19. Complain. Listen. Improve.

We (as in people) love to complain.

Hospitals spend a lot of money in order to give patients a platform to voice their complaints about recent experiences.

But often, if a patient does have a complaint, a hospital only finds out weeks later and the organization has little opportunity to rectify any issues.

our own system will employ a surefire method to overcome the delay in response: listening.  As annoying as constant complaining can become, the behavior is a great opportunity for organizational improvement.

Listening allows an organization to improve an experience now.  Increasingly, the now part of that last sentence is gaining in importance.

Employee complaints are important too.  Sometimes it is cathartic.  But it is also an opportunity for our own system to improve itself.  Listen on the employee shuttle.  Listen in the break room.  Listen in the cafeteria.  Listen in the hallways.  Listen in any area where employees mingle with fellow employees.  These interactions can provide insight on how to make our organization better.

The web provides an opportunity to listen to complaints as well: is a patient twittering?  Can we find any complaints through a blog search?  We can utilize our hospital’s social network to collect complaints.

The opportunities are there.  The complaints are many. We just have to listen.

Principle #19: Listen.  Listen.  Listen.  It really is that easy.  If you’ve worked anywhere under the executive level you know that people complain.  And instead of complaining about complainers, our own system encourages the complaints by providing an easy and safe forum for collecting them.  Wondering how to improve your organization?  Stop thinking.  Start listening.

Billy Mays sells Kaboom, OxiClean, Zorbeez, and health insurance?

This is just too good to pass up. If you watch any amount of TV you know who Billy Mays is. If not, here’s a quick refresher:

[youtube:http://youtube.com/watch?v=AroOVjn0wMA%5D

Well now he’s pushing health insurance—calling it the most important product he has ever endorsed. I present:

[youtube:http://youtube.com/watch?v=c7d85T4OfqA%5D

The non-verbals, moving charts, and great promises are superb.

However, it is complete underinsurance. And it’s too bad because the market they are targeting probably has no idea how far $1000 of annual surgical coverage goes (the cheapest plan). The most expensive option covers up to $6,000. Anyone checked the cost of a bypass surgery lately?

Here’s the company’s website. Here’s the summary of insured benefits. And of course the extra special offers.

When he says affordable, he means health insurance you can actually afford.

Capitalism at its best.

More quality results published…

We advertise results indicating the percentage of patients who always got help when they wanted it and the percentage of patients who received antibiotics one hour before surgery.

Meanwhile, the Office of National Statistics in England published the number of patients who died from superbug infections. The Guardian calls it “named and shamed.”

The report “identified George Eliot hospital, in Nuneaton, Warwickshire, as having the highest number of patients who died from the superbug Clostridium difficile, with 235 deaths between 2002 and 2006.”

We’re probably some time from such reporting in the United States. But can you imagine the ruffled feathers?

Forcing the Transparency Conversation

If not by carrot, then definitely with a stick.

CMS placed advertisements in 58 newspapers on Wednesday publicizing area hospital satisfaction rates found on the Hospital Compare website.  The ads reported the results of two questions: “The percentage of patients who always got help when they needed it. And the percentage of patients who got antibiotics one hour before surgery.”

Interesting approach.  Especially as web use increases and newspaper readership declines.  Maybe they are looking to reach a different audience.  But as an example of generational difference: I’m willing to bet more hospitals were concerned when they heard their results would be published in a newspaper than just on the website.

PS, the first patient satisfaction survey were not required.  So not hospitals reported.

More coverage: Comarow on Quality, Health Blog, USA Today

Talent!

Reality: this world requires talent not only to succeed but to survive.

Tom Peters: “We are all in the Talent Business … as much as Hollywood or Broadway or pro sports.”

Aside from giving away vacations and signing bonuses for agreeing to work for an organization, what are hospitals doing to acquire talent? Doctor shortages. Nurse shortages. Med tech shortages. The continuously shifting environment that we all try to operate in. It is not easy. At all. On top of that, we compete with non-health care organizations for the best people.

There are some great organizations doing some amazing things to get the best people. Zappos (the shoe + other things company) pays new recruits $1000 to leave a week after they start. Truth. Why? They believe that if a new employee takes the offer he or she doesn’t have the commitment required to work for their organization. Think about that culture. Think about the pressure levied by fellow employees not to accept the offer. Read about it at Mavericks at Work.

What is your organization doing to recruit talent?

What is the message your job listing site is sending potential recruits? Try to search for a job at almost any hospital website. It is not a pleasant experience. The interface is awful. Information is diffuse. Job titles are difficult to comprehend. Trying to figure out what to search for and where to search for it takes an immense amount of time. And then potential employees are forced to fill out an online application that can be difficult to understand—not to mention the fact that some of the information required is irrelevant.

