As some of you may have noticed, last year was a tough year for education, travel, and some forms of consulting. It was “the economy, stupid.” A number of our major public speaking engagements were canceled or postponed, because hospitals stopped sending employees to educational conferences. In fact, at one of the leadership conferences where we spoke last year, there were only 90 people in attendance. The previous year, there had been nearly 500.
Well, thank goodness, things have picked up a bit, and we will be speaking a few more times over the next several months. The following is an up-to-date list of locations, dates, and topics currently scheduled:
Popular Science in their March 2010 Edition published an article entitled “Waking Up the Brain Dead.” the sub-title read “A Cocktail of Therapies Jump-Starts Patients’ Brains.” Then, the May 2010 Ladies Home Journal is publishing an article entitled, “World Leaders in Translational Clinical Research for Alzheimer’s Disease,” (The International Brain Research Foundation – IBRF; in November of 2009, The Clinical Neuropsychologistpublished an article “The New Neuroscience Frontier: Promoting Neuroplasticity and Brain Repair in Traumatic Brain Injury” that was co-authored by at least two members of the IBRF, Dr. Philip DeFina and his associate Dr. Rosemarie Scolaro Moser, regarding the future of treatment for Traumatic Brain Injury (TBI).
With an 84% success rate in waking up patients from deep, irreversible, persistent vegetative state comas traditional neurologists, neurosurgeons, and neuroscientists have called these “wake ups” flukes, but once you have nearly 45 flukes, the question becomes, “Are they real?” As the Popular Science article states, Dr. DeFina and his team apply already approved medications, electrical stimulation, and nutraceuticals to the patient, but they do it in a virtual cocktail that has had a dramatic impact on these patients.
After having spent several days working with the folks at the International Brain Research Foundation, my personal heart strings began making their own music. Not unlike the work that we did at my previous employer, DeFina’s Research Foundation is blazing new trails, not necessarily by inventing all new methodologies, but by applying new approaches to well-established and FDA-approved drugs and protocols. They are making unbelievable progress with highly nuanced protocols that will potentially change neuroscience forever.
In typical “small science” fashion, the traditional approach to these patients has been to apply one protocol at a time, and when that fails, move on to the next. Dr. DeFina appropriately points out that this unconventional approach is effective because it goes to the source of numerous highly complex brain centers. He asked me to imagine the Wright brothers trying to fly an airplane one “part” at a time. “Orville, do you think this propeller will fly?” Of course, that concept is absurd, but that is an appropriate description of how Traumatic Brain Injuries are currently addressed.
Nearly a dozen years ago, when we were beginning our work at the research institute, it was obvious that the reason that cancer had not been cured was because science takes a very laser-like approach to everything; let’s call it small science. When we determined that we should have a pristine, highly-annotated collection of specially-collected breast tissue, that we should have a central data repository, and that, heaven forbid, we should have ensemble-type multi-disciplinary teams of scientists and MDs working together, it was as if we had suggested that all science be trashed. It was so controversial. To think that one scientist did not keep total and complete control over all of the data generated by his work. It was heresy.
Bottom line? I believe that the International Brain Research Foundation will have us rethinking our living wills not to many years from now as they continue to awaken deep, irreversible coma victims and help them find their lives again. Not unlike the activities at the Windber Research Institute, where the “Platinum Quality Tissue” is currently being used to map the breast genome. We are looking into the future of science, and it is very exciting indeed.
The very difficult news is that the IBRF is totally and completely dependent upon donations and grants for their work, and traditional granting organizations do not favor nontraditional approaches to curing disease and saving lives. So, after you do your due diligence, if you are as moved as I was, check out the IBRF’s website (including their excellent videos) at www.ibrfinc.org, and help them change history.
We are on a not-so-merry-go-roundwhich, 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.
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.
We 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?
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.
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.”
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.
Yesterday’s phone call from the Somerset Daily American caught me off guard. “Hi, Nick, have you heard? Congressman Murtha passed away this afternoon. Could you give us a quote?” the reporter said. Truthfully, I was not ready for this call. Having talked to friends who had been with him only a week earlier, everything seemed like it was going to be okay, but obviously, okay was not what it was. He had one of the 500,000 or so laparoscopic cholesystectomies performed each year to remove a gallbladder. This surgery has a .05% complication rate, but the call proved that, regardless of the percentages, there is always risk from human involvement.
