New Perspectives Bring New Insight

Comarow on Quality has a post titled “What Medicine Can Learn from Business.” Waiting rooms (in which patients incur long waits) have long been a part of what we do.  But new perspecitives bring new insight. Mr. Comarow shares a story of Virginia Mason’s implementation of the Toyota Production System:

During the visit, a team led by Virginia Mason’s chief of medicine met with a Toyota guru, a sensei who had absorbed the Toyota approach into his very marrow. Examining a layout of the hospital, the sensei learned that there were waiting rooms scattered across the campus.

“Who waits there?” the sensei asked.

“Patients,” said the chief of medicine.

“What are they waiting for?”

“The doctor.”

The sensei was told there might be a hundred or so such waiting rooms and that patients wait about 45 minutes on average.

“You have a hundred waiting areas where patients wait an average of 45 minutes for a doctor?” He paused and let the question hang in the air. “Aren’t you ashamed?”

We can’t have it both ways…

In Boston they fight the spread of the retail clinic (from The Boston Globe):

The mayor has argued that retail clinics providing episodic care will fracture the medical system, ultimately hurting patients.

But in St. Petersburg, Fla., traditional care providers are going retail (from St. Petersburg Times):

“A lot of hospitals are getting into more retail medicine” to boost their bottom line, said Donna St. Louis, vice president of outpatient services for BayCare.

So basically hospitals want to be able to operate in retail environments—and have no new competitors in that arena.

Hmm.  “Have your cake and eat it too?”

In Washington D.C., Senator Grassley is up to his old tricks (from the Health Blog):

Sen. Chuck Grassley took another swipe at lucrative tax breaks of nonprofit hospitals yesterday–-at a hearing that wasn’t even about hospitals.

But again, in Florida, this (from St. Petersburg Times):

Bayfront Medical Center operates Bayfront Rejuvenations at one of its convenient care walk-in clinics at 7000 Fourth St. N. And BayCare Health System, which runs several nonprofit hospitals in the Tampa Bay area, plans to open a medical spa at its St. Anthony’s Carillon Outpatient Center in late August.

Tell me how to go about defending the important nonprofit tax benefit hospitals receive when they are offering cosmetic procedures like Botox injections.  Can anyone rationalize how these medical spas are providing enough community benefit (i.e., free care) to make up for that tax free benefit?  I’m sure there are plenty of self-pay patients utilizing the services—but definitely not the traditional self-pay (i.e., no-pay) patients hospitals have become accustomed (averse?) to in recent years.

Here is an attempt:

“We do not have a medical spa. We have an aesthetic medical practice,” said Waldrep, medical director of the new practice and of Bayfront’s convenient care clinics.

OK, we’ll call it AMP for short.

Throw us a bone…

Here is another attempt:

As medical spas have multiplied, so have concerns about the quality of services they offer and the level of medical supervision present. The hospitals see themselves as a natural alternative. They hope people will automatically associate their names with higher-quality medicine.

OK, better.  But need we be reminded that traditional health care organizations have quality concerns of their own?

Finally, the real reason for the service expansion:

Just as primary care doctors have found spas a way to bolster their bottom line, medical spas are a way for hospitals to bring in dollars to balance out other services that communities need, but lose money for the hospital, such as trauma and indigent care.

Misplaced incentives make for mislaid business plans.  But building barriers around hospital fiefdoms isn’t the answer.  And dabbleing in borderline health care services isn’t either.

The answer comes from concentrated efforts to improve what we were created to do: care for patients who truly need our help.  Competition helps us get there.  Focusing on what we do best helps us do it.

Pursuing the Patient: New Marketing Efforts

Health care services marketing is beginning to respond the to the needs of the patient. Marketers in Minnesota are moving away from traditional advertising to a model trumpeting convenience and personalized care, the Minneapolis Star Tribune reports.


It could be the early stages of competition on quality of service. Not quality that we in health care are finding it difficult to define. Quality perceived by the consumer. Things like: can I get an appointment when I need one? Are providers responsive to my needs? Do I receive information in a timely manner? etc.

Mark Hansberry of Fairview says:

People “are becoming much more savvy and more informed about their health-care decisionmaking,” he said. “They want to have health care on their terms, whether it’s evening appointments or same-day test results.”

Service matters. The take away for the rest of us:

All three clinics said their market research had shown patients are becoming more demanding as they take on a bigger share of the medical bill.

Good to hear they are listening to patients (and their dollars). However, this might be a stretch:

The latest HealthPartners campaign, launched last month, includes life-sized mascots Petey the Pee Cup and Pokey the Syringe and promotes an updated patient services website.


Health Care Estimates Online?

First things first, I understand the complexities of diagnosing medical problems (and that is why we have very competent, educated physicians making these decisions. So this is a “just saying” post.)

I’ve heard the mechanic and doctor metaphor before.  You may have as well.  Here’s why it doesn’t hold up.


Wouldn’t it be neat if there was a tool available (and smart enough) to patients that could take the information a doctor has just given about a diagnosis, plug it into a tool online, and receive estimates for any necessary procedures?

Repair Pal does it for autos. From PSFK:

The just launched site lets you enter information about your automobile along with the problem it’s having, and presto – you’ll get the fair market estimate for repair and parts. RepairPal users will also be able to create profiles for their cars to keep all repair records, and receive suggested service reminders.

Just saying…

By the way, does it scare anyone else that for the majority of us there is more information stored electronically about our vehicles than about our own personal health?

Surgeon Shortage Confusion

The Columbus Dispatch carries an AP story on a report about West Virginia University hospitals, “A severe shortage of heart surgeons forces West Virginia’s largest medical center to divert some 500 patients a year to Pittsburgh and Columbus, Ohio.”

