New Name: Peyton Manning Children’s Hospital

I missed this news item last September, but on a recent trip through Indianapolis to Chicago, I noticed that the children’s hospital at St. Vincent is now named Peyton Manning Children’s Hospital.

Peyton Manning is a great quarterback, terrific pitch man, and steward for the NFL.  His popularity in Indiana is unrivaled.

Usually rebranding of hospitals includes the addition of a corporation’s name to the hospital’s handle (to the tune of a sizable donation).

While Peyton Manning has probably made some kind of financial commitment to the hospital, the size of that gift (and poential for future giving) is not likely as large as that of a corporation.

However…

Renaming the hospital to honor a living, still-playing, professional athlete is a very interesting strategic move.  And one I am quite fond of.  Manning has the ability to leverage his fame to encourage multiple corporations (and individuals) to strongly support the hospital—not just a few.  Further, considering Manning’s popularity amongst the people of Indiana, especially in Indianapolis, this is a good move to increase patient encounters.  There are people making care decisions that will select the Peyton Manning Children’s Hospital over competition based on the hospital’s affiliation with the athlete alone.

It would be interesting to see year-to-year comparisons for the three-year period on the impact of this decision in September 2010.

24. Benchmark to Perfection

In my eyes, part of the problem with the lack of progress in health care is due to the fact that health care organizations delay implementation of innovative ideas until some other organization does it first.  It just makes it easier, the argument may go.

Message to the world: the World Health Organization has endorsed the idea of using checklists to reduce patient harm.

It goes beyond waiting, however.  Often (or always) we benchmark our data (quality, patient satisfaction, outcomes, etc.) to similar organizations.  That’s fine.  But it doesn’t go far enough.  And our worries about our peer group distracts our focus on becoming the best we can be.  It distracts our attention from focusing on what matters most: the patient!

Tom Peters says: “Don’t let the “enemy” rule your life.”

He also uses this quote by Howard Mann to help prove the point:

Obsessing about your competitors, trying to match or best their offerings, spending time each day wanting to know what they are doing, and/or measuring your company against them—these activities have no great or winning outcome. Instead you are simply prohibiting your company from finding its own way to be truly meaningful to its clients, staff and prospects. You block your company from finding its own identity and engaging with the people who pay the bills. … Your competitors have never paid your bills and they never will.

I understand our obsession to compare.  No, wait, I really don’t.  Be better!  Period.  Strive to be THE BEST. Benchmark to the only competition that matters: Perfection! Seriously, move the entire industry forward.  Because if you benchmark to perfection, the peer group will benchmark to you.  And, pulling this all together, if they benchmark to you, they will be benchmarking to perfection, too!

Don’t be afraid to try something…different.

Look what Aetna is doing: creating a lottery where patients can win cold hard cash if they adhere to treatment plans.

Or at least foster a discussion starting with a question like “Chronic care: Do we need an entirely new model of delivery?”

Answer: resounding Y-E-S!

It’s a simple decision really.  Choose to be different.  Choose to be the best.  The implementation is the difficult part.  But don’t back down from difficulty.  Get the people in place to make it happen.  It really is possible…

Principle #24: our own system will benchmark to perfection.  It’s the only measure that matters.  Try new things.  If they don’t work, well try something else.  And if that doesn’t work, we’ll try something else.  And we won’t stop until it’s the best alternative.  Then we’ll keep on trying, because it won’t be best for long.  It really is possible, and we’re going to work our tails off to make it happen.  Benchmark…to…perfection.

The Progress of Ratings Services

The results of a somewhat disappointing poll for the participatory health care crew (this blog included) was publicized in American Medical News this week. The poll, conducted by Harris Interactive and commissioned by the California Health Care Association, found:

that although more than 80% of the state’s adults turn to the Internet for health-related information, less than one-quarter have looked at physician ratings sites. Only 2% of those surveyed made a change in physicians based on information posted on a rating site.

Further, the survey concluded:

that only 1% of respondents made a change in their hospital or health plan based on ratings sites devoted to those entities.

The findings are not that surprising.  Health care services have been consumed passively since the beginning of time.  A paradigm shift of this magnitude will take time.  Participatory health care utilized in an online fashion is in its infancy.  However, patients have long relied upon word-of-mouth suggestions from people they know to select care options.  As patients become more comfortable with online resources for selecting health care services, those services will become more persuasive much like traditional friend-to-friend word-of-mouth.

One of the biggest problems is the diffuse nature of ratings information.  The online ratings industry is booming.  Doctors are being rated.  Insurers are being rated.  Nurses are being rated.  Hospitals are being rated.  Etc.  And entrepreneurs long for a piece of the pie.  That means that many sites use different sources of information to create various iterations of ratings.

The next step is for ratings to begin to incorporate multiple sources of data and rank various components to come up with an overall value index.  Just such an index may improve the use of online rating services to select health care services.

