HealthcareTomorrow

Healthcare Tomorrow Has a New Home

2006-12-20T21:49:00.000-08:00

I am happy to announce that Healthcare Tomorrow has a new home.

Come visit my new website at www.healthcaretomorrow.com.

All new posts will be there.

The Best of the Best

2006-12-15T15:04:00.000-08:00

Top Gun was one of the first "cool" movies I remember watching. Maverick and Goose are rebellious Navy pilots that are chosen to attend an elite aerial combat school where they duke it out to see who would be the best of the best. I am pretty sure every boy fantasizes about that kind of glory, but I have always wondered how they knew who should attend the Top Gun flight school. How did they know who the best were?

Now that I am getting more intimately acquainted with HR I have begun to wonder the same thing about nurses and managers and executives. When we are out looking for new talent for the organization, how do we know who the best are and where do we find them? It would seem that most of the time we are just sifting through the available pool of local talent to fill positions with “the best available”. But how far will that get us? For an organization, like my own, that strives to be the best medical center in the nation, I don’t think it gets us far enough.

The problem is that healthcare workers don’t have box scores printed in the Sunday paper. The best of the best are likely humming along within their organizations and potentially invisible to the outside world. There are people that receive public awards, but those are few and far between (and those are often popularity contests anyways).

I can hear the recruitment specialists of the world saying that you find talented people by offering the right incentives and then the best will come to you. Perhaps there is something to that, but what do the best want that would distinguish them from the rest? More responsibility…more pay…more prestige…more freedom…more resources at their disposal?

But maybe it is another truism about business – it is who you know – that is the secret to finding the best. We already give referral bonuses to employees for finding new talent, but maybe we haven’t gone far enough down that road. Do your best employees know other high performers? Perhaps LinkedIn is a better search tool than Monster.

These are some interesting questions and, obviously, I don’t have the answers. I would be interested to hear from people on this subject. And don’t worry, we won’t steal you best people…yet.

Next I do Surgery

2006-11-28T11:28:00.000-08:00

So I have been studying for my Certified Healthcare Executive accreditation for the past few months (hence the low number of posts) and it has gotten me thinking about what it means to be a competent healthcare administrator again. This has come up as I have seen a number of reports on recommended quality practices. For instance, an article in the NEJM sponsored by the National Heart, Lung, and Blood Institute, recommended a series of practices to reduce door to balloon time for myocardial infarction patients. What struck me about the list was a number of the recommendations weren't just for clinical folks. Plain old healthcare administrators, in the right role, could implement some of these practices and presumably impact a healthcare outcome.

This isn't really earth shattering on its surface. As healthcare administrators, we talk about improving quality all the time, but most of that talk is around structural or process issues that speak to the cost, availability, or effectiveness of services. We certainly care about patient outcomes, but those measures have been "owned" traditionally by the medical and nursing staff. They were the ones with the training and tools (I would argue that their perspective plays a key role as well) to evaluate the outcomes of clinical care. That certainly hasn't changed and healthcare administrators will always depend on our clinical counter-parts for this.

I think what has changed is the expansion of what is being considered to impact patient outcomes. More and more we are looking at process measures, not just for efficiency sake, but for their impact on the patient. An example is wait times in the ED. We are also looking at aspects of the hospital environment that impact not only patient satisfaction, but health outcomes as well. An example is natural lighting in the patient room.

I have always said that every decision impacts the patient in a hospital, but it is becoming more clear, to me at least, that healthcare administrators impact patient outcomes. What does that mean for us as professionals? Can bad management kill patients? Perhaps. All the more reason I need to pass my test.

A Health Insurance Experiment

2006-11-12T21:37:00.000-08:00

The sample may be small - my family - but we have learned a few things from our little experiment with a high-deductible health plan.

Our experiment began with an experience that is all too common now a days - the premium of our employee sponsored health insurance was going up and we were going to bear the brunt of that increase. So we were faced with the choice of paying high monthly deductibles, something we couldn't afford, or purchase a high deductible health plan on our own and take the risk for most of our utilization.

The first thing that we learned was that you can find plans with "affordable" premiums. The catch, of course, is what you have to pay our of pocket for the standards - office visits, prescriptions, labs, etc. That is where our experience started to break down. Our particular insurance carrier had the inexplicable practice of charging us a pretty hefty "co-payment" for office visits, thus giving us the illusion of paying for our visit, and then surprising us with a bill in the mail for the true, total cost of the visit.

Even so, we did do our best to manage costs. When my wife was experiencing some nagging but non-descript symptoms, we did go see the doctor, but we decided to hold off on an MRI. We ended up having an interesting conversation with the physician about the cost/benefit of the MRI and other diagnostic options. Our physician admitted that he didn't know the cost of the MRI and hadn't had this type of conversation with his patients before. How interesting!

But even though we tried to manage our costs, the system just wasn't there to support us. The straw that broke the camel's back was a bill we received for lab work for $345. To say the least, we were not expecting such a high bill, months after the date of service. When I called the customer support desk, I told them that we were not informed of the total cost of the test at the time of service. I was told that their process was for the patient to get an itemized list of services and call the customer service line for an estimate. I responded with a frivolous attempt to explain why this is not an efficient way for the patient to understand and manage costs. The customer service rep actually told me that they don't give providers access to cost information, so that clinical decision making would not be influenced by price. Argh!

Now to be a little fair, this unnamed, large, closed-panel HMO doesn't want to give the impression that it is making care decisions based on the financial impact to the organization. Bravo, that was the perception that it needed to fight after over-aggressive gatekeeping in the '90s. But this is a new era in healthcare. Gatekeeping was the insurance companies' attempt to manage cost, because they were the one's footing the bill. Now more of the burden is on the patient and it is the patient that needs all of the relevant information, including cost, to make a good decision for himself.

So, how did it go for us? Given our circumstances, the high-deductible plan gave us the most affordable monthly premiums and we expected to pay more for services out of pocket. If we had stayed with the plan for more than a few months, then I think the costs would have evened out. Our behavior did change. We started paying keen attention to when we used medical services and, interestingly enough, we started using complementary medicine with our newfound freedom from the HMO. It didn't count towards the deductible, but all of a sudden we started looking for health solutions that produced results. Apparently, alternative medicine providers will actually take the time to listen to you, work their mojo, and for a fraction of the cost.

But with the new job, came new health insurance, and so ended out little health insurance experiment. Man, it is nice to be heavily subsidized again!

A Clean Start

2006-10-25T16:17:00.000-07:00

It has been a while since I have written a real post...so where shall I begin? How about with a clean bed, where most patients hope to start their hospital experience. Unfortunately, it appears that a clean bed isn't always what it seems. A recent article in the Archives of Internal Medicine reported that ICU patients in beds that were previously occupied with MRSA infected patients had a 40% higher chance of catching the bug than patients whose beds had not. The collective cry of "eh!" from everyone reading this statistic is definitely ringing in the ears hospital housekeeping managers across the country.

Let's take a look at the typical housekeeping department of an American hospital. For one, it is staffed by some of the lowest paid employees in the hospital, which, of course, is not a reflection of their value to the organization, but more of the market. As it is an overhead department, it is likely staffed to the bare bones as well. Frequently, this owes to the fact that housekeeping departments usually report up to a general services VP, who often reports directly to the CFO. The housekeeper is a relatively isolated member of the patient care staff. They are usually assigned a zone or group of departments to work in alone and are not considered a member of those departments' patient care teams. On top of all of this, there is a significant pressure from nursing to "turn over" beds quickly - that is to clean them after a patient has been discharged to get it ready for the next patient. It is in this context that the housekeeper preforms his or her most important task - keeping a bug from one patient from passing to another.

My hope is that this study will cause hospitals to take a second look at not only their infection control policies, but the larger issue of how housekeeping is integrated into the patient care process. If the hospital is supposed to be a special place where the sick go to get well, then we need to make sure that manage each step of the process to that end. Even the clean up.

I'm Back

2006-10-18T21:24:00.000-07:00

Well it has been over 2 months since my last post and alot has happened.

For one, I am working again in a hospital and I couldn't be happier. Consulting was interesting, but my heart wanted to be back on the provider side. My new role is Director of Special Projects in the Human Resources department of Stanford Hospital and Clinics. I am not quite as close to patient care as I would like, but I am grateful to be working on some great projects in an important department.

Second, I am plugged in again. While working in consulting, I didn't feel like I was fighting the good fight anymore. I was in healthcare, but I wasn't working for an organization whose purpose was serving patients. After a while, I felt like I lost touch with the good guys. So now I am in an organization where everything matters again, where every decision impacts patient care. Now I can't not be plugged in to what is happening in healthcare - to what is right in healthcare and what isn't. It is a good feeling.

And now that I am plugged in again, I am eager to start writing posts. I hope you will join me again to fight the good fight for hospitals and for patients.

Stay tuned.

Diagnostic Uncertainty

2006-08-10T11:35:00.000-07:00

Diagnostic Uncertainty. The phrase actually sends shivers down my spine. It is the big “I don’t know” of medicine. If there is uncertainty in the diagnostic process, then you can’t move on, you are stuck with the questions and the anxiety and the thing inside of you causing symptoms that could be a sign of anything. And, yet, diagnostic uncertainty can be a good thing too. It can be the yellow light that causes us to slow down and look both ways – to look for other symptoms and other diagnoses. Waiting a little longer for the answer, conducting that one extra test, just might be the right thing to do.

