Posts Tagged ‘health’

Moving Through Healthcare’s Version of the BP Oil Spill

May 27th, 2010

Who could have ever guessed that the United States of America would fall so far behind in education, childhood death statisticsscientific research, manufacturing jobs, and even overall, general healthcare?  Yes, of course, we are still a wonderful, strong country with incredible resources, but somewhere along the line, the train seems to have jumped off the track just a little, or is that like being a little pregnant?  No one would ever have conceived that a spark plug would be worth more than GM stock, but that’s exactly what happened last year.  Or how about the fact that large investment banks responding to the mandate to increase home sales by spreading the risk internationally could have helped put this entire world on the verge of a national depression?

For years now I’ve written about the need to provide some type of safety valve for the uninsured, underinsured, and those struggling to make it from layoff at age 58 to Medicare at age 65.  Not unlike the Kennedy-Katzenbaum bill, (you know, that HIPAA bill that was just meant to provide health insurance portability), we have healthcare reform legislation.  The really challenging thing about this new bill is that it was primarily written by policy wonks fifty percent of whom will not be working in Washington D.C. in a few years, and worse than that, it will be interpreted by policy wonk lifers who will be there long after we are all dead.

So, the “Healthcare Oil Spill” has been addressed.  What will it mean?  What does it mean?  How will it impact all of us?  That remains to be seen.  The good news is that 30 million more people will finally have a safety net. The bad news is that there are still two wars going on that are draining our treasury.  There is still financial chaos among the countries lovingly referred to by the EU as the PIIGS (Portugal, Ireland, Italy, Greece, and Spain), and, along with this group,  spending in the United States  has been out of control for at least nine years.

What will happen is anyone’s guess.  How things will be interpreted is anyone’s guess.  How the law will be enforced is every one’s guess, but in  a recent round table discussion at the Mid-State HFMA meeting, we heard four CFOs discuss the challenges that they currently face and will continue to face as life becomes even more complex.  After that session, I’m thinking that lots of mud pushed in the head of the well might just be the cure!  Goodness knows there was enough mud thrown around during this last election cycle.  Maybe we could redirect it back to the source?  I do know for sure that one thing is clear: CHANGE is INEVITABLE, the train is back on the track, and it’s coming straight toward our physicians, hospitals, and nursing homes.

How do we cope with that change?  Make sure that every ounce of fat is cut from the system.  Take a look at the list below and contact SunStone Consulting for the next steps:

Share

So “Radical” Was the Correct Term?

April 8th, 2010
In 1987, my healthcare journey began in administration by asking the question, “Why are hospitals the way the are?”  It was a sincere inside/out question that had evolved from my having been a teacher, executive director of an arts organization, president of a convention and visitors bureau, and finally a PR/Marketing and Development professional in the world of healthcare.  By 1997, my ideas had been rejected so many times by so many traditional hospital administrators, who were either my bosses or my peers, that it felt like they would never come to fruition in a conservative field where change is sometimes seen as both life and job-threatening.
butterfly metamorphosis
In 1997, that all changed when Ernst and Young evaluated the hospital where my presidential appointment had just occurred and predicted the closure of that facility due to lack of population, lack of “financial depth” (a.k.a. cash), and a health system partner that successfully was eating our lunch each and every day. It was with that information in hand that I began the metamorphosis of this organization. The presentation to the board and medical staff was relatively simple:

“We can keep doing what we are doing, and then board the place up… or we can grow by changing  the way healthcare is delivered.”

No workplace bullying - Nick Jacobs - healtinghospitals.comLuckily for me, my board chairman at that time was a risk taker because, realistically, our backs were against the wall.  So, we began a journey of change.   We removed bullies from the workplace (both physicians and employees); created a homelike environment where you did not have to leave your dignity at the door;  added bread baking machines, popcorn machines in the lobby, decorative fountains, aroma therapy, massage, humor, music, and pet therapies.  We focused on Green, focused on Dignity for employees and patients; focused on providing a peaceful, loving, and Healing Environment; focused on Family Spaces; focused on Architecture; and focused on Quality of Care.  We began classes for our employees in Hospitality in Emotional Intelligence Quotient training and embraced ideas garnered from places like the Ritz Carlton, Disney, and Dale Carnegie.  Then we established an employee evaluation system that embraced these changes and rewarded our staff financially for their work.

