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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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On Cancer Research, Incentives and Cures

September 18th, 2011

From a blog entitled TTAG, The Truth About Genetics, comes a scathing indictment of the American Cancer Society. Truthfully, some of the contents are infuriating, but especially so, because as a co-founder of a research institute, I’ve lived them. First hand. When I saw that  the American Cancer Society’s two CEOs make a combined $1.6 million dollars in salary, I wasn’t shocked. Heck, the president of a 120 bed hospital who retired recently made almost that much. ACS is a big organization with lots of moving parts. It takes talented people to run big organizations, and they typically don’t work just for food.

From the TTAG  blog:

Today, ACS’s revenue is $1 billion, and the amount that goes to research is a measly 16%. Research is not the primary goal of ACS, and one of the great things they do is help patients undergoing chemotherapy by buying them plane tickets and paying for their costs. But, even when you consider other program costs like cancer treatment for patients, ACS has the lowest score for charities in terms of efficiency: 1-2 stars out of 4. (24.78%, according to CharityNavigator.org)

See also:

Once again, no surprise. The main issue that I had with the ACS was that their research funding, as meager as it is, goes to the “Good Ole Boys,” the group that is already part of the NIH/NCI club. Okay, you say, they have to have some standards. The Komen people don’t follow that same “Good Ole Boy” path, and thank goodness. They look for good science wherever they can find it.

So, what’s the real reason that I get upset? I sometimes think I’ve written too many posts about this already, but let me say it one more time: Unless and until we realign the system that currently is used to fund basic science in this country, we will never find true cures for cancer. There is very little to no incentive to cooperate, to work together, to encourage scientists to share and to reward them with grants for cooperating.  In fact, the entire system actively discourages it. It is a “Diva”-based system, that encourages silos of power around individuals.

Bottom line? We have a healthcare system that does not support wellness and prevention, but  instead financially rewards sickness and continuous testing and care for what may have been preventable ailments, and we have a research system that discourages cooperation and collaboration. We have a pharmaceutical industry that is interested in financial blockbusters…just like the movie industry.  We have a political system that caused our country’s credit rating to be downgraded and the price of money to escalate, and finally, we have an infastructure that is crumbling.

The good news, however, is that we still are the United States of America, and if we work together T-O-G-E-T-H-E-R  this can all be fixed.  It’s time for those of us who understand this to be heard.

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

Sandpaper sheets, green jello and patients who leave with infections they didn’t have when they were admitted. Hospitals DON’T have to be this way. Nick Jacobs FACHE reveals how, as CEO, he transformed a rural, critical care hospital from near bankruptcy to a consistently profitable, internationally-recognized model of patient-centered care and innovation. By creating a hospital environment that embodies healing in every aspect of its operations, Nick’s hospital also achieved one of the lowest acquired (nosocomial) infection rates in the U.S. for five years running.

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Posted in Healthcare, Partnerships, Public Health

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Barcelona, VAT and Ambiance

August 18th, 2011

Last weekend, I traveled to Barcelona. How does one afford to spend a weekend in Barcelona in this economy with the dollar at $1.40 to one Euro, one might ask?  Points, my friends, points. When you travel enough, it’s possible to build up quite a few of these delightfully-useful but quickly-diminishing-in-value “perks,” and that’s how I got there.

Because it’s “Vacation time in Europe,” numerous hotels, restaurants, and tourist attractions offer nice packages for a reasonable number of points, and because I’d never been to Barcelona or anywhere in Spain for that matter, it seemed like a good plan. Albeit brief, my 4 day journey into yet another culture was almost worth the pain of traveling. Of course, if you remember my Serbia, Nigeria, Bosnia, Netherlands and Italy blog posts, you know that I’m all about “experiences.”

Barcelona - juice seller - Flickr Photo

Barcelona: juice seller at the Mercat de la Bouqueria - Flickr photo credit: Halvorson Photo

The longer I live, the more interested I am in how other people live. Many years ago, probably 20 or so, we had an exchange student, Monica, from Barcelona who used to stand in my family room, look out the window into the rolling fields and proclaim, “Nick, Nick, I am sooo bored.”  Truthfully, I was, too.