Healthcare providers should keep this lesson in mind, as well. Indeed, that was the finding of a group of researchers studying the treatment of pneumonia (see their article in the journal CHEST). It is generally agreed that pneumonia patients should be given antibiotic treatment within 4 hours of being seen at the hospital. In fact, hospitals are “graded” on their performance in this area and strive for 100% compliance with the practice. But here is where the diagnostic uncertainty comes in. The researchers found that there were some patients didn’t quite present as classic cases of pneumonia and the right thing to do in those cases is to delay treatment, even if it pushes the treatment past the 4 hour mark. Now my point here isn’t to discuss the validity of the study (the sample did seem a bit small) or the best practice, it is to remind healthcare providers (administrators mainly) that we can’t solely depend on best practice to guide medical decision-making. Even though healthcare is a business, medicine is a science, so they won’t always be in agreement over the right thing to do.

This is the second study that I have written about to question some of the best practices that hospitals are being asked to adopt. With the increased (and appropriate) focus on these practices, they are not likely to be the last. In the end, the industry is doing the right things – clinical guidelines, quality scorecards, pay for performance – and hopefully medical research will continue to inform it.

Still Here

2006-07-21T15:19:00.000-07:00

I just wanted my regular readers to know that I am still here and committed to writting posts once a week. The past few weeks I have been occupied with a "personal issue" that I hope to share more about with Healthcare Tomorrow readers when it resolves. Until then bear with me and see my posts on Hospital Impact (I feel more guilty if I don't write a post for Tony once a week).

EBM and AMI

2006-07-06T22:09:00.000-07:00

EBM and AMI

So I have been reading about evidence based medicine (EBM) recently and I ran across this article today. According to a study published in JAMA, a number of "accepted" clinical guidelines for treating acute myocardial infarction (AMI) are actually weakly correlated with improved outcomes. That should throw up a red flag for providers. So what do you do with those guidelines? Throw them out the window? If you are committed to following EBM, then perhaps.

A key principle of EBM, and this appeals to scientifically-minded physicians, is that you employ interventions that have evidence to support their effectiveness. This sounds logical enough. After all, what are all those medical journals for anyways. But this isn't necessarily how many physicians practice, with all due respect. A great physician speaker once defined for me another, quite prevalent theory of medicine: eminence-based medicine, or making the same mistakes with increasing confidence over an impressive number of years. As I have always said, physicians are humans too and old habits are hard to break.

Now it certainly isn't just physicians that are to blame. Most of us in the healthcare industry have jumped on the quality measurement and reporting bandwagon. In doing so, we typically accept that the measurements or protocols foisted upon us are "good medicine" (certainly as a non-clinician, I leaned on the experts for best-practice). Nonetheless, we all need to remember to keep the tenants of good science and EBM in mind as we serve the master of performance improvement initiatives. Our other master, the best outcome for the patient, deserves nothing less.

More on CDS

2006-06-23T11:44:00.000-07:00

Earlier in the week, I wrote about Clinical Decision Support (CDS) on Hospital Impact. Recently the American Medical Informatics Association (AMIA) released a roadmap for the nation-wide implementation of CDS. I find this roadmap intriguing and I immediately wanted to explore the intersection between CDS and Evidence Based Medicine (EBM)

First, let’s define the terms:

Clinical decision support (CDS) provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care (from AMIA roadmap).

Evidence Based Medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients (from Health Affairs).

If it isn’t evident from the definition, CDS is a primarily a process that is mediated by technology. The big question with CDS is how you get the right information to the right people at the right time. EBM, in one sense, is an activity that could be accomplished through CDS, but EBM can be much more than that. From my understanding EBM can be as simple as a healthcare provider using clinical research to influence a care decision. In this sense, EBM is more equivalent to CDS. But my experience with EBM also includes larger, more organizational practices, such as the implementation of clinical practice guidelines (presumably derived from clinical research). Implementing clinical guidelines is more than a technological process; it involves collaboration among physicians and nurses and the creation of monitoring and measurement processes. So CDS may assist in portions of the implementation of clinical guidelines (the identification of better-practices, the collection of clinical evidence, and the distribution of this information), but it does not necessarily provide for the entire process.

All of this to say that CDS and EBM do cross paths. Where they do cross, there will likely be applications developed that facilitate EBM. Where the two diverge is, in my opinion, fertile ground for innovation.

122,000 Lives Saved!

2006-06-14T21:41:00.000-07:00

Splash it across the newspapers and proclaim it from the rooftops: Healthcare has its most significant achievement in years, perhaps ever. Today, Donald Berwick, President and CEO of the Institute for Healthcare Improvement (IHI), announced the results of an 18 month campaign to save 100K lives, through the implementation of IHI’s set of six patient safety practices. Over 3,100 hospitals joined the effort and in the end, they saved an estimated 122,300 lives.

I realize that I have blogged about this in the past, but I do think that this has been a remarkable campaign. To get 60% of the nations hospitals to participate in a single, focused endeavor without a financial incentive is quite a feat. I attribute this to Dr. Berwick’s clarity of vision, commitment to action, and the sustained “positive-ness” of the campaign. A ton of work also went into providing education and guidance for participating hospitals.

I am also very pleased that Dr. Berwick is carrying on the momentum by announcing the next campaign to encourage participating hospitals to adopt all of the patient safety practices (50% of the hospitals had only implemented 3 of the 6 practices). My hope is that the IHI will identify new patient safety practices and use this campaign model to foster their adoption across the industry.

With all of the negative public sentiment around the need to “fix healthcare,” this campaign makes me proud to be a part of the industry.

My Own Medicine

2006-06-07T22:01:00.000-07:00

It seems that the ultimate test of any advice giver is the willingness to take his own. I am happy to announce that I am, however carefully, following my advice and venturing out to purchase health insurance for myself and my family on my own. I have opined on the need for healthcare consumers to take more responsibility for the cost of their healthcare expenditures, not for only for cost-cutting reasons, but more so to increase their sense of ownership for their own health.

So what brought about this adventure in risk balancing? With 2 young children, we are relatively frequent users of low-level medical services, like doctor’s visits and short-term prescriptions. We have enjoyed a number of years almost no cost HMO coverage, so we were a little shocked when we had to pick up the entire premium for my wife and kids with my new job. The time came to rebalance our risk equation. Premium payments were just too high. Yes, we use services, but we decided that we would rather pay full price for periodic services rather than give a big part of our paycheck to the insurance company. With all of this in mind, we chose a high deductible plan with a low monthly premium. We didn’t go all the way for a HSA, but maybe next year….

So we definitely feel like we are taking on more risk with the high deductible plan. Will it change our utilization? I can certainly see how we might wait that extra day to see if the sniffles and sore throat clear up on its own, but we are certainly planning to put that extra money away for times when there is no question that we need medical care. Interestingly, we have already started talking about ways that we can keep ourselves healthy.

Will the risk/reward pay off in the end? Only time will tell.

It All Matters

2006-05-24T23:06:00.000-07:00

My good friend Tony over at Hospital Impact is crossing over to the hospital side and yesterday, he asked for some advice about working in hospitals. Of all my experience in the hospital, I think one thing sticks out to me about being a leader in a hospital. It is that every decision matters. Some decisions will impact caregivers and make their job harder or easier. Some decisions will impact patients and make their visit more or less enjoyable. Other decisions will change the level or types of services that are available to a community, which could have significant, if not life-and-death impact on people's lives.

That may sound dramatic, but it is certainly true in a sense. Healthcare administrators (the MHA type) are not clinically trained and yet their management decisions affect patient care. Some may think that this is inappropriate or a good reason for nurses and physicians to occupy leadership positions. There is certainly nothing wrong with that idea, but I believe there is a place for the non-clinical mind in this clinical world. If I learned anything else in the hospital it is that good management and leadership are required for the organization to thrive. The necessity of meeting immediate patient need drives decisions on the floors, but the organization needs people to look beyond the patient in the bed, to scan the horizon and to manage the resources. It doesn't take clinical training to perform these tasks. It just takes a profound respect for the impact that these tasks have on the patient.

So remember that, Tony, as you move into the hospital setting. It won't make your decisions any easier, but at least you know that they will matter.

Update on CAHPS

2006-05-17T22:12:00.000-07:00

As promised yesterday on Hospital Impact, here is an update on the CAHPS survey, the standardized patient experience survey that will be collected by CMS and the results posted on the internet.

I started following the development of the CAHPS survey a few years ago. At first it was the major patient satisfaction survey vendors that were jockeying for particular questions and modes of survey delivery. In the end, there appeared to be a compromise on survey delivery (there will be 4 different modes of delivery), but it seemed that NRC Picker won the ideological battle over the questions. The 27 question survey asks about the patient's experience during their stay rather than assess the patient's satisfaction with particular aspects of care. Following the initial design, CMS conducted a 3 state pilot. The results can be found here.

Since I haven't checked in on the CAHPS survey for a while, I had assumed I missed the first phases of the survey implementation. It turns out that we are at the cusp of the implementation. The deadline for signing up for the "dry run" is May 22nd. The dry run will allow hospitals and vendors to collect data for a few months without the data being published. Once that is finished a nine-month data collection period will follow and scores will be publicly released on www.hospitalcompare.hhs.gov in late 2007.

Alright hospitals, are your ready for the survey?

A Strategy for Mental Health

2006-05-09T09:04:00.000-07:00

I haven’t written about mental health and substance abuse yet, which is odd to me, because my major was psychology and I learned something about that branch of healthcare before I knew anything about the rest. What I learned was that mental healthcare in this country is seriously broken. The unfortunate history and development of mental healthcare is that these individuals were hidden away from “normal” society and very few resources were subsequently invested into a comprehensive mental health and substance abuse healthcare system. The sad reality is that even though many, many Americans will suffer as a result of having a mental health condition or substance abuse problem (or know someone that does), we have not decided, as a society, to discuss the issues of the mental health system in the public forum or sufficiently pay for that type of care.

