7. HEALTH care (emphasis on health)

Since the beginning of Western medicine–when a patient had a few swigs from the whiskey bottle before a procedure–the practice of medicine has been reactive. And for good reason: someone has a medical problem so a doctor would address it. Why would someone see a doctor if they’re not even sick?

Well, progress is a strange thing. Today, we don’t think twice (sadly, some don’t think about it at all) about yearly physicals or a mammogram every one to two years. Proactive health care is here (that shouldn’t be much of a surprise). Preventive medicine can help to control disease–even prevent disease in some cases.

This post at the World Health Care Blog addresses the issue by discussing whether or not hospitals are moving from a model dedicated to health instead of the more traditional sickness; it was inspired by a report published by the American Hospital Association with a section titled “Focus on Wellness.”

our own system will focus on wellness. Traditionally, the post says, “efforts often address one or two wellness initiatives, such as flu shots for their own employees and the medically underprivileged, or focus on the poor and frail, as part of their mission, PR and tax-exemption maintenance strategies.” our own system will make a concerted effort to dedicate the system’s complete efforts in order to focus on wellness. More from the blog describing that mission:

This wellness focus included the call for efforts to prevent or at least reduce the incidence and prevalence of illness and injury in the first place, along with measures to manage chronic illness once it has arisen. It addresses the health risk conditions and behaviors that employee and population health management efforts by employers, insurers, and governments have been investing in for some time. This suggests, at least, that hospitals are finally being asked to become part of the solution to the healthcare/cost crisis, rather than the part of the problem they have been up to now.

Of course, sickness care will still need to be a big component of our care for patients.  However, our own system will be the impetus for the paradigm change amongst our stakeholders required to make the shift to wellness.  The shift will take considerable patient education, third-party payer support, and physician buy-in.  As the meeting place for all three of these groups, our own system can be the uniting component of a fundamental shift in thinking and practice.

Principle #7: We will focus on the health portion of the phrase health care.  our own system will bring together key stakeholders in the delivery of care and provide the needed platform to make a complete effort dedicated to comprehensive care for our patients, with an important focus on wellness.

The Answer: More Doctors?

USA Today had an article recently on the shortage of surgeons across the country, writing the shortage is particularly hurtful to the 54 million rural Americans.

The article goes on to say what many already know: more medical students are choosing specialty care and “‘fewer and fewer are going into family medicine and primary care,’ says James King, president of the American Academy of Family Physicians. And ‘many are not willing to go’ to rural areas.”

The problem, they say, was rooted in 1980s and 1990s when medical schools capped enrollment.

The solution?

To address the problem U.S. medical schools admitted nearly 18,000 students last year and the ultimate aim is to increase enrollment by 30% over 2002 numbers by the year 2015.

Whether or not we need more doctors is a matter of debate, but that’s not my argument here. There’s a reason medical students aren’t choosing career paths like primary care and general surgery and it’s easy to understand.

I was talking with a medical student who will shortly begin his intern status. We were talking about primary care; he indicated his $200,000 debt (!) and the fact that he will be in his early 30s before he makes his first real paycheck prevent him from even thinking about about general medicine as a career. So I asked, if a primary care physicians made $100,000 more than they currently make, would you at least consider it?


That’s wrong. Primary care physicians are an important element of our current system, future reform may hinge on their abilities. It’s one thing to say that we will have a shortage of physicians with the solution being to train more and an entirely different matter to convince/persuade them to train for needed primary care roles.

Paying them more is a start.

Addressing the lack of physicians in rural areas will take more creativity. Training more physicians and “hoping” they will choose underserved areas to serve is a bit naive. Maybe we could start with tuition forgiveness programs for serving in rural/underserved areas?

Empowering the health care consumer

Hotels.com has a great commercial that shows a man being carried to his room by the hotel staff. A little confused, the man looks up and asks whether he is receiving special treatment because the hotel knows that he will write a review of his experience. One of the men carrying him looks up and candidly responds, “yes.”


What a novel idea! A service delivery industry responding in a positive way to consumers who are aware and critical of their experience. Could this be possible in a hospital setting? The answer is unequivocally YES! My guess is that administrators, physicians, and other members of the hospital elite would argue with me: after all, what do patients know of the complicated processes that go on in a hospital? Capacity is maxed out, nurses are overburdened, and physicians are already carrying more than a full schedule of patients. Oh yeah, throw these aspects of a hospital stay in with the fact that patients wouldn’t know or understand the procedures or terminology that are being thrown around and the situation is ripe for patient frustration and unhappiness, right? Wrong.

A person is always more intelligent than he or she is given credit for, and there needs to be accountability for a bad experience resulting from a delay in treatment, complications from treatment, or just plain poor treatment from clinicians. Websites like healthgrades.com, revolutionhealth.com, and ratemds.com need to be utilized by health care consumers who can voice their hospital experience, good or bad.