Loved ones were encouraged to stay 24/7 as visiting hours were opened to them, double beds were placed in the OB suites, a wellness/prevention/and integrative health facility was built to embrace not only traditional therapies but to an entire gamut of alternatives.  A senior citizen center was condominiumized and made available to the Area Agency on Aging.  We had patients help us design a new Palliative Care Unit, Breast Care Center, and Fitness facility, then finally we added a world class International Research Institute.

That was 1997 through 2008.  It appears from the posting below that the world is beginning to consider some of these ideas, but lo, these many years later, they are still being referred to as “radical.”  Well, if any of you are interested in how to do what we did which tripled our organizational budget in size and doubled our workforce,  just give me a call at 412-992-6197, to participate in this program.

Obviously, Windber, Pennsylvania was where this movement all started.   Let’s make sure that it doesn’t stop.  After all, it’s not what people like.  It’s what people LOVE.

Henry Ford Health System - Nick Jacobs, FACHE - HealingHospitals.com

Henry Ford Health System Goes Radical: Creating the Hospital of the Future

DETROIT – Looking to shake up your industry, transform your medical center, and recharge your organization?

A two-day educational symposium, “Going Radical: Creating the Hospital of the Future,” may hold the key to revitalization. It will be held May 25 – 27.

Henry Ford Health System President and CEO Nancy Schlichting will share her radical, but practical strategies for success at the symposium, tapping into the wisdom of her top executives in an interactive session on the profound lessons learned during their tenure.

It was Schlichting’s brainstorm to hire a CEO for Henry Ford West Bloomfield Hospital from outside the healthcare industry. Her choice was Gerard van Grinsven, a former executive of the Ritz-Carlton hotel chain, and an expert in service excellence.

Henry Ford West Bloomfield staff will discuss its successes in differentiating itself from the competition by:

• Constructing prototype rooms for planning and community input.

• Incorporating green features in the architecture and construction.

• Building all private patient rooms, including in the emergency department.

• Emphasizing wellness and healthy living.

• Combining traditional clinical care with complementary therapies.

• Creating a unique brand and inspiring staff to think differently.

• Including family space in each patient room, including intensive care.

• Implementing a new kind of food culture in health care.

• Putting a focus on the special concerns of the elderly.

Entrepreneur Bill Taylor, co-author of Mavericks at Work and co-founder of Fast Company magazine, will be the keynote speaker. His ideas have helped shape the global conversation about how business works and “why the most original minds in business win”. His next book, Practically Radical, to be published this fall, explores how to unleash big change in difficult times.

During break-out sessions Henry Ford staff will share lessons learned while juggling the building of the $360-million West Bloomfield hospital and the $300 million renovation of Henry Ford Hospital in Detroit.

Tours of Henry Ford West Bloomfield Hospital will include a visit to the Emergency Department, wellness center, and an inpatient room. At Henry Ford Hospital, participants will tour the Center for Simulation, Education and Research – one of the largest facilities of its kind in the Midwest that provides hands-on training with medical mannequins.

Symposium sessions include:

• Creating a Culture of High Performance
• Facility Innovations Through the Eyes of the Patient
• The Best of Both Worlds: Clinical Excellence Meets Integrative Medicine
• Transforming Hospital Food
• Radical Outreach: Relationship Building to Win Over the Community and Recruit Staff
• Thriving in Detroit: A Blueprint for Transforming Your Hospital System and The Physician Perspective

each and every day.  It was with that information in hand that I began the metamorphasis of this organization.  The presentation to the board and medical staff was relatively simple, “We can keep doing what we are doing, and then board the place up, or we can change the way healthcare is delivered and grow.”
Share

What’s Still Missing?