So, why Barcelona, VAT and the “A” word? I fell in love with the city. I loved the ambiance, the food, the wines, the architecture, and the people. Maybe it was the fact that there are two million souls living there, and I never felt uneasy even once. Unlike my last trip to Chicago, where I couldn’t sleep all night because of the continuing chorus of sirens from emergency vehicles, Barcelona’s street in front of our hotel erupted in the wail of those distinctive, European sirens only
about four times, from Friday until the following Monday.

Interior of La Sagrada Familia basilicaSome of the little things that captured my attention included the walk/don’t walk sign on the streets that actually allowed you enough time to cross at your leisure without being hit by an oncoming car. The people and cab drivers were polite and, most importantly, there was a feeling of helpfulness and respect in the shops, restaurants and architectural wonders.

Of course, by Sunday evening, we had visited nearly every architectural work of Antoni Gaudí, and toured and listened to a great concert at the inspiring Palau Música Catalana. Barcelona is today one of the world’s leading tourist, economic and cultural and sports centres, and this all contributes to its status as one of the world’s leading cities.

But what about the rest of the title of this blog post? Every time we purchased something material there, the VAT tax was applied, and when I asked someone to explain it, the answer was simple, “It’s how we pay for healthcare.” Consequently, when we walked the streets over that entire weekend, we saw a total of five beggars, and three of them had a Starbucks Cup to catch the falling Euros.

The other things that we saw everywhere were dumpster-style recycling binsBarcelona: color-coded recyclying bins. And not just any bins, either. Very fancy, clean, able-to-be-picked-up-mechanically bins, that were specifically color coded for every imaginable kind of recyclables. Not rocket science, but a comment on community pride, sustainability or climate change, perhaps.

So, we’ve taken care of the creation of a pleasant ambiance on numerous levels with extraordinary architecture, beautiful tree-lined streets, recycling, healthcare, low crime and compassion for fellow human beings. We didn’t see many Mercedes, but we also didn’t see much evidence of poverty, either. The beaches in town were public, and not controlled by exclusive beachfront hotels. Barcelona’s public transportation was a pleasure — clean, comfortable and efficient, with a train to Paris that delivers you there in about three hours…and the Tapas, wine and customer service were all simply amazing.

Nationally, Spain’s unemployment rate hit 21.3%, and they are listed as one of the PIIGS:  Portugal, Ireland, Italy, Greece and Spain…i.e., economically-unsound EU countries. In spite of these huge challenges,  Barcelona was a great city, a great experience, and a great setting with world class arts. So, should we charter an Airbus 380, load up our U.S. Congress, and fly them to Barcelona?

Nah, it wouldn’t help.

Hmm. Maybe we should fly them to Somalia?

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Posted in Public Health, Travel

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The Smurfs and Culture

July 29th, 2011

The other day, I was imagining a conversation between our U.S. elected officials about the Smurfs.  On one side of the aisle, the rhetoric would go something like this: “I believe that Poppa Smurf  represents Karl Marx. He is not the leader of the Smurfs but an equal who is admired by the others for his age and wisdom.”  Then they might say, “And Brainy Smurf represents Trotsky, as he is the only one who comes close to matching Papa’s intellect.  He wears round glasses, is often isolated, ridiculed for being too professorial and is even ejected from the village for his ideas.”

Photo Credit: AP/Richard Drew

Furthermore they might add, “The smurfs don’t have private property, have adopted a collective-style economy and no individual Smurf is represented as either superior or inferior to others.” Someone would yell out, “They probably even have healthcare for everyone!” Consequently, the conclusion from one side of the aisle would be that the Smurfs are Socialists and are destroying the fabric of our society.

Then the other side might say something like: “Gargamel represents capitalism and embodies all the negative attributes associated with that economic system, such as greed, ruthlessness and the pursuit of personal gratification.”  “Gargamel is the quintessential symbol of Wall Street and will take his billions in tax cuts but never create even one job,” this side would say. At the same time, they might surmise that, “Azrael represents the worker in the ruthless, free-market state that is Gargamel’s house, and his union must be busted!”  Their final conclusion would be that, “The wealthy are taking all of our money and destroying the middle class.”

Is it any wonder we can’t get a debt ceiling bill?

