino effect of these actions both nationally and internationally. Who could have predicted the over negative blows on all forms of air travel; the economic spin down, the billions in investments needed or reportedly needed to protect us; and finally, the breakdown of our personal freedoms?

Similarly, as we watched the large investment and mortgage related financial institutions begin their minute by minute trip into no- man’s land, we could only shudder with concern over things like pensions, business investment opportunities, ownership of our homes, and the future of our overall economy. As our government began to move from deregulation to government control and ownership, the hollow words of the past certainly rang out like a clapper-less bell.

Allow business and industry to be free, deregulated, uncontrolled, and we will all be better off, or will we? As we see the results of the cheaters, the liars, and the snake oil salesmen, it becomes abundantly apparent that left unregulated our current business culture is filled with those who don’t play correctly, ethically, or reasonably. As the great grandson of prominent and trustworthy Quaker merchants, it pains me to observe the obvious corruption, corner cutting and lack of ethical conviction present in today’s business world. It is reminiscent of Henry F. Potter from “It’s a Wonderful Life.”

How will this impact your health? The slide has already begun. As reported in the Wall Street Journal by Vanessa Fuhrmans, “As the credit crunch threatens to throw the economy into a deep slump, Americans are already cutting back on healthcare spending, a sector once thought to be invulnerable to recession.” Visits to physicians, purchases of prescription drugs, and preventive tests are all measurably decreasing. Some people are cancelling their own health insurance to cover the costs of gasoline and consumer goods. Others are just avoiding what they know to be appropriate medications and screenings.

Quest Diagnostics reported in this article that the number of tests ordered for the uninsured fell 8% in the second quarter compared with their normal 1% quarterly growth. OB/GYN visits, according to the same article, dropped 6% in the first quarter alone this year.

It’s not just the uninsureds who are cutting back. “A recent analysis of claims from 250,000 people in several dozen mid-Atlantic employer health plans suggests even people with coverage are cutting back on care.” They reported nearly a 19% cut back in elective knee surgeries, a 6% decrease in pap smears, and a drop in prescriptions for anti-depression of 29%. Actually, that one was the most mystifying for me. It would seem that there would be exponential growth in this area.

This particular snapshot of the future also presented this query: “What’s next: Doctors and health-policy experts worry that by delaying care in the short term, patients will end up paying more in the long term if their health deteriorates.” Deregulated health care which will lead to deregulated health?

F. Nicholas (Nick) Jacobs, FACHE

Upon making my decision to leave teaching nearly 30 years ago, I interviewed with numerous companies. At the first interview, the human resource director looked up at me and said, “You’re a teacher. You bring nothing of value to the business world. It’s as if you were a drill instructor in the military. That does not help us in any way. We are not interested in you.”

The second interview was a much worse experience. I arrived at the office of the public relations/marketing director of another local firm. He looked up from my résumé, crumpled it in his hands and threw it into the waste basket in front of me and said, “Not interested.”

During the next interview, the HR director looked me in the eyes and said, “If you could do anything in this world, what would you do?” My reply, 29 years ago was, “I would be a writer and speaker.” He smiled and said, “You don’t want to be in retail. Put my name down as a reference and get the heck out of here.”

In the Wall Street Journal, Melinda Beck wrote an inspirational article about rejection and those who are moved in a positive way by denunciation. She talked about actress and singer, Julie Andrews who was rejected as “not photogenic enough for films.” She also talked about the rejection of the Harry Potter books by 12 publishing companies, Michael Jordan being cut from his high school basketball team his sophomore year, and numerous other successful people like Walt Disney, the Beatles, Dr. Seuss and Thomas Edison.

What was it that made them continue to drive forward, to push their ideas and dreams to reality? In the article, Ms. Beck says that the psychologists call it ’self-efficacy,’ the unshakable belief that they have in themselves to succeed.” “It also is the hallmark of ‘positive psychology,’ which focuses on developing character strengths rather than alleviating pathologies.”

Here was the key point to the article: Those people who succeeded believed that persistence will let them beat the odds. “Sometimes genius itself needs time.”

The good news about this is that, according to Harvard Medical School psychologist, Robert Brooks, “You can develop a resilient mindset at any age.”

Bottom line? Do not allow negative responses to disrupt your dreams. Go for it. No matter what your age is.

The other night I was watching PBS and saw a show about the bridges of Pittsburgh.  As a kid there was a bridge between downtown and the North Side.  When I looked it up on Wikipedia, I found the following story:  The Fort Duquesne Bridge is a steel tied arch bridge that spans the Allegheny River in Pittsburgh. It was colloquially referred to as the Bridge to Nowhere because it was constructed from 1958-1963 by PennDOT, and never opened for traffic until October 17, 1969.

When we look at our own personal journeys, it is sometimes very interesting to trace the origins and destinations of our bridges; where they have been and where they could be or more importantly where they are actually taking us.  The journey always has a series of connectors, confluences, and mergers that were as unpredictable and unimaginable as could ever have been conceived. 

Sometimes those connectors were mentors; sometimes partners, sometimes friends, but more often than not, those people who have had the most influence on our progress and on moving us toward our goals have been people who did not like, support, or believe in our work, our mission, or our dreams. 