April 3rd, 2010
We are on a not-so-merry-go-round which, even after health care reform, continues to promote a system of illness incentives  that are improperly reimbursed, improperly addressed, and inappropriately segmented. We continue to consider body parts as if they are not connected to or a component of the whole.
Wellness Wheel - Image credit: Marquette University

Tort reform still has virtually no teeth.  This causes physicians to practice sometimes over-the-top medicine in self-defense. When will it be time to begin to throw the switch and teach patients what we already know so well; that wellness, wholeness, and health can change the quality of our lives completely? Our medical schools need to embrace wellness and prevention as a path to health. Not unlike indigenous man, it is time that we begin to realize that our brains do have something to do with our bodies.  We live in a commodity driven society which does not always promote the best, most healthful food, even miminal exercise, stress management, or self-nurturing. Instead, because of those quarterly reports to the stockholders, these companies promote what is the most lucrative and often the easiest to sell.

Oprah.com - Health and Wellness - Nick Jacobs -  HealingHospitals.comWe know that drinking a soft drink with 10 teaspoons of sugar is not healthful. We clearly understand that quadruple cheese anything might eventually catch up with us, or that Uncle Buck’s 72 oz. steak can’t really be good for our arteries. Fried and buttered everything, a total lack of exercise, and more stress than anyone can ever dream of will not extend our lives

One night a few weeks ago I couldn’t sleep, and at 3:00 AM, I looked up and saw an apparition… Oprah. There she was, talking about food. The person she was interviewing said, “Oprah, in the 1960’s, our food cost us 18% of our annual income. ” Maybe that’s why there weren’t more restaurants at that time. Families were stretched just eating at home. He went on to say that, “In the 60’s, healthcare costs us 9% of our income.”  Finally he said, “Now healthcare costs us 18% of our income, and food costs us 9%.”

So, that’s the trade off. We can buy good, farmer’s market-type healthy, organic food and have low healthcare costs, or we can buy manufactured, additive filled food, and pay more for our healthcare.  How much further down this cul de sac must we go as a country before we begin to realize the path to health and wellness or longevity?

Health and Wellness - Nick Jacobs - HealingHospitals.com

Share

Healthcare Reform. . . It’s only just begun

March 10th, 2010

This week’s Bloomberg Business Week magazine featured a phenomenal and very personal story of healthcare that actually captures many of the challenges around healthcare reform.  The author, Amanda Bennett, takes us on a journey that she has titled, “Lessons of a $618,616 Death.”  The true title, however, should have been, “How Do You Put A Price on 17 Months?”  In this article, Ms. Bennett takes us on the step-by-step, blow-by-blow journey that ended with her husband’s death.  She and a friend painfully reconstructed every page of his medical records, every dollar paid by her insurance companies, and every charge made by the various doctors and hospitals that treated him during the last years of his life.

Business Week end-of-life issue - Nick Jacobs - healinghospitals.com
Amanda Bennett and Terence Foley

She showed 1.) the grand total of charges, $618,616, 2.) the actual monies paid by the insurance companies to the hospitals after contractual negotiations, $254,176, and 3.) the total paid by her family, $9,468. In the article, she described the 30% overhead/administration costs, the costs of experimental drugs inside and outside of trials, and the 4,750 pages of medical records that were amassed during this time. For those of us who have “spent our time” trying to live within, cope with, and better understand America’s healthcare system, there were no surprises.  For those of us who have watched a loved one take this cancer journey with all of its mysterious unknowns, there were also no surprises. Ms. Bennett’s quote, “The system has a strong bias toward action,” was, I believe, the most poignant in the entire piece.

A few weeks ago, I had lunch with a very healthcare-savvy individual who, when I jokingly referred to death panels, almost came across the table at me.  She did not believe it was funny.  To say that she was passionate would miss the point.  Only the day before, I had spoken with another very intelligent healthcare reform advocate who indicated that the entire concept of death panels emanated from a payment code that reimbursed physicians for simply (or in some cases finally) talking to patients about their alternatives.  I had heard other explanations, but neither mattered.  What matters is that, in many instances, we are not discussing appropriate alternatives or revealing the quality-of-life issues often overlooked before beginning long courses of experimental drugs, or oncology drugs that may not have any positive impact on the health outcome of the individual.