I bring up mental health and substance abuse, because, as it seems to be the case lately, I have found a report that I think should and will have a significant impact on the direction of mental health and substance abuse care. The report is entitled, “From Study to Action: A Strategic Plan for Transformation of Mental Health Care”. The report is the second in a series of publications that brings together previous national studies on mental healthcare, including the IOM’s Crossing the Quality Chasm, and creates a “crosswalk” between them. In other words, this report finds the common ground between significant policy papers and forges strategies for action. I think that publications like this are significant because they give us a framework through which to focus our transformation efforts. When some of the stakeholders in healthcare, and in this case, mental healthcare, can agree on documents like this as a starting point for discussion, they can get to the work of real, constructive change.

Participate

2006-05-03T09:10:00.000-07:00

I have been thinking again about healthcare leadership. My belief is that leadership is displayed in the things you say and do. The things you choose to say and the things you don’t say can encourage people to act or stifle them. My thoughts lately have been about how we do leadership, especially outside of our organizations, how we participate in the transformation of healthcare as an industry. This may sound like a pitch from your friendly professional organization, but it is authentic. I do believe that leaders should participate in local, regional, and/or national healthcare activities. Not only do these organizations and initiatives need volunteers, but your presence shows your commitment to healthcare and your organization’s commitment to being part of the solution.

I could say more, but then I would start to sound preachy.

Here is a really exciting opportunity to volunteer. The Certification Commission for Healthcare Information Technology (CCHIT) lists volunteer opportunities on a page aptly named “How to Participate”. If you are experienced in healthcare IT, then you can volunteer on work groups that evaluate IT solutions for certification. This is a great way to participate and demonstrate leadership.

Toyota at UI

2006-04-25T14:13:00.000-07:00

Toyota at UI

Here is a story from my alma mater, The University of Iowa Hospitals and Clinics. Good old UIHC has hired an automotive expert to bring lean manufacturing concepts to the hospital. The first project in the ED has reduced wait times and increased patient satisfaction.

This is a great example of a hospital using knowledge from another industry to improve care. While it is generally recognized that we should use “cross-industry fertilization”, I haven’t seen it used extensively in healthcare. I think part of the problem is that we don’t necessarily know where to look. Everyone knows that Toyota (and other manufacturers I am sure) have come up with processes that are extremely efficient. We also know that the banking industry has standardized data, so that ATMs across the world can securely access our account and dispense money. But where else should we look? What does the retail or marketing or shipping industry know that we can learn from? Which industry has better practices in customer satisfaction or rapidly applying research or increasing safety? If we took a broad and systematic look at other industries, we could find opportunities to learn and in turn improve healthcare.

Starbucks makes a great latte, but does it do something else that we could use to lower mortality rates. I think we should find out.

A note to regular Healthcare Tomorrow readers. Sorry about missing my post last week. The well was dry on Monday night. Hopefully it won't happen too much in the future.

EHRs in the Exam Room

2006-04-10T16:28:00.000-07:00

I found a perfectly wonderful study and resource this past week. It was a study published in the Annals of Family Medicine entitled, "Physicians, Patients, and the Electronic Health Record: An Ethnographic Analysis." The researchers observed how physicians interact patients while inputing to an EHR. Basically, the researchers found that physicians aren't very good at interacting with both the patient and the EHR at the same time.

So why am I so excited about this study? Besides the fact that I get to write "ethnographic" in my post (making me look very smart), it is bcause EHRs are coming and we better figure out how to integrate them into the doctor/patient relationship. This study is a first step in figuring out what our new healthcare world will look like and how we can "humanize" a system that is becoming increasingly driven by technology. Wonderfully, instead of bemoaning this fact, the authors have taken a very practical approach to managing this coming trend. Along with the article, the authors have produced a handy guide with tips for physicians on how to successfully integrate an EHR into the patient encounter.

I hope that we will see many more studies like this.

Finding this study made me so happy that I won't even quip...if their typing is as bad as their handwritting, then...

Baby Thomas - Part 3

2006-04-03T22:39:00.000-07:00

Last week I introduced Baby Thomas and his truly brave and frank mother, Sara Bickle. Sarah shared some more comments with me about Thomas's care. Their experience continues to reinforce how important it is for hospitals to attend to the total expereince of care.

Here are Sara's comments:

I mentioned before that the Children's nurses and doctors had been so motivated about pain and so proactive about preparing me to be the "care manager" for little Thomas. When we moved to the oncology floor Monday, I was disappointed by a difference in the way we were treated there, and this change brought to my attention the practices that had made my stay so positive on other floors.

The first change I noticed was that, out of about 14 people who came into our room in two days, just three of them introduced themselves and told us what they were doing (one was a housekeeper - I must say, Children's housekeepers rock). I never realized what a gift this had been until I didn't have it. Knowing someone's name, department, and what they're doing to your kid is particularly important in a teaching hospital like Children's, where about 20% of the doctors and nurses you see aren't allowed to do much for your baby without calling someone else in. Talking to the wrong person while your trached baby is wretching and writhing feels a lot like being put on hold when you've called 911.

The other big change I noticed was that people assumed I knew a lot of things that I didn't know. Nurses would ask me if my son was on such-and-such a medication and a doctor looked miffed when I couldn't tell her precisely what kind of medicine I was asking for on Thomas's first night of chemo. I got pretty frustrated, but later I realized that on the oncology floor, all the families and patients really are professional patients. Thomas was the newest and youngest patient on the floor and we just didn't have the comfort level and information that everyone else apparently had.

Those are really some of the only negative experiences we had with Children's, and it didn't seem like that big of a deal once I said to myself, "It's just a different culture." But I wonder how I would feel about it all if this wasthe beginning of our hospital expereince, and not the end. The good news is, at Children's, I could probably talk to a floor manager and get a sign on our door telling staff to introduce themselves, and Lord knows, I am way more informed about meds today than I was three days ago.

You can read more about Baby Thomas at The Official Thomas Bickle Blog.

Baby Thomas

2006-03-27T17:18:00.000-08:00

Baby Thomas – The patient experience is one of the best tools we can use to measure the overall quality of the care we provide; but too often, the actual patient experience gets lost in patient satisfaction scores and graphs. That is why we should take a step back every once and a while and actually talk to our patients. In that spirit, I am pleased to share a very moving and insightful patient experience.

Some friends of ours told us about the Bickle’s and directed us to their website. The Bickle’s, of Dallas, Texas, are going through an incredible, and heart-wrenching, experience. They have a 6-month old son, Thomas, who was diagnosed with a brain tumor. You can read more about Thomas’s story and how he is doing on their website, The Official Thomas Bickle Blog. I recently got the opportunity to communicate with Sarah Bickle, the mother of Baby Thomas, and she agreed to share some of their experience with me.

What follows is a series of questions I asked Sarah about their experience in the hospital and with their care givers. Sarah was kind enough to offer some very thoughtful and candid responses. Due to the length of the questions, I will post the second half of the questions on Hospital Impact tomorrow.

Describe the hospital room that Thomas is in?

All of the rooms that I've seen in Children's have a window and at least a couch for parents. One wall is painted a color like lavender in a wavy shape that goes around the room. There's a wipe board where staff for the day writes their names and a sink and a computer for staff that folds away. Thomas's crib has his name on a decorated piece of paper above it. The rooms are well-thought out; even in ICU we had a little shelf in the armoire that holds the TV to put our belongings in and there are 2 drawers under the bed/couch (in ICU, it doesn't fold out, but it is wide enough to sleep on).

What has the hospital or nursing staff done to make you more comfortable?

Writing their names on the board each day and night makes a big difference - even if we know our nurse we may not remember her name at 3 a.m. When we first arrived, the neurosurgery floor made it a point to let us know where the family kitchen was, how we could store food, what the cafeteria and chapel hours were, and things like that. The floor manager and some kind of customer care representative also introduced themselves in the first day or so, so we felt like we knew where to go with questions or needs from the beginning. Finally, the staff was just great with our son. I can think of 3 people out of probably close to 70 staff members we've seen who didn't seem genuinely thrilled to be with our son - and I include housekeeping in this list as well. There's no way we would've been as stable and functional as we are now if we hadn't had such an amazing staff and hospital system.

Do you feel like you are a part of the decision making process when it comes to the care and treatment of Thomas?

Definitely, especially when it comes to pain. I’ve never really had to defend a request for pain meds to anyone. They listen, but they take my word for the fact that Thomas is in pain. That was a big relief.

A Few Thoughts on Leadership

2006-03-21T07:37:00.000-08:00

A Few Thoughts on Leadership – It has been a while since I have talked about leadership on this blog. I have been thinking lately about leadership and the role it plays in transforming healthcare. I saw leadership displayed firsthand this year at HIMSS. Everyone working towards the EHR at the federal level and in the private sector are showing tremendous leadership. The fact that all the major players are agreeing to work on a single set of standards is monumental – knowing when to follow is an important skill of a leader.

One of my heroes in healthcare leadership right now is Dr. Donald Berwick. I saw him speak last fall in San Francisco. He was rounding up support for the 100K Lives campaign. I have written before that I think this campaign is the most positive thing happening in healthcare right now. Dr. Berwick took some serious problems in our system and turned them into an opportunity for our industry to shine. I can’t wait to see the results of the campaign this summer.

Dr. Berwick appears to have caught the nation’s attention again with his commentary that regardless of race, American healthcare is mediocre across the board. That story was picked up in papers across the country last week (Boston, Seattle, Kansas City, Miami, Chicago). Again, he has brought focus to the problem at hand and has done it in a positive way. Now hundreds, if not thousands, of Americans will be asking their doctors if they are getting best-practice care. Dr.Berwick has set us up to succeed – another great leadership skill.

