Term it Inexcusable

Kreuziger’s experience is shared by most Americans: They want the convenience of e-mail for non-urgent medical issues, but fewer than a third of U.S. doctors use e-mail to communicate with patients, according to recent physician surveys.

“People are able to file their taxes online, buy and sell household goods, and manage their financial accounts,” said Susannah Fox of the Pew Internet & American Life Project. “The health care industry seems to be lagging behind other industries.”

That, from this story. Commentary here.

The blame can’t be placed entirely on physicians. The fact that we don’t pay them for a much less expensive patient encounter (even preventive in nature, depending on how you want to look at it) is completely arcane.

“Medicine is very conservative. It changes slowly.”

Too slowly.

To the future: new practice models

Scott Shreeve on new practice models at The Health Care Blog:

These services are representative of a growing number of similar practices that serve as an example of another important concept to consider in preparing for next generation health care. Millenial patients will demand a new range of services, many of which currently do not exist within the current medico-industrial insurance construct. In fact, the provision of niche services which have traditionally fallen outside the concept of traditional health care may prove to be the biggest opportunity to impact care delivery.

Have you thought about the future today?

On Your Radar: The Point

The Point (think Malcolm Gladwell’s “The Tipping Point“) “helps groups of people, large or small, coordinate action and solve the problems they share.”

With any activity that involves a group of people, we want to know that enough others are participating for our contribution to make a difference. Once participation crosses that “tipping point,” people are more than happy to take action. So, on The Point, each user-generated campaign is only “activated” when the tipping point is reached.

The possible uses of The Point are limitless. Form an ultimatum against an unsatisfactory company. Raise money for a group purchase or charity. Broker an agreement between a group of people. Plan an event with your friends. Those are a few we’ve thought of, and you will think of many more. The Point facilitates any situation where people want to know that enough others are committed before they are willing to commit. Now you can know if your contribution will make a difference before you lift a finger or spend a dime.

From Springwise:

To do this, The Point takes the notion of the tipping point—that point at which group action will produce a clear result and inevitable change—and applies it to organizing group efforts. Those who join a campaign pledge to take specific action—to boycott a company, for example, or donate funds toward a cause—but no one actually acts until the campaign reaches its preset tipping point, or number of pledged participants. When that point is reached, however, the action is triggered and participants make their donations, attend the event or boycott the organization. The Point can also be used to organize anonymously until a campaign builds to a level that provides safety in numbers and allows people to reveal their identities comfortably.

It’s a wonderfully cool idea. But you could end up on the wrong side of coolness. Hospitals could be affected in a number of ways: community benefit concerns, organizing providers, unhappy employees, disgusted patients…

World Health Congress

Pure brilliance this week at the World Health Care Blog.

Like Dr. Jay Parkinson‘s (the coolest doctor in the world btw, here is his full-time blog) flat out indictment of our health care system:

Let’s talk about the characteristics of people who use healthcare in the US:

1. They spend someone else’s money on routine and specialized goods and services. “The United States has the best healthcare someone else can buy.”

2. They have no easy way to gain knowledge when they need it (like Pricegrabber) about how much they will “spend” on a given service and, often times, product.

3. If they do have knowledge about the amount they’ll spend, it’s often in the form of the amount of the co-pay (a heavily discounted price that cheapens the value of a doctor’s visit to a near meaningless ten dollar bill).

4. There is no way to shop for value.

5. There is no way to have the consumer experience similar to a visit to the Apple Store because doctors are paid for volume rather than the retail consumer experience.

6. Online rating systems are terribly flawed. Only people with an agenda (either a great experience or negative experience) go out of their way to rate their doctors. Therefore, “consumers” have no ability to measure value.

7. Value, in the mind of the consumer, is how long they waited for an appointment, how long they waited in the doctor’s office, how much they had to pay for the medication they were prescribed by a physician, and how much of the transaction their insurance covered.

8. All of these “values” are worsening in the minds of consumers in the current healthcare climate due to the trends showing an ever-increasing cost-shifting to employees and decreasing physician reimbursements causing an increased volume of patients in the doctor’s offices.

