Posts Tagged ‘nosocomial’

Going “Rogue” – An Open Letter to Healthcare CEOs

October 17th, 2011

For the past three years, I have had a chance to dig heavily into the future, and I’m pretty convinced that the old saying, “Necessity is the mother of invention,” has never been more true than in today’s healthcare environment.  What was a given before in healthcare management may no longer be so in the future, and since most hospitals only Chief Innovation Officer is the President him or herself, their tasks of visualizing, understanding, deciding and directing the future of the organization will be shifting even more heavily from quantitative deciding-and-directing to the more qualitative visualizing-and-understanding side of this leadership equation.

Although I understand the reluctance of most CEO’s to be on the bleeding edge of creativity, my experiences at my former positions can significantly reduce or mitigate the majority of risk from any decision regarding innovation.

Our new competitive environment has an insatiable appetite for information, access and connectivity and it’s a well known fact that a periodic injection of chaos fosters creativity and forces your co-workers to leverage technology.   Because most organizations already have an environment that is built on trust and collaboration, injecting a little creativity can put their CEOs in more of a position to be the orchestrator and the inspirer.

That Used to be Us That Used to be Us is the new book by Thomas Friedman and Michael Mandelbaum in which they analyze four specific challenges Americans face as a nation—globalization, the revolution in information technology, the nation’s chronic deficits, and our pattern of excessive energy consumption—and spell out what they believe needs to be done to sustain the American dream, and achieve true supremacy based on innovation and excellence.

As an innovator and futurist,  several sections of this book captured my imagination and brought closure to a myriad of beliefs that I have instinctively embraced over the past few decades.  When my responsibilities revolved around the CEO position, I always saw my job as being a contributor to an environment where creative decisions were embraced allowed to happen and then those innovators were rewarded and inspired to keep going.

As the co-founder of a Research Institute, one issue that continually resonates with me is that  “We don’t have enough ‘rogue’ CEO’s in healthcare administration to take risks so that the rest can benefit from both their successes and knowledge.”

Well, fortunately, I’m your guy.

For the last several years I have been out there implementing unusual things, and many of these disruptive ideas are coming to pass in a big way.  I was the first hospital CEO to blog, starting in 2005 (HealingHospitals.com), was an early Planetree board member, created the first breast cancer research center dedicated to the Department of Defense, and filled my hospital with Integrative Medicine, hotel amenities, and music.

Below, I’ve listed thirteen new examples of areas of innovation, in which we’ve been working for the past three years, as well as numerous ways to pay for these initiatives.

 Thirteen Examples of Disruptive Technologies and Practices That Hospitals Need to Understand 

  1. Robotic algorithmic software that improves emergency room flow by 37 to 50 percent.
  2. Financial transaction software that reduces electronic transfer fees exponentially (25% of health care income is from electronic transfers.)
  3. Utilization of nurses and actuaries as patient advocates to significantly reduce your employee health costs.
  4. Preventative medicine reimbursements that can double a physician’s income and add bottom line profits to hospitals.
  5. Treble growth potential of your organization through adding Integrative Medicine
  6. Diabetic retinopathy telemedicine for Family and Internal Medicine docs.
  7. Proteomic and genomic testing creating new “hospital income.”
  8. Peritoneal lavage that extends Stage 4 cancer patients from three months to five years or more.
  9. Bone scaffolding that supports bone growth and virtually eliminates bone infection.
  10. Special bandages that protect and stem cell cocktail sprays that heal burn wounds
  11.  Access to a cancer consortium that allows small and medium hospitals to become Certified Cancer Centers
  12. Hospitals paid “not to play” during an energy crisis as a back-up to the power grid.
  13. Green hazardous waste disposal costing 25% less than traditional methods

If you’d like to learn more about any adopting any of the concepts above, or receive a leadership presentation that will enable your staff to see the opportunities (rather than just the threats) in our current, uncertain environment, here’s where to find me.

Why Are Hospitals The Way They Are? from Nick Jacobs, FACHE on Vimeo.

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Posted in Healthcare, Hospital Administration, Integrative Health, Leadership

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Fracking, Beiber Fever…and Bedbugs

May 12th, 2011

Every once in a while, it’s important to write about things that are hot. (It keeps the blog numbers up.) Well, hydraulic fracking, Justin Beiber and bedbugs… yes, bedbugs are all very hot and in the news again. While the D’s and the R’s sort out the nuances of cutting $14 trillion or so from the U.S. federal budget over the next few centuries, we still have to deal with the day to day challenges of living on this planet. In Pennsylvania and New York at least, the hot news — according to the New York Times — is the radioactive water that is reportedly being forced from deep below the surface of the earth as a means of releasing natural gas reserves:

“The relatively new drilling method — known as high-volume horizontal hydraulic fracturing, or hydrofracking — carries significant environmental risks. It involves injecting huge amounts of water, mixed with sand and chemicals, at high pressures to break up rock formations and release the gas.”