I think these examples of leadership are so important to our industry, but they must be supported by leadership at the local level. Hospital leaders need to stay informed of the positive trends in the industry and make every effort to bring local communities (gently) into the transformation.

No Wires

2006-03-13T22:37:00.000-08:00

No Wires – I remember the wired remote that came with our first VCR. It seemed odd to have a tiny box with a few controls tethered across the room to our television stand. Sure it was more convenient than getting up from the couch, but it just wasn’t elegant. When we got our first wireless remote control, it felt right. This was what a remote control should be. This was an elegant solution. In healthcare, we need some elegant solutions.

One company, Hoana Medical, Inc., has envisioned an elegant solution. They have created a device (a pad the patient lies on) that measures a patient’s vitals without wires. In fact, the pad doesn’t require anything to be attached to the patient. It can sense heart and respiration rates while the patient lies on their bed.

Can you imagine what this could do for healthcare? Patients would be immensely more comfortable without wires protruding from everywhere. “What about the IV lines and the breathing tubes,” you ask. Perhaps someone is working on a technology that will make those go away as well. I hope so, because this is a step towards Star Trek. It is a taste of the way things should be, the way we have dreamed they could be.

What does an elegant solution do? It changes things. It changes the way we interact with the world and how we work. Elegant solutions in healthcare will change how patient care is delivered. They will open up new worlds that we didn’t even see coming. And they will change medicine just like remote controls changed television. You won’t be able to imagine how we lived without them.

I am a consultant?

2006-03-07T07:03:00.000-08:00

I am a consultant? – Yesterday was my first day of actual, on-site, appear-to-know-what-I-am-doing consulting and…it went pretty well. We spent the first hour or so putting together the computers we would need for training, but then we really got started. We ended up training a handful of users on our software and really got them started on our process. The users seemed to understand what we were asking of them and I even think there were a few “ah-ha” moments. We didn’t offer profound, unknowable wisdom…we just got them started on the right foot. I know our executive sponsor was pleased that we were there.

I was happy to be back in a hospital again. I do feel like our software and process truly helps hospitals provide safer (at least more compliant) care and that is gratifying. I could see how consulting on billing practice or construction management benefits the hospital and leads to better patient care, but we are truly dealing with how the hospital provides care and what it does to make it better. That is what I got into healthcare for.

And so far I haven’t stolen anybody’s watch…to subsequently tell them the time.

RFID

2006-02-27T23:11:00.000-08:00

RFID - I have to write one more observation about HIMSS06. There were alot RFID companies there. I have been following RFID for a few years now and I was surprised to see so many new companies with RFID solutions. If you haven't been initiated yet, here is a brief description. Basically, the hospital tags its equipment (and people too) with RFID chips and then sensors placed throughout the facility "ping" the tags and locate the tagged object. While RFID was developed for tracking inventory, hospitals can use the technology to locate medical equipment, patients, and staff.

I really believe that this technology can lower costs and help to re-imagine the care process. All of the RFID companies have ROI analyses that show how much hospitals save from improved utilization of assets. As with a number of other technologies, I am not sure if an ROI can really capture the total value of its use. I see a great value in giving front-line healthcare providers the ability to quickly access the location of the tools they need to do their job...and in some cases, the patients they need to do their job on. RFID is one of those technologies that can actually change the care delivery processes. Instead of searching for an IV pump or wheelchair, a nurse or aide can just look it up. The time that was once wasted with manual searching can be replaced with activities that actually add value to the patient. Further, I imagine that front-line healthcare workers will feel more confident about the care that they can provide with this information at their finger tips.

As I mentioned, I have been watching this technology develop in healthcare for a number of years and it seems to be catching on. Nonetheless, RFID is still in its infancy stages in healthcare, but I was encouraged recently by the news that Eclypsis and PanGo were joining forces to integrate RFID into a clinical information system (EMR). This is an exciting partnership and it very well could be the future for hospitals. So look for RFID coming to a hospital near you.

Medicare Part D

2006-02-20T22:38:00.000-08:00

Medicare Part D - Even before the program was up and running, I heard rants about Medicare's prescription drug plan. Critics claimed that the plan is too confusing, that it wouldn't save seniors any money, and that it would actually make people worse off. I always suspected that these claims were premature and, finally, there is an economist (i.e. - someone smarter than me) that agrees. Geoffrey Joyce, of the RAND Corporation, says that it is too early to pronounce Part D DOA in his commentary, entitled "A Simple Rx for Part D". Mr. Joyce even gives seniors some advice on enrolling and selecting a plan. Truly, it will be at least a year before we can know the effectiveness of Part D. So if you hear criticisms before then, I would be skeptical.

Speaking of RAND...I did receive a comment last week on my recent post about HSAs. The commenter, Lag2, asks if I had ever heard of the RAND study on health insurance, which shows that consumers reduce both appropriate and inappropriate care when they have increased cost sharing. In the spirit of dialogue, I would like to respond to Lag2's comment.

I have heard of the RAND study, though I recall it being some time ago. If I am wrong on that, please let me know. Regardless, my claim in the post is that HSAs are such a radical new product in the insurance marketplace that we can't assume how individual's will respond. Though I don't remember the details of the RAND study, my assumption is that the experimental groups had higher co-pays. That is not the whole story with HSAs. Along with a greater "out of pocket" cost, HSAs offer a financial incentive for longer-term health management. That is a dynamic that has not been studied.

HIMSS 2006 - A Photo Journal

2006-02-13T23:55:00.000-08:00

Today was the first day of HIMSS and for the 5 people in healthcare who aren't here in sunny San Diego at the conference, here are some pics from my Razor phone. The exhibition hall was incredible. There are hundreds of vendors, and the big ones, like Epic, spend major money on "booths". Epic's has a fireplace. A few, Like Eclipsys pictured here, even had a balcony with private meeting rooms. The award for best swag (that is vendor speak for little give aways) goes to Misys. They have a brand new Corvette with their name painted on it. How is that for advertising?

HSAs...Wise?

2006-02-06T23:12:00.000-08:00

HSAs…Wise? – One of the central pieces of President Bush’s healthcare reform package is HSAs. This experiment in coverage has been slowly, but surely gaining momentum over the past few years, despite many critics cries that they are the wrong answer for our health system. Now I don’t know if they will have the cost lowering effects that the President claims they will have, but I do think that they will continue to grow in popularity and that they will have a positive impact on our health system.

I believe HSAs will grow because of one unavoidable fact about the employer-based system. While employers derive benefits from covering their workforce, it is the individual who is ultimately interested in her own health. Early adopters have shown that people are willing to take their healthcare spending decision into their own hands. Critics may argue that it is the wealthy and healthy that have opted for HSAs. This may be true, but there hasn’t been a critical mass of employers offering these plans as of yet. As more employers offer these plans, the less wealthy and healthy will have the opportunity to weigh the costs and benefits for themselves. I think critics will be surprised at the choices that people make. While there will certainly be some apprehension about converting to an HSA (they are new and different), the incentive to “take the risk” is substantial. Instead of the employer paying a premium to an insurance company (a benefit the employee may infrequently use and almost certainly undervalues), the employer would be paying the employee to manage their own health. Something more and more of our citizenry want to do anyway.

And how will HSAs benefit our health system? I actually see HSAs as an evolutionary change in health coverage. Again, critics claim that high healthcare utilizers won’t choose these plans. That conclusion makes two assumptions. The first is that the current coverage options will be available. There is no guarantee of this. Insurers have been developing consumer-driven plans like mad and it is only a matter of time before employers start offering them and before HSAs start replacing plans that are higher cost to employers. This is going to change the calculus of health care coverage. When a full-coverage PPO is not an option, then the good old “it’s covered” approach to healthcare decisions won’t be sufficient anymore. The “risk” of HSAs may look a little different in this light.

A second assumption is that employers have an obligation to subsidize healthcare costs (and therefore always will). To the surprise of some, my strongest reason for supporting HSAs is not that they create a more efficient market-driven healthcare system. I think that there could be benefits from a more market-driven healthcare system, but I have a firm belief that, as a society, we have become too dependent on someone else paying our healthcare bills. If I utilize healthcare services, I should pay for them. They benefit me and my family. This doesn’t mean that I believe a heart surgery should put a family in the poor house, but lets recognize who is truly responsible for the paying the cost of care – the individual who utilizes it. To the extent that they benefit my employer and my employer wants to help subsidize the cost, great. To the extent that society is improved when its members (especially those with less means) are healthy and productive, then let the government chip in with our tax money. To the extent that the cost of catostrophic risk can be minimized through high-deductible risk pools (i.e. - insurance), then lets do that.

I believe the time of corprately micro-managed healthcare decisions is coming to an end. HSAs make the patient the payer and the ultimate decision maker. That is how it is in almost all other facets of our life and that is how it should be in healthcare. There are certainly other fixes our health system needs, but this is a re-alignment that needs to happen.

Healthy, Wealthy, and Wise?

2006-01-30T20:52:00.000-08:00

Healthy, Wealthy, and Wise? - Tomorrow night, President Bush will give his State of the Union address and he is expected to share his vision for healthcare reform. From everything I have seen, the playbook he will be reading from is Healthy, Wealthy, and Wise, a new book by a collection of economists associated with the American Enterprise Institute. The authors recommend a number of legislative changes to tax and insurance law that are intended to increase competition and the level of individual participation in healthcare purchasing decisions.

