Dinnertime: Coach John Wooden

You know that question, “If you could have dinner with (some number) of people, who would they be and why?”  (Or something similar).  It is an intensely difficult question to answer, especially when there are no parameters.

So, starting today some insights from the best; from people worth having dinner with.  In honor of the March Madness apex this week: Coach John Wooden, the greatest basketball coach (teacher?) ever.  His definition of success, “Peace of mind attained only through self-satisfaction in knowing you made the effort to do the best of which you are capable.”


The video is from a speech at TED in 2001, the insights of which can be deployed in your health care world:

Three rules he used to govern his team, insight he received from his father:

  1. Never be late.
  2. No profanity.
  3. Never criticize a teammate.

Another set of three, also from his father:

  1. Don’t whine.
  2. Don’t complain.
  3. Don’t make excuses.

A couple of more thoughts:

In whatever you do, you must have patience.
There is no progress without change.
Things will work out as they should providing we do what we should.

While all very good, the never be late may be the most poignant lesson for health care.  Oh the possibilities.

A really good story.

### This post may look long, but I think you’ll be immersed in short order.  It might even be beneficial to your psyche. ###

As many (or none) of you may know, Beth Israel Deaconess Medical Center in Boston is in the midst of budget troubles (there are few hospitals — or organizations for that matter — who are not).  What makes the Beth Israel situation different is that the CEO, Paul Levy, blogs.  His commitment to transparency transcends the quality environment.

Here is a quick rundown if you are unfamiliar.  The problem the hospital faces:

For BIDMC, our hoped-for 2% FY09 operating margin (about $18 million) has disappeared. The state has reduced Medicaid payments by over $7 million, our major insurer is paying us less than we had hoped, and research funding has also fallen short by several million dollars. In addition, patient volumes are substantially lower than budgeted as people in the community defer or forego medical visits and treatments.

Right now, at best, we can break even for the year if patient volumes return to budgeted levels. However, if they stay at current levels, we will face an operating loss of up to $20 million. This is the contingency for which we must prepare, or else we will have insufficient funds to invest in the buildings, plant, and equipment needed.

With this knowledge in hand, Mr. Levy decided to ask the people of BIDMC for their ideas to help trim expenses during town hall gatherings.   Kevin Cullen of The Boston Globe best describes the scene at one of those meetings:

He looked out into a sea of people and recognized faces: technicians, secretaries, administrators, therapists, nurses, the people who are the heart and soul of any hospital. People who knew that Beth Israel had hired about a quarter of its 8,000 staff over the last six years and that the chances that they could all keep their jobs and benefits in an economy in freefall ranged between slim and none.

“I want to run an idea by you that I think is important, and I’d like to get your reaction to it,” Levy began. “I’d like to do what we can to protect the lower-wage earners – the transporters, the housekeepers, the food service people. A lot of these people work really hard, and I don’t want to put an additional burden on them.

“Now, if we protect these workers, it means the rest of us will have to make a bigger sacrifice,” he continued. “It means that others will have to give up more of their salary or benefits.”

He had barely gotten the words out of his mouth when Sherman Auditorium erupted in applause. Thunderous, heartfelt, sustained applause.

Paul Levy stood there and felt the sheer power of it all rush over him, like a wave. His eyes welled and his throat tightened so much that he didn’t think he could go on.

Reducing personnel costs (layoffs) became the prime target (largest expense for a hospital) and to begin senior managers took a reduction in pay.  Mr. Levy himself reduced his own pay by 10 percent while also foregoing his annual bonus (+ he and Mrs. Levy have committed to matching employee donations to the hospital at a rate of $1 for every $10 donated).  Here he is on the response he received after his call for idea assistance:

As expected, the response from the staff has been spectacular. People have a terrific sense of community and are quite willing to make sacrifices for the good of their fellow workers. … Beyond the general feeling, I was very, very pleased when I asked people if they agreed with my predisposition to protect our lower wage earners (e.g., transporters, housekeepers, food service people) from measures we take, even if it means that other people have to give up more of their salary and benefits.

Mr. Levy has finalized his decisions after exploring all considerations; the proposal includes a number of efforts to reduce expenses.  The best news is that projected layoffs were reduced from a high of 600 to the expected 150.  I cannot do the letter Mr. Levy sent to the people of BIDMC explaining his decisions justice without reproducing it whole—so I urge to you read it in its entirety.

While I am impressed by the translucence Mr. Levy allows of his organization, I’m more taken by the way he has introduced, handled, and shared the hospital’s problems with the people of the organization.  As a (hopeful) future health care leader, I’d like to thank Mr. Levy for providing an (almost) first-hand experience to an organization’s financial troubles.

At times, I’m unsure of how serious senior leaders are to exposing students and new graduates to difficult management situations (one piece of evidence: several conversations with student attendees at ACHE Congress on the general uselessness of the student program).