“With hydrofracking, a well can produce over a million gallons of wastewater that is often laced with highly corrosive salts, carcinogens like benzene and radioactive elements like radium, all of which can occur naturally thousands of feet underground. Other carcinogenic materials can be added to the wastewater by the chemicals used in the hydrofracking itself.”

Of course, the essence of those two paragraphs will be the source of numerous heated discussions between environmentalists and the gas and oil lobbyists until this issue can be sorted out. In the meantime?  Well, that’s the question du jour.

On a lighter note, my five year old grandchild, Nina, is madly in love with Justin Beiber. She knows every lyric from every one of his songs and regularly either dances or does gymnastic flips to his music. On Saturday, she, her brother, sister and I worked to clean up their two car garage sized playroom. She turned on the Karaoke Machine and let it rip. We were all dancing and singing to the Bieb as we put the toys away, cleaned up the miniature kitchen, folded baby doll clothes and stacked their books.

Justin Bieber - photo credit: celebrity-gossip.net - Nick Jacobs FACHE - Healing HospitalsImagine my shock when one of my Google news alerts appeared spouting the fact that young Justin suddenly had become violently ill at one of his concerts in Manila, then quickly returned to the stage. He had been diagnosed with a bad chest infection prior to the show, but insisted on performing, having tweeted before the show, “Sick as a a dog… But the show must go on.” As a non-medical/non-science healthcare guy, the diagnosis made me a little curious, (remember, I’m a musician, too), but Yahoo Answers cleared things up for me with this patient testimonial: “I’ve spent so many years of my life convincing myself that I have emetophobia, because when I was about 11, I was sick from a chest infection and I threw up…” So, there you have it:  Justin is not the only person who gets sick from being sick. So, relax, Nina, he’s going to be okay.

Now, some additional disconcerting news. After having  personally survived a bedbug attack at a top-notch hotel in a major U.S. city last year,  I read with trepidation that it has recently been discovered that MRSA infection has now been associated with the scratching that comes after the bed bug bites.  This dangerous, antibiotic-resistant bacteria (usually acquired from hospital visits or things like high school wrestling mats), is a strain of the bacteria Staphylococcus aureus which is called Community Associated MRSA or CA-MRSA.  Because it is resistant to oxacillin, penicillin, amoxicillin and other antibiotics, it is not to be ignored.  My medical friends tell me that the best treatment for bed bug bites is to keep the area clean, use antibiotic ointments or gel and keep a close eye on the bite to ensure that it doesn’t become infected.

So, all of you frackers, Bieberbots and bedbug-dreaders …should have a sip of some Grey Goose or Courvoisier.  They’re not radioactive, may calm your fear of tossing your cookies, and would probably – in the right quantities – kill bedbugs…or at least make you stop caring if  they didn’t.  And, if you still want to learn more…well, there’s an app for that.

Bedbugs 101 mobile app - Nick Jacobs, FACHE - health 2.0 - healthcare

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Posted in Current Affairs, Healthcare

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Sometimes it’s Better to Punch a Bear in the Face

March 27th, 2011

I’ve tried to avoid controversy, but since my reading audience has dropped by a few thousand readers after departing my previous CEO position a few years back, I doubt that this will cause me any more problems as a consultant than I’ve already caused by expressing my opinions in previous posts. So, for those of you who are still dependent upon me for financial support, I apologize.

This morning, I read an article in the Pittsburgh Post Gazette by John Hayes entitled “Meet Your Neighbors: The Bears,” about black bears living in Pennsylvania. The essence of the piece is that there are about 18,000 bears living among the 12,000,000 citizens of Pennsylvania, yet there are only about 1,200 bear-related complaints to authorities a year. The bigger issue, however, is that there have been no reported deaths caused by black bears. They don’t eat people.

During this same period of time, I read a post by my friend and fellow patient advocate, Dale Ann Micalizzi, referencing an article about the former president of Beth Israel Deaconess Medical Center (BIDMC) in Boston, Paul Levy,  another nontraditional hospital CEO who espouses transparency. “Admiting Harm Protects Patients” is the article appearing in today’s Las Vegas Sun. In my book, Taking the Hell out of Healthcare, which Paul graciously endorsed on the cover page, we talk about patient rights, patient advocacy, and the need to have someone with you during your hospital stay to ensure that you are not going to become a statistic. In today’s article, Paul is recognized for the work that he did with his blog — a blog which I encouraged him to write and to keep writing — in which he challenged the hospitals of Boston to reveal their mistakes, to stop keeping the infection rates and other problem statistics secret.