9. Value, to consumers, is increasingly becoming “Did I actually see my doctor?”

A host of bloggers are covering the World Health Care Congress in Washington D.C. There is a lot of good stuff to comb through. Here’s the first post with bios of all who are blogging this week. Start there and read through the rest.

Hospitals Should Compete on Quality

What would happen if hospitals competed on quality?

Competition is rare in health care. Really. Health care is full of rivalry. There’s a difference.

From the trusty Merriam-Webster OnLine: competitor: “one selling or buying goods or services in the same market as another;” rival: “one of two or more striving to reach or obtain something that only one can possess.”

I would suppose that rivalry is similar to what Porter calls zero-sum competition.

Competition is healthy and it should force prices down while improving the product delivered. Here’s the problem: prices are not decreasing. And quality is improving—because it is the right thing to do—not because of the forces of competition.

It may be possible to compete on price at some point in the future. But until health insurance is reformed so that patients know how much health care really costs, I just don’t see it happening. If we’re really interested in competition, and competition sooner rather than later, it is going to have to be quality of care that leads the way.

This isn’t a new idea, but I like it, and I think it could go somewhere.  The prevailing question has been “will competition improve quality?” But why not just compete on quality since we’re having such a difficult time competing on price?

CMS is working toward a quality comparison solution.  But its development is slow and functionality minimal.  Quality measures are difficult to agree upon for comparison purposes.  Difficult is the key word here, it is not impossible.  It is another opportunity to be proactive about positive change.  Hospitals are already late: Health 2.0 companies are pushing the comparison tools forward.  Thankfully.

Here’s the question: is your organization hiding behind a rock or leading the way in quality reporting?  Competition on quality could very well be the future.  And if so, the transition will be swift (it won’t be phased in by CMS, it will be forced in by outside forces).  Will you be ready?

Happy Hospitals: Smiles are Worth a Billion Words

A friend was describing her hospital workplace culture recently.  Problem: people rarely smile.

The power of a smile.

The winter months do get long.  Gray is gray is gray.  But I think there is a much larger problem here.  How can we make people truly happy when they come to work in the hospital?  How do we get people to care about the vibe an organization conveys?

(sidebar: check out Gretchen Rubin’s The Happiness Project)

We have to make people care.  (For a relevant metaphorical blog post, read this one by Ben Casnocha)

I believe it goes further than great wages and good benefits.  Those are important, no doubt.  Crafting an enjoyable work environment is vitally important.  Responding to employee needs.  Asking for employee input (secret to success: acting on employee input).  Truly valuing employees is key.  Saying we value employees isn’t it.  Employees that feel valued…is…it.

Not having been in management, I’m unaware of the difficulty in building an employees-are-valued environment. But having worked in a plethora of organizations my list of things not to do is long.  Let’s just say there is plenty of room for improvement.  The thing is, many organizations are not trying to improve.  And that could be a fatal mistake.

It does start at the top.  Step 1: smile when you’re in the building (not every event in a hospital calls for a smile, but make it your default facial expression).  Step 2: ask employees how they are doing and if they need anything to help them do their job better.  Step 3: ask patients if you can do anything to make their visit more comfortable. Step 4: repeat! repeat! repeat!

I do know the first step in making a hospital a warm and inviting place for patients: the workers inside the hospital need to be warm and inviting.  Not groundbreaking.  But I’ve yet to find a place that is perfect.  And if your organization isn’t perfect, why aren’t you working on being so?

Learning by Surfing: Issue 1

Often I find things I would like to share but don’t have enough days in the week to do so.  Solution: Learning by Surfing [working title].  Here will be links, comments, other stuff, etc. that time did not allow me to share earlier in the week.

Well, you know, effective markets aren’t created by vacuums. Markets are ways to channel human energy and ingenuity, but only when they’re transparent, when they’re structured, when you’re building on human social capital, when you’ve got talent and investment capital. If we really want to think about new solutions, it’s not just identifying the right people and the right programs; we need to create an environment where these people and solutions are able to thrive.