This is definitely a market approach to fixing healthcare; and while I would tend to favor such approaches personally, I still wonder if these changes will benefit a broader spectrum of our society. Over the next few weeks, I would like to explore the particulars of the President’s proposal. I hope you will join me in some critical assessment. Also be sure to watch Hospital Impact, as I am sure that Tony and I will cover the President’s speech later this week.

I will have to take a break from the series in a few weeks, as I will be attending the HIMSS Conference in San Diego. I am sure that my first HIMSS Conference will produce some interesting experiences I will share with Healthcare Tomorrow readers.

Mocha and an MRI

2006-01-23T22:38:00.000-08:00

And now for something a little different...

Mocha and an MRI - You may not have thought about it before, but every time you order a Mocha at Starbucks, you are buying an MRI for your barista. In fact, according to Starbucks, on a per cup basis, your barista’s health insurance costs more than the coffee beans. I stumbled across this factoid recently, while reading a very well done article by Professor Michael Lipsky entitled, Starbucks and Healthcare. In the article, Professor Lipsky makes the point that in addition to raising awareness about the rising cost of healthcare, companies like Starbucks get a little self-promotion from advertising that healthcare coverage is a significant cost of production. I suppose it does make me feel better about paying $3.50 for a coffee drink, knowing that I am subsidizing someone’s health insurance.

A Dialogue

2006-01-16T22:49:00.000-08:00

A Dialogue – As it says in the “About” section of this blog, I intend for Healthcare Tomorrow to be a discussion. Throughout the months I have received a number of encouraging and insightful comments from readers. I have come to realize that one of the drawbacks of Blogger (the service that hosts this blog), is that I cannot email people who leave comments unless they have an account with Blogger. Thus, I have not been able to dialogue “off-line” with many of them. Perhaps if Healthcare Tomorrow continues to grow, I will move to a more user-friendly service. Until then, allow me to dialogue “on-line” with Tim Gee, a gentleman that commented on my last post, A Theory.

Here is a portion of Tim Gee’s comment:

Andrew - great treatment of areas to address in our health care market. There is one, however, that never seems to get much attention - that was a critical issue back when I worked for an e-health connectivity startup.

Proponents of a single payer system say that the market driven approach to health care has failed, what with continued rising costs and less than 100% coverage of the population. The problem with this (and this is maybe the fourth element) is that our health care market is far from "market driven" - there are many distortions and indirect relationships between buyers and sellers, who pays and who benefits. I'm thinking about employers who pay for health care that is consumed by employees with little regard for cost or efficacy; or hospitals whose real customers are private practice physicians rather than patients; and payers who, through these distortions, wield power that is out of proportions to their theoretical role of managing risk.

These distortions in our health care marketplace, mainly the result of regulation and politics, have created the biggest barrier to reforms and technology adoption that would improve outcomes, patient safety and increase coverage through lower costs. Because of these distortions, each player in the health care market asks, "what's in it for me?" when considering change or investing in technology - and frequently, because of these distortions there is in fact little in it for them because the benefits are accrued by someone else in the health care delivery chain.

Tim – First of all, thanks for the comment, I really enjoy hearing from readers. I think you make a great point about the market place. It is a web of incentives and disincentives that don’t quite motivate the “right” behavior. As a philosophy student years ago, I learned that you can’t truly make anyone act outside of their own best interest. And that is why programs that align the interests of the different players to the end that we want to achieve is a key to fixing healthcare. We have seen some programs come about that are intended to do just this. At the beginning of the food chain, the purchasers of healthcare (I know it seems like it should be the patient, but we just aren’t there yet) have begun to change the incentives. Through Leapfrog and other business alliances, providers and insurance companies are being put on the hot-seat for improving quality and paying for quality. In order to engage the patient in cost-effectiveness decisions, insurance companies, no doubt at the behest of employers, are offering HSA-like products.

I think we would all agree that these are just the first steps in aligning the incentives and creating competition around what really matters – improved quality outcomes for everyone. But this brings me back to my theory. If we, the leaders of healthcare, are going to create a system that works for everyone, then we must be committed to continual improvement, we must use the tools of technology to get there, and we must be committed to looking beyond profit and create the incentives and the environment that works for everyone.

Again, thank you, Tim, for your comment. I hope to hear more readers in the future.

A Theory

2006-01-09T22:30:00.000-08:00

A Theory - I have a theory on the essential elements to creating the healthcare delivery system that we should have. It struck me recently that there are three elements that are required to get us there. Now they aren’t necessarily simple things, in fact, they are quite broad categories, but they seem to encapsulate, for me, the forces needed to accomplish this task.

The first element is the never-ending struggle for improvement. Complacency is one of the silent killers in healthcare. When we accept the status quo, convince ourselves that “we provide good care”, or just don’t know what to do next, then we will never move beyond the level of care provided today. This is a hard element because it asks everyone involved in the care process to question their own performance. There is always an opportunity to improve outcomes, reduce variability, share more information, and communicate more effectively.

The second element is technology. As I enter the world of healthcare technology, I am becoming more convinced that we need the tools of technology in order to provide safe and coordinated care. Over the next decade, there will be billions of dollars spent on healthcare IT, and, yet, the biggest hurdle to realizing technology’s potential to improve care is the re-imagination (I am borrowing that from the Toyota Avalon commercial) of the very way care givers provide care.

The third element is a commitment to make the system work for everyone. This one is a great challenge. It is easy (relatively) to build a system that is profitable. The challenge is to remember that there is an additional end to strive towards. To remember that after the business model works, we have to make it work for those who lack access.

I know that theories aren’t much use to people. A theory isn’t a proven fact. It may not solve anyone else’s problems. But, for me, it is a hunch; recurring themes that seem to pop up every time I read an article about the industry, come across a new idea, or wrestle with the big issues of healthcare. In this new year, and with my new role, I imagine that I will be writing more about these elements. I have to see if my theory is correct.

Off For the Holidays

2005-12-26T20:43:00.000-08:00

Off For the Holidays - There is nothing like the combination of family-gatherings and turkey dinner to take your mind off of healthcare for a spell. Thus, my next post will be January 9th.

I wish all Healthcare Tomorrow readers a blessed holiday season.

New Year, New Job

2005-12-19T22:51:00.000-08:00

New Year, New Job – A few weeks ago, I shared that I was laid off from my job at the hospital. I am happy to announce that I will be joining Xpediate Consulting LLC in the new year. Xpediate has created a software application that helps hospitals prepare for their JCAHO survey and then maintain continual readiness. I will be helping the company develop its software application and add functionality.

This is an exciting company and an exciting new role for me, but I must admit that I was a little apprehensive about the opportunity at first. If you have read this blog before, then you know that I am passionate about hospitals and healthcare. At first, I was concerned that this job would remove me from hospitals and I would loose touch with all the great things that hospitals are doing to improve healthcare. However, I have come to learn that I will be a part of improving healthcare in a different way. As this application evolves, it will give hospitals an even greater ability to manage their quality improvement programs. As the industry moves towards the electronic medical record, computer applications, like ours, will be all the more necessary for improving quality and communicating results with the various stakeholders.

In thinking about this blog, there is no doubt that my new focus on healthcare IT and patient safety/quality will impact the topics about which I write. As always, my hope is that readers will find the posts interesting and helpful. I am still invested in the future of hospitals and healthcare. Perhaps in my new role, I can help shape that future.

You Are Feeling Better As You Read This

2005-12-12T22:39:00.000-08:00

You Are Feeling Better As You Read This – Ever since I was introduced to it in high school, I was fascinated by the concept of the placebo effect. The idea that an innocuous stimulus, like a sugar pill, could create such a powerful response in the human mind and body intrigued me. I always thought that it should be put to better use than just being one of the test groups in a scientific experiment. According to this article in the LA Times, researchers have been working on methods for harnessing the power of the placebo effect for actual treatment.

The growing evidence surrounding the placebo effect reinforces the importance of the mind/body connection to healing. For healthcare providers, this should serve as yet another reminder of the importance of the patient experience. Every stimulus in a hospital, from the attitude of the care givers to the atmosphere of the patient room, will have an impact on the healing process of the patient. Is the patient bored? She may lose her drive to rehabilitate. Does the light in the corner flicker constantly? The patient may get annoyed and experience more pain. Does the patient feel guilty about being a burden on his family? He may lose the will to live.

Healthcare providers often say that they attend to the whole patient – body, mind, and spirit – but do they really put as much weight on the impact of the mind (and spirit) on healing as they do on physiological? If studies showed that a half-hour conversation with a social worker or the patient’s best friend lowered pain or blood pressure or LOS (length of stay), would physicians prescribe it? I would certainly hope so.

The Sound of Silence

2005-12-05T23:37:00.000-08:00

The Sound of Silence – This past week my family went to Disneyland and stayed in a hotel close to the park. I would highly recommend staying close to the park, except for one drawback. After a long day of rides and standing in lines to meet the characters, our kids were ready for bed or falling asleep right about the time…the fireworks started. Our hotel room shook with every boom, crackle, and whistle of the 15 to 20 minute long shows. To say the least, the noise was not conducive to relaxation and sleep.

While it usually isn’t due to fireworks, hospitals are noisy places as well. All the beeps, pages, machines, squeaky wheels, conversations, and general comings and goings of a typical nursing floor create a cacophony in their own right. A noisy hospital has been shown to impact patient sleep, nursing productivity, and even contribute to medical errors. So is there anything a hospital can do besides continual shushing?

As a matter of fact, there is. The November 2005 issue of Healthcare Design (a publication of The Center for Health Design) has a great article on sound masking, a technology that essentially dampens ambient noise through speakers mounted in the ceiling. Known in the past as “white noise,” modern systems produce sounds that are just as effective and more pleasant to the listener. Apparently, the systems also promote privacy by “muting” conversations to people not in the immediate vicinity.

