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 example, for the past ten years, the only thing that would typically pass between my lips at a holiday party would be party garnishes. No kidding; decorations, twigs, sticks… and the occasional veggie. No dips, no chocolates, no meats or shell fish, no cookies, no pie, no fat.

One interesting factor that evolved from embracing that philosophy is that, in spite of all of my efforts to enlongate my life, my personal challenges never really decreased. It hit me one day when I was looking in the mirror that I was actually peering at the enemy, and it was me. It has been pointed out to me that, for all intents and purposes, I am a crisis magnet.

During those years of complete passion for the Ornish program, there were many days where my adrenaline flowed freely. It usually happened when Dr. Ornish and Dr. Atkins had debates on television about their very different diets. Truthfully, the diet was such a small part of the Ornish program that it angered me when so much emphasis was placed on the complete disparity between these two very different programs.

Well, tonight I felt closer to Dr. Atkins than I had ever felt. In 1976, my buddy Jim and I went on the Atkins diet and lost about 30 pounds. That diet ended because the pork rinds, hard boiled eggs, and thousands of chicken wings, rashers of bacon, sides of beef, and pounds of cheese just became too much for me, and they probably resulted in my needing the Ornish diet.

What made me feel close to Dr. Atkins this time? Ice. He had slipped and fallen on the ice, hit his head, and eventually died from the injury. Well, tonight provided me with a bonding opportunity with Dr. A. It was the beginning of the holiday season. The kids had gathered for dinner with the four and a half grandkids, the soon to be deployed son-in-law, Moosie the dog, and Kiki the cat. It was a nice gathering and, as I walked off the porch and onto the walk, my feet went out from under me, my body went air borne, and I fell directly on my back with the force of a meteor hitting a dry lake. The wind left my body. Stars were flying around my head like a Road Runner cartoon, and pain began sweeping through my limbs in waves.

The difference between Dr. Atkins and me was that my head did not hit the ground. Was it a conscious decision to hold it up, or was it just pure luck? Don’t know, but, at least for now, it seems like I might live. The last time this happened to me was on a cold winter afternoon in 1978. After teaching for eight hours, I was leaving school with a baritone saxophone case in one hand and a euphonium case in the other, both destined to go to the repair shop. It was then that my feet left the ground. Once again, the air completely evacuated my lungs. It was that very day that I vowed to always wear rubber-soled shoes in the winter. Didn’t help tonight. Oh, well, at least my fall didn’t include a head injury. Dr. Atkins and I both needed more salt in our diets.

No fear. I’m still here.

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.

One imperative for any leader is a positive mental attitude. We must work tirelessly on believing in ourselves, and then we must work constantly to reinforce that belief with positive self-talk. If we embrace that concept that we can, there’s a very good chance that we indeed can. If, on the other hand, we believe that we won’t, we probably won’t. This single belief can initiate all forward movement. Winners in life constantly encourage themselves to think that I can, I will, and I am, and they don’t focus on the past —the should have, would have, or can’t do’s are gone forever. We can never make a better past for ourselves.

Last year, one of our employees attended a non-traditional educational seminar whose primary focus was directed toward the analysis of different personality types. When the employee returned, I asked, “What did you learn?” Their response was, “I learned that the primary function of people with my personality type is to pee on your cornflakes, to rain on your parade, and to frustrate your every creative idea, because that’s just what we do.”

Hence the opening paragraph of this piece. We are in difficult economic times, and the general counsel from our advisors is more often going to be to take no risks. If they are doing their jobs, we will be inundated with reasons why we should be against almost everything. In fact, words like growth, expansion, and opportunity all seem to be put away as this storm cellar mentality prevails. They will argue that they are saving their organizations by “shrinking to greatness” while opportunity after opportunity slips away.

One of my favorite visuals of this mind set comes from the 1990 movie Ghost where the people were helped to find their place in eternity by little demons that came out of the sewer grates to drag their souls into Hell. As leaders, we are surrounded every day by people who see their job as one of hard, cold, black and white facts. There are the extremists who spend their days spreading pessimism, fear, gloom, and negative energy; looking at the down side as they constantly undermine not only growth, but the attitudes that foster growth. The blacker the sky, the deeper the reinforcement of their concerns, and the more intense the corporate paralysis becomes throughout the organization.

Positive Mental Attitude Psychologist, Denis Waitley helped to change my life when he lectured on this topic nearly 30 years ago. He had been the U.S. Olympic athletes’ psychologist. Dr. Waitley taught us to learn from the past, set vivid, detailed goals for the future, and live in the only moment of time over which you have any control: now. He always spoke about the reality that life is inherently risky and that there is only one big risk you should avoid at all costs, and that is the risk of doing nothing.

