Two of my favorite subjects converged on The Early Show this A.M.: education and health care. A really neat story of what technological progress can make happen in the classroom when health care disaster strikes.
Here’s some more from Microsoft.
Pseudo-Vacation Update: Nearing an end, normal blogging to resume soon.
It’s only vacation in the sense that posting will be light due to prolonged bouts of limited internet accesiblity.
Here’s some light Wednesday reading on the difficulties of pay for performance from The New York Times.
Best line from the piece: “Whenever you try to legislate professional behavior, there are bound to be unintended consequences.”
The University of Chicago Medical Center is drawing criticism over a “strategy to steer poor and uninsured patients with less serious injuries to other facilities to focus on treating the most challenging cases,” especially from the non-profit sheriff Senator Chuck Grassley according to the Chicago Tribune.
Meanwhile, newly appointed Grady Memorial Hospital CEO Michael Young took a swipe at Atlanta-area hospitals saying “I think the other hospitals need to do a gut check on their missions, and see if they’re doing their fair share,” at a recent news conference reported by The Atlanta Journal-Constitution.
We all know hospitals that fulfill their non-profit missions daily; and we all know hospitals that could improve. Our health care system presents difficulties in treating patients who are not properly insured. Non-profit or not, hospitals need to keep their doors open. Whether it is a new strategy to treat uninsured patients outside of the emergency department or a plea to other leaders to help carry the load, hospitals are increasingly pursuing new efforts to sustain themselves.
The realty is that most hospitals try to limit the number of uninsured patients they care for—it’s happening in every metropolitan area throughout the United States. Some try harder than others. Some are more transparent in their efforts than the rest.
Whether you consider what the University of Chicago Medical Center is doing is right or wrong, the problem with the criticism is this: the reason they have come under fire is because they have been transparent in their efforts. We know about what they are doing because they have openly communicated it. Being singled out is wrong when there’s evidence of the practice elsewhere.
Further, any investigation into whether or not UCMC is properly carrying out its mission and taking care of the necessary number of uninsured patients does nothing to solve our problem of millions of uninsured Americans and their poor access to necessary health care.
MyRapidMD is a cell phone service that allows first responders access to all of your important medical information in an emergency situation. It seems like a great idea. Here’s an article all about the service at the Los Angeles Times.
But the service is plagued by a problem common amongst health care innovation: slow adoption.
This is what’s holding MyRapidMD back according to the LAT: “The company has to persuade first responders across the country to check cellphones as a matter of policy.”
EMRs. Checklists. Innovation culture. All plagued by slow adoption for various reasons.
An oft-used sports analogy has athletes, coaches, and reporters speaking of “getting over the hump,” a moment when the worst is over and success is imminent.
It’s not too simplistic to reduce the problems of health care innovation to slow adoption—whether it’s steep implementation costs, over regulation, or the organization’s culture (etc.).
The new idea isn’t the tough part of the process. Getting over the hump is the true obstacle.
How do you know when service is broke? Do you listen to patients? To staff? Is it a gut feeling?
There’s only one way to know for sure: experience it.
The Chicago Sun-Times brings news of a county sheriff willing to do just that (via Freakonomics Blog):
Lake County Sheriff Mark C. Curran Jr. sentenced himself today to a week in his own jail, saying he believes spending time behind bars will make him a better cop and a better person.
“I believe that I can be a better sheriff by having a better understanding of jail operations from the perspective of an inmate in the Lake County Jail,” Curran said before being locked up. “I believe that I will receive significant introspection from staying in the jail with inmates for a week.”
Jail. JAIL! If a sheriff is willing to experience one week in a jail, surely a hospital executive would be willing to experience a night in the hospital.
His plan:
Curran plans to live in a cell, eat jail food, mingle and talk with other inmates in common areas, while also attending numerous programs offered in the facility, including substance abuse counseling, parenting and educational classes, along with religious services.
That immersion, he said, should give him more insight into everything from safety issues to what programs may be needed help inmates straighten out their lives and avoid future crimes.
“My experience in the jail will help me to better understand our existing programming, as well as any possible unmet needs that exist in our programming,” said Curran, a 45-year-old former prosecutor elected sheriff in 2006.
An inpatient stay is the new hospital report card.
Do it all: arrive through the ED, register, be wheeled to a room on a gurney, wear the robe, talk to doctors and nurses, be transported to radiology (and everywhere else), wait for food, try to eat that food, use the restroom, take a bath, try to sleep next to a roommate separated only by a curtain, use the telephone, use a cell phone, enjoy the television, tug the pull cord, etc…all just like a patient in the hospital (surgery not required, though it medically necessary, all the better).
The insight: valuable.
Granted the service that a hospital executive receives will be biased. But that’s not the reason to do this, not for aspects of service that can be easily observed. No, this time is meant for those aspects of service that can only be experienced.
Would you be willing to spend time as an inpatient in your hospital? Be careful how you answer. If the answer is anything close to “no,” it’s time to get moving and start improving.
Principle #33: At our own system all senior leaders will be required to spend time in the hospital: live the service, improve the service. If someone is unwilling to comply with such a requirement, well, that says about all a patient needs to know about our hospital.
New hero: Phillip Newbold, CEO of Memorial Hospital in South Bend, IN, and the self-described “champion of innovation” at the hospital. The hospital’s website is Quality of Life dot org, tremendous!
See previous posts on innovation centers here and here and here and here.