You may not think that noise is a significant problem in your facility, but there is a simple test you can do to see if noise is an issue. Go up onto a nursing unit and stand near a nurse’s station or a patient room. Then close your eyes and listen for all the different noises. Now imagine that you are in pain or nauseous or nervous. You may be surprised by what you hear and how much it bothers you.

There are a lot of programs to improve the patient experience. Providing peace and quiet is the least we can do.

A Question of Economics

2005-11-28T22:45:00.000-08:00

A Question of Economics –Healthcare economics is an interesting science. Healthcare economists start by placing a value, even dollar values, on things that the lay person would consider beyond value, like a year of your life or the ability to feed yourself. In my opinion, healthcare economists make a number of large assumptions to reach their conclusions, but they do provide analytical rigor to healthcare debates that often lack objectivity.

A case in point is the value of new technology. The American healthcare system takes great pride in offering the latest and most technologically advanced care. But is new technology worth the cost? Is it saving lives (probably) or just increasing the cost of care for everyone (probably).

Earlier this month, Siemens announced that it was releasing a new kind of CT scanner, the Somatom Definition (hereafter “SD”). Instead of adding slices to the new model, as we are all used to, Siemens has added a second x-ray tube. Siemens claims that this will increase the speed of imaging, thus increasing the speed of diagnosis, reduce the patient’s radiation exposure, and increase the quality of images of moving parts, like the heart. This added capability also comes with a $3 million price tag.

So is the SD really worth it? Should hospitals mothball their $2 million 64 slice scanners for a new SD scanner? A health economist might begin to answer that question by evaluating the claims of the SD. If the SD produces higher-quality images and diagnoses are more accurate as a result and treatments are thus more effective, then there is incremental value to the patient. That value is multiplied, essentially, by the number of patients that will use that scanner in its lifetime to create the total value of the SD. That total value may or may not be greater than the $1 million dollar premium over the 64 slice.

This may seem like an esoteric way of looking at things. Indeed, we are accustomed to and typically accept arguments like, “If it saves one life, then it is worth it.” But the fact is that we have a healthcare system that must be designed for more than the individual patient and when it comes to adding cost and capability to the system, the economics matter.

Just Like Reading the Paper

2005-11-21T23:28:00.000-08:00

Just Like Reading the Paper – Most everyone seems to agree that an electronic health record (EHR) will be “better” than paper records, though, as a few have pointed out, there has not been significant research demonstrating the benefits. As I think about the national effort to create an EHR, another paper-gone-digital medium, the newspaper, can serve as an example of how going digital can “improve the system.”

In “ye olden days,” reading the paper was a full-fledged ritual that involved shaking, folding, scanning, and skimming. While some people would read the paper cover to cover, I assume that most would go to their favorite sections (e.g. – the sports pages) and skip entirely their least favorite sections (e.g. – the sports pages). This was a completely manual process that took time, and I don’t think it is too much of a leap to liken it to reading a medical record.

So what has changed now that newspapers have gone digital? Alot. On the internet, you can customize which news stories come up on your screen, based on category or on keywords. You can also have news emailed right to your inbox on a regular basis. Even further, a new technology called RSS can go out and find particular news or headlines as they get published on the internet and bring them back to your computer for you to view. For more information on RSS, click here. These are all ways that make your information consumption more efficient and more effective. Indeed, I use all of these methods to keep a daily tab on local and national healthcare and business news. This is something I could never do looking through newsprint. In one sense, these technologies have multiplied my productivity.

Taking cues from newspapers’ migration to the internet, how might EHRs benefit the healthcare system? Very simply, computers are tools that can sort through data thousands of times faster than humans. If we tell computers what we want to see – the last blood pressure reading, drug allergies, a physician’s order – then the computer can find it virtually instantly. Gone will be the days of flipping through the chart or calling the lab for a critical value. If some of the same technology described above is used in EHRs, information could be “pushed” to nurses and doctors when it gets generated and put into the system. This would essentially eliminate an entire process step from patient care.

In making diagnoses, forming treatment plans, and documenting treatment, doctors, nurses, and other caregivers are trafficking in information. This information is needed by other caregivers to coordinate treatment and for a whole host of other functions (billing, quality control, etc.). Part of understanding how EHRs will change healthcare involves understanding how healthcare personnel are information workers as well as care givers. There is no doubt that "going digital" has changed and improved the life and productivity of the information worker. It can do the same for care givers.

A Man Without a Hospital

2005-11-14T22:59:00.000-08:00

A Man Without a Hospital - When I wrote my last post, In Good Times and Bad, I had no idea how personal our hospital’s financial turn around would become. The very next day I was told that I would be let go. This came as quite a shock and, as one would imagine, has caused some significant soul-searching.

One of the most difficult parts of this process is realizing how much of yourself you pour into your organization. It is only when we pull up and start to remove ourselves that we realize just how much of our mental and emotional energy went into the organization. Suddenly laying down your work “mid-run” is quite a shock to the system.

I have been comforted, however, through the realization that my passion for hospitals and my concern for what happens to them has not diminished. I know that I am still a hospital administrator at heart, even if I am, for a time, without a hospital.

Now this is not a personal blog, and I don’t want to dwell too much on my personal experience. While my posts reflect the issues that I think are salient, I have never wanted this endeavor to be about me. My purpose with Healthcare Tomorrow is to discuss issues that are relevant to hospitals and healthcare today with an eye to the future. I am writing this post, in the spirit of disclosure and out of a respect for my readers.

So given all of this, I would ask Healthcare Tomorrow readers to bear with me as I find a new hospital into which I can pour myself. I will continue to post and it is my hope that you will continue to read.

In Good Times and Bad

2005-11-07T22:24:00.000-08:00

In Good Times and Bad – Recently, my friend Tony over at Hospital Impact wrote a post on hospitals that have gone through hard financial times and the strategies they used to make the turnaround. In a time when my own organization is going through its own financial difficulties, I found his post both timely and encouraging. Among its stressors, financial turnarounds involve difficult decisions about people and services where the impact on the organization and the community is uncertain. With many hospitals (I believe the figure is near 50%) running in the red, due to low reimbursement, uncompensated care, or costly government mandates, I am sure that many hospital administrators can sympathize.

I spoke with a mentor about the changes we are making at our hospital and he told me about a CEO he had worked with in the past. Every few years, regardless of financial performance, this CEO would ask every department director to redesign their department. He would ask them to clean the slate and design a department from scratch that would offer the same level of service with fewer people. This process was difficult for the organization, but the CEO was convinced that it was necessary for the organization’s long-term health.

I think my greatest lesson during this time is that an organization must always stay fit. Even in the good times, an organization needs to stretch itself and create a resilience that avoids dips in performance all together or else makes them much smaller. There are lots of reasons for a hospital to stay fit – improved quality, expanded services, etc. – unfortunately I am discovering yet another.

A Boutique Hospital?

2005-10-31T22:42:00.000-08:00

A Boutique Hospital? - Boutique or concierge medical practices have received quite a bit of criticism for limiting access to healthcare in a time when the number of uninsured is on the upswing. This article in the New York Times recaps the familiar debate. There is no doubt that boutique practices create a two-tiered system, where the "haves" get special service and the "have nots" don't, but there is something rational about this rebellion from the norm. When it comes to our health, people would naturally want special attention. Kaiser Permanente hit the nail on the head with their TV commercial featuring a man being followed around by a team of physicians. Surely, many physicians would want to practice this way as well - lighter case loads, deeper relationships, a more thorough understanding of the etiology of their patient's conditions, better service. In fact, it is an artifact, however necessary, of the current healthcare system that "boutique" isn't the standard of care. The economics of our current financing system simply don't allow physicians to provide this level of service (though I am sure that they would argue that they are providing at least adequate care outside the boutique model). In the end, it is a matter of degree and supply. There are probably not enough physicians to provide this level of service to everyone.

So could there ever be a boutique hospital? And what would it look like? Certainly, we could envision a hospital with a higher level of service. The concierges would welcome you to the hospital, orient you to its amenities, and walk you to your room, where you would be met by your personal nurse, who would take the time to discuss your stay and schedule your facial in between your MRI and physical therapy. There are, no doubt, individuals that could pay for such hotel-like services in a hospital, but, as one might guess, this is not a model that would work for the larger healthcare system. Whereas physicians are more of a personal resource, something that people consume individually, hospitals are by nature a community resource, something that is shared. As with all other shared resources, hospitals must operate in a way that is not cost-prohibitive for its users.

So there probably aren't boutique hospitals on the horizon. While hospitals can provide great service, the economics of the current system simply don't allow for highly individualized hospital services, like personal nurses. Nevertheless, we can imagine what boutique hospital care would look like, and as we raise the bar for quality and customer service, we will be brining that vision to everyone.

Genetics is Here?

2005-10-24T22:55:00.000-07:00

Genetics is Here? - I was quite surprised today to find Sciona, a company that sells direct-to-consumer genetic testing. Apparently, you can purchase their kits in select pharmacies, swab your mouth, and send in the sample. In a few weeks, Sciona will send you a report with nutritional and lifestyle recommendations based on your genetic makeup. This a remarkable turn of events. When, in the history of medicine, has bench science (here the Human Genome Project) skipped over the medical establishment and been made available directly to the public? There is, of course, much ado about the scientific legitimacy of such products (see the story in the Denver Post), but if Sciona can prove its products' validity and utility, it could further enable consumers to manage their own health sans physician.