Right now, health care consumers treat health care as a commodity, something for which there is no qualitative differentiation across the market. But, the truth is that health care is NOT uniform. There are good physicians and bad, there are good nurses and bad, there are clean hospitals and dirty hospitals, there are efficient hospitals and inefficient hospitals, etc.

Empowering the health care consumer by expanding his/her knowledge of a given health care setting would hold caregivers accountable and, just maybe, lead to physicians and/or nurses carrying their patients from the lobby to their rooms because they know that patient will write a review describing his or her experience at the hospital.

A Grand Welcome(s)…

A couple of items dealing with welcomes…

Per usual, Beth Israel Deaconess Medical Center is doing something extraordinarily right (at least in my opinion). I’ve written before on the difficulties of navigating a large hospital, especially on first visits. While many organizations offer information desks, BIDMC is being proactive in delivering help to individuals who walk through their front door by utilizing “greeters.” Their job “is to be available to help people find their way in the hospital, including escorting them as necessary to find the right place in our 2 million square feet of space.” (Applause!)

The second item of note is a welcome of our own. When our own system started, my full intention was for it to be more than just me trying to carry this conversation (hence the our in the title, and all the we talk from the beginning). I’m excited to welcome Matt Vestal (read about him here) to our blogging team. Matt and I often have stimulating discussions on all-topics-health-care and his questions/insight/ideas will add value to this blog and contribute to our evolving search for the definition of sustainable health care.

Again, if you consider yourself a health care amateur, and feel like you have something to offer to our own system, contact me!


Yesterday, CMS and Health Affairs published an analysis of the growth of U.S. health care spending through 2017.  In one word: Up.

Covered here by the WSJ Health Blog, go here for the AP string.

$4.3 trillion is the expected amount that we, as a country, will spend on health care in 2017.  That’s only slightly more than double what we spent in 2006, $2.1 trillion.

The big point:

“As a percentage of gross domestic product, known as GDP, health care spending is projected to increase to 16.3 percent in 2007 from 16.0 percent in 2006.  By the end of the projection period, health care spending in the United States is expected to reach just over $4.3 trillion and comprise 19.5 percent of GDP. ”

Forgive me for addressing the elephant in the room, but where is an extra $2.2 trillion going to come from?  Listen/read/watch anything on health care  and you are sure to hear about our unsustainable spending habits.

Add this: the report doesn’t take into consideration the possible increased role of government through health care reform, ala Barack and Hillary.  John McCain’s plan gets at reform a bit differently.  Regardless of the direction we, as a country decide to go, I’ve realized that health insurance reform addresses a piece of the puzzle, it will not be the elixir that cures all.

Further, a component of all plans is the promotion and utilization of preventive care.  While the benefits are good for public health, a report in the New England Journal of Medicine recently said, “Sweeping statements about the cost-saving potential of prevention, however, are overreaching. Studies have concluded that preventing illness can in some cases save money but in other cases can add to health care costs.”

Quite the predicament in which we find ourselves.

Here’s an interesting post on learning from another industry.  After reading “Will Disruptive Innovations Cure Health Care?” in the Harvard Business Review (if you have access to HBR, it’s worth the read) by Christensen, Bohmer, and Kenagy, I’m beginning to think we just need to start over, completely.

Retail clinics may be a start down the right path; however, whether they will work (as in accepted) or not is still up for debate.  But the thinking is right on cue.  A bill of $4,300,000,000,000.00 leaves nothing sacred.  We can choose to change, or be forced.  The time to act is now, you can be the solution, any ideas?

Population Growth and Hospitals, Finding Help

Hospitals continue to cope despite arguments of severe nursing shortages. Take the state of Iowa for example, where officials say that current nurse staffing runs 8% below the desired level and could reach 27% within ten years. Nationwide, the country could run a deficit of 340,000 nurses by 2020.

Although slowing, United States population growth should reach nearly 400 million by 2050. All the baby boomers should be retired by then, too. We see the need for nurses.

FastCompany has a blog called The Big Idea (which more or less is a thought of the day) and one day last week it was this, inspired by the California Department of Finance: “You can build all the walls you want, but this country is going to have a Hispanic majority by 2050. ”

I haven’t seen nurse shortage predictions that extend to 2050, hopefully we have some game-changing innovations in nursing care by that time to quell the need. But, right now, the responsibility falls to hospitals to reach out to these new Americans and encourage them to pursue a career in health care, especially nursing.

We are going to need the help. Here’s a story of something like this already happening. But the idea needs to spread beyond traditionally Hispanic (Texas, California, etc.) states.  We’re going to experience the shortage everywhere and this new population can provide the help in every corner of the country.

Two-year old magazines in the waiting room…

What does a magazine from 2006 in your waiting room say about your organization?

A lot.

What if there is more than one?  And even a Hancock Fabrics catalog from 2004?

A lot more.

