I received this quote from a friend today: 

He who knows only his own side of the case knows little.

His reasons may be good, and no one may have been able to refute them.

But if he is equally unable to refute the reasons on the opposite side,

if he does not so much as know what they are,

he has no ground for preferring either opinion.”

? John Stuart Mill, British philosopher
from his classic On Liberty, 1859

My new friend, Dan, has been helping me by holding up a rather small mirror, and suggesting that I explore ME in that looking glass.  For the past two years, my patterns have not changed appreciably.  My work day starts very early and typically ends very late.  During those working hours, it has been my custom to continue to pursue those imaginative, creative inventions, ideas, and interventions that can help to change lives, businesses, and futures in a very positive way.  My enthusiasm for these discoveries, however, seems to get me into trouble because I’m always trying to provide answers before anyone asks me questions. 

Everywhere we go people are selling us something.  We are being inundated with opportunities to try something new, something different, something wonderful that will change our lives.  We not only become callus to these approaches, we become cynical and sometimes very negative toward them.  Hence, when I try to explain that, there really is plenty of money available to us to add those services and to create the type of environment that we know the Baby Boomers and their kids would love, the push back begins. 

In fact, Dan held up his hand and said, “Put your hand against mine.”  Within seconds we were pushing on each other’s hands.  It’s a natural thing.  We see the hand and begin to push back on it.  Our experiences, our intellectual capacity, and our self-assurance all work against us as we assume that “we have the answers,” and that no matter what is on the table, you have experience and knowledge that allows you to counter its winning characteristics. 

Dan suggested that I begin to approach things differently.  He suggested that I stop telling people all of the details of my incredible discoveries and allow them to tell me where their pain resides.  Allow them to tell me what hurts.  Then, suggest some of the marvelous potential cures that have been so much a part of my research over the past few years.  Maybe we should all listen to DAN? 

As CEO’s (and former CEO’s) we all know a lot.  We’ve experienced a lot, and if we weren’t fairly self-assured, we wouldn’t have gotten the job in the first place.  So, maybe, just maybe, instead of always trying to fix everything before we really understand the details, maybe it would be good, really good to just LISTEN for awhile.   

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Dear Dr. Collins:

In 1974 my father was diagnosed with a rare form of lung cancer, and our lives were changed forever.  He had stopped smoking back in 1960 when the Surgeon General had finally declared that cigarettes are “bad for your health,” but it was already too late.  My son had been born one year earlier and my daughter was born two months before my father’s death on July 5, 1975.  During his death watch he proclaimed that, “Had science been honest with us, he would never have smoked.” 

Dr. Collins, I was involved in running hospitals for over 22 years but did not realize the  depth of this science  problem until I helped to create a research institute in 2000.  Because my background was originally music performance , education, and then hospital administration, I did not have all of those preconceived notions about science that you and your peers have been strapped with over the centuries.  Upon interviewing our first three PhDs for positions at the research institute, it was very clear to me that the ”Calf Paths” (poem by: Samuel Walter Foss) of science completely controlled our journey to cures, or, as in my father’s case, to the lack of cures.

When I asked them why they had not won the Nobel Prize, their answers were open, honest, and priceless.  They were following the long established paths that had been put in place by the people who preceded them.  Then they explained to me that, not unlike the training that our Diva’s receive in music school, it was “All About THEIR INDIVIDUAL SKILLS and TALENTS.”  Heaven forbid that they share the ideas for their secret sauce because the person to their right or their left might take away their “NIH grant,” grants which have become suspiciously “Good Ole Boy” grants given primarily to members of “The Club.”   The rules of the system are:  “Don’t share information; don’t ever tell anyone the key to your secret research; don’t co-operate.”  The incentives are completely misaligned.

Until you approach science like a Ensemble with soloists rather than Soloists backed up by minions, the men, women, and children of this generation will continue to die needlessly as well.  Dr. Collins, it’s 2010, 35 years since my dad passed, and I miss him as much today as I did then.  The NIH and medicine knew well before the 60′s that cigarettes were killing people, yet we still manufacture them and push them into the hands of our children today. 

You know that “the system” that you oversee is “BROKEN,” but, unlike what is being attempted in healthcare reform, there is NO EFFORT to implement SCIENCE REFORM.  Not unlike the generals of wars past who must live the remainder of their lives remembering the blood that is on their hands from the decisions that they have made, unless you work to change this ridiculous system of science, you too will have to live the remainder of your days realizing that you allowed the Calf Paths to remain in place.  Step back; look at the insanity of a system that does not encourage people to truly share their data in meaningful ways; that embraces the status quo and tradition so completely that truly significant progress has not been made since Nixon declared war on cancer; that penalizes researchers financially for trying to change the Calf Path, and the mirror will still contain the images of the organizations that you direct.

This dog is no longer in that hunt, but I want progress to be made for my kids and my grand kids.  I want you and everyone around you to admit that the status quo is broken, to begin to reward people significantly for opening their hard drives and notebooks, for exploring the hundreds of ignored orphan diseases; and for playing as an ensemble instead of making demands like a Diva. 

My Father was a wonderful, intelligent, caring man.  My children were raised without his input, his insight, his knowledge, and his ever present love.  He smoked cigarettes with asbestos filters.  Smoking and asbestos . . . two strikes, and you’re out!   Continuing on the current Calf Paths of science; three strikes and we’re all OUT.

Happy Father’s Day!