Interestingly, Ms. Bennett did indicate that for all of the time, money, and pain invested in this journey, no one could confirm that her husband’s life was actually extended by these medical experiences.

Someone once described America’s healthcare system to me like this:  You walk into Nordstrom, order several three-thousand-dollar suits, a dozen shirts and some handmade, silk Italian ties, then turn to the person beside you and say to the clerk, ‘”He is paying for this.”  Our heroine Ms. Bennett did mention the fact that her husband would probably have questioned the use of all of these funds in this manner and the relationship that these expenditures might have had on all of the other people in the world who might have been helped by these dollars.

Taking the Hell Out of Healthcare by Nick JacobsWhen healthcare reform is discussed, it is personal.  It is also deep, and it is costly, but the bottom line always comes back to this: “How do you put a price on 17 months?”  In my book Taking the Hell out of Healthcare, I discuss the journey that my father and our neighbor took together over about a 17 month period.  Both diagnosed with lung cancer, my father decided to go for it all.  He had surgery, chemo, radiation, more radiation, and more chemo.  My neighbor, a man without significant health insurance coverage, decided to spend his time with his family.  They both died on the same day.  My father died in a cold, tertiary care hospital where no clergy was present, his family members were not all able to be there with him, and it was over.  In contrast, our neighbor died peacefully in his home, surrounded by his entire family.

Ms. Bennett did say that she was glad that she was not a bureaucrat having to deal with these issues.  Frankly, I wish that she was!

Share

Inflationary Indices

February 19th, 2010

As the pulse is still an indicator of health in human beings and other animals, health care-related inflationary indices can be a measure of economic health, growth, and change in our business.  After perusing nearly six pages of single-spaced inflationary projections in an Amerinet-produced report, two jumped out at me, the two highest.  One was more significant than the other, but both tell their own story.

Photo credit: Eric Zamora - University of Florida IFAS

Ice-covered Orange Tree Photo credit: Eric Zamora - University of Florida IFAS

The first was coffee/juice, and the projected costs for these two items are up 10 percent. At first my curiosity was piqued by this, but then I saw the explanation further over on the page.  It said that these increases were based on the recent freezes in Florida, which will have a significant impact on juice pricing.  I guess that makes sense.  The trees and oranges froze and were ruined, but it was interesting to me that every other orange-growing country in the world hadn’t jumped into the market and taken advantage of this shortage situation.

The even more difficult quandary created by this coffee/juice category, however, was that the coffee wasn’t explained.  Surely, everyone knows by looking at a world map in Starbucks that coffee comes from places that are not Florida. Maybe it’s just a “calf path” item. You know, some ancient, primeval calf made a trail in the woods named “coffee/juice” and we still follow that path today.

I’m sure that many of you are now wondering what the second category is, the second highest predicted commodity increase for health care, and, honestly, I can’t wait to tell you.  Why am I excited about this one?  It’s because, you see, it is a NIGYSOG (Now I’ve Got You, You Son of a Gun) moment.  For nearly five years, I’ve been predicting some very obvious changes that are about to sweep through the healthcare delivery system.  Our blogs, newspaper columns, and speeches have all directed you toward these changes, and over and over, the vast majority of healthcare management professionals have either ignored or rejected these pronouncements; sometimes out of fear and sometimes out of a “wake me when it gets here” mindset.  Honestly, when it comes to prognosticating, it made me feel like Punxsutawney Phil.  (Oh, and what was that advertisement I read today?  “You have just survived the worst snow storm in this area in the past 100 years.”)