Being unable to display (somewhat) current issues of magazines is a problem.  It’s almost to the point that an organization is trying to be that bad.  Patients who bring in their own magazines and leave them behind should be better able to keep the stack refreshed.  But what reason would hospital waiting rooms have to keep patients reading about Google’s purchase of YouTube or the World Cup in Germany?

Beside reminiscing about the good ol’ days of health care spending in the United States, nothing. (Well, I guess you could prevent them from reading well-intentioned, yet slightly misleading articles, like this.)
It’s a culture problem.  It shows how your organization feels about its most important customers.  It’s (all!) about the patient experience: and at any appointment (like many of us have experienced) waiting is a key component.  And in a competitive market, it’s reason enough to try the guys down the street next time.

Competition of pride?

There’s a mess going on in California regarding the retroactive termination of insurance benefits well-covered by The Health Care Blog, so go there for the wonkery.

But what caught my attention was in the fine print of the post: “(FD I am a HealthNet individual policy holder and they haven’t “recivved” me yet. Then again I haven’t had a claim in 3 years!)”

A big push of consumer-directed health insurance and high deductible health plans is to get consumers involved in care decisions, more or less taking away the perception of free care that often arises when patients are well covered by traditional insurance policies.  The ethics, along with the pros and cons, of this notion can debated later.

What struck me was the exclamation of pride of not having a claim in three years.  I don’t want to spend any time in a clinic or hospital either, but when do no claims become a bad thing?  Obviously we are not privy to the specifics of the individual policy, however, as some experts claim, HDHPs may prevent patients from seeking needed care.

My question is, will a period of no claims become a competition of pride amongst us?  A boasting of sorts?  Maybe.  But is it a good thing?

6. Share Our Stuff

Sharing is the way to do business.

Google (and others) allows developers to download it’s code for applications like Google Maps.  Those developers then create “mash-ups” combining ideas: a map and something else (a pretty cool example: “Time Space Map is an encyclopedic atlas of history and happenings that anyone can edit.”)  Linux is an operating system (similar to what many of you are using currently: Windows).  Only Linux is developed by anyone who wants to–the source code is freely available to anyone–developers collaborate on creation.

Some more examples:

According to Bloomberg, “Harvard University professors may publish more research online, free to readers, after the school’s arts and sciences faculty adopted a new policy.”

The University of California Berkeley has a YouTube site where you can view a number of lectures including “Physics for Future Presidents.”

Stanford utilizes iTunes for much the same purpose.

The Public Library of Science “is a nonprofit organization of scientists and physicians committed to making the world’s scientific and medical literature a freely available public resource.”

Sharing themes abound.

Ideas don’t do any good if you place them under lock and key hang onto them for dear life.  They will probably be irellevant in a year anyway.  The power of ideas comes when they are shared, when they can be thought about, utilized, and implemented everywhere.

Maggie Mahar’s “Money-Driven Medicine” brings us this vignette from Dr. Donald Berwick, co-founder of the Institute for Healthcare Improvement, “Berwick recalls phoning a hospital in Houston to learn about its reportedly successful innovations in pneumonia care, and being told that ‘the gains were enormous but that the methods could not be reported to the public–excellent pneumonia care offered the hospital local competitive advantage.'”

The book continues as Dr. Berwick says, “The enemy is disease.  The competition that matters is against disease, not one another.  The purpose is healing.”

Maybe we all need to re-visit the sharing lesson.

Principle 6: It’s not mine, it’s not yours, it’s ours.  We’re in this together (this meaning fixing our health care system).  Revolutionary ideas need to be diffused…quickly…incessantly.  our own system will share all we have to offer, from research, to innovative ways to care for patients, to the ways we do business.  It’s time we rid ourselves of selfishness and come together and share to achieve a common good.

What’s your opening act?

Who is opening for you?

Late night talk shows have a person dedicated to warming-up the crowd before Conan, Dave, Jay, or Jimmy start the monologue.  Headlining bands around the world do the same thing when they utilize opening bands during live concerts.

First impressions matter, a lot.  First impressions matter in a job interview.  First impressions matter on a first date.  Even magazines pay attention to first impressions.

This is important in our hospitals, too.  The unhappy (or even just blah!) person at the registration desk sets the tone for the rest of my visit.  Driving around a complex medical campus, frustrated, just trying to find where I am supposed to go starts my visit down the wrong path.  The volunteer that greets me with a smile as I walk in the door could make all of the difference.  The cleanliness of the hospital’s grounds and facilities, the serene water piece near the entrance, the amount of paperwork I have to fill out before my visit, the amount of time I wait before seeing a provider, all matter.  The list could go on.

First impressions are so fragile–it truly takes so little to make a good one (or to go horrendously awry).  A hospital can manage a patient’s experience.  Setting the tone that this hospital is different, that this hospital truly cares about about the patient, can make all the difference.

Who is opening for you, more importantly what’s your opening act?