One of my last professional trumpet playing jobs, “Smurfs on Ice,” was nearly 25 years ago. So, Brainy, Jokey, Grouchy, Greedy, and Stinky were all part of my early years, and now they are coming back, but the world is not the same!  So, be careful Smurfettes. Don’t invest in the market, real estate or dot.coms.  Try to avoid those outrageous credit card interest rates.  Don’t, whatever you do, don’t believe what the heads of the big banks and insurance companies are saying, and, for goodness sakes, buy gold, or maybe buy precious blue stuff.

When I was a kid, I was on journey to learn. So, when my dad bought me a box of vocabulary words and helped me learn ten new words every night, it wasn’t because he wanted us to grow up and be rich.  To him, the most important thing that he could do for his children was to make sure that they got an education.  He was all about the awareness that comes from exposure to information.

It started for me as a simple challenge to read the Bobbsey Twins books, and then the Hardy Boys, and from there, works by Mark Twain, Shakespeare, Dickens, Poe, Roth, Hemmingway and Tolstoy. Going through life without all of these friends would have been an empty and lonely journey. I’ll never forget when my brother, a young teacher at the time, introduced me to his classical record collection.  Yes, I was a trumpet player, but when I discovered Mahler, Beethoven, Mozart, Bach, Wagner, Brahms, Handel, Stravinsky, Chopin, Mendelssohn, Berlioz, Bartok and Sibelius, my life was changed forever.  Between the written word and the music, the mysteries, joys, challenges and humanness that is life became more apparent to me every day.

We have migrated away from anything but basic education and our favorite pastimes are video games, celebrity magazines and reality TV shows. Maybe that’s why we seem to have lost our way in this country.  We no longer embrace a culture of open mindedness, understanding and compromise.  Is it any wonder our U.S. Representatives can’t work together?  Maybe they are simply unenlightened…Maybe they all need to spend some time with the Smurfs and read a few blue books.

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Posted in Current Affairs, Leadership, Music

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The Budget Impasse and Death

July 16th, 2011

David Brooks wrote a very interesting column last week in the New York Times entitled  “Death and Budgets,” in which he explains the current Washington D.C. budget impasse and compares it to our collective inability to come to grips with our own mortality.

David Brooks - The New York Times - Nick Jacobs, F. Nicholas Jacobs, FACHE - healthcare - healing hospitals - SunStone Consulting

David Brooks | Josh Haner/New York Times

His treatise quotes S. Jay Olshansky, one of the leading experts on aging, who argues that life expectancy is now leveling off, and others who say that, we are marginally extending the lives of the very sick. Brooks goes on to articulate that, “A large share of our health care spending is devoted to ill patients in the last phases of life.”  Then enumerates upon the fact that, as a country, we will be spending $1 trillion dollars annually, double Medicare costs right now, on Alzheimer’s disease alone by 2050.

His closing thoughts revolve around the fact that “unless we confront death and our obligations to the living like his friend who was recently diagnosed with ALS, we will not be able to reduce health care inflation and balance our budgets. “ He then concludes that “we think the budget mess is a squabble between partisans in Washington. But in large measure it’s about our inability to face death and our willingness as a nation to spend whatever it takes to push it just slightly over the horizon.”

Since 2005 I have written  many times about this issue. In fact, one of my most quoted experts on this topic is a previous Pittsburgh resident, former Colorado Governor Richard Lamm, who spoke openly about the immorality of “inter-generational resource theft,” where the voting senior citizens have pulled the majority of the healthcare resources away from the children of our nation. According to Lamm, this generational robbery has contributed to produce one of the highest infant mortality rates in the civilized world  and has provided the resources allowing our seniors to squeak out another few months or days of life.

I also remember one of my Carnegie Mellon professors, Ian Rawson, PhD, describing the resource challenges presented in certain extremely conservative states where they have refused to fund organ transplants for children.  Obviously, those who voted most often and most passionately were the seniors themselves who could then use those resources for mechanical life support or surgeries on the frail elderly that neither extend nor improve the quality of their lives.

As a former hospital CEO, it seemed clear that the medical schools had taught the Northern European philosophy that “Death at any time is failure.”  It seemed that the very reality of our mortality was overlooked.  Having had responsibility for funding a palliative care unit in my last hospital, it struck me as sad that the vast majority of patients being admitted there arrived for the last week, day or few hours of life, and the “life extending measures that had be foisted upon the patient and their families” prior to that time neither reversed the disease nor improved the quality of their lives.  Unfortunately, some of this is about income for the provider, but most of it is about our inability to face the end of our time here on earth.