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This morning I had an experience that could only be described as Transformational. My presentation to the World Health Care Congress 2nd Leadership Summit was finished yesterday afternoon and it went as well as could be expected. We discussed HCAHPS, Employee Engagement, Patient/Family Partnerships, Evidence Based Design, and how to appropriately staff the various seats on the proverbial bus.

My flight was not scheduled until Friday, so attendance at the morning sessions seemed like a viable option. Listed on the speaker’s schedule was B. Joseph Pine ll, and his topic was “Work is Theatre and Every business a Stage and Authenticity: What Customers Really Want.”

As Mr. Pine went through his 55 minute presentation, my initial reaction was “Yep, knew that; heard that before; understand that,” but then, during the last five minutes of his prepared remarks, Joe hit us between the eyes with that thing that had always been there but had never become completely clear to me during the past two decades.

He asked us what people wanted when they joined a health club, went to business school, or a psychiatrist? The answer, of course, was that they were looking to be transformed. Each and every day for a dozen years, I have watched this process and never grasped the nature of this metamorphosis.

One of the participants made a point of asking why it was that a person could come to a hospital, have open heart surgery that changed or even saved their life yet would not donate even $200 back to the hospital during the annual fund drive? Yet that same person would leave their entire estate to a university that they had attended fifty years earlier? What was the difference? In both cases something dramatic had happened, but in the case of the open heart surgery, it was just seen and presented as a service or at best an experience.

The university however, provided a significant transformation of the life of that person. This simple description explains why so many open heart patients go back to doing exactly what they had done in the past, and end up back on the table two or three more times. It was seen by the patient as a service or at best an experience.

With this in mind, my observations of what happened to those patients who participated in the Dean Ornish Coronary Artery Disease Reversal Program was that, for the most part, they had joined that program looking for a transformation, and that indeed is what they found. Most of the participants who had come there seeking a total change and a new way of living a more healthful life were transformed by the program. They no longer perceived of themselves as being victims of their health.

How does this all play out in the field of healthcare? WalMart is going to produce a commodity, electronic health records, competing with WalMart on any level will prove to be a fruitless journey because they have mastered the world of commoditizing services. The Starbucks experience may get customers in the door time and time again, but what is it that we need to do that will produce grateful, loyal, generous customers or patients forever? Provide a transformation.

For those of us who are getting this, begin to look at your hospital, your practice, your business as more than just a service and much more than an experience. Think of what you do as providing the tools necessary to transform those with whom you are working, and present your product, your passion, your involvement with the client, the patient, the customer as a means of transforming them. Dedicate yourself to helping them reach their goal of changing their life in a positive way forever, and see where that leads you. TRANSFORMATIONAL CHANGE is what we all seek at some level. The product: To help us make our lives better.

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Hospitals and health professionals rate as some of the most highly scrutinized organizations and businesses in the United States. Hospitals and physician’s offices, durable medical equipment companies, and home health agencies are under the magnifying glass of federal, state, and local government inspectors.

Some would say that this is with good reason as we scrutinize the numbers behind the analysis. As annual health care costs continue to ascend toward a projected $2.4 trillion (16.6% of the GDP*) and with health coverage a major political issue this year, the potential of a $72 – $240 billion annual loss (3% – 10%** of the total health care outlay) to health care fraud and abuse and mistakes, remains a major issue for private citizens, corporations and government agencies.

In order to put this in perspective, the overall numbers at play relative to the $2.4 trillion healthcare budget are significant. The monies estimated to be consumed inappropriately reach a staggering $236 – $787 loss per capita, or enough money to insure up to 30.5 million Americans, or 65% of today’s total uninsured population of 47 million.

The pendulum swings both ways in this scenario, however, as these issues occur on both sides of the provider and healthcare user coin. The Centers for Medicare and Medicaid began RAC audits utilizing Medicare Recovery Audit Contractors (RACs) to recoup $980M from Providers in demonstration projects in California, Florida and New York. To say that this system is fair, equitable, and was well conceived would be an exaggeration because the auditors employed to do these audits are paid a percentage of their findings, and that inherent conflict alone stresses the validity of this arrangement on many levels.

A few specialty healthcare finance based organizations like my new employer, SunStone Consulting, concentrate in preparing hospitals for these inevitable visits by the RAC auditors. When these specialty companies do their work appropriately there is no reason for the RAC auditors to destructively move through the billing and medical records departments of each hospital.

The very essence of the problem is that, no matter what the intent, any time federal dollars are involved, these investigating authorities appear to have already made a determination that the problem or mistake was a purposefully fraudulent act whereas, in fact, it is quite possible that it was an oversight, an honest mistake, or an inappropriate key stroke.  To determine the validity of these situations in which fraud, abuse, and overpayment are suggested, research through organizations such as HealthCare Insight specialize in identifying, preventing, and investigating both provider and patient fraud health care claims.

Companies like this typically provide private and public sector health care claims payors (Health Plans, MCOs, Insurance carriers, TPAs, Medicaid, Medicare, etc.) with a comprehensive suite of clinically validated fraud and abuse surveillance solutions designed to maximize claims administration accuracy and minimize payment waste.

Interestingly, with the bailout bills from both the Bush and the Obama administrations being activated on an ongoing basis, one must stop and ask how much each one of those nearly trillion dollar initiatives will cost to audit, investigate, and qualify. It’s obvious that the hands off theories did not work, and now we will see the pendulum swing back as far as it will to attempt to  over correct the sins of the past.

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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 all of the lights went off simultaneously.  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.

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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.

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