I am often transfixed by the similarities between health care and education reform.  The above quote is from Frederick Hess, the director of education-policy studies at the American Enterprise Institute, in a New York Times Magazine article discussing education reform through philanthropy.  I don’t know which industry’s problems would be easier to fix, but maybe if were to find solutions that work in one, we could solve the problems in the other.  Interesting outlook by Hess, “We can’t solve it without outside intervention.”

1 Friday: 4 Futures is one component of a New York community based initiative that “seeks to engage Western New Yorkers in exploring possibilities and setting goals for a stronger, improved health care system for the eight-county region.”

The project’s goals are to 1) promote broader, informed civic engagement in our communities on matters of health and health care; 2) give voice on health care priorities to those who use and those who pay for health care; 3) define a people-driven set of priorities which can be tracked to measure progress toward the desired goals; and 4) learn lessons from other places about ways to improve our health care system.

1 Friday: 4 Futures seeks to help people think about the future of health care in New York through four intertwined stories (pdf) that takes place on one day in the future.  “The date is the same in each story but each Friday has been reached along a different path, with distinctly different outcomes for all involved.”

Just noting a different attempt at laying the groundwork for reform.

The Comarow on Quality blog turned its forum over to a nurse for a blog post to write about her encounter with the health care system from the patient side when she took her daughter to the ED.  She documents her concerns, demands, and overall thoughts on the entire experience.  I always find it interesting when providers’ experiences with health care shift their thinking.

The discouraging part is that she came back for post two.  This time to address the (many negative) thoughts and comments of other nurses on her experience.  Interesting stuff.

From the Health Business Blog:

American Public Media, which produces radio shows such as Marketplace, has launched Health Care Idea Generator, a website dedicated to a discussion of how to improve the American health care system. Everyone seems to have an idea or two on what’s wrong with health care and how to fix it, so the site is an attempt to harness that energy.

As I was reading the post, it struck me that all the of the ideas would effectively add costs to the system, which also was the opinion of David Williams:

Like so many of the health care ideas out there, all of these will end up boosting overall health care spending, which isn’t going to help our overall problems.

Tom Peters and customer service.  Nothing is Irrelevant.

From Al Dente:

To curtail Japan’s overweight population, the Japanese health ministry recently mandated that all waistlines among its 56 million workers over age 40 be below “regulation size” of 33.5 inches (for men). Any company failing to bring its employees’ weight under control–as well as the weights of their family members–will be fined up to 10% of its earnings by the government.

14. Connectedness: healthTV at our own system

More information is key. Providing an abundance of information to patients can be challenging. Properly organizing and delivering that information can mean the difference between a satisfied and dissatisfied patient.

If you’ve ever walked into a hospital room you know there is one thing most have in common: the TV is on.

Video on-demand is a concept many are familiar with. our own system will use the technology to create an interactive media channel delivered over an internal network. Johns Hopkins has a patient safety video on-demand service:

Patient education is an important part of your hospital stay and recovery after discharge. It is important for you and your family to understand your condition, treatment and any follow-up care you may need. As part of our television service, the hospital offers a wide range of patient education videos and informational presentations on our free Patient Education On-Demand TV System.

In order for the channel to carry a professional feel, our own system will hire a team to work with providers and employees to create content. That staff will need skills in videography, production, writing, graphic design, among others.

The possibilities are truly endless.

Patients could be welcomed by management with a video. Providers could each have a video describing what they do and who they are. An outline of hospital services and local community information could be displayed and disseminated with ease. Or how about hospital policies, principles, and other information. our own system could explain its commitment to the highest quality care, or information about its Leapfrog designation (and U.S. News ranking), or latest Joint Commission accreditation survey findings, or policies related to medical record privacy.

After a physician provides a diagnosis and answers all of the patient’s questions, that patient may desire more information. It could be provided in video format and may include information about the diagnosis, treatments, and what to expect from that point on.

How does a visitor get to the cafeteria from the hospital room? Or to a coffee stand? They could watch a video tour outlining the way to the cafeteria before setting out on the journey in order to gain familiarity with the surroundings.

Another opportunity include healing video options like NewYork-Presbyterian:

Patients at NewYork-Presbyterian Hospital are tuning in to a unique television channel specially designed to promote healing. Putting aside pundits, police dramas and other anxiety-laden programming, they can now relax and reflect to uninterrupted video imagery of beautiful and inspiring natural vistas—a meadow of wildflowers, ducks swimming in a mountain lake, etc.—set to soothing instrumental music.

