Month: October 2008

37. Mission and Vision Implementation (Walking the Talk)

It’s a simple change, really.

The strategic planning/business development group at our own system is now the Department of Mission and Vision Implementation.  Why?  Because a not-for-profit hospital has one meaning for existence: fulfilling its mission.  Mission and vision statements are easy to craft, much harder to follow.

The stories of hospitals who fail to mission and vision implement are plentiful (ask your family members the next time you get together to tell you about a disappointing health care experience, be wary of the can of worms being opened).

The strains upon our health care system are such that fulfilling the mission and vision have become increasingly difficult, that’s no reason for retreat (in fact, make it a call to arms).  Questions of quality remain as hospitals say they are dedicated to providing the highest quality care.  Charity care is questioned as hospitals promise to provide for the community’s needs.  Treating patients with dignity and respect continues to be a challenge.

It’s akin to the marketing department at a corporation whose lone function remains advertising.  Marketing is their business.  Fulfilling the mission and pursuing the vision is ours.

How often is your hospital’s mission and vision considered in decisions made at meetings?  Not often (ever?)?  Big problem.  If the mission is our purpose then every (every!) decision we make regarding the here-and-now will be guided by the mission.  If the vision is our road map to the future then every (every!) decision we make about the future will be guided by our vision.

Principle 37: If you want to be the best, then make an effort to be.  From here on out, it’s about one thing: mission and vision implementation.  Always.  Simple task with potentially staggering results: read the mission and vision before every meeting.  Every meeting.  And don’t let up until all of the organization’s actions align with these very important words, for words are words apart from action.

Treatment so fast you’ll freak

I listened to someone speak today while taking advantage of a provided lunch.  The lunch consisted of subs from Jimmy Johns.  The person said “Jimmy Johns is pretty cool, Subs so Fast You’ll Freak.”  Subs so Fast You’ll Freak is a marketing tagline used by the company.  The person continued, “Maybe hospitals should be ‘treatment so fast you’ll freak.'”  It was an off-the-cuff comment, but you know, thinking like this just might be our problem.

Health 2.0 Thoughts: Clay Shirky

It’s Wednesday, a whole week removed from the opening of Health 2.0.  The bad thing about posting a week later: everything has probably already changed.  And so, still relevant or not, this begins a yet-to-be-decided part series on thoughts from Health 2.0.

Clay Shirky had a great keynote.  Here are some selected comments (most likely a mix of my own words and his, with my comments in the parentheses):

  • Most valuable thing connected to the internet: people
  • Patient-Centric Medicine: internet is implementation layer
  • TRUST is the key (recurring theme throughout the conference) for information to flow
  • The changes made to the Catholic Church by the Second Vatican Council can be used as a metaphor for the changes going on in health care (very impressive metaphor, IMO); Vatican II shifted the focus of the church from the leaders to the parishioners, Health 2.0 is shifting focus of health care from health care deliverers to patients (I’d even argue it is shifting us from health care to health)
  • We’ve always had informal health care conversations, you just couldn’t see them before (innocent conversations around the table…)
  • When you give new people access to information things are are going to get weird, and they are

A short open letter to our dearest Health Care

Dear Health Care,

I thought it would be good for you to know that it really is possible to change—even if you’ve been set in your ways for most of your history.  Yes, it seems difficult.  But you’ve have shown a few instances of wanting to do better (indeed you may have been coerced; however, the good faith efforts have been duly noted).  I have confidence in you, even as you continue to make unsustainable business decisions.  If you need further inspiration, read this story about a 100-year-old newspaper that decided to stop actually printing a daily edition and publish in online format only.  Just remember: anything is possible if you put your mind to it.

Sincerely,

Reality

Wasted: Health care spends like a drunk sailor

Impassioned plea for action.

The biggest problem with waste in health care: it’s easy to talk about, much harder to get rid of.

And the pertinent question at this point is this: did this problem arise because of government involvement or despite it?  And the even more prescient brainteaser: will this problem be more likely solved with more government intervention or less?