Don’t get me wrong, conservative thinkers are important in the balancing act of leadership, but they must never be given the power to control all aspects of an organization. It is a recipe for disaster. The result will be stagnancy and eventually, business failure. There must be a means to carefully look at what they have to say, to evaluate the risks outlined, and then to make a decision based upon the prudent person process, but, having said that, remember that leadership is not a gutless proposition.

If you are not interested in some sleepless nights, tension filled meetings, or numerous failures, don’t get into the game. As Waitley says, the winner’s edge is not in a gifted birth, a high IQ, or in talent. The winner’s edge is all in the attitude, not aptitude. Attitude is the criterion for success. There are two primary choices in life: to accept conditions as they exist, or accept the responsibility for changing them.

A leader’s world is not always black and white.

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.

The One Slide

Several dozen bloggers in the health care field and beyond are today engaged in a blog rally*, simultaneously posting the item below to encourage conversation about a topic that’s often avoided but needs to be addressed in every family: How we want to die. I’ve written about this before, with regard to my mother. Please try it, using the slide above as a discussion guide. It’s not that hard to have the conversation with your loved ones once you get started.

—

We make choices throughout our lives - where we want to live, what types of activities will fill our days, with whom we spend our time. These choices are often a balance between our desires and our means, but at the end of the day, they are decisions made with intent. But when it comes to how we want to be treated at the end our lives, often we don’t express our intent or tell our loved ones about it.

This has real consequences. 73% of Americans would prefer to die at home, but up to 50% die in hospital. More than 80% of Californians say their loved ones “know exactly” or have a “good idea” of what their wishes would be if they were in a persistent coma, but only 50% say they’ve talked to them about their preferences.

But our end of life experiences are about a lot more than statistics. They’re about all of us. So the first thing we need to do is start talking.

Engage With Grace: The One Slide Project was designed with one simple goal: to help get the conversation about end of life experience started. The idea is simple: Create a tool to help get people talking. One Slide, with just five questions on it. Five questions designed to help get us talking with each other, with our loved ones, about our preferences. And we’re asking people to share this One Slide – wherever and whenever they can…at a presentation, at dinner, at their book club. Just One Slide, just five questions.

Lets start a global discussion that, until now, most of us haven’t had.

Here is what we are asking you: Download The One Slide (that’s it above) and share it at any opportunity – with colleagues, family, friends. Think of the slide as currency and donate just two minutes whenever you can. Commit to being able to answer these five questions about end of life experience for yourself, and for your loved ones. Then commit to helping others do the same. Get this conversation started.

Let’s start a viral movement driven by the change we as individuals can effect…and the incredibly positive impact we could have collectively. Help ensure that all of us - and the people we care for - can end our lives in the same purposeful way we live them.

Just One Slide, just one goal. Think of the enormous difference we can make together.

(To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team. )

Some of the reasons behind this gap in medical science lead back to a broken system with inappropriate incentives locked firmly into place. How do we get the basic discoveries to be translated and moved into actual treatments?

Why are so few of the discoveries making their way to both treatments and cures? It is because our system of NIH-sponsored science is set up to discover things; plain and simple. Once the discovery is made, articles can be written, which is the sought after reward in academia since these publications lead to more grants from the NIH, and so the circle goes round and round.

Image Credit: Corbis

The obstacles to translational research in which the studies actually move from the scientist’s bench to the patient’s bedside are so intense that they are referred to in some areas of the scientific community as the “valley of death.” According to Begley’s article, “The valley of death is why many promising discoveries-genes linked to cancer and Parkinson’s disease; biochemical pathways that ravage neurons in Lou Gehrig’s disease-never move forward.”

The author challenges the incoming Obama administration and Congress to take a look at this daunting dilemma and to begin to revamp our biomedical research system by creating what Richard Boxer, a urologist at the University of Miami, and Lou Weisbach, a Chicago entrepreneur, call a “Center for Cures” at the NIH. Interestingly enough, the model that they endorse is exactly what was created here in Windber where multidisciplinary teams of biologists, proteomic and genomic scientists, technicians, and biomedical informatics specialists work together with Walter Reed Army Medical Center to move a discovery to an actual cure.

Of course, with the cuts made to the NIH funds, creating anything new that is unfunded could take away from basic research, and limit hopes for these cure discoveries. The article explains that while the NIH budget was doubling, new drug approvals fell from 53 in 1996 to 18 in 2006. What’s wrong with this picture? Twice the money, less than half the discoveries.