The second most highly inflationary bell ringer from the Amerinet report is one that spot-on supports our predictions completely.  (Drum roll, please.)  It is biotech products.  The prediction is that the cost of biotech products will increase an average of about nine percent.  Upon examining the comment section beside this category, the following sentence appears:  “Increased demand will drive these price increases.”

Windber Research Institute - Image by PlanetRussell.net

Many of you may still be scratching your collective heads in wonderment.  “What are ‘biotech products,’ and why should I care about them?,” you may be asking.  Let’s take a quick historic look at life in the biotech lane.  In 2001, when we co-founded a research institute that had specialty areas in biomedical informatics, tissue banking, proteomics, and genomics, it cost approximately $100,000,000 (that’s 100 million) to map ONE human genome. This year, that number will fall to below $500. If you take that ratio of product-to-cost and project it forward, it doesn’t take too much imagination to conclude that not so many years or months from now, your physician will potentially have (or want to have) access to your molecular profile.  It will provide insights into your personal health that were heretofore unavailable, even unimaginable.

Once issues involving insurance coverage, confidentiality, and ethics are resolved satisfactorily, these tests will become a routine part of your annual physical.  Complete Blood Counts, lipid profiles, prostate or breast testing, and genomic and proteomic analysis will provide your caregiver with answers that make the practice of medicine until now seem hit-or-miss by comparison.

Share

Staying Humanly Grounded and Healthcare Reform

December 26th, 2009

Each year I put up the tree and begin to believe that it is magic. The room feels and looks warmer. Often, I’ve considered leaving it up all year as a symbol of joy, love, and happiness, but when I returned home last evening it hit me that it was not the tree as much as it was the carefully wrapped packages beneath it. Once they were gone, the room seemed void of its magic.

It hit me that those packages represented anticipation, love, and sharing in ways that truly touch your soul. Those acts of love represent the essence of that entire experience, price or cost don’t really matter.  It’s the giving.

Healing Hospitals: little girl in hospital bed with caring doctorI try to end every night by reading CarePages from a local children’s hospital website; stories of young children that have many times reached the end of effective treatment and are waiting to meet their destiny decades before their time might have been.  The outpouring of the deep, soulful hurt that their parents, siblings, and grandparents are experiencing from this journey is always profoundly moving to me.  In many of these instances, the only gifts that we have left to give them are our  love and support.  That, however, is not the case for the majority of our fellow men in this country.

It won’t be long until the final product of the healthcare reform effort will appear.  We all know by now that it will be a patchwork quilt of sometimes horrendous compromise.  We can also count on the fact that the negative rhetoric will reach decibel levels typically heard only when standing in close proximity to a jet engine.  The pundits will parade up and down the isles of righteousness, and they will be spouting off their theories regarding what should have happened.  At the end of the day, however, when we approach our bathroom and bedroom mirrors for that last inevitable look, we must all dig into our humanity and ask one very real question: “Will it be better for the uninsured than it had previously?”

As a former hospital CEO, it became evident to me in the first six months of my administrative training that only those without insurance were destroyed by the system.  Only those who were not under Medicaid or an other insurance were hit with the awful burden of paying for everything at the full, retail price.  The fallout was clear.  Due to the risk of having to pay full costs to the hospital, they either were too frightened to go for treatment until it was too late, or they lost what little they had; their homes, their savings, and their possessions.

In a country with such unbelievable abundance, where not just the number but also the quality of the cars, clothes, and even pets that we own are held up as barometers of success, we have often allowed our fellow man to suffer and die for economic reasons.

That fact is no more obvious than at any children’s hospital in Pennsylvania, where you’ll see parents from conservative states where childhood transplantation surgeries were always denied, so as to avoid increased taxes.  You’ll see these parents waiting in line to establish residency here so that they can at least have a chance to save their child’s life.

Healing Hospitals: Mother kisses son in hospital bed

Regardless of your politics, regardless of the dysfunctional (mal-)functioning of our government, in which some of our representatives and senators have taken us to the brink of collapse due to their inability to co-operate; regardless of these issues, we are looking at the beginning of health care reform.  I just pray that we don’t revert to the inhuman practices of our recent past.

