A Note from Nick Jacobs

On October 23, it was my honor and privilege to speak at the PATIENT-CENTERED CARE CEO CONFERENCE in Chicago with some very impressive CEO’s and Leaders. My topic was “Linking a Patient-Centered Approach to Quality Improvement and HCAHPS,” but my deeper theme was “Leadership with a Heart - Developing Love and Respect in the Workplace by Nurturing Staff, Physicians, and Patients.” For those of you who were able to attend, thank you for your kind words of encouragement and support.

As was explained during my introduction, I have made the very difficult decision to leave Windber Medical Center, but I leave with a commitment to spread the word both nationally and internationally about the journey to Patient Centered Care and how to achieve it.

Obviously, it is a risky time to attempt to begin this endeavor, but, because no time is ever completely safe, it was my decision to reach out to my peers and friends to offer my commitment to work with you with that same passion to help you achieve your goals regarding this effort.

Because Sunstone Consulting is an organization that has specialized in finding additional financial support for hospitals, we can bring you not only the formula for Patient Centered Care, but also the needed additional financial support to achieve your goals in this area.

Although I will not officially complete my assignment at WMC until December 31st of this year, my current schedule permits me two days per week to begin to develop new relationships with my friends and peers. Should you have interest in contacting us for a visit to Windber, or if you would just like to make inquiry regarding engaging us for work at your facility, please feel free to either respond to this letter by E-mail or to call me at the following contact address below.

Once again, thank you for the privilege of working with you on such a significant topic.

Warmest Regards,

Nick Jacobs

Nick Jacobs

F. Nicholas Jacobs, FACHE
International Director
SunStone Consulting, LLC
1411 Grandview Avenue Apt. 803
Pittsburgh, PA 15211
nickjacobs@sunstoneconsulting.com
jacobsfn@aol.com
Mobile: 412-992-6197
Fax: 866-381-0219

Yesterday afternoon the realities of humanism, mortality, and fear attempted to take me out for about the one millionth time in my life. A phone call came from a loved one casually explaining that the doctor had potentially discovered a problem that needed further examination. When the office called for an appointment to have the scan done, they were told that it would be approximately a week before there was an opening in the schedule.

As an insider, I knew that a certain number of slots were held each day for emergency or unscheduled procedures. Not unlike the hotel that holds back a room or two from the 1-800 reservation list, just in case a preferred guest or luminary comes through the doors, flexibility is something that hospitals have to embrace at some level.

Once again, as an insider, a call to the department resulted in an immediate invitation to come in for the test the very next day.

My route to health care management was a particularly unique and circuitous route, and it left me asking the question, “why does it have to be this way?” I’ve personally done everything that I can to make it humane, patient centered, and sensitive.

If you or your loved one wants to know the inside story on how hospitals work, take a look at my new book, “Taking the Hell out of Healthcare.” It really can help. It is a simple “how to” book aimed at the everyday person who is having to deal with this complex and sometimes difficult world of health care.

My passion and personal commitment has always been to patient advocacy, transparency, and human kindness. Find out how to make the system work for you.

Over the years people who’ve liked me have referred to me as a real visionary, but, in all fairness, the people who thought that I was an incompetent also called me a visionary. One group called me that as a compliment. The other group used the description as a put down. Considering that my physician discontinued my prescription of Atromid S medication back in the late 70’s because he said the it caused early cataracts, I’m not all that sure about my actual vision.

As a kid it was fair to say that my approach to any problem that came my way was, well, it was just different. In fact, I’d spend hours trying to come up with unique solutions to problems that otherwise might have only taken a few minutes to solve the normal way. It was my thing.

In fact, my problem solving skills could only be described as journeys down the “Road Less Traveled.” Kind of the McGyver approach. What can I do to meet this challenge by using a Zippo, some thread, a chewing gum wrapper, and piano wire? Of course there were sometimes periodic episodes of near tragedy from this approach, you know, like the time I watched the front right wheel on my wagon roll past me as my journey took me down the 80% grade that my parents called the backyard. Thank God the axle dug in just enough to stop me before the approaching cliff. (The bobby pin didn’t hold.) Between Evelyn Wood’s Speed Reading course and Cliff Notes, I read Moby Dick in about 13 minutes.

By the time college rolled around, it was clear that my addiction had spread from alternative methodologies of problem solving to a pure and simple love affair with anything that was new, cutting edge, leading (or even bleeding) edge or avant garde. “Contemporary” was the catch word all those years ago. From art films to modern music, there was no end to my attraction to new and novel things.

Well, Inside Healthcare ran an article by Clay Sherman that was entitled Think Global and Act Local that contained some great tips for survival in healthcare. Mr. Sherman talked about the Joint Commission the way that most hosptial CEO’s would like to, but do not have the guts to do so. He described the Joint’s role as one of minimalism, and that was where his description stopped. His suggestion was to drop the Joint and to engage some larger, more aggressive organizations like NCOA or Leapfrog. His words of wisdom here were, “Either embrace a rigorous standards process, or watch your successor do it.”

Mr. Sherman went on to suggest the need for us to embrace best practices methodologies, new standardization techniques, online communities for patients with similar diseases, and he closed by saying “Stay centered focused in building human assets — its their brains that are going to get you there.” Hmmm? Sounds a little like last week’s blog.

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?

What do you do when you don’t have enough money to do what you need to do for you or your family’s health? I know, it’s a redundant question? You go without, delay or borrow from your future in the form of debt. According to Reed Abelson and Milt Freudenheim of the New York Times in their recent article Even the Insured Feel the Strain of Health Costs, as employers struggle to keep up with mounting costs to cover their employees, the average cost of an annual health care premium for that employee has nearly doubled since 2001, from $1800 to nearly $3300 a year.