Needless to say, I was quite excited when I stumbled upon the Henry Ford West Bloomfield job site. Often job sites have an obligatory “Find Your Dream Job” or “Pursue Your Passion” message on the front page to inspire job seekers before sending them on a voyage. HF West Bloomfield actually means it (I think, no tests yet). A job seeker can do the traditional search or they allow a person to: CREATE YOUR DREAM JOB! What a concept! Here is what the site says:

What’s your dream job? Is it flexible hours? The opportunity for growth? An office with a window? Whatever your dream may be, we want to hear it.

Why? Because the best way to attract the most qualified talent is to give them what they want. But first, we need to know what that is. So tell us. Use the space below to describe your idea of the perfect job.

Whether it’s compensation for continuing education or having the best cappuccino readily available, no detail is too small.

The maverick job seeker then writes on ideals of the job: ideal title, ideal responsibilities, ideal job description, and how you would improve health care.

Great idea. I think it will translate into great people. Can your organization best their effort?

Google Health Launch

In case you have not heard, Google Health launched on Monday.

Here are the thoughts that actually matter. Jay Parkinson (his idea) summarizes a few here.

Lots of coverage. My apologies if it gets overwhelming. Here are some interesting excerpts:

Extensive review from TechCrunch:

The big competition here is between Google Health and Microsoft’s HealthVault. (Revolution Health is more of an information portal at this point, and who is going to trust their health insurance company?). Whereas HealthVault’s strengths seem to lie in tying together different health information silos on the back end, Google Health is focusing more initially on the consumer side. It is trying to do an end-run around the health establishment by trying to get consumers to manually load their own medical information into their profiles. HealthVault allows this as well, but seems to have stronger partnerships with back-end health data providers. Google will no doubt tackle the existing health data silos as it proceeds. It really has no choice if it wants to organize the world’s health information.

Health Blog:

On a tour, Google explains that, yes, this is another “personal health record,” a way for patients to store and manage their medical information in one place. But Google seems to be trying to address one of the big problems with PHRs: maintaining them is a big pain.

PSFK:

What’s a little disappointing is that the racial profile questions are a little naive. South-Asian/Indian? Sorry! Middle Eastern origin? Sorry!While they seem to be taken from dated census question, Google have failed to be open enough to take into account the 63 racial profiles that the Census bureau acknowledges nor the growing mixed race population. There isn’t even an ‘Other’ box. And therefore if you don’t fit Google’s racial criteria, you can’t fully use the site.

Kaiser Network:

According to the Wall Street Journal, “It remains to be seen how willing consumers will be to store sensitive personal medical information online” (Wall Street Journal, 5/20).

Patient advocates and privacy experts have “expressed concern that, despite password protection, sensitive health records stored online could be compromised,” the Globe reports (Boston Globe, 5/20). Pam Dixon, executive director of the World Privacy Forum, said that the federal medical privacy rule issued after the enactment of the Health Insurance Portability and Accountability Act does not cover medical records placed on a third-party online service (Metz, AP/Chicago Tribune, 5/19).

Roni Zeiger, product manager at Google, said that the company will share information in PHRs only at the request of users (San Francisco Chronicle, 5/20). Marissa Mayer, vice president of search and user products at Google, said that Google Health will have the “highest level of security” (AP/Chicago Tribune, 5/19).

Hospital Impact:

Hospitals who are savvy in the ways of 2.0 will have their physicians appear higher in search results. Yup, this is yet another way to search for physicians, but honestly, I doubt people will use this tool to make physician decisions. More so, they’ll go onto HealthGrades or other Physician rating sites. The “Find a Doctor” option on Google is more so that we can automatically add our physician’s info into our profile quickly.

Healthcare Economist:

Google promises never to advertise on Google Health. So how will they make money? Likely, there will be a Google search bar in the Google Health portal and Google can collect ad revenue from related Google.com searches.

The Health Care Blog/Geek Doctor:

At BIDMC, we have enhanced our hospital and ambulatory systems such that a patient, with their consent and control, can upload their BIDMC records to Google Health in a few keystrokes. There is no need to manually enter this health data into Google’s personal health record, unlike earlier PHRs from Dr. Koop, HealthCentral and Revolution Health. Once these records are uploaded, patients receive drug/drug interaction advice, drug monographs, and disease reference materials. They can subscribe to additional third party applications, share their records if desired, and receive additional health knowledge services.

e-patients:

Lowlights include the fact that it only allows importing data from 8 different personal health record services (none of which are software-based records which you may have from a Windows program or what-not), and no exporting of your data whatsoever. So much for being “open.” Also, apparently Google is licensing health information from ADAM and incorporating it into the record when you want a quick reference, taking Google down the road of yet again competing against publishers and playing favorites in this space. The user-interface is… clunky, to put it gently. You have to add a medication, test or procedure, and then click on it separately to add its details. It looks like the interface was designed by programmers, not people who actually deal with health conditions on a day-in, day-out basis.

Health Care Despecialization

Mr. Adam Smith wrote of specialization, or the division of labor, in The Wealth of Nations several hundred years ago.  He “foresaw the essence of industrialism by determining that division of labour represents a qualitative increase in productivity.”