It was always disconcerting to see a priest or minister as a patient in critical care screaming out in fear of their own death.  It would seem that they, of all people, could find peace in the upcoming transition. So, what about the rest of us?

In closing, and this too is my “one note samba,” until or unless we begin to reimburse for wellness care, embrace death as part of life, and stop rewarding our scientists for “not sharing their ideas” with each other, we will continue to act pretty much like my daughter’s dog, Chipper. Tail-Chasing-R-Us, and Washington DC is currently engaged in chasing a tail that could easily wipe all of the china off the dining room table.

All we seem to see are blades of grass in our fields of dreams.

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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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Posted in Healthcare, Hospital, patient-centered care

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Medical Homes – Defining What Patients Want

February 13th, 2011

The definition of a medical home can be confusing to those who have not been dedicated students of this terminology. As the medical home concept has been added to the healthcare landscape of  the U.S., many uninformed healthcare professionals look at each other and shrug as if they seem to expect to see villages being built with work-out facilities and critical care equipment as part of the accoutrements. Instead, the concept of the medical home (also known as the Patient Centered Medical Home – PCMH) refers to patient-centered care, a phrase that we and Planetree have been using for over thirty years.

Imagine a physician’s office or clinic where the patient’s records are reviewed prior to each visit to ensure that the necessary immunizations, tests and wellness milestones are in place and accounted for on a consistent basis. If that stretched your imagination, consider a medical support staff that communicates by secure e-mail and phone to organize the patient’s care. Add to that an electronic medical record system that tracks the patients, their tests and prescriptions. That is just the beginning of what a medical home could be and do.

One of the companies with which SunStone Management Resources is working goes so far as to add nurse- patient advocates to the mix and then assigns them to help sort through the morass of decisions every person faces with significant co-morbidity risk factors. This system not only helps the patient, it holds down costs by giving people a stable, well-coordinated patient centered medical experience. As an advocate, I believe that it will be key to stopping the loss of billions of dollars in unnecessary treatment costs that conversely leaves millions of our citizens without appropriate medical care.

These outcomes can only be achieved by developing years-long, longitudinal relationship with the primary care provider and their team, and with patient advocate nurses who are assigned to work with those teams to help sort out the redundant tests and medications that often evolve from interacting with as many as nine different specialists each year. This number of hands usually results in at least 15 office or clinic visits and countless unnecessary tests. Imagine how great it would be to have someone who can lead the patients more efficiently through this journey.

In a recent edition of Modern Healthcare, Andis Robeznieks wrote an article entitled “In Search of Medical Homes.” Interestingly, it described the evolving requirements from the National Committee for Quality Assurance for medical home standards. Some of you may remember that this journey began officially in 2008. Of course, the Joint Commission and the Accreditation Association for Ambulatory Health Care were also in on the act as they began that same journey. The question posed by these organizations centers around the unique qualities of a patient-centered medical home.

Somava Stout, MD - Cambridge Medical Associates - Nick Jacobs, FACHE

Somava Stout, MD

Even though, as the article pointed out, the NCQA was experiencing success from their medical home practices business line, patients weren’t experiencing that same feeling of success, attention or comfort. According to Mr. Robeznieks this fact was eagerly confirmed by the patients as they filled out their patient satisfaction scores. The piece went on to outline the latest and greatest revisions to the NCQA standards which included, heaven forbid, a stronger voice from the patients. My favorite quote from the article was from Dr. Somava Stout, Vice President of Patient–Centered Medical Home Development for the Cambridge Health Alliance: “One of the things we do over and over again in healthcare is we don’t remember to include the patient as a partner in designing the (personal ) healthcare system.”

In summary, medical homes would provide patient-centered care that results in reduced visits to specialists and allows less expensive primary care doctors to care for the majority of people’s health care needs. This in turn would result in higher quality outcomes with greater patient satisfaction and more funds to take care of the under insured.

Sounds like a plan.

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Finding the Cure…for Bullying

January 21st, 2011

No workplace bullying - Nick Jacobs - healinghospitals.comThis week, NBC’s Today Show featured another story about bullying. As I have have mentioned in previous posts here and elsewhere, I believe that bullying is the quintessential cancer on our lives in places of business, in the military, politics, and relationships of all types.  The good news – actually the very good news –  is that there has been some incredible work being performed on this topic through the efforts of Dr. Matt Masiello at my former place of employment, the Windber Research Institute in Windber, PA.  Grants through the Highmark Blue Cross Foundation of Pittsburgh have fueled this initial effort and the academic and quantitative analysis being done by Clemson University has documented this work.  I believe that this joint effort is a magnificent  example of what can be done to change the future course of events currently being controlled by bullies.

