Simplicity reigns

If we could just simplify stuff (discharge instructions, number of stent brands to choose from, working with other departments, etc., etc., etc.) in health care the system would greatly improve.

Retailers are trying. From The Wall Street Journal:

For years, supermarkets, drugstores and discount retailers packed their shelves with an ever-expanding array of products in different brands, sizes, colors, flavors, fragrances and prices.

Now, though, they believe less is more.

The article is likly behind the password wall.  So here’s the meat of their argument (though likely quite different than the benefits to health care, the general jist is that simplification improves business):

Now retailers are cleaning up the clutter. They are trying to cater to budget-conscious shoppers who want to simplify shopping trips and stick to familiar products. Retailers have found that eliminating certain products can lift sales and profits, in part by cutting excess inventory and making more room for house brands.

“All that go-go 1990s where we were adding items in and adding items in, and people wanted more, more, more, more choice… just didn’t pay off,” said Catherine Lindner, Walgreen’s divisional vice president for marketing development, at a recent conference. Looking at store shelves, “People say, ‘Whoa, you’re bombarding me. Help me figure out what I need.'”

The health care path

Generally (over the last 20 years): inpatient health care (pdf) utilization has been flat, outpatient care steadily increasing, and home health treatments rising.

What emerges is a trend toward treatment options that have become more convenient for patients (the cost usually declines, too; but not necessarily):

Inpatient Care —> Outpatient Care —> Home Health Care

That’s good and the path is getting longer.  Home health care services have been provided to the most needy patients.  The next logical step, which is already being taken, is to provide health care in the home to patients who are not as needy; for example, the home monitoring of cardiac patients.  And home monitoring toes the line on the next logical step: personal care for diagnoses previously needing professional assistance (personal care could/should, definitionally speaking, include personal responsibility for healthy eating/living/exercising as well).

Health care services will continue to be pushed down this path:

Inpatient Care —> Outpatient Care —> Home Health Care —> Personal Care

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)

Freak!

(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)

Generation Generosity

Trendwatching:

The most important driver behind GENERATION G is a wide variety of consumers and citizens being more generous. We’re talking the collaborative / free / creation / crowdsourced / gift / sharing movement that—especially online—has unlocked in entirely new ways the perennial need of individuals to be appreciated, to be loved, to feel part of the greater good, to contribute, to help… To basically find status and gratification in something other than consuming the most or the best.

Don’t think this a passing phenomenon: younger generations practically live online, while over the last dozen or so years, virtually every prediction of how the web would infiltrate the ‘offline’ world has proven too conservative. As our favorite online guru, Kevin Kelly, rightly stated a few years ago: ‘online culture is the culture’.

So… Everything seems to have aligned to make generosity (“liberality in giving or willingness to give”) a leading theme in the business arena this year. As always, companies can learn from consumers, though it’s not a ‘want’ but a ‘need’: companies need to mirror this societal shift if they want to regain their relevancy. We’re talking truly becoming a caring brand—one that is generous to customers, generous to employees, generous to the environment, generous to social causes, and so on. We know you know this: GENERATION G is more about context and timing than out-of-the-blue insights. (italics added)

Health care is in a unique situation to become a significant part of this movement.  Obviously, keeping the doors open is priority one.  But generosity is something needed now, much more so than in times of abundance.  Has your organization’s generosity risen, fallen, or remained the same during the economic slide?  What level of generosity existed in 2007?

Health care by the people…

Get it done yourself health care:

CNN:

One morning a couple of months ago at Westchester Medical Center, Dawn Verdick gave Daniel Flood one of her kidneys.

Verdick and Flood were not friends or family. In fact, they were total strangers from the East and West coasts. But that’s not the most unusual aspect of this case.

The patient and donor were brought together after Flood’s three daughters placed an ad on Craigslist, the online classifieds site that offers everything from autos to real estate and guitar lessons to massage.

The New York Times:

They borrow leftover prescription drugs from friends, attempt to self-diagnose ailments online, stretch their diabetes and asthma medicines for as long as possible and set their own broken bones. When emergencies strike, they rarely can afford the bills that follow.

…

In dozens of interviews around the city, these so-called young invincibles described the challenge of living in a high-priced city on low-paying jobs, where staying healthy is one part scavenger hunt and one part balancing act, with high stakes and no safety net.

Appreciate the self-reliance, fear the self-infliction.  Self-health requires an ethics conversation, good or bad?

Neighborhood health care delivery

Wal-Mart is opening its first Marketside store (yes, that Wal-Mart).  The concept is a 15,000 square foot (much, much smaller than the Super Wal-Mart) neighborhood market.  It’s meant to compete with Tesco’s Fresh & Easy entrance into the United States.

The Financial Times reports the new concept “marks a dramatic break with the branding of the rest of Wal-Mart’s more than 3,400 low-cost US stores.”

What does this have to do with health care?

The trend.  It’s smaller, manageable, intimate, community-like.  If a Super Wal-Mart is 1000+ bed quaternary hospital, then a Marketside neighborhood market is a … to be determined.

Some may think it’s a retail clinic, but the analogy doesn’t hold here.  The retail clinic depends on the foot traffic generated by the big box retailer or pharmacy.  It’s not a specialty hospital either, not enough product offerings.  Most likely it’s a health delivery concept that hasn’t reached the masses yet, like the medical home or micro practice.

Regardless of what it actually is, the concept of neighborhood health care delivery is much more desireable than the mass production of a primary care clinic attached to a super hospital.

What’s a mistake?

More payers are ending payments to hospitals that result because of mistakes.  Makes intuitive sense.  Turns out, however, that defining mistakes is a rather gray exercise.