Because he was trained as an economist and a city planner, Paul Levy was considered an outsider by his peers when he took over the troubled Deaconess hospital, but as he quickly turned it around, he did so through the eyes of an outsider. In December 2006, he published his hospital’s monthly rates of infection associated with central-line catheters, which are inserted deep into the body to rapidly administer drugs or withdraw blood. These central line infections, which can be caused by nonsterile insertion of the catheter or not removing it soon enough, are preventable. The Centers for Disease Control and Prevention estimate 250,000 central-line infections occur annually, costing $25,000 each and claiming the lives of one in four infected patients.

Dale Ann Micalizzi (L) and Paul F. Levy (R) - Healing Hospitals - F. Nicholas Jacobs, FACHEHe then challenged the other Boston hospitals to do the same. He was accused of self-aggrandizement, egomania, and numerous other witchcraft-like things, but the bottom line was that the number of infections went down, and they went down because the staff and employees wanted to do better and wanted them to go down.

What else happened at Beth Israel Deaconess?

• Hospital mortality of 2.5 percent, which translates to one fewer death per 40 intensive-care patients.

• Cases of ventilator-associated pneumonia, from 10-24  per month in early 2006, to zero in as many months by mid-2006.

• Total days patients spent on ventilators from 350-475 per month in early 2006 to approx. 300 by mid-2007.

• The length of an average intensive care stay from 2005 through 2009, the average stay was reduced by a day to about 3 1/2 days.

(See my previous post on outrageous claims at my prior place of employment.)

Well, in today’s article about the bears, I read that “when bear attacks occur they are generally very brief, and injuries can include scratches and bites.”  Here’s the part I had not anticipated from the bear conservation officer: “Fight back, don’t play dead.  Unlike other North American Bears, black bears don’t consider people to be food.  When it realizes what you are, or gets a painful punch in the face, it is likely to go away.” I believe it’s a useful metaphor.

If you or your organization would like to hear a CEO or two speak about patient advocacy (and way better healthcare), I’m sure I know a former teacher/musician and a former city planner who would welcome the invitation.

Patient advocacy is in your hands!

Health 2.0 Leadership (1 of 2) from Nick Jacobs, FACHE on Vimeo.

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Posted in Healthcare, Hospitals, patient-centered care

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Excerpts and Opinions on “What Makes a Hospital Great?”

March 17th, 2011

Dr. Pauline W. Chen’s March 17th New York Times article answers the question, “What Makes a Hospital Great?” In this article, Dr. Chen finds:

Dr. Pauline W. Chen - surgeon & New York Times contributor - Nick Jacobs, FACHE

Pauline W. Chen, MD | Blog: paulinechen.typepad.com

“Hospitals have long vied for the greatest clinical reputation. Recent efforts to increase public accountability by publishing hospital results have added a statistical dimension to this battle of the health care titans. Information from most hospitals on mortality rates, readmissions and patient satisfaction is readily available on the Internet. A quick click of the green ‘compare’ button on the ‘Hospital Compare’ Web site operated by the Department of Health and Human Services gives any potential patient, or competitor, side-by-side lists of statistics from rival institutions that leaves little to the imagination. The upside of such transparency is that hospitals all over the country are eager to improve their patient outcomes. The downside is that no one really knows how.”

I’ve written often about the failed promise of technology alone, and this is reaffirmed in Dr. Chen’s findings:

“…hospitals have made huge investments in the latest and greatest in clinical care — efficient electronic medical records systems, ‘superstar’ physicians and world-class rehabilitation services. Nonetheless, large discrepancies persist between the highest and lowest-performing institutions, even with one of the starkest of the available statistics: patient deaths from heart attacks.”

As she asks why this is,  the answers have become relatively clear from a study that was released in the Annals of Internal Medicine this very week. This research indicated that it was not the expensive equipment, the evidence-based protocols, or the beautiful Ritz Carlton-like buildings. It was, instead, the culture of the organization.

Hosptials in both the top and bottom five  percent in heart attack mortality rates were queried by the study team. One hundred fifty interviews with administrators, doctors and other health care workers found that the key to good (or bad) care was “a cohesive organizational vision that focused on communication and support of all efforts to improve care.”