I’ve decided to dedicate this as a very personal look back at my journey with Jack Murtha. Ironically, we had grown up practically as Pennsylvania neighbors in Westmoreland/Fayette Counties. My first real meeting with Mr. Murtha was during the 1977 Johnstown Flood. I was a young teacher and volunteer who was mopping the floors of the relief centers, getting things ready for survivors who had lost their homes when I heard a helicopter come flying in and saw a tall, impressive, 44 year old Congressman deplane. He had only been in Congress for a few years, but had clearly learned enough about the System to keep then-President Carter on his toes and get legislation passed to help his home district.
My very next encounter with Mr. Murtha wasn’t until about three years later, when his Washington office called me to see if they could help my employer at that time, Laurel Arts of Somerset, with a bill that was going through the House before Ronald Reagan took office. Nothing came out of that call except for the fact that I realized that his employees were parents of former students and people who liked and respected my work from those days.
Then the big encounter hit. Mr. Murtha was looking into bringing the National Park Service into Cambria County to start what became the America’s Industrial Heritage (Tourism Development) Project. He and several other Congressmen came to the University of Pittsburgh in Johnstown to hold a Congressional hearing on the project, and, as the newly-elected President of the Laurel Highlands Convention and Visitors Bureau, I testified against the plan and explained that if they didn’t include Westmoreland, Somerset, and Fayette Counties, we would not display any literature promoting it at all of the tourist sites that we controlled. They agreed, and not many months later, he ended up representing Fayette County as part of his district. It worked out for both of us.
A few years later, I had transitioned into healthcare senior leadership and invited Mr. Murtha to introduce Bob Hope at a fund raising event for the Mercy Hospital of Johnstown. Approximately 6,000 people were in attendance and Mr. Murtha got as much applause as Mr. Hope. The following year he helped us bring in Henry Mancini and his orchestra for a similar event and our respect for each other began to grow.
Rep. John P. Murtha speaking at Biotechnology Expo (2004)
In 1997, when I became the President of Windber Medical Center, Mr. Murtha and I were seated near each other at a dinner party. It was there that we began to discuss healthcare, and his vision for the future. Anything that would help the soldiers stay well, prevent illness, or stop it before it became an issue was his goal. I heard him speak at the opening of one of his many health center initiatives at Walter Reed Army Medical Center, and he said, “I have 13 honorary degrees, hundreds of awards, and am well known as for my work in defense, but I want my legacy to be healthcare, prevention, and wellness.
His contributions to healthcare, however small they may seem compared to what he has done for the world and for mankind, through his tireless and dedicated work were where his heart was. His strength and vision made him the most impressive human being that I have ever known, and my love and respect for both him and his wife, Joyce, cannot be calculated in mere human measurements. I am proud of him, his work, and his commitment, and I know that the seeds that he has planted in Breast Cancer Research will go on to save thousands of lives someday.
Ironically, it was healthcare that took his life. No one can ever replace Jack Mutha; his knowledge of the system, his guts and determination, his singular efforts to help a district that had been devastated by natural disaster, his kindness and great personality. No one. So, today, I write with great sadness that our great friend is gone, but at the same time, I vow that his name, his contributions to humanity, and his memory will never be gone.
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.
What’s the old line? “We’re going to beat the troops until morale improves.”
“Extraordinary claims require extraordinary evidence.” Cosmos – Carl Sagan (1934-1996)
Over the last several years, we have made extraordinary claims in our blogs, our speeches, and our consulting. We have made claims that have been questioned, sometimes scoffed at, and generally ignored by the masses who believe that their way is the only way. It is almost as if these claims are so seemingly “out there,” that many believe they could not possibly be true.
less than 1% infection rates
lowest restraint rates
lowest re-admission rates
lowest mortality rates
99% patient approval rates
97% employee approval rates
In hindsight, should we have just kept these claims “under the basket” because too many believe they look too good to be true?
When we claimed a bottom line that was over $2.5 M in a hospital with fewer beds than an average wing of most hospitals, you could see the frowns of disbelief on the faces of financial officers. When we claimed those approval rates, the CEO’s of other hospitals simply smiled and probably thought to themselves, “…maybe in your little hospital, but NEVER in mine.”
Now that I am no longer affiliated with my previous employer, let me throw down the gauntlet to you. It is my complete and sincere belief that these results, with your total support and endorsement, can happen in your facilities. It is my further belief that I can help deliver those results for you, so that instead of laying people off, you too can double or triple in size. I believe that you can take your everyday challenges and turn them into unbelievable successes. How? Take the pages from my book on hospital management. (The one that’s not published yet, but firmly planted in my heart and head.) In the interim, get yourself a copy of my first healthcare book that has been published, Taking the Hell Out of Healthcare.