It’s time for a human win.

Share

It’s Been (Quite) a Year…

December 19th, 2009

Last year at this time, as word of the global economic meltdown was beginning to take hold, we saw the beginning of a decline in all aspects of purchasing, including the  optional surgeries and tests in our hospitals.  At the same time, as a member of several volunteer boards, we began to see declines in ticket sales that went as high as 20%.  Later, we met with restaurateurs who indicated that their business was down between 10 and 20%, an amount that proved to be terminal for numerous marginal companies.

obama_health_costs

As the year proceeded, we saw  hospitals make extensive cutbacks in employee  education, travel, and marketing.  This trend became the norm in the industry.  The healthcare-related industries that seemed to hurt the most were those involved in construction and new equipment acquisition.  One type of firm that did well was financial consulting groups, like SunStone Consulting, LLC , organizations that specialized in finding money that hospitals had already earned, but had either not been staffed deeply enough to pursue or that did not know the processes necessary to generate these funds.

For those of us in administrative consulting, the year has been interesting.  Decision makers stepped back a little and waited to see where Obamacare was heading, to collect more cash in a society where “cash was definitely king,” and to cut back on new initiatives until things had settled down economically.  These leaders watched the markets, looked at investment activities, counted revenue versus expense results, and generally became more conservative in their leadership approaches.

What’s on the horizon:  There is an old saying that “He who looks into a crystal ball to predict the future will get crystal in his eye,” that is not far from truth.  Are we completely out of the woods?  Not by a long shot.  Will there be additional taxes, additional expenditures that are not budgeted nationally?  Yes, most assuredly, there will be, but are we certainly seeing more positive signs in virtually every economic indicator that would predict at least a somewhat more optimistic overall outlook.

Wall Street Journal: Pointing to renewed signs that the global slump is bottoming out, the International Monetary Fund on Wednesday upgraded its outlook for 2010 while slightly trimming this year’s forecast.

The overleveraged global financial system continues to cast a shadow over the economic outlook, however, and the fund urged policymakers not to become complacent about recent market improvements.

“Financial conditions have improved, as unprecedented policy intervention has reduced the risk of systemic collapse and expectations of economic recovery have risen,” the IMF said in its updating its outlook for the world economy and financial system. “Nonetheless, vulnerabilities remain and complacency…

100_on-iceSo, if we embrace those little rays of hope as a means of restarting the economic engines, if we visualize a better future for all of us, if we focus on the positive, at the very least we most likely will find a better parking space at the Mall!

Happy Holidays and here’s knowing that 2010 will be a better year for everyone.  (It wouldn’t take much!)

Share

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?

nicksblog_boomercouple_golf400

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.

Share

Another Day, Another “A”

November 12th, 2009

Straight-A Report Card One of my many college roommates, Mark, graduated with a perfect, straight-A GPA.  In those days the grade point average indicating perfection was a 4.0.  He worked harder than anyone I had ever known, and hardly took even a few minute break from studying.  For all intents and purposes, he had virtually NO social life, and, except for the occasional pinochle game and a coke-and-pizza break between study sessions, Mark was 100 percent committed to perfection in his grades.  As he became more and more sure of himself over the years, he would walk into our apartment and yell out, “Another day, another A!” and mean just that.

One of the greatest challenges of my life has been finding those measuring sticks that quantify our accomplishments.  In fact, the quest to solve just that ongoing problem has caused me plenty of sleepless nights.  I know, for example, that the infrastructure established for our research institute was so singularly unique, so perfect, so incredible that it should  become an international model.  In fact, when the National Cancer Institute evaluated just one aspect of the  institute, they indicated that the tissue repository was “The Only Platinum Quality Tissue Repository in the United States.”