Elizabeth H. Bradley, Phd, Yale School of Public Health

Elizabeth H. Bradley, Phd, Yale Global Health Leadership Institute

“It’s how people communicate, the level of support and the organizational culture that trump any single intervention or any single strategy that hospitals frequently adopt,” said Elizabeth H. Bradley, Senior Author and Faculty Director of Yale University’s Global Health Leadership Institute.

So, it wasn’t the affiliation with an academic medical center, whether patients were wealthy or indigent, bed size, or rural vs. urban settings that mattered in hospital mortality rates. Rather, it was the way that patient care issues were challenged that made the difference. The physicians and leaders at top-performing hospitals aggressively go after errors. They acknowledge them, and do not criticize each other. Instead, they work together to identify the sources of problems, and to fix them.

One of the most telling findings in this study was that relationships inside the hospital are primary, and the physicians and staff must be committed to making things work. Dr. Bradley said. “It isn’t expensive and it isn’t rocket science, but it requires a real commitment from everyone.”

So, the next time that you select a hospital, look up its statistics, and I guarantee you that you will be surprised. When it comes to outcomes, to nurturing or even competent care, the biggest is not always the best.

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The Obligation is Real

September 21st, 2010

On Saturday night a group of people will gather at a restaurant  for a celebration of life since graduation from high school. I won’t be there. Neither will Joe, Butch, Tommy and half a dozen others,  but their absence is for a very different reason: they have passed away. I, on the other hand, will just be passing. So, why not go this year?

Nick Jacobs, FACHE at the beach with his grandchildrenWell, it’s a kid thing. You see, part of my birthday present to each of my kids was an overnight stay at a resort with their spouses, and, low and behold, there is no one to watch three of the grandkids and the brand new chocolate lab; no one, that is, but me. Why would I sacrifice the opportunity to hang with my old buddies for the chance to change diapers, mop up housebreaking accidents, and argue over bathing and bedtime issues?  Why?  Because it was part of the commitment, that kid commitment.  They will be my kids until either I die or they do, and with that come certain obligations that are real.

Why bother you with all of this personal blog stuff?  It’s about obligations.

The other day, a bright young man met with me at lunch to ask me questions about the American Healthcare System. Interestingly enough, I don’t believe that  my answers were what he had expected. You see, we have certain beliefs about our rights to generate, earn, and receive money in this country. What is missing, however, is a realistic reward system that aligns the appropriate reimbursements with the actual needs of the country. When he asked me how many hospitals would invest in purchasing his product, one that might help to eliminate hospital infections, my response was “Not many.”

You see, with obligatory bottom line orientations, many of the hospital CEO’s and CFO’s are not anxious to spend money on a  product that might work.  More importantly, with a lack of transparency, the public exposure that most organizations have relative to this infection problem is still somewhat limited.  It was easy to explain that if “St. Elsewhere” was exposed for having a 24% infection rate, not unlike a five star hotel having bed bugs, you can darn well bet that something would be done and done quickly, but the issue is not so pressing when it is under the basket.

Over the last few years, I have lost some wonderful friends who have had fantastic surgeries at highly respected hospitals.  These surgeries would have been impossible to have in a “normal” hospital, but, having said that, two of them died and one lingered near death for two years due to the infections they acquired there.

If this was widely publicized public knowledge, might he be able to sell more product?  The question was rhetorical and the answer is absolutely, positively, yes. So, back to obligations. Why is it that we must be exposed in order to become aggressive about serious problems in our systems?  The answer is simple: It costs money, and resource allocation is the number one challenge of most hospitals.  Hence my point about our financial incentives.  If we were reimbursed, rewarded and paid, not in an unconnected, cottage industry manner, our treatment regimes and protocols would change.  If we knew that it would be our financial responsibility to amputate limbs for advanced diabetes, would we be more eager to spend money on wellness initiatives?

Truthfully, it’s our obligation, and, as our fellow human beings suffer, we are currently seeing a movement toward political groups intent upon repealing reform measures. That is a backward view of an already complex challenge. It is our obligation to help our fellow man. “Do unto others …or pray you don’t lose your health insurance.”

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“Extraordinary claims require extraordinary evidence.”

December 3rd, 2009

“Extraordinary claims require extraordinary evidence.”
Cosmos – Carl Sagan (1934-1996)

healing_mural420

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.”

eldercare_nurse5_445

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.

doctor_welcome220The 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.

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Posted in Healthcare, Hospitals, Leadership

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Healing Hospitals

October 18th, 2009

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 - HealingHospitals.com
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.

HCD-Cover-10_09These 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.

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Posted in Healthcare, Hospitals, Integrative Health, patient-centered care

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