Example after example is delineated in the Times article regarding those individuals who just can’t afford the challenges presented by the rising food and gasoline prices. Those featured families and individuals skip meds, wait longer to take sick children to their pediatrician or are facing staggering bills from health care institutions. According to the accounting firm, Deloitte, the average American income that goes toward health care expenses is now approaching 1/5 of their total household spending annually.

As a hospital administrator, it is never easy to listen to the general public throw stones at the medical industrial establishment, but when it comes to fancy, esoteric diagnostic tools, unproven drugs that can cost $6000 a dose or the very best physicians known to man, bring ‘em on becomes the hue and cry as we, the health care consumer wants nothing but the best for ourselves and our families. This is America. We deserve it.

Of course, if you are looking for elective surgery and you happen to live in England, you will wait on average 1.5 years for that intervention, and if you are in Scotland, it will be very close to 2.5 years before that same surgery is available.

My Democratic friends embrace the hope of the future through proposed health plans that insure the masses. My Republican friends warn of the horrible train wreck those plans will cause in hospital emergency rooms as every George, Dick and Conde will make their way to our hospitals with no barrier in place to prevent them from over running our already strained bastions of care.

Regardless of your political bent, it does seem unconscionable that we have nearly 48,000,000 uninsured accounted for by the government. Most of these uninsured are young, single moms and kids who either can’t or choose not to vote. (No one has ever believed that to be a co-incidence.) This figure also does not include the underinsured and quite possibly may not include any of the 50,000,000 illegal aliens. We are the only industrialized nation in the free world that does not have a true health policy for our citizens.

So what is the answer? The iron triangle of the best, fastest and cheapest health care is something that cannot exist in a system that is still hanging on ever so completely to an acute care based model when the vast majority of our health care challenges are now chronic care cases. We 78,000,000 Baby Boomers are taking more pills to control our varied maladies than existed in total just 20 years ago. Ask your pharmacist how many drugs there are now compared to 1988.

One very real answer to this health problem sometimes seems too simple. Our nearly $2 trillion in yearly health care expenditures includes less than four percent of its total dollars for preventative care. Much of our problems are about wellness.

So, wash your hands, drop some weight, exercise, cut out the saturated fats, stop smoking and live a less stressful life by doing something other than stare at the television…or else just wait for that little blue pill that will help you be skinny, tan and sexy, and then sell the family car to pay for it.

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.

Back in the 70’s, competitive marching bands came into vogue in Western Pennsylvania. Let me explain the before and after of this phenomenon: Before there were competitions, bands were made up of nearly 10 times more students than they typically have today. My bands ranged in size from 120 to 185 students. Once competition came into play, the borderline students were not able to survive. Consequently, it is not unusual now to have 20 students or less in a band.

What’s happening in medicine and in health care overall? The Government is taking a three-pronged approach to improve quality in health care:

1. They are pushing quality through public reporting. (Check a website near you.)

2. Enforcing quality through the False Claims Act. (Check a prison near you.)

3. Incentivizing quality through payment reform. (Check a checkbook near you.)

Senator Chuck Grassley is quoted as saying, “Today, Medicare rewards poor quality care. That is just plain wrong, and we need to address this problem.”

HMO’s are currently embracing “pay for performance” plans for physicians and hospitals. Medicare is introducing value-based purchase plans. Medicare is proposing the linking of quality outcomes to physician payments.

As I have written before, hospitals will no longer be paid for hospital acquired conditions. That seems like a rather simple fix, but to appropriately determine if the condition was not acquired at the hospital, extensive testing must be added pre-admission at considerable costs to the hospitals.

James G. Sheehan, Medicaid Inspector General of New York said, “We are reviewing assorted sources of quality information on your facility to see what it says and if it is consistent. You should be doing the same.”

Except for the financial implications, not unlike my competitive band story, the goal was to work toward perfection. The public reporting of quality of care is intended to:

1. Correct inappropriate behavior

2. Identify overpayment’s

3. Deny payments

The False Claims Act, on the other hand has different goals. When asked how he viewed the False Claims Act, Kirk Ogrosky, U.S. Deputy Chief for Health Care Fraud said, “You will see more and more physicians going to jail.” I guess the prisoners will be receiving better care.

Where’s it all going? Competitive band. Will it improve health care delivery? Probably, for the patients who can find the few docs and hospital that will be left? I recently had a conversation with a young computer specialist who took care of physician practices. He said, “Doctors and hospitals haven’t figured it out yet, but they are simply becoming data entry centers for ‘Big Brother’ as the facts and figures are accumulated to be used against them any way the payers decide to move forward.”

Looking back at the school year that included gym class twice a week for the entire year, rich courses in music and art, and remembering a time when priorities included those classes intended to make every student well rounded, we have to ask, “Is education today better?”

Maybe this is all too complicated to get our arms around, but if there are 78 million Baby Boomers, and the Medicare Trust Fund is heading toward bankruptcy, then we probably will see every rule in the book being applied to keep from paying out money, because there is simply not enough money to go around.

Will health care improve? Once we understand that technology is not the end all and cure all that creates healing; once we endorse prevention, wellness, optimal healing environments, and systems approaches to health and wellness, health care will improve. I’ll bet you that it will have very little to do with the rules that are unfolding right now and much more to do with the creation and acceptance of a National Health Policy.