If you are a genuinely kind person, that will show through in your management style. Kindness is not weakness.
If you care about your staff, they will care about not only you but also about your patients.
If you treat people with dignity at all levels of the organization, your organizational culture can change.
If you help the 10 percent or so of your employees, physicians, and others who do not support this philosophy to find work at neighboring institutions, they will be the gift that keeps on giving as they run rampant over patients at those hospitals and drive those patients to your doors.
These are not difficult assignments. They require only that you stick to your resolve, that you always try to do what is right, and that you do not stop until all of the necessary changes have been made. Healing organizations start with YOU. Healing organizations embrace their human resources. They embrace patient families. They DO NOT function like cold, corporate America. They function like patient-centered America. Kindness in the workplace is not a gimmick, not a fleeting idea, not a once or twice a year thing, it is a complete commitment to a change in culture that reaches out to patients, employees, and medical staff.
The cost? In the big picture, the cost is not even a consideration. Your investment now is less than you can imagine, as your facilities grow, expand, and thrive. Besides:
What does it cost to be nice?
What does it cost to be civil?
What does it cost to be kind?
Healing Hospitals are a way of life. Make sure that your hospital becomes just that, a place for healing.
As I was moving some books around today, I noticed a paper that had fallen out of an old notebook. At the top of the page was the title Growth. Although the year does not stand out in my memory, the circumstances do. If a guess was involved, it would be ’05 or ’06, but no date was present. The situation was one of determining not only how to avoid laying people off because of necessary budget cuts, but how to grow the organization, so that all of the staff could remain employed and get their raises on an ongoing basis.
Of course, there were a list of issues relating to attracting physicians and patients. That “yada yada” list included traditional ideas like recruitment, increased marketing in a new clinic, new equipment for the breast center, expansion of the Emergency Department, performing more traditional surgical procedures, a higher-slice CT scanner, etc.
Then, there were the decidedly non-traditional ideas, like the addition of a data fusion center, increased uses of integrative medicine, a minimally-invasive bariatric center, expansion of the laboratory to include proteomic and genomic testing, management of donated tissue, and telemedicine were all there.
Looking back at that time in my CEO tenure, all of those ideas came to fruition, along with a 3T MRI with breast coil, and every one of these changes came with a certain amount of dissonance and conflict. When it all came down to it, however, the piece that worked the best – the area of concentration that yielded the most profound growth, – the ultimate, saving grace was that of producing a healing hospital.
On that same piece of paper was this note: “We must attract a heart-centered musician to work with the patients and their families.” We found that woman, Rachel, and along with her cohorts, Jean (who did aroma therapy, Reiki, and drumming), the music of healing and transition began. Later, physicians like Dr. Kelly brought flower essences and a half dozen other healing modalities. People were uplifted, reconnected, and relaxed. Through the use of therapeutic music, we gave the patient what they needed at the moment.
Each week, it will be my goal to give you a peek into the world of healing hospitals where people don’t come for an oil change, a new body part, or a shot of life, but rather a place where people go to heal. As a country our medical facilities have been lured into becoming factory-like for the sake of survival, but what we found was that the more humanness, the more loving, caring attitude, the more hope and help we could give in nurturing the body, mind, and soul, the better we did, the bigger we grew, and – most importantly – the happier our patients, their families, our physicians, and our employees became.
For the past several months, I have been searching for a new blog title. Nick’s Blog, NickJacobs.org, Ask a Hospital President, Taking the Hell out of Healthcare… none of them really told the story of my passion, my drive, my desire to change healthcare in a way that would be meaningful for every patient, every employee, and every physician. Finally, the idea of what exactly I believe in, try to strive for, and teach hit me: “Healing Hospitals.” Not only do I believe that we can make our hospitals healing places, I also believe that we can heal the hospitals themselves.
Nick Jacobs, FACHE – HealingHospitals.com
For too many years, the Socratic style of teaching our docs has basically made many of them as tough as professional football players. We have experienced “The Old Guard” in nursing, where, when new nurses come on board the older nurses are encouraged to “eat their young.” We also know that the over-utilization of overhead paging, blood tests in the middle of the night, loud staff members, et al lead to what can only be described as a tense environment.
For the past 20 plus years, we have advocated a kinder, gentler hospital environment. During that time we have introduced all types of non-traditional healing environments, integrative medicine, roving psychologists, drum circles, aroma, music, pet, and humor therapy as well as the elimination of bullies from the medical staff.
