What are the odds?

It’s hot in Las Vegas and the heat is on local hospitals as the Las Vegas Sun begins an ongoing quality investigation:

As part of a two-year investigation, Sun reporters Marshall Allen and Alex Richards have obtained a record of every Nevada hospital inpatient visit going back a decade — 2.9 million in all. The information, coupled with interviews with more than 150 patients and health care insiders, has yielded a sweeping and detailed portrait of hospital care in Las Vegas.

Revealed are the dangers patients have unknowingly encountered as they enter delivery rooms, surgical suites and intensive care units, including thousands of cases of injury, death and deadly infection associated with stays in Las Vegas hospitals.

There have been previous red flags about hospital safety. A suicidal patient, for instance, recently hanged himself while under observation at MountainView Hospital, and a woman in labor was ignored at University Medical Center, leading to a miscarriage.

A recent study found that Nevada hospitals have the worst rate in the nation of readmissions in the nation, meaning discharged patients needed to return within 30 days to the hospitals for additional care.

But the public has not known the scope of the problems, even though the state has been gathering inpatient data since 1986. The data, gathered primarily for cost-control purposes, are based on individual hospital billing records that state law mandates be collected for the purpose of analysis.

Witty swipes aside–the question now is what’s next? Will patients use the data to make hospital choices (something that hasn’t really gained traction on a national level…yet)? Will patients be able to interpret the data? How will the hospitals react?

There’s a joke about Las Vegas healthcare according to the article:

“Where do you go for great health care in Las Vegas?”

“The airport.”

The fact remains, however, that there isn’t an in depth way to compare hospitals nationally. The initial data presented doesn’t reflect favorably on Las Vegas healthcare, but where that puts those hospitals against others in the nation isn’t apparent. 

Las Vegas hospitals fought the release of the data. I’m sure their arguments had some merit; but for the betterment of healthcare in Las Vegas and around the country data publication like this is necessary. With the attention the Sun will receive for the investigation, I wouldn’t be surprised to see it replicated by other newspapers around the country.


I’ve never really been a “numbers” guy. They don’t allow enough legal/moral creativity for my interests. But that doesn’t mean I don’t respect them. Numbers are vitally important to any business adventure. I just think that sometimes we place too much importance on them–especially when those numbers are just projections without much more than an office-based person using data to make an educated guess.

The focus on numbers is warranted. Healthcare is actually still pretty new to cost containment (hospitals were once reimbursed on how much they spent, can you imagine such a world?). So when the gales of the fee-for-service came crashing down upon the ship, numbers mattered more. They’re going to matter even more as we navigate through the bundled-payment storm. By mattering more, there will be more of them.

Ayyyy matey.

Joking aside, numbers are important. But so is everything else. (Like people.)

A recent work task combined with this Chris Guillebeau post have given me more perspective. Numbers are goals. Goals provide focus. Given the complexity of healthcare, focus is a rare element. Numbers provide a sense of control in an environment that is far too crazy to ever really have control. 

Goal numbers can be financial (a budget), performance (zero errors), or interest inducing (hmmm…).

William Taylor at Fast Company asks this question in an article, “So why is it that so many of the numbers we encounter in business–from endless Excel spreadsheets to bloodless calculations in business plans–make our eyes glaze over rather than set our minds racing?”

That’s been my struggle. Numbers have often produced a state of mind-numbing boredom for me. But Taylor notes that the right numbers can tell a compelling story. Like this one: “We’re in front of whiteboards 4 hours a day, but only use them for 4 minutes.”

Yeah, that’s because we’re all looking at the numbers.

3 @leighhouse @danielpink Drive links

If you haven’t dove into “Drive” by Dan Pink yet, you’re due. It takes everything you thought you knew about motivation and turns it around. There are serious implications (everywhere in healthcare, but especially) in the physician compensation area–financial rewards don’t always motivate the behavior they’re intended to. Anyway, Leigh Householder posted a thought trifecta on the subject that can hold you over while Amazon ships a copy.

The India problem (or: why we all have accountant blood on our hands)

Advice Dan Pink gave me

Where innovation comes from


The Genome At Ten

When I started college in 1994, we were told there were over 100,000 genes in the human genome. Today, it’s estimated to be about 20,000 based on our findings from the Human Genome Project.

Science humbles me. We know so little about the human body. And what we “know” today will be different than what we “know” in ten years. The practice of medicine will have gone through two fundamental transitions— there is a common belief within the medical profession that the practice of medicine changes every 5 years. What’s state of the art today is either disrupted by something better or by more accurate information. 

One hundred years ago, only about 10% of doctors graduated from medical schools. The rest were essentially shaman. Healthcare is a very new “science.” 

That’s why I tend to view the practice of medicine with skeptical eyes. I know what we don’t know. And extrapolate that out a bit more…and you can see why I feel so strongly about healthcare bankrupting our country. The science of healthcare in America is completely based on a moving target. We’re trying to understand the minutiae, rather than focusing on just getting the stupid simple basics right 99% of the time.

Digital training!

An interesting nugget from Ed Cotton who heard NPR’s Vivian Schiller at the Wired Business Conference:

Vivian Schiller had a different story, she was all about responding to changing times and about embracing digital platforms as rapidly as possible. She was proud that NPR’s radio listeners are at an all-time high (60% increase in the past 10 years), but yet NPR is rapidly embracing all things digital. 

One of her most interesting ideas was to ensure all 300 journalists at NPR received digital training, so they knew how to integrate digital elements into their stories.

Digital training! Can you imagine the reach new digital tools might have if hospitals held digital training for everyone? How cool would that be? You might not think so, but I say very, very.