But the California Department of Public Health may be ushering in a new trend: fining hospitals for making mistakes.

Forecast: increasingly gray.  Issuing fines for “mistakes” is making the distinction between mistake and intentional harm more difficult to define.  Stay tuned.

UPDATE: a comprehensive list can be found here.

Medical tourism gains Olympic notoriety, links

American speedster Tyson Gay is expected to be in the hunt for a gold medal in the 100-meter dash in Beijing on Saturday.  But he almost didn’t make the trip.

Gay took a scary spill at the Olympic trials five weeks ago that brought his appearance in the 100 meters into question.  From ESPN:

One week after setting the American record in the 100 meters and also running that distance faster than anyone else ever has, Gay’s quest to double up at the Olympics in the 200 ended prematurely and painfully during a quarterfinal heat when he collapsed due to what was described as a “severe cramp” in his left hamstring.

Gay pulled up about a dozen strides into the race, after perhaps 40 meters. He collapsed to the ground and lay there as his competitors raced ahead and a stunned Hayward Field crowd went silent. Officials quickly brought a modified stretcher onto the track and wheeled him to the medical tent for examination.

In order to be sure the injury wasn’t anything more than cramps, Gay was treated by a physician…in Germany:

“The hamstring is 100 per cent,” he said after being treated by specialist Hans-Wilhelm Mueller-Wohlfahrt, the doctor of German football giants Bayern Munich and the German national team.

Olympic Medical Tourism—it has a ring to it, no?

Niko Karvounis’ recent in-depth look at medical tourism is worth your read at Health Beat.

Also, The Economist takes a free market look at medical tourism.

Organizational Obesity: Are health care organizations too fat?

I’ve recently been kicking around potential reasons for the notorious slow-to-change health care organization phenomenon (fact?).

There are many potential possibilities: slowing down the speed of change in an environment that is controllable while the rest of the world changes minute-by-minute around it.  Financial incentives.  Variability of patient needs.  Dependence upon “contractors” to send business their way.  The list is lengthy.

But here is another thought: are health care organizations too heavy administratively?  Are there too many administrators, executive vice presidents, senior vice presidents, vice presidents, directors, managers, billers, processors, assistants, communicators, marketers, analysts, information servicers, health informaticists, human resourcers, etc.?  Could organizational obesity be the ultimate contributor to the unalterable tardiness of progress?

I don’t know the answer.  But what I do suspect is that beefy administrative staffs (as opposed to beefy patient care staffs) creates a largesse bureaucracy.

Stiff and rigid bureaucratic structures created by corpulent administrative staffing reduces accountability.  That (lack of) accountability can then be passed amongst the pertinent corporate players until an initiative fizzles out, money runs out, or industry changes require movement to another objective.

If you’re shaking your head, I’d rather it be done if you know for sure that this is not the case.  You very well could be right.  Because I’m just wondering and proposing.  Heck, I’m planning a career in health care administration.  But if you’re shaking your head because you are relatively sure, I’d ask you to dig deeper.

The problem is that traditional bureaucratic organizations have more layers between the people making decisions and the people affected by those decisions.  Flatter organizations would be in tune to the needs of patients and front line staff—the people whose needs are (should be!) the organization’s focus.

But instead, this solution: add another administrator and create another department to connect with patients.  And the march toward organizational obesity carries on.  Connecting with patients is every employee’s job.  Even the employee most removed from patient care will encounter a patient sooner or later.

SSM Healthcare in St. Louis has cut its organization’s staff by nearly 200 employees in 2008.  Most recently, it was mostly hospital top managers receiving pink slips.  This editorial says:

Most losses have been part of a larger shift to make the SSM system more cohesive. Most decisions on human resources, finance and technology will be made at two regional offices or at corporate.

Efficiency matters.  Productivity matters.  SSM is looking to find a way.  Is it the beginning of a trend?  Too early to say, but the current economic situation is not helping.

Varied payer demands, complex regulatory and accreditation requirements, and complicated management needs have made larger administrative staffs necessary in health care.  But has health care staffing become too fat?

The new health care environment is pushing for more value.  Again from the St. Louis Post-Dispatch:

Hospitals are facing increasing pressure to improve care while cutting costs. Quality directives from managed-care companies and the government are coming with slight, if any, increases in payment. And lately, some hospitals are seeing fewer patients.

Higher quality, better patient care, lower cost.  Increased value is not achievable through deep cuts of direct patient care staff.  That leaves one other group.  Guess who it is.

Back to Listening

The Church of the Customer blog has a short interview with author Josh Bernoff, (“Groundswell: Winning in a World Transformed by Social Technologies“).

It is a good exchange on social media. The power of social media in health care organizations hasn’t yet been realized (heck, we’re just getting around to proper patient use). It’s coming.

Favorite exchange:

What’s the secret ingredient at companies that understand the value of two-way communication with customers and why is that ingredient so hard to replicate at other companies?
Most managers say they want to hear from customers. They don’t. They like the idea of a mass of consumers but individually, customers are quirky. Most companies keep them at arm’s length with phone systems and call centers and focus groups. Why are you stuck on the other side of that one-way glass? Dell is an example of a company that now gets it. Michael Dell talks in terms of 100 million customer touches per year. When you think of those touches as an asset, you’ve changed your thinking. For your company to attain that thinking, it helps to build a social application. It will slowly and inexorably change your attitudes to be more customer-centric, especially at is succeeds and spreads to other applications. It takes years, but it works.

Personalized health care is the new raison d’etre in some organizations. That’s good…when it happens. In order to personalize, a hospital must encourage individual conversations with each patient. We have some work to do. Social media will help.