The Health Blog brings us news about a new rating service called the Hospital Value Index created by Data Advantage.  The plan:

The idea is to measure not just quality, but also cost and efficiency to identify the best hospital bang for your buck.

It promises to rank more than 1,400 hospitals in markets covering 180 million people — roughly 42% of all hospital activity by its measure — and serve up lists of the top-value hospitals in the U.S., and in different markets. Another list shows “high value” hospitals ordinarily in the shadow of more famous neighbors.

The Health Value Index remains imperfect.  Read the Health Blog post for some of its drawbacks.  But the new rating service is an improvement that brings together diffuse information to more easily compare hospitals.  Looking forward to the next step along the innovation process…

Vacation Plans: The National Health Museum?

The Miami Herald:

Atlanta has been selected over Washington and other cities as the site of a $250 million National Health Museum designed to teach visitors about healthier living and serve as a stage for international health events.

My hope is that their healthy living programming will reach nationwide, not just those who visit in Atlanta.

I also have slight objections to museum-ization of the topic.  Is the health of the people in this country really worth exhibiting?

The museum will incorporate a conference facility of some sort along with installations like:

A ”Move” zone, for instance, will focus on how the human body works and how exercise and activity is important, for instance. A ”Connect” zone will show how everyone’s health is connected around the globe.

Most of the funds raised will be done so privately.

Pardon the realism, but wouldn’t multiple less-expensive healthy living centers located around the country do more to impact health in the U.S. than a centralized shrine to our health breakthroughs?

Pricing Transparency Debate

There’s some debate on the usefulness of pricing transparency (as it stands) in health care here here and here at the Health Care for All Healthy Blog.

Here’s the gist of the discussion at HCFA:

Of course, we’re not so neutral in this discussion. Paul’s [Levy, health care CEO who blogs] worried about accuracy and validity. Charlie’s [Baker, health care CEO who blogs] view is let’s get this started, and make improvements along the way. Our concern, which we wrote about two days earlier (with two interesting comments added), is whether this is really worth it. Our point, that price transparency may not be too useful, and could lead to price increases, was picked up by this week’s lead Modern Healthcare article.

I understand all sides.

Creating measures that are accurate and valid is vitally important to develop a reliable comparison tool that we can all agree upon and create together.

On the other hand, health care moves incredibly slowly—and if we wait until the data used is agreeable to all parties involved, comparisons may be impossible until mid-century.

The misplaced incentives of health care financing make for creative pricing strategies.  The risk that prices could rise from transparent data is real.

But in the end, if consumerism is to truly take over health care decision making, complete transparency must become the norm: knowing the cost of care is an important component of the revolution.

Transparency is transparency is transparency. But only if its truly transparent.

How much is that going to cost, Doc?

The Milwaukee Journal Sentinal:

What’s the cost of surgery for a spinal fusion of the lower back in southeastern Wisconsin?

It can range from $25,000 to more than $50,000.

The price depends on the hospital and the doctors. And that’s just for patients covered by one insurer — Anthem Blue Cross and Blue Shield. It would differ for other health insurers.

The wide disparity in prices explains why businesses and consumers contend that more information on what hospitals and doctors charge is needed to lower costs and make the health care system work better.

Seconded.  But there’s a problem:

Yet the effort to provide consumers with meaningful information on prices is proving to be a lot slower and more complicated than expected.

Transparent pricing is an important bit of information patients could use in selecting providers and choosing where to seek medical care.  But as the article states, it’s not always an easy task for a patient to find such information.  Hospitals have an opportunity to make that easier.

Two health systems in Sioux Falls, South Dakota, post prices.  Sanford Health posts price averages for the top 25 diagnoses at its main hospital prominently on its website.  The table displays information in four categories: minimum, median, average, and maximum charges along with specifics about charge, length of stay, out of pocket cost with coverage, and out of pocket cost without coverage.

Competitor Avera also posts price information, although it is more difficult to find and doesn’t provide as much information.

Here’s a comparison on strokes: Sanford, Avera.

There’s obviously still room for improvement.  But it’s a great start.  Price transparency helps us toward what really matters: competition on value.

As covered previously, at least one health system is working hard on making prices transparent amongst a group of competitors.

Second Opinions Online

USA Today has an article about online second opinion services. One would think it to be a booming market, however the largest three providers of said services only offer about 3,000 opinions annually.  Here’s the service explanation:

Online second-opinion services offer patients consultations from specialists based on the medical records that they fax, mail or send via the Internet. The average cost, payable upfront via credit card, is $500 to $1,500, depending on the number of radiology or pathology interpretations required. Patients then receive online access to a second opinion in about two weeks.

The problem: “A limiting factor is that most insurance companies do not cover remote second opinions.”

However, the Cleveland Clinic and Cigna recently inked a deal to provide (the former) and cover (the latter) online second opinions for insured individuals.  As more insurance companies begin to reimburse for the service, utilization is likely to rise.

23. Get out of the office!

That feeling of less time to do more is real.