Many times, our inspiration came from the power of those people who were most passionately against us than from those who supported us. Bob Strauss in his e-How blog writes:  Like duels and opera hats, the concept of mortal enemies has fallen by the wayside in modern times, and more’s the pity. The fact is, everyone can use a good mortal enemy: there’s nothing like the possibility of being waylaid, fisticuff-ed, and tied to a railroad trestle to make a guy just glad to be alive.

As very small children, the funniest jokes that kids can come up with always seem to be "poopy talk" jokes.  As we age, it is interesting that we remain shy about our natural functions.  In fact, some people are so shy that they would rather die than say, do, or even think about anything related to their colons. 

The E-mail that I received this week was a challenge to "Take the Test," and, although it was an advertisement, there were enough good points made in that E-mail that I decided to dedicate this week’s blog to Katie Couric.  In 2000, Katie submitted herself to a public colonoscopy on national television.  Why?  Because she had lost her husband at the relatively young age of 42 to colon cancer. 

After Katie’s big adventure, among the 400 gastroenterologists surveyed, the number of colonoscopies performed each month rose from an average of 15 before the Couric exam to 18.1 after.  It was so successful that it is still referred to as the Couric Effect.

As indicated in the correspondence, over 150,000 people are diagnosed with colon cancer each year and at least 1/3 of them die.  Unlike ovarian and numerous other cancers, there are several screening tests available to determine the presence of colon cancer. 

At a meeting last year our Chief of Medicine stated that "There is no longer a reason why anyone should die from colon cancer."

Even though it was part of my suggested battery of tests the year before, my colonoscopy was completed a few months ago.  Except for the fact that I woke up with a few children’s tattoos on my body from our playful employees and a threat that there would be a video at 11, all went well. 

Okay, I will admit that the preparation for the test was somewhat of a drag, but it wasn’t as bad as being a long term patient.

The goal of their E-mail was for us to persuade everyone to use their diagnostics. The quoted website was: www.DoYouHaveTheGuts.com 

The goal of this blog is to get you to think about taking care of yourself.  It is to convince you to love yourself and your family enough to ensure that you all have a future.  It is to get you to be saved by having a colon test, some test, any test. 

If you’re still embarrassed by colon jokes, GET OVER IT.

It could truly be a matter of life or death.

The other day a very compelling story appeared on America Online (AOL).  I’m sorry that the name didn’t catch my attention, but, in fact, Tony Chen pointed it out to us on his Hospitalimpact.org blog.  Glenn Beck, a correspondent for CNN, had a bad experience in a hospital and then shared that experience. 

What Tony had pointed out was that my recent post on Hospital Impact was also about empathy.  Two of the quotes from that post were:  Maya Angelou who said, "I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel."  And: As we move about in our world every day . . . remember that warmth, concern, compassion, and empathy are NOT bad things.

Glenn had a hospital experience that very nearly put him over the edge, and, in fact, due to the pain cocktail that he had received, he admits that he was even contemplating suicide.  Here are some quotes from his article Put the ‘care’ back in health care, featured on CNN.com/health:

"At the hospital I was often treated more like a number than a patient.  At times, staff members literally turned their back on my cries of pain and pleas for help."

He went on to say, "I’ve now seen our system at its very best and I’ve also experienced it at its very worst.  But in each case, the difference had nothing to do with whether the hospital had the latest equipment or whether it looked like the Taj Mahal.  It had to do with compassion.  It had to do with respect.  It had to do with treating people the way you’d want to be treated going through something unfamiliar and frightening."

From the website: ReligiousTolerance.org we find 21 different religious and six different philosophical interpretations of the Christian phrase, "Do unto others as you would have others do unto you."  Just a few of those are listed below:

Confucianism:  "Do not do to others what you do not want them to do to you."
-Analects 15:23

Buddhism:  "…a state that is not pleasing or delightful to me, how could I inflict that upon another:" 
-Samyutta Nlkaya v. 353

Hinduism:  "This is the sum of duty: do not do to others what would cause pain if done to you. 
-Mahabharata 5:1517

Islam:  "None of you (truly) believes until he wishes for his brother what he wishes for himself." 
-Number 13 of Imam "Al-Nawawi’s Forty Hadiths."

Unitarian:  "The Inherent worth and dignity of every person:’  "Justice, equity and compassion in human relations…"

Native American Spirituality:  "All things are our relatives; what we do to everything, we do to ourselves."

Shinto:  "the heart of the person before you is a mirror.  See there your own form"

Judiasm:  "thou shalt love thy neighbor as thyself." 
-Leviticus 19:18

If these were not convincing enough, there are nearly 20 more included from other religions and philosophies like Yoruba, Zoroastrianism, Ancient Egyptian, Brahmanism, and the Baha’i Faith.

How is it that the world embraces this philosophy, that the "Golden Rule" is our guide, yet we permit environments in health care that tolerate the intolerable?  This, my friends, is a leadership issue.  Do not blame the employees.  Do not blame the physicians.  Do not blame the environment.  BLAME THE LEADERSHIP.  Hold the leadership accountable.  Every department manager, vice president, or president who allows this should be challenged, should be confronted, and, if it is not corrected, SHOULD BE REMOVED.

It is not a matter of choice. It is not business. It is human dignity.  Transparency provides the information needed to correct these indignities, and if they are not corrected via change, you have not exerted your God given rights as a human being, and this is one time when compassion should be trumped by accountability!