The Today Show story that I saw featured the Massachusetts school where, due to cyber-bullying, a young girl committed suicide last year.  Apparently, another girl is now having the same experience at the same school. With the help of programs like this comprehensive anti-bullying program, the former Secretary of Education from PA, Jerry Zahorchak, (now Superintendent of the Allentown PA school system), embraced the effort to quell and discourage this type of destructive behavior.  And the program, under the direction of Dr. Matt Masiello has successfully been introduced across the  entire State of PA. (Matt had started the Allegheny County’s Goods for Guns program in 1994, when he was the head of pediatric intensive care at Allegheny General Hospital. To date, this program is responsible for collecting more than 11,000 illegal guns from the streets of Pittsburgh.) Matt has had the same success with this anti-bullying program. Now, both Massachusetts and Maryland are looking into embracing this effort.

This anti-bullying program is based on a European program with which Dr. Masiello had become familiar.  This is a school system-wide effort that is very well documented and results in tremendous awareness and reduction of bullying at all grade levels.

The trainers bring a group of teachers and administrators together in the school system, and then “train the trainers” as to how this effort can become part of the philosophy of the school.  They start the training in the spring, typically launch the school wide effort in the fall and run it for at least a year. During that time, detailed records are kept measuring outcomes.

Matt Masiello, MD - Windber Research Institute - Nick Jacobs - Taking the Hell OUt of Healthcare

Matt Masiello, MD

Matt is a wonderful physician, a truly giving person and a saint of a man who is the only U.S. representative on the board of the World Health Organization’s Health Promoting Hospitals program. I hired him before I left Windber Research Institute, and he has worked tirelessly to address both this problem and the problems of childhood obesity.

The Olweus Bullying Prevention Program (Olweus.org on the web, @Olweus on Twitter) has impacted more than 400 school districts and 20% of all school-aged children in Pennsylvania. It has also had up to a 50% reduction in student reports of bullying …and bullying others.

For more information, please contact me or Dr. Matthew Masiello at the Windber Research Institute.

Michael & Marisa’s anti-bullying song – “The Same”

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Posted in Current Affairs, Healthcare, Hospital Administration, Hospitals, Leadership

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Making Sense of Tucson

January 11th, 2011

It was 1991 when one of  my professors at Carnegie Mellon University began discussing health policy in the United States.  He told us about Arizona, where the state government had decided to stop paying for transplants.  Then he went on to explain that desperate families were moving from Arizona to Pittsburgh, just so they could establish residency in Pennsylvania, and their loved one could receive a transplant.

At around that same time, an outspoken politician from Colorado, former Governor Richard Lamm, who ran for President of the United States on the Reform Party, described the travesty of Medicare vs. Medicaid.   He described the older generation as committing “generational murder” because, even though many times there was no hope  for their survival, for extending their life or for having any quality to their life, we, as a nation, spend 60% of our Medicare dollars on the last  30 or so days of life.  He advocated being honest and allowing people to decide if they wanted palliative care.

What he also pointed out was that, as a country, we continue to have one of the highest infant mortality rates in the industrial world. The reason, he theorized, was because the seniors voted and the young mothers didn’t and no politician would dare vote against that senior coalition.  (This is not about death panels, it is about honesty in healthcare. It is about transparency and explaining the facts to the families so that they could make rational decisions.) None of his words were well received, but nevertheless, they were filled with candor and embraced very difficult ethical views.

Giffords Tucson tragedy - Nick Jacobs, FACHE - Healing Hospitals

The bottom line?  It is a very sad situation when we have to, in effect, sentence people to death at any age because resources are not available to save them, but this is emphatically not about rationing of care, because rationing infers giving everyone a little less.  This is about making a government decision to take away everything. So, this is about making rational  resource allocation, not based upon the number of votes needed to get re-elected, but based on the value of a life at any and all ages.