It seems calendars are getting fuller every day.  The red light on the telephone blinks daring one to enter the voicemail queue.  Hundreds of emails await a return to the computer. In fact, for some tech companies the information overload has affected productivity so negatively that they have formed a partnership to research solutions.

The responsibilities of this modern world are intense.

In this Wall Street Journal article, Novartis AG CEO Daniel Vasella comments:

“I’m locked in,” he says. He is booked nearly solid until September, with back-to-back meetings and trips that were scheduled months ago. “Due to the constraints, I have to put down in priority things I like to do and that would be very interesting. I can’t spend as much time as I’d like to at hospitals, talking with doctors and patients who use our products. This is where I hear and see so much and get so many ideas.”

Requirements of constant connectivity are impacting management…in a bad way (from the same article):

“They [CEOs] complain about a lack of spontaneity in their workdays and little time to mull over problems that crop up. They often have to make do with phone calls and emails when a face-to-face meeting might be more effective.”

Limited management visibility is noticed by employees and negatively impacts the culture of an organization.

At our own system, limited desk time for managers will be “strongly encouraged.” The kind of strong encouragement that borders on requirement.  Managing people means interacting with them. Management By Walking Around (MBWA) is the philosophy we will live by.

Annie Stevens, managing partner at ClearRock, highlights the issue in an article at Management-Issues:

“There has been a greater tendency to try to manage employees by e-mail, memos or in meetings, rather than managers and executives getting out of their offices, walking among the employees they manage and talking with them. Many companies are missing out on the benefits they can get from this.”

Here’s the kicker—actual human to human interaction is required:

Key to an effective MBWA approach is to prepare yourself for hearing feedback and insights that you may not agree with.

“If the purpose of conducting MBWA is only to reinforce your current beliefs, you should save everyone’s time and don’t do it. The goal should be to uncover honest and objective contributions from people you manage without them feeling they need to tell you only what you want to hear,” said Stevens.

Here’s the message: do it.

Principle #23: Human interaction is vitally important.  Talk to employees.  Talk to patients.  Talk to providers.  Ask them how things are going.  Ask them if their needs are being met.  Ask them for their ideas.  Ask them anything!  Build relationships.  Full calendars, voicemails, and inboxes are no excuse.  Clear some time.  Get out of the office.  Get to know employees.  Besides, sitting in an office all day is awful.

The voices are getting louder

The individual voices of physician discontent are becoming louder.

The easy response is no response.  There are plenty of capable students who are turned away from medical schools on an annual basis that would be more than happy to receive a spot in the class of 2012.  Don’t like your job? Find something else…

But that argument is simplistic and elementary.  There is obviously something very wrong with the environment that many physicians are currently operating in.  And that should concern all of us.

A very wise health care administrator once told me, “There are two types of people in a hospital: those who care for patients and those who don’t.  If you’re a person that doesn’t care for a patient, you damn well better be working hard to make the jobs easier for those who do.”

What’s going wrong?

It’s a combination of many issues.  Reimbursement rates are constantly pushed downward.  Risk of malpractice lawsuits is rising.  Scopes of practice are under fire.  The days are long.  The list could go on.

This essay in The New York Times highlights the real reason for physician frustration: “There are serious consequences to this discontent, the most worrisome of which is that it is difficult for doctors who are so unhappy to provide good care.”

It need not be like this.

By no means am I advocating that administrators bow down to every physician command.  The physician’s frame of mind versus the administrator’s frame of mind is what keeps health care organizations open.  But it is time that a concerted effort be made to make the practice conditions for physicians favorable once again.

Conditions that allow providers to do what they do best: care for patients.

(links courtesy of Kevin M.D.)

Asking Questions and Innovation in Practice

Lots of cool stuff going on at SSM St. Clare Health Center.

Namely, question asking:

Building from the ground up, SSM officials sought to streamline the health care delivery process through a facility that maximizes patient and practitioner efficiency. They started by turning inward, scrutinizing processes like outpatient admissions and emergency department procedures and soliciting opinions from staff, physicians and patients.

“It’s asking each one of us who deliver health care in today’s current state to really broaden our horizons, challenge the way we do things, ask ‘why’ a million times and then figure out what’s the right way,” said Brobst, a clinical director at St. Joseph.

YES!

And a commitment to delivery innovation:

Brobst oversees a unique 22-bed medical and surgical pilot unit that mimics conditions at the soon-to-open St. Clare. Housed in a medical office building connected to St. Joseph, the pilot unit allows nurses and physicians to implement new procedures and processes in real-world conditions.

The health system also spent more than $110,000 on a full-scale mock-up of a patient’s room at the new hospital. More than 150 St. Joseph employees have walked through the prototype in the last two years, providing feedback that resulted in changes ranging from the creation of individual nurse alcoves outside each room to wall-length safety bars leading from the bed to the bathroom.

YES!

Forward thinking hospitals. It’s cool to see good ideas in action.