Posts Tagged ‘health 2.0’

Carrots or Sticks?

January 30th, 2010

When you do the math, you can rather quickly determine that, as the aging process continues with the Boomer generation, federal funding for health care and Social Security will become more and more scarce. At the same time, we have all read the sobering national statistics regarding unnecessary deaths from hospital missteps. The CMS (Center for Medicare and Medicaid Services) previously introduced a form of pay for performance, or –more accurately– no pay for performance, which has already caused a great deal of change in the American Healthcare System.

As is widely known by now, CMS has decided to literally stop paying for the treatment costs of preventable medical complications.  This actually may seem like an intelligent idea. This approach is referred to by some as visibility for good care, and there is no doubt that it will represent the beginning of a stampede from the third-party insurance payers to follow the CMS “Big Dog.”  In fact, several companies have already announced that they will not be reimbursing hospitals for similar errors, as well.  The truth of the matter, however, is that this step does not even begin to address the problem.

The problem is not about penalizing hospitals, it’s about creating an incentive system that is not disease and sickness based.  Until the pyramid is flipped, we will not see the necessary changes to halt this financial slide to economic oblivion.

Sanjay Saint, MD, MPH

About 9% of U.S. hospitals presently use daily reminders to help physicians remember which patients have urinary catheters in place.  According to the University of Michigan’s Sanjay Saint, a professor of internal medicine, about 74% of hospitals don’t keep tabs on how long the catheters are in place.  But the real issue is that about 98% of hospitals and physicians don’t completely address issues of wellness and prevention that can allow us to remain well until we die because there is little or no incentive to do so.

Logic would dictate that because financial reimbursements will be connected to these hospital-created mistakes, infections or injuries, someone will surely pay more attention to the current misses.  But what if the entire system was based on keeping people healthy?  What if all of our focus was on exercise, appropriate food consumption, and stress management?

Unfortunately – or fortunately, depending upon your perspective – the United States has become the most proficient country in the world when it comes to capitalism, and much of capitalism is based on manipulating people to get them to consume what will bring the financial success and rewards to the corporations.  If you doubt this, just go to Eastern Europe to see what is happening in an environment with unregulated tobacco advertising.  The circle has started all over again.

In the old carrot-and-stick arrangement, there will be plenty of hits.  Wouldn’t it have been interesting, though, to reward hospitals where mistakes are almost nonexistent so that the less successful medical centers might line up to learn from them, or to reward docs and hospitals for helping to keep people healthy all the time. Carrots work, too, and with much less grief.

Carrots and (Celery) Sticks

What’s the old line?  “We’re going to beat the troops until morale improves.”

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Healing Hospitals: Get ready… Get set…

November 25th, 2009

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

Carnac’s answer: “Sis, boom, bah.”

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

Well, here’s my version.

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

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

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

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

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

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

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

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

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

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

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Planetree or Bust!

October 4th, 2009

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

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

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

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

Nick Jacobs, FACHE
Nick Jacobs, FACHE

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

Integrative Medicine

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

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

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

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

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

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

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

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

Remember, “All You Need is Love.”

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Make Sure That You are on the Right Side of the Paradigm Shift

January 15th, 2009

The word paradigm provides a cerebral representation of a model that, throughout our lives has remained relatively constant. Transformational changes in the manner in which we travel, how we communicate, and even in the ways that we are educated have simultaneously produced significant shifts in those models as well. In the early 90’s, we were informed that the information being transferred to us would only be viable and, in fact, would be very nearly invalid within about 18 months or so after ingestion.

Those parameters of informational decay continue to diminish exponentially as we immerse ourselves in 24-hour instant access to changing data, innovative discoveries, and altering states of acceptance of ideologies that were once believed to be infinite in their substance. Science is only valid until the next discovery.

The archetypical model of high-tech health care that was believed to be our “Star Trek” salvation from the ills of our parents, and their parents is currently being exposed as an artificial promise that has failed to deliver healing. Each decade our technologists have produced new; more sophisticated, and higher priced equipment with promises of earlier detection. Unfortunately cures have not been part of the equation. The additional technology has simply produced additional questions.

As we delve into the diva world of science, we find many reasons why significant progress has not been made, mostly related to a lack of continuity in the incentive systems. But, because of these failures to heal, we also may now be able to discern another reality that will truly contribute to the new world order of medicine.

Dr. Lee Hood, M.D., Ph.D

Lee Hood, M.D., Ph.D

Dr. Lee Hood, infamous for his work in the creation of the equipment used by our present day scientists, launched a school of thought that has been generally accepted in the scientific community, Systems Biology. Dr. Wayne Jonas has pursued with passion his work in Systems Wellness. Both of these edge-running thinkers are also working to contribute to a medical degree at a leading university that will be entitled Systems Medicine.

The uniqueness of this type of thinking is not the newness of it. It is, in fact, a melding of the old and the new, the oldest and the newest approaches to healing. What Drs. Hood and Jonas separately yet collectively are advocating is an approach to illness that embraces the complexities of genomics and proteomics and allows that knowledge to be firmly wrapped in a swaddling of information that, in many cases, has been with us since indigenous man walked the earth, an Optimal Healing Environment.

Wayne B. Jonas, M.D.

Wayne B. Jonas, M.D.

We have all been inundated by the mythical promise of cures from fraudulent presenters, and the result of those untested, unproven, and unfounded promises has created a culture of distrust, cynicism, and fear that thwarts the reemergence of those healing practices that represented not only viable alternatives, but, in many cases, the only alternatives that were available to our societies less than eighty years ago. As we more clearly understand that the human body is a comprehensive system that interacts within itself on a myriad of levels, we also can begin to understand why individual responses to certain types of healing modalities also produce very different results, i.e., Systems Healing.

The philosophies, beliefs, and practices of the American Board of Integrative Holistic Medicine, a major group of practitioners who have come together to provide not only education, training, and additional resources to physicians in general, have also come together to ensure that those Systems Healing practices that were pushed aside for the promise of high tech and high chemistry are reintroduced to medicine and healing in an appropriate and informed manners. Their work is not new to mankind, to medicine, or to healing, but it is a reemergence of those long proven, highly embraced modalities that promote and support health and wellness, the new paradigm?

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A Note From Nick Jacobs

October 24th, 2008

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 FACHE - Author of Taking the Hell Out of Healthcare

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

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