The Wall Street Journal brings news of the coolest innovation center yet:
The Innovation Café is an unusual teaching laboratory created by Philip A. Newbold, the veteran chief executive of this midsize community hospital and health system. He converted a failed delicatessen into a venue where staffers and outsiders can learn to craft new ideas.
[snip]
It was a tour of an innovation training center for Whirlpool staffers that sparked the establishment of his teaching lab. He persuaded his employer to become the first U.S. community hospital with an innovation research-and-development budget. The board committed up to 1% of annual revenue for innovation activities. That equals about $4 million a year. The hospital ended up spending just $195,000 in 2005, $622,000 in 2006 and $711,000 in 2007 on innovation efforts such as venture start-up costs and staff training. But the increase in related operating profit was as much as three times the annual expenditure.
Other cool stuff from Mr. Newbold: visits other innovative businesses, rewards staff for “good tries,” developed private label health drink through strategic partnership, worked with IDEO, developed a cryo tank, and shares his innovation ideas with others in the health care field.
Be thankful that Maggie Mahar blogs: The crux of our problem. Fix primary care to fix health care.
A month ago, a fellow MHA friend told me about a conversation he had on the golf course with a current MBA student. Though not friends, it turns out the two had something in common: they were both interested in jobs in the health care field. The MHA friend then asked the MBAer, “Why health care?”
The MBAer’s response? “For the money.”
Insert appropriate jaw drop here.
The above conversation transpired around the same time of a couple of synchronistic news stories.
Ohio execs sentenced for $1.9B fraud
Memorial Regional Hospital Administrator Resigns
3 Southern California hospitals accused of using homeless for fraud
The shady dealings of some health care leaders prompted a few blogosphere conversations (as well it should) on the poor decision making skills of accused (see above) leaders. Not everyone puts the needs of patients first, occasionaly money gets in the way.
Much of the debate surrounded a licensure process for hospital CEOs. While that type of credential is unlikely to keep out fraudulent individuals, it would provide a base level of knowledge for health care executives. And isn’t that what a license is all about anyway, knowledge? If that’s the case, then we already have a process in place: Fellow of the American College of Healthcare Executives. If it is a “board certified” CEO that a hospital seeks, requiring that individual to be a Fellow of ACHE seems to be a solution.
But that doesn’t solve the general problem of improving decision making as a leader. A lack of knowledge is a factor in poor decision making. We know that the complexities of both medicine and health care are tremendous—it seems nearly impossible to expect any one person to be well versed in both. While I have no statistics to back this up, my assumption is that the physicians who do decide to take on executive roles often end up dedicating the majority of their time to the business role over the clinical role.
This is how a hospital should work: physicians have knowledge of the business side and the business people have knowledge of the medical side.
One of the solutions proposed in the Health Beat post is this:
In an article titled “Physician as Hospital Chief Executive” published in Vascular and Endovascular Surgery earlier this year, Robert E. Falcone, MD Bhagwan Satiani, MD, MBA, go a step further, suggesting that, perhaps, the management of medical care is so important that it should be left to doctors.
I don’t think that is necessary. But it is imperative that health care leaders (the ones without medical degrees, me) be able to completely understand both the business and medical ramifications of a decision. But how?
Listen.
A former summer job (laborer) taught me an important lesson on the power of a can of soda on a hot day. It does two things: 1) breaks down barriers and 2) provides an insightful look at the front line. The lesson: given the opportunity and due respect, people are more than willing to explain what is important. But you have to listen.
Instead of perching in a top-floor office find the information necessary to make an intelligent decision that balances the needs of all stakeholders. The “power-of-one” observation is a principle of former Medtronic CEO Bill George. The system often gets in the way of successful communication. The importance of some decisions is such that the only information that matters is straight from the source.
As written in “How the Wise Decide:”
What George and other leaders who diligently practice the principle of Going to the Source understand is that firsthand information is the best information. It is unfiltered by others, it provides subtle details and nuances that are lost in Power Point presentations and, most important of all, it shows us reality in all its messy details and emotion. Without face-to-face encounters with the people who are driving the future of your business, you will miss out on the power of emotional input.
How did he make it happen?
Bill George knew the tremendous value that derives from making power-of-one observations. In any given year he spent an astounding two thirds of his time in the field gathering first-hand information. Not many CEOs can find a way to do that, but George set up a senior management team that took care of other matters to allow him to get out of the office.
Read about Mr. George’s “power-of-one” observation here, here, and here.
Find the source. Listen. Intently. So we can avoid future iterations of this.
From FierceHealthcare on Aug 22:
Despite the subprime mortgage-fueled financial markets meltdown, ongoing problems in the U.S. economy and ongoing pressure on margins, things weren’t too bad for not-for-profit hospitals in 2007 according to financial industry ratings firm Moody’s Investors Service. After reviewing audited fiscal 2007 financial statements for 410 non-profits, the firm concluded that operating performance and liquidity remained stable for non-profits last year.
From Kaiser Network on Aug 26:
Downgrades in the credit ratings of U.S. not-for-profit health care systems and hospitals exceeded upgrades by a 2-to-1 ratio this year for the first time since 2003, according to a report released on Monday by Standard & Poor’s Ratings Services, the Arkansas Democrat-Gazette reports. The report examined trends at the 138 not-for-profit health care systems and 470 stand-alone hospitals that S&P rates.
Excerpts they are, but it seems like two different conclusions, no?
Hi, I'm Drew Weilage. 