The video on-demand service could also provide answers to questions that may be tough to ask. If the patient is dissatisfied with an aspect of their care, it may be difficult to ask a nurse how to make a complaint. A video could explain who to call and how we will respond.

Most importantly, the videos would cover safety issues in the hospital. They could explain proper safety procedures, how the hospital deals with safety and infection control issues, and what kinds of questions to ask providers related to safety.

Principle #14: Some patients want as much information as they can get, others could care less. Instead of trying to find the balance between giving too much paper and not enough, healthTV at our own system would allow patients to choose what they receive. This type of media allows the hospital to individualize care and improve patient satisfaction. We have nothing to hide. Being completely open with patients is the right thing to do. As connectedness continues to evolve, our own system will use the latest technologies to improve the patient experience.

What health care actually costs

Our employer based health insurance system distorts the real cost of health care.  Some (rightfully so) attribute our current consumption activities to this distortion.

A classmate was relaying a conversation last week that she had had with a group of law students.  She asked, “How much do you think open heart surgery costs?”  One response, “a couple of thousand bucks.”

The WSJ Health Blog wrote a couple of weeks ago about San Francisco restaurants reacting to a local mandate to provide health insurance to employees.

Since the beginning of the year, San Francisco businesses have been required to offer health insurance to employees or pay a fee to the city to fund health care.

Some restaurants are passing the fee on to consumers in the form of a health surcharge, which shows up on the bill as a flat fee ($1 per person, or so) or as a percentage (like sales tax).

Interesting thought.  A surcharge at the bottom of a Wal-Mart receipt?  Or a hotel bill?

Can you imagine GM placing a line item at the bottom of the sticker on a new car detailing a $1,500 surcharge for health insurance (back when they offered it to retirees).  Not that it would change the bottom line price.  But do you think that would make someone think twice about purchasing the vehicle?

Real Quality: no more lip service

Hospitals have most likely responded (let’s hope) to CMS’s decision to not pay for a number of medical problems arising from hospital mistakes.

Good news. CMS has come out with a proposal to not pay for nine more preventable conditions.

Is quality getting the attention it deserves at your hospital?

My guess is (and probably dependent upon your role in the organization) that the answer is “not really.” We all know it is important. BUT! Some hospitals take quality very seriously. Most are just trying to figure out how to prevent the conditions CMS won’t reimburse for. And some hospitals probably shouldn’t be in business. It’s the bell curve. We need to shift that curve to the right.

Hospitals have been entangled in an epic struggle to stay clean since the days of Semmelweis (maybe a few years later). We’ve all seen the posters, maybe participated in a class, possibly evaluated the data. It’s been going on for years.

We know what hand washing (or alcohol sanitizing) can do. Here’s quick refresher if you have forgotten. Yet compliance rates are still poor. What is the problem? My take: accountability.

It’s time to stop paying lip service to quality. High quality is not adding a sentence to a mission statement. It’s not reporting required data to CMS. It’s not telling employees that quality is our top priority.

It is action. As an extreme, think of how good hand washing compliance would be if the person in charge said, “You will wash your hands at every appropriate moment or you will not have a job tomorrow.”

I’m a big fan of a blame-free environment. Report, report, report! But there needs to be balance. From the the New England Journal of Medicine, “But if we really are serious about making care safer, I would argue that we need to find the right balance between blaming mistakes on systems and holding individual providers accountable for their everyday practices.”

We must find the resources to make quality our top priority. Period. In an era when patients will demand to know everything quality-related about our services, we must be ready and willing to comply. CMS has provided the “business case” by ending reimbursements for hospital mistakes (and are working to reinforce the issue by extending the list). The question is, do you want to lead the way (and by proxy, define what high quality is) or slowly follow? The right side of the curve will be filled with leaders. Organizational success will follow.

UPDATE: Coincidentally, two quality related stories today: Cigna is following the CMS lead and the GAO says the feds haven’t done enough to establish quality and infection control guidelines in hospitals