Archive for September, 2009

Interesting Words to Think About

September 25th, 2009

The time has come to realize that the old habits, the old arguments, are irrelevant to the challenges faced by our people. They lead nations to act in opposition to the very goals that they claim to pursue — and to vote, often in this body, against the interests of their own people.  They build up walls between us and the future that our people seek, and the time has come for those walls to come down.  Together, we must build new coalitions that bridge old divides — coalitions of different faiths and creeds; of north and south, east, west, black, white, and brown.

The choice is ours.  We can be remembered as a generation that chose to drag the arguments of the 20th century into the 21st; that put off hard choices, refused to look ahead, failed to keep pace because we defined ourselves by what we were against instead of what we were for.  Or we can be a generation that chooses to see the shoreline beyond the rough waters ahead; that comes together to serve the common interests of human beings, and finally gives meaning to the promise embedded in the name given to this institution:  the United Nations. (President Barack Obama’s Speech to the United Nations)

Obama Speech UN 2009

Interestingly enough, there were 22 years in a row when I could have made the same speech (Okay, it would not have been rendered  as eloquently as the President’s, but the content would have been similar.)  The most disconcerting thing about this statement is that I was referring to the internal stakeholders of many hospitals.  One of my favorite statements during those years because of all of the infighting was that “We are not the enemy.”

An enormous amount of energy is expended in almost every healthcare organization on internal power struggles.  In many cases these struggles revolve around issues relating to money.  Questions like “Should the radiologist or the cardiologist be permitted to perform one particular test?”  Turf battles over procedures always seem to be part of the equation.  Other struggles revolve around perceived power relating to whatever positions are held because someone wants more control of larger pieces of the budget.

Power, control, greed?  All of these traits are part of the human experience, but when an organization expends much of its energy on these issues, the result is wasted time, wasted resources, wasted anguish, and, in many cases, lower quality outcomes.

Watching old movies of workers in factories during World War II have always fascinated me because we, as a country, had found a common enemy toward which we could focus our angst.  The fact that health care never seemed to be able to embrace illness as the common enemy always created intrigue for me. Yes, we would rally and work together when emergencies hit, but the other daily activities became somewhat mundane and boring, and our instinct seemed to be to revert to power, control, and greed.

Maybe, just maybe, we could find a way to marshal the medical staff, employees, and administration, the volunteers, and patient families to work together every day in every way to create an actual healing environment where patients can be surrounded with the energy of love, kindness, respect, dignity, and healing.  Maybe this environment could be the goal of every hospital executive, and they could begin and end each day by focusing on setting the example for the creation of a healing environment.

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What the Heck is Going On?

September 21st, 2009

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.

Tomtomorrow_GlennBeck_

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.

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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, @#%&+^@#”?

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Healthcare Reform or Health Insurance Reform?

September 12th, 2009

President Obama’s eloquent address to Congress on his proposed changes to the U.S. healthcare system was fraught with ambiguous issues that will certainly provide a feeding frenzy for opponents. When the President stated that “This country’s failure to meet this challenge year after year, decade after decade has lead us to a breaking point,” he was exactly correct. We are the only industrialized nation in the world that has not addressed this challenge.

There are too many people without coverage of any kind who use emergency rooms as their primary care physician. Unfortunately, the difference in cost between a visit to your emergency room vs. a visit to a physician’s office is exponentially different.

Q-tipsIf we, as a country, do not believe that we are paying for these patients in some real way, then we are not cognizant of how the system is being contorted in order to allow hospitals to remain solvent. When you hear individuals complain about the high cost of Q-tips in a hospital, it’s because they are being priced to help cover the losses being incurred from the millions of uninsured.

So, what is it that we must address? When the President said, “Under the present system, due to job loss or illness, many could lose their coverage,” he was totally accurate. Unfortunately, millions of Americans have come to experience this phenomena first hand, and could lose their homes, investments, and their possessions because they have no insurance. So, as President Obama appropriately questioned, “What is the best solution that is both moral and practical and best reflects the ideals and freedoms upon which our country is based?” He was clear to explain that implementation of either a Canadian-style system or an individual based system would both be a radical shift, and each represents extreme positions that would completely change the way healthcare is delivered in this country.

barack-obama-health

So, if we eliminate the extremes and concentrate on compromise, we begin to see signs of conciliation that might be embraced. For example, there appear to be very few people who would argue against providing “more security and stability to those who have health insurance.” The majority of Americans also seem to embrace the concept of providing some type of coverage for those who currently have none.