A quick visit to their website reveals an interesting front page highlight—“The WVU Heart Institute — Excellence in Cardiovascular Care.”

That highlight links to this page with some intriguing verbiage:

The WVU Heart Institute has the doctors, technology, and facilities to make a rapid diagnosis and take, quick effective action 24 hours a day, 7 days a week, 365 days a year. We’ve refined our coordination and teamwork to a science.

To be fair, the AP story does have this bit from interim vice president Fred Butcher:

But Butcher says the report has errors. He also complains it’s based on interviews with 14 of nearly 360 faculty. He says another review is likely.

Interesting. Something (or lack of) is going on at WVU.

UPDATE: An article today in the Pittsburgh Post-Gazette clears things up…a bit.  The hospital was not happy with the reporting effort of health adviser R&V Associates—so they fired the group.  But read the article, things are a bit tumultuous at West Virginia University’s Health Sciences Center.

Visual Map of Hospital Quality

One more reason for complete transparency: has mashed Google Maps and hospital quality and the result is a pretty neat tool.  A tool that CMS should have developed long ago—the mashup uses CMS Hospital Compare data.

But as Tony at Hospital Impact writes, “This is a nice little tool for patients, but as always, it’s only as good as the underlying data.”

Encouraging Patient Involvement

The Chicago Tribune brings us this story:

Four years ago, when Edward Lawton was admitted to a New York hospital for surgery, he came prepared.

He brought his own case of sterile gloves and asked nurses to use them after washing their hands with soap and water.

He asked for a blood pressure cuff to stay at his bedside so it wouldn’t come in contact with other patients.

And he requested that newspapers not be delivered to his room because “newsprint is dirty” and he wanted to avoid the potential for contamination.

Lawton had reason to be careful: He had acquired several painful, debilitating hospital-based infections during a surgery nearly six years before.

The empowered patient. It’s the type of patient that hospitals want. Hospitals want them because they participate in health care. They are double checkers. And they improve outcomes.

The traditional caveat:

It helps if doctors and nurses are receptive and if they talk to patients and families in terms that they can understand. Rush-Copley Medical Center asks them to do just that each morning in the intensive care unit, when doctors, care managers, nurses and families meet at patients’ bedsides.

Caveat or not, if patients are asking the questions, answers are sure to ensue. Getting them to ask the questions is the difficult part:

Earlier this year, a study of 80 surgery patients in London reported that patients found it much easier to ask factual questions—”how long will I be in the hospital?”—than challenging questions such as “have you washed your hands?”

This reluctance could stem from the aura of authority that surrounds doctors, the authors speculated. The study was published in the British journal Quality and Safety in Health Care.

In December, a separate study of 856 adults in Pennsylvania discovered that 91 percent were willing to ask doctors or nurses to explain something they didn’t understand. But only 25 percent were prepared to ask providers whether they had washed their hands before an examination.

Participatory health care–when the vast majority of patients feel empowered to ask questions–is a change our health care system needs.

PS: it’s coming.

PSS: I’m late to the party.

21. “Treat Employees Like Customers”

Have you ever experienced an organization where it seems that every employee enjoys what they do?

There aren’t many organizations like that—but the experience is so outstanding that it is memorable for years to come.  If you’ve ever flown Southwest Airlines, you are likely to have enjoyed such an experience.  The same goes if you have had a question answered by the Genius Bar at The Apple Store.

David Anderson at Signal vs. Noise writes on why service at those outstanding organizations rises above the rest, “When employees are trusted and treated like adults, they appreciate it just as much. The result: loyal employees who want to stick around forever.”

A culture is not created overnight.  It is built, and molded, and coddled over time.  And an important aspect that often gets overlooked in today’s go-go-go world is the benefit of having long-tenured employees remain in an organization’s workforce.  They carry the torch.  Whether or not they knowingly and explicitly do so, they pass an organization’s cultural values on to the new hires.

But we’ve all come across the bitter curmudgeon who has been on the job too long. Most people don’t start out that way—they break down over time as the system eats at their passion.  They are barely able to overcome their burnout on a daily basis. The problem is that they, too, are passing on individual values to new hires.

Both are cycles.  Both are difficult—one to get into, the other to get out of.

Mr. Anderson provides the example of Southwest Airlines founder Herb Kelleher:

Over the years, whenever reporters would ask him the secret to Southwest’s success, Mr. Kelleher had a stock response. “You have to treat your employees like customers,” he told Fortune in 2001. “When you treat them right, then they will treat your outside customers right. That has been a powerful competitive weapon for us.” As he stepped away from the company this week, his line didn’t change.

“We’ve never had layoffs,” he told me the day before the annual meeting, sitting on the couch of the single messiest executive office I’ve ever seen. “We could have made more money if we furloughed people. But we don’t do that. And we honor them constantly. Our people know that if they are sick, we will take care of them. If there are occasions or grief or joy, we will be there with them. They know that we value them as people, not just cogs in a machine…”

“There isn’t any customer satisfaction without employee satisfaction,” said Gordon Bethune, the former chief executive of Continental Airlines, and an old friend of Mr. Kelleher’s. “He recognized that good employee relations would affect the bottom line. He knew that having employees who wanted to do a good job would drive revenue and lower costs.”

Treating people right.  It is as simple as that.

Principle #21: Treating our people right is a fundamental philosophy of our own system.  Treating people with respect and honor is the foundation to building a culture that people want to be a part of long term.  That will translate into memorable and enjoyable experiences for our patients. Getting on the path is difficult.  But necessary.