These are just a few of the very effective mechanism that can be introduced to create healing environments in hospitals. Healing gardens, labyrinyths, 24 hour visiting, double beds in the OB suites, and the beat goes on and on with decorative fountains, fireplaces, skylights, balconies, but most importantly dignity and respect amongst all staff and visitors toward patients. So, “Healing Hospital” has multiple meanings. Healing will take place more quickly, thoroughly, and meaningfully in these facilities, and the entire staff will be charged with the promotion of healing by creating an overall healing environment.
Well, I’m sure if you type in nickjacobs.org or even Ask a Hospital President.com you’ll still get to us, but remember that our overall goal, our direction, our mission, our passion, and our job is to help you to create healing environments where infection rates drop, as will lengths of stay, readmision, restraint and mortality rates. Call us at SunStone Consulting, LLC. 412-992-6197.
Over the years it has been my aspiration to try very hard to help you laugh, and, regardless of the depth of the topic, I’ve always looked to find humor somewhere in the message. For example, potty training, Smokey the Bear, flying DVD’s, even old dogs with no tricks.
Today, however, I am writing about an issue that may inflame some of you and prove to be very troubling to others. It’s not my goal to do either. I’d just like to bring into focus the crazy stuff that seems to be taking us over, a kind of Bird Brain Flu that doesn’t have a vaccine and that appears to be enveloping our nation.
You see, it is my humble opinion that we as a country have reached a new low point in dumbness. The wild, inflammatory rhetoric, a/k/a crazy talk that’s being spouted every day, appears to be pushing the fringe players out from under their rocks and their basement fortresses. This political flu is taking us to levels of foolishness that are so low that even a Limbo expert couldn’t fit under the broom stick.
Have you noticed how open public hatred and outright prejudice has become? It’s like we’re living a rap song from Gran Torino. Each and every day we hear the ranting of media talking heads leading the charge to endorse this movement. For those of you who have read my work over the past few years, you know that I personally am repulsed by bullies, by racists, and by those who believe they are superior to other human beings.
The new accusations and sick suggestions that are the current craze are veiled as protests regarding big government, health insurance reform, and a lack of confidence in the ship of state. What they really seem to be, however, is fear and lack of tolerance for our President. So what if you don’t like him? There still have to be some limits and boundaries. Are there any more lines?
I’m telling you, the crazies are coming out from their caves. Seriously, watch out for them. Many of these radicals are great examples of why some animals eat their young.
Just last week on a trip to Washington D.C., I had to be evacuated from the Pittsburgh airport because a passenger was carrying a defused hand grenade in his suitcase. What is the single thought that must be in the mind of any individual who believes that a weapon, even, as it turned out, an inert one, such as that grenade, would be okay to pack for your plane ride? Let me guess. That thought was “Duh?”
It seems that every time some poor innocent gets shot in this country, there was some fringe individual who believed that he was not only given permission to take their life, but that there was an overwhelming endorsement of his actions that would somehow vilify him from any prosecution, and reward him with glory. Does that sound like the Jihadi 72 virgins thing to you?
Yes, we have freedom of speech. Yes, we have the right to bear arms, but do we have the right to just be nuts in public? Maybe instead of statins in the water system to control cholesterol, or fluoride to prevent tooth decay, we should start putting Zoloft or some other selective serotonin reuptake inhibitors (SSRIs) in that keep the brain from becoming unbalanced.
What’s wrong with love, kindness, and the golden rule, of doing to your neighbor as you would have them do unto you? Can’t we look for compromise without demonizing those with opposite views?
Can’t we stop endorsing or even worse stop inflaming those with extreme views? When is enough enough? When will we return to civility, to compromise, and to brotherhood? Would you rather have peace, love, and rock ‘n roll, or “Go ahead. Make my day, @#%&+^@#”?
F. Nicholas “Nick” Jacobs, FACHE, is Senior Partner at (SMR) Senior Management Resources, LLC. In that capacity he provides transformative, strategic solutions to companies, organizations and individuals. He has decades of experience in hospital management, with an acknowledged reputation for innovation and consumer-centered leadership.
Throughout his career, Mr. Jacobs has developed a reputation for innovative leadership that focuses on effective delivery of service that puts the patient’s needs and concerns first. He speaks extensively on this topic and has spoken for the American College of Healthcare Executives, American Hospital Association, and the World Health Organization numerous times.
As is widely known by now, CMS has decided to literally
The cost? In the big picture, the cost is not even a consideration. Your investment now is less than you can imagine, as your facilities grow, expand, and thrive. Besides:
These are just a few of the very effective mechanism that can be introduced to create 