As my time away from the hospital and research institute quickly approaches twelve months, my passion for the accomplishments that we experienced there has become even more clear to me, but where is Judge Simon when you need him?  How do you grade them?  Worse yet, how does one convince his former peers that the design that grew out of the ideas that became the philosophy of our hospital should be treasured as a new way to achieve perfection on multiple levels? …Another Day.  Another A.

fierce_hospital_innovators

Having an infection rate that never went above 1 percent; an extremely low length of stay (3.2 days); low readmission rates, low restraint rates, unbelievably low litigation rates that almost didn’t register on the charts at all.

If your CFO is reading this, simply add the following to each one of those accomplishments . . . $$$.  How does a small hospital in Western PA with one major health care plan produce a bottom line in excess of $2M?  More importantly, why wouldn’t every hospital administrator want to adopt these approaches?

So what’s the “secret sauce?” We did this by working endlessly to create a truly healing environment, not to be confused with simply doing our jobs well . . . that was a given. We all had to do our jobs well, AND create an environment that fostered a healing atmosphere.

People actually got a chance to begin the healing process.  By eliminating overhead paging, permitting loved ones to stay over with 24 hour visiting, as well as pet, aroma, music, and humor  therapies, integrative medicine, kindness, a commitment to nurturing, patient centered care and a total commitment to the creation of an optimal healing environment, we began to see outcomes that were previously thought to be literally unthinkable.

Another day.  Another A.

Share

Creating Functional Healing Hospitals

November 8th, 2009

Why Healing Hospitals?  Transparency.  Human Dignity.  Patient Advocacy. All of these represent a new way of administering health care in this country.  Our industrialized model of care in the mirror image of factory-like settings is no longer acceptable, viable, or an alternative.  We, as a country, as a society –as a culture, need to step up and do what is right.  Love, kindness, nurturing, and a commitment to patient advocacy are the correct ways to interact with our patients.

healing_mosaicMany organizations who embrace the various human dignity monikers such as Planetree and Eden Alternative do so for marketing clout, for positive press, or for hoped-for financial gains.  Upon meeting some of these leaders, transparency becomes a very recognizable trait because they themselves are transparent –and not in the good  sense.  Rather, they are transparently “takers” in an environment that is much better served by “givers.”

For a country that is so obsessed with standardized tests, our healthcare delivery scores are abysmal, astonishing, and asinine. Not unlike our appetite for Biggie fast food meals and Biggie drinks, our appetite for beautiful trappings without substance, for corporate jets, for the power of millions and in some cases billions of dollars in reserves has resulted in a dysfunctional health delivery system that looks at patients as widgets.

Nicholas D. Kristof - NYT photo Nicholas D. Kristof  NYT photo

Nicholas Kristof, New York Times Op-Ed columnist has written another compelling article about the  U.S. health system, in which he quotes the latest World Health Organization figures. (Download the .pdf file.) According to the WHO report, the United States ranks 37th in infant mortality (partly because of many premature births) and 34th in maternal mortality. A child in the U.S. is two-and-a-half times as likely to die by age 5 as in Singapore or Sweden, and an American woman is 11 times as likely to die in childbirth as a woman in Ireland. He then quoted another study, a recent report by the Robert Wood Johnson Foundation and the Urban Institute that looked at how well 19 developed countries succeeded in avoiding “preventable deaths,” such as those where a disease could be cured or forestalled. The U.S. ranked in last place. Dead last.

He did find one health statistic that is strikingly above average: life expectancy for Americans who have already reached the age of 65. At that point, they can expect to live longer than the average in industrialized countries. That’s because Americans above age 65 actually have universal health care coverage: Medicare, he writes. Suddenly, a diverse population with pockets of poverty is no longer such a drawback.

Learning how to convert your hospital to the standards of  Healing Hospitals is not rocket science.  It is, however, not without tough decisions, aggressive doses of nonconformity, a passion and commitment to patient advocacy, and a strong desire to improve infection, readmission, restraint, and mortality rates.  It can be done, but it takes guts, a break from the conventional, unconventional wisdom, and a willingness to do what is not only right …but also what is very, very smart.

WHO Report – Primary Health Care: Now More Than Ever

View more documents from Nick Jacobs.

Share