Finally, (and this post is not meant as an endorsement of a particular health care payment philosophy) can a market-based health care economy bring about the needed reform or will it take a czar of American health care?

Oh, and the other thing about waste: that money is someone’s income or an organization’s bottom line.  Expect actions to reduce it to be battle-like.  We’ve definitely got some work to do.

36. Get out of health care

The complications of delivering health care often demand customized solutions.  But that doesn’t mean we need to depend on the ideas inside of our walls for inspiration.  We could do a lot to improve ourselves if we just looked beyond our doors.

Memorial Hospital and Health System in South Bend, Indiana has been doing just that for years.  There are plenty of examples of organizations getting out of this industry to improve what’s going on inside.  Here are a few.

Memorial has taken an innovation model from industry:

Back in 2000, [CEO Phil] Newbold and Memorial’s Vice President of Marketing, Diane Stover, searched for innovation models within health care and found none. “There was a time, a change would come from Medicare or another funding source and our leadership team would react rather than stick to a plan,” Stover stated. “We launched this initiative to spark positive changes and increase control of our destiny.” Newbold led the charge to engage all 3,800 employees in an understanding of the many challenges facing them and of a commitment to innovative thinking and solution prototyping. The first step was visiting innovators like Whirlpool, 3M, DuPont, W.L. Gore, GE, and Procter & Gamble.

Others have taken checklists from pilots:

In 2001, though, a critical-care specialist at Johns Hopkins Hospital named Peter Pronovost decided to give it a try. He didn’t attempt to make the checklist cover everything; he designed it to tackle just one problem, the one that nearly killed Anthony DeFilippo: line infections. On a sheet of plain paper, he plotted out the steps to take in order to avoid infections when putting a line in. Doctors are supposed to (1) wash their hands with soap, (2) clean the patient’s skin with chlorhexidine antiseptic, (3) put sterile drapes over the entire patient, (4) wear a sterile mask, hat, gown, and gloves, and (5) put a sterile dressing over the catheter site once the line is in. Check, check, check, check, check. These steps are no-brainers; they have been known and taught for years. So it seemed silly to make a checklist just for them. Still, Pronovost asked the nurses in his I.C.U. to observe the doctors for a month as they put lines into patients, and record how often they completed each step. In more than a third of patients, they skipped at least one.

Some have borrowed barcodes from grocery stores:

The next time you need medication at Medical Center Hosptial don’t be surprised if a nurse asks you to hold out your arm. This month, nurses started using a new bar-code technology to make sure the right medicines get to the right patients.

“All that information is right there on the computer so they don’t have to go back out to the nursing unit and gather that information from a paper chart,” Sharon Nash, the Horizon Admin-Rx project manager, said.

Memorial calls them inno-visits.  You can call them what you want.  The important lesson here is that we realize the extraordinary benefits that come with looking beyond health care, the inspiration that comes with a change of scenery.

The problems of health care are many, so numerous that one could sit in an office the entire day reading and prophesying about nothing but health care.  Time better spent would be to visit/read/listen/do/join/experience anything outside of this industry.  Your next great idea may come from an experience at a NASCAR track, in the chat of an art historian, from the pages of a great book, or on a visit to Method.  Seriously.

Principle 36: Every decision maker at our own system will be “strongly encouraged” to get out of health care, if only for moments on a daily basis.  The concept of looking beyond our walls will play a significant role in transforming our health care system, indeed it already is.

In: Read This

Some links, from last week, for your reading pleasure this week.

MinnPost, a non-profit online publication, profiles (and debunks) Minnesota’s uninsured population.  Quite interesting, not at all what I thought.

There’s a country more obese than the United States: Australia.  PSFK reports on the government’s response involving measuring tapes, the easy to remember phrase “green for lean, red for spread,” and $30 million.

The X PRIZE Foundation and WellPoint are offering a $10 million prize if you can improve quality and lower costs in American health care.  I’m a big fan of the idea, though I think a better approach would be to offer smaller prizes with specific desired outcomes.