What the President and most of our elected representatives are avoiding in the conversation is talk about quality, safety, end of life care, wellness, prevention and outcome data.

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David B. Nash, MD

I had the fortuitous opportunity to hear David B. Nash, MD, MBA and Dean of the Jefferson School of Population Health’s presentation on Population Health. At the risk of misquoting Dr. Nash, I will carefully attempt to touch on only a few of the facts, figures, and points that he made in his analysis of what it would take to fix the system.

One of the most profound points that Dr. Nash made was in seeking the answer to the following question:

What percent of adult Americans do all the following?

  1. Exercise 20 minutes 3x a week
  2. Don’t smoke
  3. Eat fruits and vegetables regularly
  4. Wear seatbelts regularly
  5. Are at appropriate BMI (Body Mass Index)

The answer surprised even this writer. Only 3% of American adults are following all five of these wellness and prevention guidelines, and 40% of deaths are the result of smoking, unhealthy diet, physical inactivity and alcohol use. In an interesting analysis of the President’s healthcare speech, finance author  J. André Weisbrod writes: “I see it as a Darwin Awards kind of issue. You are free to be stupid and I am free to not have to pay for your stupidity…”

Bundled payments, end-of-life counseling, evidence-based medicine, an emphasis on quality and systemic approaches to ensuring safety are only a few of the myriad suggestions recommended in Dr. Nash’s presentation.  Bottom line? The third rail of politics is limiting honest, open dialogue regarding reform, and time is running out.

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On Data Breaches

September 4th, 2009

About two years ago, I had a call from my local bank asking if I had purchased a washer and dryer… in Barcelona, Spain. Somewhere, someone had gained access to my credit card number, and used it illegally for that  purchase overseas.

It was not too long after that that another bank informed me that my card had to be canceled because of a data breach at a national chain store where I had purchased some clothing. (I have since come to learn that this data breach has already cost their parent company over $220M.) Then, a few weeks later, another card had to be canceled and re-registered.  Finally, about three months after that, restrictions were placed on still another set of cards due to similar, but entirely unrelated breaches. Three cards, three banks, multiple breaches …and my wallet was still firmly tucked in my back pocket.

Joe Carberry / David Chamberlin / FORBES magazine - data breaches - NickJacobs.org
In a recent article in Forbes Magazine, the facts and figures of this new, growing phenomena were outlined statistically so as to begin to bring some sense to the table regarding what we are facing.  The authors, Joe Carberry and David J. Chamberlin state that “Only 36% of C-level executives are confident their organizations will not suffer data breaches in the  next 12 months.”

As healthcare gears up to go completely electronic, we must remember that there are, for all practical purposes, entire countries dedicating serious efforts to breach the United States data banks.  Hackers are no longer  identified as stereotypical, 98 pound computer savants.  Many of them are professional criminals and terrorists.  As a former CEO, I always had to be cognizant of the risk, then do whatever we felt we could afford to do to help mitigate that risk.  Rarely, however, have I seen any type of comprehensive commitment to a comprehensive, multi-faceted approach to this effort.

computer security1_220The laws that address data breaches involve not only civil but also criminal penalties, and the individual laws of various states are most times very different.  It doesn’t matter if your business is located in only one state. What matters is where your customers are from, and if they are a diverse group, you must comply with each
state law regulating breach notification.

SunStone Consulting, LLC, and Immersion Ltd., through their InfoLaunch suite of products, are positioned to assist you to prepare for any type of breach.  As Carberry and Chamberlin state, preparation must involve not only legal, but also communications, the C -suite, and risk management.  They further recommend the following steps:

1. Be prepared

2. Move quickly

3. Take action, and

4. Be responsible.

The  professional reputation damage that could be encountered by the hospital or physician practice that is not responsible, not prepared, slow moving, and not action-oriented can be devastating.

Are you prepared?

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