Finally, the elephant in the room?  Those people killed and wounded in Arizona were killed and wounded because of a man who is most likely mentally ill.  We, as a country, must begin to address this mental health issue with parity, with commitment and without judgment.  No family is without some member who is suffering from some mental health issue, but  this discussion is still ignored, hidden or buried.

So, when the pundits ask if it is about the rhetoric? We don’t know. When they ask if it is about the availability of weapons and ammunition?  The answer seems to fall under that same category. BUT, when the question is properly directed toward mental health?  The answer seems to be absolutely, yes without a doubt.

During this time of reflection, let’s get serious about the very real and very big challenges that this nation faces. We must, as a nation, take these challenges head-on and deal with “problem solving,” and if this Congress does not begin to take action and begin to solve problems, then we must vote again in May and November to continue to make our voices heard.

Unless we can begin to talk with each other with dignity and respect, we will not make progress.  Until we begin to respect the other person’s point of view and understand that debates are healthy again, we will not make progress. Our leaders need to debate, but at the end of that debate, it is essential that they walk out of the room together and agree that they are all here to do a job, and that job is to solve problems.

My heart goes out to all of those families who were impacted by this awful tragedy.

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Posted in Current Affairs, Healthcare, Medicine

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Engage With Grace

November 26th, 2010

Excerpts from: Chapter 18 of  “Taking the Hell out of Healthcare“

by Nick Jacobs

When Dying is Finally Enough


The Dichotomy of Death

On Thursday evenings from 1970 until 1975 there was a standing invitation to play pool at Jim’s Dad’s house.  Now, the truth of the matter was that, as young school teachers, most of us barely owned houses, let alone a pool table, so one of my colleagues parents’ opened their home to allow us to have some safe recreation. During those innocent days of my mid twenties, many of the world’s problems were solved. Jim’s father was a wise old philosopher in his early sixties,  a retired coal miner who loved to be around the kids.

One night, we began discussing religion, faith, and death as we mechanically yelled out lines like “16 in the side pocket.”  The discussion became particularly heated when it came to hypocrisy of our healthcare system. We kids or at least this kid listened in amazement as old Carl explained how life was in the old days. His relatives from the old country had salves and ointments, herbs and mustard plasters that took care of virtually every ailment known to man, and when they failed and death was inevitable, death was accepted. He used to laugh and say, “But now, everyone wants to go to heaven, but nobody wants to die.”

It was then that the subject changed to today where there was truly a cure for nearly everything, or so it seemed at age 23.  Get sick? Take a pill or get a shot. But then, a few weeks earlier, my father had been diagnosed with lung cancer and was given less than a three percent chance of survival. As Carl and I discussed this situation, he put his arm on my shoulder, and wished me luck. At 58, my dad was still a young man, and neither my education, my prayers, nor my love would be able to save him.

The American way of death seems to be that death is not acceptable at any age, at any time or for any reason. Death is rarely seen as the inevitable future that we all face. Our American system of death is that it should not  happen. Death is no longer accepted as part of life. Oh, yes, we hear those words, but when it is our loved one, they are very difficult to embrace or articulate.

Our medical schools, our nursing schools, our technology schools train  our students in most cases that death is failure. This is why we have a system of health care that is crumbling under our very eyes. Through drugs, machines, and other advances, we have the ability to allow individuals to live longer than ever in the history of mankind. It is absolute reality that more people will have an opportunity to live longer than 100 years of age than ever in history, but at what cost, and with what degree of quality?

Engage With Grace - The One Slide - Nick Jacobs, FACHE - Healing Hospitals - Taking the Hell Out of Healthcare

Because of our culture, we fight death until we are shocked by it, and the result is that we, as families miss the wonderful opportunity to allow our loved one a peaceful, beautiful, comforting transition.

Palliative care, a.k.a., hospice care, provides that transition.  In a hospice program, we experience love in all forms until death. Hospice provides a womb-like environment where love can replace fear, where family can be the center of that love, and where the transition can be a beautiful, healing journey for everyone involved so that it becomes a peaceful transition.

What Can You Do?

Do your personal homework. Begin to talk to your loved ones early on about their wishes.  Make those wishes as clear as you can. Do not be fearful that anyone will let you die before your time. Trust that your family or friends can support you in your intentions, and be sure that you put everything in writing that you possibly can. Most importantly, however, try to find peace with yourself.

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Posted in Family, Healthcare, Hospitals

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