Granted, this educational opportunity is unlikely the motive for Mr. Levy revealing his organization’s struggles; although, as I’ve gotten to “know” Mr. Levy through his blog, he has a proven commitment to education.  I’m confident that there are more health care leaders in this country working along the same path as he; but Mr. Levy is the first to provide unprecedented (real time) insight through a blog.

Anyway, Mr. Cullen sums up how I feel nicely in the The Globe:

Paul Levy is trying something revolutionary, radical, maybe even impossible: He is trying to convince the people who work for him that the E in CEO can sometimes stand for empathy.

Though you’re likely to shrug it off, I would like to express my appreciation for your courage, Mr. Levy, along with your fresh approach to health care administration.

Catching up…

Blogging has slowed while on vacation but reading hasn’t; sharing good stuff is always a priority.  So I’ll try a Noah Brier inspired linkdump since I’m in the throes of another rain-soaked Germany day.

Remember flattening the health care organization?  Well a one-man software company has committed to becoming a completely open company.  It’s a very interesting read (the comments, too) with some potential health care lessons.  This may be the most important:

It used to be hard to imagine that anything serious could be build without the creation of large hierarchical organizations. But if one thing has really been shown in these recent years, it is that self-organizing groups in many cases can outperform traditional organizations.


Wouldn’t it be cool to present a cool idea at TED some day?  Well, here may be an opportunity akin to the minor leagues: TEDx—an independently organized TED-style conference.  From the website:

In the spirit of “Ideas Worth Spreading,” TEDx is a program that enables schools, businesses, libraries or just groups of friends to enjoy a TED-like experience through events they themselves organize, design and host. We’re supporting approved organizers by offering a free toolset that includes detailed advice, the right to use recorded TEDTalks, promotion on our site, connection to other organizers, and a little piece of our brand in the form of the TEDx label.

In another TED-related link, this conference (via Berci) has the potential to be zen-like.  Although the cost may prohibit some (most? maybe that’s where TEDx comes in…) who truly need to be there from going, it’s down the right road.


Wayne Smith needs your help (via Good Community Blog) in finding an organization to partner with to start a giving program through HSAs:

Basically, this is a social business model. The idea allows people to give small amounts of their pretax paycheck each week to pay for others’ health care without any incurred risk and by bypassing government channels. It is privatized health care philanthropy administered on an individual payout basis.

0.1% (or some other small amount) will be the default giving level. Members of the HSA will be signed up automatically and informed that they may choose to opt-out or increase their giving. The objective is to set the default option low enough that people will not be motivated to opt-out. There is also the opportunity to allow individuals to donate the balance of their HSA to the program at the end of the year (potential default option), and to the program as the beneficiary upon an individual’s death (another potential default). The idea may also be able to leverage the Cass & Sunstein idea of Give More Tomorrow, since the contributions will be withdrawn from pretax individuals’ pay.


My vision of a truly useful personal health record.


So Ohio State is giving medical students the use of an iPod Touch/iPhone.  Maybe EHRs will truly be embraced by the health care establishment when they make providing care easier (i.e., handheld devices helping provide care); another step in that direction reported by PSFK:

But two new devices for the new iPhone OS demonstrate just how the iPhone is going to make monitoring your health both more immediate and interactive. One app can control a blood-pressure cuff that plugs in to your iPhone, and Johnson & Johnson revealed a similar app and device that tests blood glucose levels.

The war against cross-subsidization

Using the time provided by a trans-Atlantic flight (and the spring break from normal studies), I’m finishing “The Innovator’s Prescription.”  Another great excerpt:

Not surprisingly, we reap the same inefficient results that characterized Communism.  Hospitals aggresively pursue some types of procedures—like coronary bypass surgery, for example—that are highly profitable.  And they often shun money-losing services such as psychiatric and trauma care, as well as services like preventative and primary care, which could save costs in the long run.  Eventually, more and more people lose “access,” as the services that aren’t paid well or must be provided at a loss become harder to find.  But the profits and losses aren’t a reflection of value to their customers, prices, society, or the forces of supply, demand, and competition: they are the phantom result of inaccurately set prices that are grossly ot of line with costs.  Yet as in the communist system, we muddle along because the prices that are set mistakenly high roughly offset those set mistakenly low, allowing most hospitals and physicians’ practices to eke out a modest profit after all cross-subsidization is complete. 

Can anyone provide a logical, believable, and defendable reason for why heart treatment is of more value (based upon treatment cost) than depression?

The free marketeers would claim that an absolutely free market would best distribute health care resources; the single-payer contingent is not comfortable with the fairness of that thought.  Opposite, a completely controlled government system would provide equal care for all; yet the free marketeers are uncomfortable with subjective pricing.

As we continue to debate our next health care reform effort; is an efficient system with limited government intervention fathomable?  The point is moot, regardless.  We’ve got some time yet in the system currently in operation.