The sad case, however, is that even those organizations that try to establish these new world order cure centers are not funded by the NIH because of this fundamental design to enhance only basic research. The article ends with this: “I’d be willing to put up with potholes in exchange for a new administration spending serious money to take the discoveries taxpayers have paid for and turn them into cures.”

It is my prediction that the collapse of the planet as we know it will come from HIPAA.

According to Wikipedia,

“The Health Insurance Portability and Accountability Act was enacted by the U.S. Congress in 1996. The Centers for Medicare and Medicaid Services explain that Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Title II of HIPAA, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers.”

Sounds pretty reasonable, doesn’t it? Just hire a full time security person for your electronic medical records, oh and don’t forget to spend millions to create the medical records in the first place. After that, life will be just fine? Right? Wrong.

If you have had little training in what the term oxymoron means, this would be a classic example; “The Administrative Simplification provision.” This provision was intended to deal with the privacy and security of health data. That is also a very noble idea. If two patients are in the same room, and someone is discussing the status of either patient, there should be a sound proof curtain between them. Soundproof curtains would also qualify as an oxymoron. For those of us who have lived this nightmare called HIPAA, Senator Kennedy has often been quoted regarding the fact that his intentions when designing this act have become grossly bureaucratic in their implementation.

Here’s the totally mystifying, Merlin-type description; the standards are meant to improve the effectiveness of our health care system by encouraging the extensive use of electronic data interchange in the U.S. health care system. Seriously, all of this sounds good. The problem comes when hundreds or thousands of government bureaucratic health care wonks and healthcare attorneys are introduced into the equation.

Well, a few weeks ago, according to Managed Healthcare Executive Magazine, the department of Health and Human Services, Office of Civil Rights (OCR) and the Centers for Medicare and Medicaid (CMS) and Providence Health Services, Providence Health System, and Providence Hospice and Home Care entered into the first case where a monetary settlement was paid to resolve a potential violation of the HIPAA privacy and security standards.

Providence agreed, without admission of liability, to pay $100,000 to the government over a data breach. This case did not involve a single egregious violation. So, it appears that, HHS may believe that enforcement time has come as they become more aggressive in their investigations and enforcement of these laws. Hence, the end of the world may be approaching. If all of the hospitals are fined into closure, and then the avian flu hits, the most often heard phrase will be “Hasta la vista, Baby.”

I don’t mean to make light of such an important topic as patient confidentiality or the potential portability of health insurance, but, if any of us mere mortals could objectively step back and witness the chaos, expense, and outright insanity created by the current implementation of these statutes, the only objective phrase that could eventually emit from that experience would be, “Holy, $%#@&!”

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.

In fact, while visiting a really upscale mall for a photo session with my two year old granddaughter, Lucy, an employee engaged me in a conversation about the rotten economy. About five minutes into the conversation, she indicated that there are currently 150 stores in the chain for which she works, and that only five percent of them made budget last month. Portrait pictures must fall into the category of a luxury as their business is severely impacted by this economy. More directly, however, she indicated that she needed stitches removed the other day, and that, “she did it herself” rather than spend the $20 co-pay.

So, are we seeing decreases in important tests? Are we seeing patients avoiding emergency room visits? Are we seeing patients cutting their prescriptions in half? Yes, to all of these questions. Anne, however, seemed to be talking about the “big boys,” where their millions or billions in investments have recently tanked. If you are so big that your income from running the hospital is not a major source of protection, and your income from your investments is propping you up, then the problems begin to manifest themselves exponentially.

“Some hospitals are responding by digging into their investment income more deeply than usual, using it to finance capital projects, or even meet operational needs. Others are issuing bonds with the scary codicil that they’ll buy them back if finicky investors want to dump them,” states Zieger in her column.

She further goes on to explain that “both of these situations put a huge squeeze on hospitals’ long-term viability. One robs from their long-term assets to solve medium-term problems, while the other puts the hospitals at risk of being bled dry by investors who get spooked.”

Well, wouldn’t ya know? Yes, we are seeing a few challenges due to decreased electives, but not because we were living off of our investments. The other good news is that, because we froze our fixed pensions several years ago, we are seeing very little impact upon them from the huge drop in those investments as well. Unlike many of our larger peers, neither of these issues is similar. Between the drops in the market, the loss of pension funds, the decrease in electives, and the down-grading of their viability by the bond markets, their challenges look galactic in size compared to ours.

Sometimes smaller is just safer.