Posts Tagged ‘transparency’

E-Patient Dave: Let Patients Help!

August 7th, 2011

After a life-changing experience, Boston area businessman Dave deBronkart has re-named himself E-patient Dave.  My introduction to Dave took place on January 26th, 2010.  We were both invited to make presentations in Washington D.C. at the Health 2.0 STAT event. This was my first rapid-fire Ignite or Pecha Kucha-style presentation, and, frankly, I was at first a little overwhelmed by the brevity. Having been a teacher for the first decade of my career, the experience was similar to following the Assembly Day bell schedule in any school. We had strictly limited time to “tell our story,” and as the first hospital CEO in the country to have had my own blog (beginning in 2005), it was a story that I had told before in cities like Chicago, Las Vegas, Washington D.C., Charleston. What I hadn’t expected to hear that evening was my fellow presenter Dave’s powerful and inspiring story.

Interestingly enough, after retiring from my hospital CEO position in 2008, my passion had been redirected toward the one thing that touched me the most during my 22 years of hospital administration, patient advocacy. It was simple to me. The United States of my youth was changing, but healthcare, not unlike many other professions, has always been filled with terms, attitudes and activities that are mysterious, confusing, sometimes inhuman and usually concealed from the very patients who are receiving the services and benefits. Consequently, it was my desire to reach out to every person to let them in on the “inside track” to healthcare, to share with them the insights gained by my two-plus decades in the business, and to help them get the excellence they truly deserve regarding treatment, respect and care. The result was my first book, Taking the Hell out of Healthcare.

Dave, on the other hand, told the story of his own very personal journey through his near-death experiences as a patient at one of the Harvard Hospitals. His very moving and special story was one that not only touched everyone’s heart; it also demonstrated the very deep and real need for transparency, communication and access to our own health records.  Interestingly, the happy ending to Dave’s story was a twist on what had been a very moving and very different ending for one of my closest personal friends about two decades earlier. So, the good news for Dave was that they had refined, improved and eventually perfected that treatment that saved his life.

The most important aspect of his story, however, was that his physician encouraged him to seek input via the Internet from other people who had lived through similar experiences. It’s where Dave found the recommendation that later proved to be the secret to his survival.

Because of his compelling story, his amazing recovery and the beauty of having lived to participate in his daughter’s wedding, there was not a dry eye in the house. As a patient advocate, I freely admit that included my own eyes. Dave is exactly what this country needs right now. He is a man who is utilizing all of the tools available to all of us via Internet connectivity, and he is pushing hard for positive change that is sorely needed in our field.  So, you go, E-patient Dave… don’t stop now.  In fact, don’t ever stop.

e-Patient Dave de Bronkart, Nick Jacobs, FACHE, Health 2.0 DC STAT meetup #health2stat

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Wikileaks and Transparency

December 9th, 2010

LONDON (Dec. 8th) —Held without bail in Wandsworth prison, Julian Assange has been deprived of his trusty laptop, so the WikiLeaks founder can’t supply an inside scoop on life behind bars. But if the pro-transparency campaigner could leak just one word about conditions in Britain’s biggest jail, he would probably settle for “cramped.”   (via AOL NEWS)

Wikileaks' Julian Assange at TED - Nick Jacobs, FACHE

At my last CEO position, there were about 650 employees on the hospital side and another 50 at the research institute, but in the position that I held as the Chief Communications officer immediately before that,  there were over 4,500 employees.  Any one of those employees could  potentially have become PFC Bradley Manning.  Manning is the young man being accused of leaking millions of pieces of information to Assange’s Wikileaks. Every disgruntled, well-intentioned and sometimes naive employee who either had an “axe to grind” or who simply embraced a philosophy of openness would have potentially presented a major problem to any organization that was built around secrecy at all costs.

In my 20+ years as a hospital administrator, there were hundreds no, thousands of incidents that could have been “leaked” to family, friends and the media regarding incidents that may or may not have been problematic.  My memory goes immediately to an online discussion forum where the death of Congressman John P. Murtha was being dissected by a group of Bethesda Residents;  specifically, young U.S. Navy physicians who were venting and expressing their fears regarding their “being held responsible for the death of this powerful Congressman.”  The amazing thing to me was the it was a running dialogue that was, yes, online. The discussion topic thread was etitled Did we kill Congressman Murtha? The anonymous user names went through case-by-case analysis of other undeserving patients who did not emerge with their lives from surgeries at the hospital over the previous weeks and months.  These were individuals who, according to their estimations, should have. Imagine my shock when I came upon the casual page which, at minimum represented a potential HIPAA violation.

