Archive for March, 2011

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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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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Communication: It Can Make or Break You

March 8th, 2011
This might be one of those blog posts that you cut and paste to forward to your friends, family, peers or boss …or you may forget that you read it as soon as you have finished it. My experiences in healthcare leadership have placed me face to face with thousands of people who communicate in remarkably different ways. It has been my experience as a non-medical, non-scientific professional that the majority of the communication problems that exist in the workplace seem to be rooted in the nuances between only two of the four basic personality types.

We often hear statements like “He just doesn’t understand me.” “We are talking about the same thing, but she is on a totally different wavelength.” “I just don’t trust him. He embellishes the truth.” “What do you mean by the word, ‘is?’” Although we might drive the same make of car, live in somewhat similar homes, read the same newspapers (whether in print or on an LCD screen) and even enjoy Lady Gaga, we sometimes really have challenges with communication.

Bridging the communications gap - Nick Jacobs, FACHE - HealingHospitals.com
These differences can come from the styles of training, education, or upbringing that we’ve had. Whatever the case, it is real, and honestly, it can be maddening for both sides. One personality type sees the world as completely filled with opportunities. Of course they recognize that there are mountains to climb, but they also embrace the fact that there are hundreds of different paths leading to the summit, and that no one way is the absolute right way to get there. These are people who, when given all of the reasons in the world why something won’t work, can find ways to legitimately avoid those obstacles and make it work. Remember, “There’s a pony in there somewhere.”

Like the creator of the DiSC personality profile, let’s call these people the high “I’s: Initiative, influential, inspiring, impressive, interacting, and interesting.” They tend to accentuate the positive, eliminate the negative, and “Don’t mess with Mr. In-between.” They often do not embrace exact detail because to them it usually doesn’t matter. Theirs is a broad picture painted with pastels that blend easily into one another.

If you are a very meticulous person, both intellectually and emotionally, it is not uncommon for you to want things to be as perfect as they can be. This does not mean that neat people or conscientious people should be categorized in any way because multiple types can have these traits, but if you notice your neighbor on his stomach hand trimming the grass blade by blade with tiny scissors, be worried, my friend, be very worried. Let’s call these people the high “C’s.” They are conscientious, cautious, compliant, correct, calculating, concerned, careful and contemplative. They are the detail people. These are the folks who can discuss the use of one word in a sentence for hours. They represent the Faculty Senate, so to speak.

Without stereotyping anyone, let’s consider the person who made straight A’s all through school. They sometimes become obsessed with those A’s, and would go to almost any length short of cheating to make them. To a valedictorian, an A minus can represent a form of failure. How does this perfection addiction impact their thinking over a lifetime? Where do communication points break down with this type of “no one can do it better than me,” souls? When is enough enough as points are made and subjects are explored. If we don’t know the grading scale, we must continue to push the topic until we feel that it has been completely exhausted. This type of perfection can drive the “We live, we love, we die” people absolutely crazy.

In order for things to make sense to the “Cs,” everything must be linear; your sentences, your thought patterns, your decision making must all be orderly and logical. Black and white and perfection are usually the only things that will bring them comfort. Even with that, they many times will revisit the issue, question it again and again, and then let the person with whom they are attempting to communicate know that they are at fault because their communication techniques don’t match their C needs.

Another trait of these individuals is that they are usually risk averse, and, if you don’t answer them based on their detailed perfection level, some will consider you foolish or untruthful. So, how do we find the common ground?

Let’s face it. Communication can make or break a company, can ignite relationships …or end them. Neither group are bad people, we are just different, and goodness can and does come from both personality types. So, what is the answer to these communication problems?

First, we must recognize and then celebrate these differences. It is absolutely critical for us to find comfort zones and then to celebrate them. An “I” personality answer like, “We’ll figure it out,” may not be what the detailer is seeking, but it certainly is a valid answer. On the other hand the I’s could go that extra step to try to provide the “C’s” with what they feel will meet their needs (in as complete detail as possible).

And if you’re on the other team, make a solemn vow not to avoid the dreamers because a lot of science emanated from science fiction, and they are often times our creators, our artists, and our miracle workers.

So, as we “embrace the differences,” remember that it does “Take Two to Tango,” and that one of you can be creative while the other can strive for perfection. A team like that will never be caught short. As Steve Jobs said, “Your time is limited, so don’t waste it living someone else’s life. Don’t be trapped by dogma – which is living with the results of other people’s thinking. Don’t let the noise of other’s opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.”

In closing, it was Einstein who said, “Imagination is more important than knowledge…” So, let’s all imagine a better world, a world that is not run and controlled by the economists, but one that embraces the passions of our hearts and our emotions.

We really can have it both ways.

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My Shortest Blog Post Ever

March 2nd, 2011

From Modern Healthcare:

The Thirteen Top States

7,345,000  California

6, 433,000  Texas

4,118,000  Florida

2,837,000  New York

1,985,000  Georgia

1,891,000  Illinois

1,685,000  North Carolina

1,643,000  Ohio

1,409,000  Pennsylvania

1,371,000  New Jersey

1,350,000  Michigan

1,273,000  Arizona

1,014,000  Virginia
__________________

27,744,000 Total

The Other 37 States:

16,036,000
__________________
43,780,000 Grand Total

This is, by far, the shortest blog post I’ve ever written.

As a self-proclaimed patient advocate, this blog is dedicated to those 43,780,000 people that the numbers above represent.

THEY ARE THE UNINSURED IN THIS, THE WEALTHIEST COUNTRY IN THE WORLD.

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