If Sciona is not careful, it is this disconnect of physician and medical information that could be its own downfall. The medical establishment, and physicians in particular, are significantly vested in being the gatekeepers of medical information (they didn't go to medical school for nothing!). So you can bet that anything that removes the physician from the mix is going to meet with some resistance. The case in point here is total body scans. A year or two ago everyone (hospitals and physicians) was worried that imaging centers would steal all our business by offering total body scans without a physician referral (this was for out-of-pocket payment of course). The fad eventually died a natural death because the medical establishment made a concerted argument that total body scans didn't statistically lead to better health outcomes. While this argument may work again against Sciona, it may also wear thin on a public that is increasingly interested in managing their own health.

If Sciona is successful, this product could truly ease us into the age of genetics in medicine. Without much difficulty, one could imagine primary care physicians adding genetic screens to their H&Ps. Among other uses, hospitals could use the information to increase the efficacy of pharmaceuticals. Now there is no doubt that there are significant ethical issues surrounding the use of genetic information, particularly how it is communicated and kept private; nonetheless, we appear to be entering a very exciting era of medicine even sooner then most of us expected.

Instructions not Included

2005-10-17T22:35:00.000-07:00

Instructions not Included - Judy Foreman, a freelance writer for the Boston Globe, LA Times, and other newspapers, wrote a great article recently entitled A Visit to the Doctor. The article advises patients to, among other things, prepare questions, take a friend, and leave with a plan of action. As a provider of services, the article reminds me of how complicated we have made healthcare.

As I was leaving the hospital today, I saw a patient in our radiology waiting area holding our patient's rights form newspaper-style, just inches in front of his face. I couldn't help but wonder if any of the 8 pages of small-font, HIPAA jargon made any sense to him. These aren't the only hospital documents that befuddle our patients. Hospital bills continue to live in infamy over their mysterious codes, subtotals, and "descriptions". Just last week an article in the New York Times compared deciphering hospital bills to confronting a Kafka-esque faceless bureaucracy (I can't say that I am a Kafka exert, but it is a dramatic analogy). Fortunately, the good people at the Patient Friendly Billing Project have been trying to simplify and standardize hospital bills for some time now, but the shear complexity of medicine (DRGs, ICD-9, HCPCS codes) and dated technology have kept many hospitals from making bills easier to understand.

The most unfortunate aspect of our complex healthcare system is that it places an additional burden on patients that are already struggling with illness. Hospitals should always be aware of this and make concerted efforts to ease our patients into and through the system. If we can't make the system less complex, then we can at least provide a more palatable experience for our patients. And maybe some instructions.

CDH is Coming

2005-10-10T21:11:00.000-07:00

CDH is Coming - According to this year's group health insurance survey by the Millman organization (press release), 93% of insurance carriers in the U.S. will offer some form of consumer driven healthcare (CDH) plan in the coming year. That is more than twice the number of insurance companies that will offer tiered provider networks (44% in the survey) based on cost and quality. The message is clear. Health Savings Accounts (HSAs) are coming. Will physicians and hospitals be ready to serve these customers?

I don't think so. I haven't seen near enough chatter amongst hospital folk about how they will respond to CDH plans. I think hospitals are still trying to figure out 1) how this is all going to work and 2) is it good for us? We have invested millions of dollars to set up electronic data interchanges with the payers and we are just now getting proficient at it (remember that was part of HIPAA too). So even if we were good at collecting money from individuals, which we are not, then hospitals would have to figure out how to charge these patients something that even resembles a market rate for services. Many hospitals couldn't tell you what a MRI scan actually costs them; their charges have departed from the true cost of the service many moons ago through across the board increases to the chargemaster. My guess is that hospital CFOs see market driven prices cutting into the revenues they depend upon for cross-subsidization.

The slow response from hospitals will delay the adoption of CDH plans, but it won't stop them from coming in the long run. Without a sufficient and open provider market, patients will not be able to shop around for the best deal. In California, hospitals have been required by law to make certain charges public, but the information is far from user-friendly at this point. Hospitals can bet that this information is going to become more public and easier to compare. It did for quality data. Indeed, hospitals need to remember that these patients will also shop based on quality and, whether we think it is valid or not, there is plenty of that kind of information available for consumers already.

More Than a Hotel

2005-10-03T21:56:00.000-07:00

More Than a Hotel - Many hospitals have pursued hotel-quality customer service and amenities. This makes sense. Fine hotels excel at making their guests feel "at home" or "like royalty" or "away from it all". Hotels capture these themes and every aspect of your stay creates the particular experience that the hotel is selling. Hospitals could really use a dose of this philosophy. If we could just get our admitting clerks to buy-in to our holistic, spiritual, total person, healing environment, care experience!

I think part of the problem is that we don't really know what these themes mean ourselves. We have a sense what holistic is. We can certainly tell what it isn't. But what is a healing environment? Again, I have to give props the folks at The Center for Health Design. They can provide hard, demonstrable research on which environments promote healing. But I still think there is more. I believe we have confined ourselves by the concept of the hospital or hospital room. Putting a plant in each patient room is nice, but it doesn't "bring nature to the bedside". Good design can certainly go a long way. If your hospital room looks more like a hotel than a scene from One Flew Over the Cuckoo's Nest, then you are in good shape. In fact, I believe that good design will separate the hospitals of choice from all the rest.

But these is more work to be done. All a hotel has to do is sell you their experience for your one night stop over or your one week vacation. A hospital is where you must go for healing, for restoring what was once whole in your life. I won't accept that that has to take place in a sterile room...where you sit for hours or days...watching television. A truly healing environment will provide tranquility and rest, but it will also engage the person. So you might be tied to an IV pole, but at least you could be looking at beautiful art or strolling through a meditative garden or writing a letter to your best friend telling her that you have decided to live. When we figure out how to engage the patient in healing, through the physical space and the experience, then we will have created a healing environment.

Am I Competent?

2005-09-27T21:00:00.000-07:00

Am I Competent? - Coming from a philosophy background, I pride myself on asking good questions. This is a question that has been echoing in the back of my head for a while: Am I a competent healthcare administrator? Moving past the simple answers (Yes, I am qualified for my job. No, I don't have the right experience or the right training), I think this is a question that should make every healthcare manager pause.

I am sure that many managers would attest to some of the following statements: I do what I think is best for the organization, I see the big picture, I have gotten positive feedback on my performance reviews, I manage the budget, I have increased volume. But are these enough? Have you ever asked yourself: Am I using the right tools? Are we stuck in a rut that I can't even see? Could we actually provide truly error-free care? What am I doing that is keeping the organization from succeeding? Am I not the right leader for my department at this time?

My hope is that these questions would motivate healthcare leaders to build their managerial toolboxes and take bold steps to make radical changes in their organizations. Good organizations can become great and even great organizations can strive to raise the bar. I am reminded of another question that motivates me: Have I done my best work yet? If your answer is yes, then it is time to retire. If your answer is no, then you are ready for the challenge and you have taken at least one step towards competence.

At What Cost

2005-09-18T14:42:00.000-07:00

At What Cost - In August, The Commonwealth Fund (CMWF) released a report called "Seeing Red: Americans Driven to Debt by Medical Bills". In this report, CMWF claims that 37% of Americans have difficulty paying medical bills, have accrued medical debt, or both. On the surface, this appears to be quite a troubling statistic - a point the CMWF really drives home. And yet there is an underlying, and unmentioned, assumption that is driving this message: it is wrong for anyone to have any amount of medical debt. Books could be written (and I am sure some already have) on the question of whether or not healthcare is a public good that should be provided for all Americans regardless of their ability to pay. Whether it is or it isn't (and I will certainly devote future posts to this subject), the question of individual responsibility for healthcare utilization and financing is relevant.

Healthcare is a resource that people utilize at different frequencies and intensities. In this way, healthcare is like another public good, transportation. While the government provides the infrastructure for transportation (i.e. - roads and highways) and some means of transportation (buses, subways, etc.), the utilization of transportation is almost entirely paid for by individuals in direct proportion to their individual use. While it is just as important for me to get to work or the grocery store as it is for a person with less means or more means than myself, I have taken on personal debt to buy a car. Without a car, my options for utilizing transportation are practically limited, but not eliminated. We, as a society, have accepted that people will take on debt to utilize the transportation system. I am sure that many more than 37% of American adults have done the same. Furthermore, to meet transportation needs, you can choose to buy a used Honda Accord or a brand new Mercedes SUV. Both choices allow you to use the transportation system, but the level of personal financial responsibility is substantially different. This is a state of affairs with which most Americans are comfortable.

There is much more that could be said on this topic. Certainly, the comparison between healthcare and transportation breaks down at some point and the uniqueness of healthcare decisions have to be examined on their own. The point made here is that public goods are not completely financed by the government (education is another example of a public good that has multiple tiers based on the ability to pay), and thus some amount of personal financial responsibility is and should be expected.

Nun of My Business

2005-09-14T21:37:00.000-07:00

Nun of My Business - This past week I got to hear the Superioress General of the Daughters of Charity (that is the head nun of the largest group of religious women in the world) and Sr. Carol Keehan, also a D.C. and the recently appointed President/CEO of the Catholic Health Association, speak about the role the Daughters of Charity have had and continue to have in healthcare. The Daughters are seriously committed to healthcare as a ministry of the Catholic Church and they have been doing healthcare for almost 400 years. That gives them quite a bit of credibility when it comes to sticking to the mission and evolving with the times.

Point in fact, a number of Daughters of Charity were beheaded during the French Revolution in the 1790s (and we are nervous that the OIG is tough on physician contracts!). More recently, one of the Daughter's hospitals in San Francisco was destroyed in the earthquake shortly after it was built. That was the 1906 earthquake by the way. What did the sisters do? Rebuild and keep on caring for the sick and the poor. I have to say that I am deeply moved by the sister's commitment to the mission and encouraged by their stories of adversity. Indeed, many Catholic hospitals have harrowing stories to tell from their own history.