Well, it’s all about transparency, my friends, and this movement is only the beginning.  Unlike Kevorkian’s efforts which were almost single-handed, this is a movement, a viral, well-funded, philosophical movement that feels like “Damn the torpedoes, full speed ahead.” And it’s “coming to a theater near you.”   Not unlike the content of the sensitive documents that have been appearing online recently where peoples’ lives are at stake,  hospitals and physician offices face many of the same realities every day.  How many people, like PFC Manning, may not be truly insane or wish to destroy the government, but simply believe that their assistance in exposing the truth will “set us free?

Transparent Butterfly - Nick Jacobs, FACHE - Healing HospitalsAs business leaders not many decades ago, we were urged to treat every e-mail and every comment as if it was being reported by Mike Wallace on 60 Minutes.  Of course, not many of us did, nor could we stick to that difficult rule of communicating, but think of the potential ramifications if Mr. Wallace had been as potentially ever-present as Mr. Assange.

What is my formula for success?  It’s always been the same.  Be as transparent as you can possibly be. Seems simple, but try it sometime. Don’t break the law. Don’t give out information that is inappropriate as in personally destructive regarding individuals, but be as open about your operation as you can possibly be.  Encourage an environment of openness when it comes to issues, mistakes, etc. and the frustration levels will go down, down, down…sometimes to the point of having employees telling you, “I wish I didn’t know so much.  Life was easier when I was in the dark.”  That’s when you’ll know you are beginning to provide a truly transparent business environment.

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$500 Billion From Where?

October 26th, 2010

In a recent conversation with a long time healthcare CEO, he made the following observation:

“There are about 2,750 pages to Obamacare.  I have no idea what the implications are of the first 2,700 pages, but I do know that at least 50 pages allude to the fact that $500B will be cut from hospital reimbursements in order to support the new legislation, and it’s also clear that these monies will be cut based upon quality.  Pay-for-performance will be the new catch phrase of the reimbursement world, and our peers are not ready for this stark reality.”

How does one move from a non-transparent system to one that allows anyone to log onto healthcare websites and search every detail relating to the success rates, scores, and capabilities of any given institution?  One very obvious “missing element” in hospital-related problems is the lack of dedication to getting to the “root cause” of most issues.  We are great at work arounds, but rarely take the time, energy, and have the cultural commitment to dig deeply enough to literally stop the root cause of the problem.  Is that why there are a reported 98,000 people killed by our facilities, and about an equal number injured each year?


Several organizations have attempted to take on these issues, but few have gone beyond scratching the surface of the real problems.  As bundled payments become the norm, a commitment to getting the highest available reimbursement for procedures will take on a new meaning.  Imagine a great doctor in an under-performing medical center where his or her work is not rewarded equally to a peer in a stronger hospital, because that bundled reimbursement was lowered due to institutional medical imperfections. Charles Kenney in  The Best Practice, and Steven Spear in The High-Velocity Edge have both addressed some of the nuances of this new culture, this new world order, but for hospital administrators, physicians, and staff to “get their arms around it,”  there will need to be transformational shifts in the fundamental culture of the organization.

Leadership will be forced to accept personal responsibility for virtually everything that occurs in an organization.  Employees will need to be empowered to embrace shared values, and key targets such as patient and employee safety will need to be identified so that goals can be set that stop nothing short of a level of complete PERFECTION.

The healthcare establishment will also need to embrace transparency within their organizations, and that information must be shared with everyone.  Most importantly, it must include the human element.  What is the human impact of each and every error or mistake?  This point alone will represent a major cultural shift in the way we do business.

Truman's phrase "The Buck Stops Here" - F. Nicholas Jacobs, FACHE

Employees, physicians, and administrators will need to actually be taught to see risk, and be provided with data upon which actions may be taken.  Most importantly, however, problem solving must be encouraged and supported at every level of the organization.

How is this all possible?  I was recently on a speaking tour to several hospitals, and the bottom line at these facilities was that their leadership was “new age.”  They had worked diligently to decrease the hierarchy and to reduce and reorganize the roles of those in operations in order to support the fastest possible improvements.

The tsunami is coming, however slowly it may appear to be; it is approaching our healthcare shores, and quality – no, perfection, is the only means left for achieving success or, in many cases, is the only way to survive.  We must discipline ourselves to see problems and not simply try to work around them.  We must establish a problem solving culture.  We must set our goals and empower all of the players to do what is needed to solve these problems once and forever.  Harry Truman’s phrase, “The Buck Stops Here,” should become every CEO’s mantra, and the journey will finally begin, the journey to solve the myriad repeating problems in our current system.

Nick Jacobs, FACHE - HealingHospitals.com

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