Medicine is becoming more specialized.  So specialized, in fact, that we now term it sub-specialization.  Our most specialized hospitals are now quaternary hospitals (after years with tertiary label) which “typically provide sub-specialty services, such as advanced trauma care and organ transplantation.”  We have no reason to think that further specialization will not continue.  Medical students are skipping over primary medicine, instead opting for specialty service for a multitude of reasons.

Some have warned that a lack of primary care providers is going to be a problem.  Most recently the Health Blog wrote of the problems related to fewer general surgeons by presenting this scenario involving a patient who needs surgery:

Imagine that the five-person surgical group faced with the problem patient in the not-too-distant future has its own issues. The colorectal surgeon is away at a national meeting. The hepatobiliary surgeon has exceeded his or her mandated work hours for the past 24 hours and is home. The breast surgeon doesn’t do emergency laparotomies, the needed procedure. And the minimally invasive surgeon only did two open ulcer operations during her residency training. Oh, and the surgical oncologist no longer performs abdominal surgery.

What to do? The usual go-to guy would be the general surgeon, who could be counted on to deal with the complex case of the moment with aplomb. But the ranks of competent, broad-based surgeons are dwindling, as John Welch, a general surgeon affiliated with Hartford Hospital and the University of Connecticut School of Medicine, warned in a speech before the New England Surgical Society last fall. So the hypothetical five-person group, sans general surgeon, may be here before you know it.

Sub-specialists already reign. As we noted last month, more than 70% of surgeons do a sub-specialty fellowship these days. And the number of general surgeons per capita has fallen 25% in the past quarter century.

The question: is all of this specialization good for health care?

The seemingly ultimate proponent of specialization, Mr. Smith, provided a caveat in his writing: “in a further chapter of the same book Smith criticises the division of labour saying it leads to a ‘mental mutilation’ in workers; they become ignorant and insular as their working lives are confined to a single repetitive task.”

Obligatory jab: sound familiar?

As patients with comorbidities (especially obesity) continue to complicate medicine, treatment often calls for balancing many therapies for very sick patients.  Sub-specialization has been positive in advancing medicine.  But increasingly we need individuals to manage a patient’s many treatments.

Last week I went on a tour of a brand new hospital.  They are trying many new things (most of them evidence based).  In particular, the patient rooms were built to accommodate all needs a patient may have while in the hospital.  There are no specific floors for specific patients.  So a nurse may be caring for a pediatrics patient, an ICU patient, and a stroke patient (etc.) during the same day.  The tour guide commented on the difficulties encountered in helping nurses shift their perspectives from caring for patients with a common diagnosis to caring for patients with different diagnoses.

In other words, despecialization.

Is this the future?  Are there significant problems with specialization?

The Freakonomics Blog highlighted a recent story by Michael Pollen in The New York Times writing on Wendell Berry’s economic insight:

For Berry, the deep problem standing behind all the other problems of industrial civilization is “specialization,” which he regards as the “disease of the modern character.” Our society assigns us a tiny number of roles: we’re producers (of one thing) at work, consumers of a great many other things the rest of the time, and then once a year or so we vote as citizens. Virtually all of our needs and desires we delegate to specialists of one kind or another — our meals to agribusiness, health to the doctor, education to the teacher, entertainment to the media, care for the environment to the environmentalist, political action to the politician.

Mr. Pollen links the issues of specialization and a personal attempt to go green:

Specialization is what allows me to sit at a computer thinking about climate change. Yet this same division of labor obscures the lines of connection — and responsibility — linking our everyday acts to their real-world consequences, making it easy for me to overlook the coal-fired power plant that is lighting my screen, or the mountaintop in Kentucky that had to be destroyed to provide the coal to that plant, or the streams running crimson with heavy metals as a result.

In medicine, it could theoretically be said that sub-specialization has obscured the lines of connection—and responsibility.  We have all heard a story about a patient who didn’t receive a simple drug treatment because the bevy of specialists caring for her all thought that another physician had done it.

Despecialization will continue to occur in some health care environments as our system continues to evolve—possibly even in the traditional specialities.  However, sub-specialization is a great thing for individual patients.  The work these people do is saving lives that just a decade ago would have been lost.  But the problem is that while we continue to move medicine forward we seem to have forgotten the importance of the generalist.  Sure, there are many people advocating for primary care.  But actions speak louder than words.  Continuing specialization will advance medicine in the future…if generalists are given the proper attention.  We must save the generalist! 

Collectively, on the average, health care needs to despecialize.

Medical Onshoring

A new health care delivery concept called “Medical Onshoring” is on the horizon.

The concept involves Native American reservation land. That land is sovereign meaning that local and federal governments have no jurisdiction allowing the concept to bypass local/state/federal health care regulations. From Healthcare Economist: “Health workers from foreign countries can be hired for lower wages and will not be subject to U.S. medical restrictions while they are on American Indian sovereign lands.”

Here is the story from a North Dakota newspaper. And there is a blog, too (but only a few posts).