As an extra thought, however, why not explore what has worked in Germany.  No, not the health care system; but the country itself and the path it has followed since recovering from Communist rule following World War II.  There are still socialist policies in place; however the country has grown into the world’s third-largest (Europe’s largest) economy and the largest exporter.

The thing to remember is that it’s possible for the free market and goverment intervention to co-exist.  Although far from ideal, it’s the American health system in its current form.   The system is in need of change to asure coexistance is mutually beneficial to all involved.  Easier. Written. Than. Done.

Local health concerns

I’ve written: Who better to understand the health care challenges of a community than local delivery organizations?  Recent research by Richard Florida et al. reveals that “States with large concentrations of working class jobs had lower levels of income, GDP per capita, and well-being – pretty much everything across the board.”

Most important to health care delivery is the well-being aspect; both physical health and healthy behavior were negatively correlated in states with a large share of working class jobs.  So again, if so much of health care is based locally, why are we trying to solve its problems nationally?


42. Green = Go

Happy St. Patrick’s Day.

Organizations need people who are always moving, always on the go.  The type of people who drive the long way to a destination because the short way means waiting in traffic.  Always need to be moving.

Moving means progress.  Granted, the wheels are going to spin at times.  It might even mean it takes a little longer to get where they’re going.  But this is for certain: once they reach an endpoint they begin their search for the next.

Now is a time for action.

Hospitals are looking for ways to decrease costs, to be more efficient, to utilize resources more effectively.  During a time when “all is fair game” the possibilities are limitless if the barriers are removed.  Let the folks who like to move, move faster.  More at bats gives the organization more opportunities to find success (that from Tom Peters).  Try lots of potential solutions in semi-controlled environments.  If it works, spread it.  If not, scrap it.  From the Institute for Healthcare Improvement:

An important tool in creating a successful pilot and spreading change throughout an organization is rapid-cycle testing. Rapid-cycle testing allows organizations to test and refine ideas quickly and on a small scale.

As Tom Peters says, and as rapid-cycle testing allows, “Ready. Fire. Aim.”  Start trying.  Go!

Principle #42: We’ll empower our workforce to start testing and encourage them to not cease.  Enjoy the day of celebration. Believe it or not, the day means something.

In: Revolutions

Two excerpts from Clay Shirky’s piece on newspapers (though it’s applicable to health care and more):

Revolutions create a curious inversion of perception. In ordinary times, people who do no more than describe the world around them are seen as pragmatists, while those who imagine fabulous alternative futures are viewed as radicals.

That is what real revolutions are like. The old stuff gets broken faster than the new stuff is put in its place. The importance of any given experiment isn’t apparent at the moment it appears; big changes stall, small changes spread.

Old people are online, too

The Millenials are called the Net Generation because of their (our) prowess on the information superhighway.  But since so few of them seek health care help online, why would a health care delivery organization waste time in creating an authentic online experience?

The result is that many health care delivery organizations’ online strategies suck (my opinion, it should be a fact though) (by the way, do they even have strategies?).  But wait!  Here is some interesting information provided by Pew Internet and American Life Project on health care decision makers:

Generation X (those ages 33 to 44) is the most likely group to bank (67%), shop (80%) and look for health information online (82%). (emphasis enthusiastically added)


(In the spirit of your favorite game show): That’s not all, Jimmy!  Look at these data on heavy health care users use of the web to find health information:

  • Younger Boomers: 74% of the 79% who use the internet
  • Older Boomers: 81% of the 70% who use the internet
  • Silent Generation: 70% of the 56% who use the internet
  • GI Generation: 67% of the 31% who use the internet

At a time when low cost everything is in vogue, updating (creating?) your organization’s online strategy is a genuine opportunity.  Get crackin’!

(Pew link via Ted Eytan, MD)

And then Wal-Mart from right field…

Wal-Mart: the giant…health care integrator?

Wal-Mart‘s (astonishing?) announcement Tuesday from The New York Times:

Wal-Mart Stores is striding into the market for electronic health records, seeking to bring the technology into the mainstream for physicians in small offices, where most of America’s doctors practice medicine.

Evidently the retailing giant will partner with Dell (hardware) and eClinicalWorks (software) to complete the service.  Installation, maintenance, and training will be included.  The product will be offered through the Sam’s Club brand.  It’s going to be (relatively) cheap, too.  More details:

“We’re a high-volume, low-cost company,” said Marcus Osborne, senior director for health care business development at Wal-Mart. “And I would argue that mentality is sorely lacking in the health care industry.”

The Sam’s Club offering, to be made available this spring, will be under $25,000 for the first physician in a practice, and about $10,000 for each additional doctor. After the installation and training, continuing annual costs for maintenance and support will be $4,000 to $6,500 a year, the company estimates.

An affordable EMR option.  Waiting, patiently, for the reaction on this one.  (Mr. Osborne’s quote above is interesting, too.)