How did the Daughters evolve with the times? Well, for the most part, the Daughters were the pioneers in healthcare, especially in America. When the military needed nurses to care for soldiers in the Civil War, it was the Daughters (and possibly other religious orders - of that I am not sure) that cared for both sides. When the settlers headed West for land and gold, it was the Daughters that founded the first hospitals West of the Mississippi and the first hospitals in Northern and Southern California.

So as we work towards the healthcare system of the future, we can bet that the Daughters of Charity will be right there at our side, leading the charge and caring for the sick and the poor.

The Cost Challenge

2005-09-02T22:25:00.000-07:00

The Cost Challenge - There are not alot of positive trends in healthcare. The number of uninsured is increasing (at the moment). Quality is improving in the areas that are getting the most attention (CMS demonstration project, Core Measures, IHI), but still lagging in others. There is huge variation in the standard of care across the country and between racial groups. Insurance premiums increased by only single digits last year - that is sort of good news. But one of the key trends to watch is the cost of care. The cost of care just keeps on going up and I believe it is a trend that providers will have to reverse if we are going to create a healthcare system that is accessible to a majority of Americans in the future.

Cost is a very difficult problem. Almost no individual line item of cost is getting cheaper over time. Wages increase annually. Facilities become more costly to build. Technology is in constant need of refreshing. Supplies may be the one area where significant, industry-wide efforts have been made to control costs. Whether it is through group purchasing or supply chain management, we have at least been able to come up with reliable tools for managing the cost of supplies. Unfortunately, supplies are the least of the costs mentioned in this paragraph.

To further complicate the problem, there is a general sense that the industry, from a provider perspective at least, has already gone through the "easy" cost-cutting phase - streamlining the organizational chart, reducing staff to bare minimums, and being stingy with other expenses. With the new prospective payment system in the eighties and HMOs in the nineties, healthcare providers had to bring costs more in line with reimbursements. Even so, a stasis was not reached and real costs resumed their steady march upward.

This leaves us with the task of reducing costs in a system that has already had alot of the fat squeezed out of it. If the "easy" cost-cutting is done, then what is there left to do? The difficult, hard-to-see cost-cutting, obviously. I have heard from a number of sources now that there is probably about 30% waste in the healthcare system. Where is it? It is hiding in management practices that don't rely on data, process that have never been designed for efficiency, systems for care delivery that are not based on the patient, and staffing models that are not sensitive to predictable volumes. Certainly, there could be more added to this list.

There are at least two challenges for healthcare providers here. One challenge is to find the waste in the system and extract it without compromising quality care. Work smarter, not harder, as they say. But before that, providers need to come to believe that we need to reduce costs, not just for the financial health of the individual organization, but to lower the cost of healthcare across the board.

A Visit From the Jaycos

2005-08-29T16:28:00.000-07:00

A Visit From the Jaycos - I haven't been able to post for a few weeks because of our impending JCAHO survey. Now that it is over (and we are still fully accredited), I will be able to get back to "real life" and blogging. I do have to say that we had an intense, but very positive survey experience. The surveyors were thorough, fair, and tried to provide as much education as possible to the leadership and our staff. This was our first experience with the tracer methodology and everyone noted that it was an improvement over the older survey methodology.

So will JCAHO help us get to the healthcare system of the future? I think it certainly has a role and its new Shared Visions, New Pathways seems to be a positive shift in accreditation philosophy.

The cost of accreditation has always been an issue, especially when it is compared with the value of the survey process, or stated differently, the value created for the patient by an organization being accredited. JCAHO has taken a swing at both of these issues with its new philosophy.

On the cost side, the process of preparing for a survey in man-hours (and copying!) was always considered much higher than the actual charge for the Joint to come out and do the survey (a number of thousands of dollars based on the size of the organization). By making its surveys unannounced and emphasizing the importance of continual readiness, healthcare organizations are forced to build compliance with the standards into their systems. Building a system right is much less costly and more effective than trying to fix it in a hurry.

On the value side, I have heard the criticism that, at worst, JCAHO's focus on policy and procedure distracts form patient care and, at best, that JCAHO sets the bare minimum standard for "quality" care. The tracer methodology has certainly taken the focus from policies to patient care (though we still had to provide a number of binders!). When the surveyor starts thumbing through a chart, you become keenly aware that every chart, and thus every patient, needs to have all the bases covered - informed consent, pain assessment, plan of care, etc. While many of the standards focus on the very mundane topic of documentation, it does provide value to the patient for all the documentation bases to be covered. Further, JCAHO has made patient safety a key aspect of the accreditation process with its National Patient Safety Goals. You can't argue that the NPSG have not improved care.

So, with this new survey process, JCAHO is raising the bar for healthcare quality - it has at least helped us to raise the bar. As JCAHO evolves, so do the thousands of healthcare organizations that it accredits, so here is to JCAHO and its new vision. Cheers!

What is Right

2005-08-09T21:05:00.000-07:00

What is Right - With all the media attention on what is wrong with healthcare, I thought I would try to list a few things that are right with healthcare. If we are diligent, we can build on these trends and create a better healthcare system for tomorrow.

IHI's 1ooK lives campaign is right on the mark. They have taken solid patient safety research and set out on a self-styled "political campaign" to sign hospitals up to help meet their goal of saving 100,000 lives. Participating hospitals implement the best practices, collect and send in the data, and wait for the final count in June 2006. Assuming the target is reached, this is going to be a big win for the industry. I think this will generate a lot of momentum around patient safety and set the stage for future campaigns.

Palliative care is the right way to care for people in the last stages of life. While I haven't seen a lot of momentum around palliative care, it is certainly a concept of care that has matured and found increasing acceptance and adoption within hospitals. Palliative care recognizes that patients have different needs and goals in the last stages of life and customizes care to meet those needs. One organization that is leading the way to build palliative care programs is the Center to Advance Palliative Care.

Research in the design of healthcare facilities is creating environments that truly promote healing and wellness. Evidence-based design, as it has come to be known, creates environments for patients that reduce noise, decrease the risk for the spread of infection, and promote wellness through improved space for families and exposure to nature and natural light. The research has shown that well designed facilities reduce length of stay, increase staff satisfaction and morale, and are less expensive to operate. The Center for Health Design has pioneered the concept of evidence-based design and is a great resource for any hospital that is considering major capital investment in facilities.

Saving Healthcare

2005-08-03T21:33:00.000-07:00

Saving Healthcare - I believe that Health Savings Accounts (HSAs) will have a significant and positive impact on how healthcare is purchased and utilized. Detractors say that HSAs don't work for everyone - and that may be true - but HSAs have major advantages that will thrust them into a prominent role in our industry.

First, employers will realize that HSAs will save them a significant amount of money on health expenditures. HSAs are basically a shift from a defined benefit to a defined contribution - this transition has already taken place with retirement benefits. This will not take employers completely out of the healthcare purchasing business, but it will significantly change the employers role in healthcare utilization decisions - an area that has always been awkward for employers. The end-user of healthcare services (the employee/patient) , will finally be the one making the healthcare purchasing decisions.

This is the second main advantage of HSAs: the patient becomes the purchaser. Little argument needs to be made why this is a benefit, though some have questioned whether or not the patient has the capacity to be a good purchaser of healthcare services. This, I imagine, will be a self-correcting problem. There are innumerable resources available for consumers to make smart purchasing decisions - websites, consumer guides, entire networks on television; once patients become purchasers in any significant number, the same type of resources will materialize and enable better decision making.

In light of this coming trend, this question must be answered: what is the provider community going to do with consumer driven healthcare? Indeed, the insurance industry is already offering HSAs and other consumer-driven products. The simple answer, in broad terms, is that providers will need to revisit not only how they market their products to potential patients, but the very structure of how they provide care. A timely article from HealthLeaders entitled Hospitals and Consumer-Driven Healthcare: Five Marketing Moves offers a number of excellent suggestions for hospitals on the marketing front. On the structure side of the question, providers need to ask what the "consumer-driven patient" is truly looking for - one-stop shopping, integrated services, common sense billing, a comprehensive approach to their health.

The hope behind consumer-driven healthcare and HSAs is that the patient will be able to purchase care that meets their health needs better. It is time for healthcare providers to offer that kind of care.

2005-07-27T12:54:00.000-07:00

SorryWorks - Yesterday I came across a great organization called The Sorry Works! Coalition (www.sorryworks.net). Sorry Works encourages healthcare providers to fully disclose medical errors to patients and their families right off of the bat. The result, they say, is that malpractice litigation is avoided in most cases, because the patient and family get what they want from the beginning - an admission of responsibility and an apology.

This is not a new concept (I have seen literature on apologies before), but I was surprised that I had not heard about this organization until now. With all the fuss about medical malpractice costs over the past few years, why hasn't this program received more attention? My guess is that the medical malpractice insurance carriers believe that they will see a bigger impact on their bottom-lines from capping awards. Indeed, as Health Affairs has recently confirmed, the increase in medical malpractice premiums over the past number of years far exceeds the payouts to plaintiffs. Where do you think that money is going? (Please don't read that I am anti-profit - every for-profit company has that right - but one of healthcare's key problems is that it's costs are out of control and money taken out of the system by corporate profit is money not spent on improving the nation's health status.)

This concept just makes sense and it is the right thing to do. Organizations need to take a serious look at this and ask themselves why they are letting defense attorneys and risk managers get in the way of doing the right thing. If SorryWorks really works, then everyone, providers and patients, will be better off.