"The Ronan Report" provides insight about the activities at the Western Maryland Health System in Cumberland, Maryland, and about the changes taking place in healthcare today from a CEO's perspective.

Wednesday, April 23, 2014

An End of An Era

This morning, I drove by the former Memorial Hospital to see the status of the demolition.  I have attached a few photographs of the current status of the buildings that are being demolished.  The medical office building is already completely demolished while the North wing is currently under demolition.  The Main Hospital appears to have been gutted for salvage and appears to be next for demolition.  The South Tower is undergoing a salvage operation at this point in time and then should  be demolished after the main hospital.  

I was surprised that after working on that campus for 20 years, I wasn't at all impacted by the demolition process.  Possibly, if the demolition process started right after we vacated the building, as was recommended to the City then, I would have been truly moved by the process.  When I look at that campus today and envision what could be placed on that site, I feel good about the next chapter that is awaiting Cumberland and the former Memorial Hospital.

Monday, April 21, 2014

Creating a Culture of Quality

There is an interesting article in the April 2014 of Harvard Business
Review on Creating a Culture of Quality.  The article covers the four
essentials of quality which are leadership emphasis; message credibility;
peer involvement and employee ownership.

Leadership Emphasis - Managers are told that quality is a leadership
priority; they walk the talk on quality and when they evaluate employees,
they emphasize quality.

Message Credibility - Messages are delivered by respected sources in the
organization.  They are consistent and easy to understand.  The messages
have to appeal to them personally.

Peer Involvement - Most employees have a strong network of peers for
guidance; they routinely raise quality as a topic for team discussion and
peers hold each other accountable.

Employee Ownership - Workers clearly understand how quality fits with the
job; workers are empowered to make quality decisions and are comfortable
raising concerns about quality.

After reviewing the above and applying it WMHS, I need to re-examine our
emphasis on quality.  These four essentials exist, but not to the extent
that they are emphasized in the article.  I need to ensure that our
leadership is emphasizing quality with their employees and creating a

true culture of quality.

Friday, April 18, 2014

Redefining the Hospital

The attached article is from the latest issue of Hospitals and Health Networks magazine. Our value based care delivery model continues to get a great deal of national attention.  It wouldn't be possible without a lot of dedicated people at WMHS who really do understand the importance of such a care delivery model.

An Appalling Story

This AM, I read a story about a woman from Macon, Georgia, who WAS a radiological technician.  She was just sentenced to 6 months in jail, 10 years probation, a $12,500 fine and not allowed to work in health care for 10 years.  Her crime, she was too busy to read mammograms of over 1289 patients so she simply entered them as negative.  Of the 1289 patients, 10 had breast cancer and two have since died.  The District Attorney said the plea deal was fair.  Really?  Because she had personal problems and got behind in her work, she directly contributed to the deaths of two people.  The DA said that she was also very cooperative; one can surmise that the hospital where she worked is being sued.  

After I shared the article with my team, I was immediately assured that we have many systems of checks and balances in Radiology, Lab and the rest of our clinical areas.  It is always good to check, just in case.  A few years ago something similar happened at WMHS involving a Billing Office employee who was also suffering from a host of personal problems and decided not to do her job.  In fact, she created a ruse to demonstrate that she was performing as she was supposed to be performing.  Once her deception was uncovered, she was immediately fired and and it took a great deal of time to recover hundreds of thousands of dollars in billings that were never submitted, which we did.  We immediately audited her areas of responsibilities and put a number of safeguards in place to ensure that a similar practice could not recur.  In our case, it involved money and it served as a great learning experience.  Thank God, that our learning experience didn't involve the loss of life.

Monday, April 14, 2014

A Successor Has Been Named

At the end of last week, Kathleen Sebelius, Secretary of Health and Human Services, resigned.  Her tenure was marred with the disastrous start up of HealthCare.gov and everyone knew that she wasn't going to survive the mid-term elections in November.  The "fall gal" in this case will be Secretary Sebelius, but again, that's politics.  

However, the rub for me is related to her successor, Sylvia Mathews Burwell.  Ms Mathews Burwell is a "proven manager" from the Office of Management and Budget according to the Administration, but she has zero experience in health care, medicine, social services or public health.  Isn't that pretty much what the Secretary of HHS oversees--those four areas?  We now have an individual who is a policy expert and she will be running one of the largest components of our Federal Government.  No one is DC seems to mind that she is an experienced bureaucrat with no related experience to HHS.  Her primary responsibility will be to get the Affordable Care Act up and running.  

Members of Congress are hoping for answers from Ms. Mathews Burwell on the future of health care in America.  Really?  I expect Ms. Mathews Burwell will be well prepared to address issues related to the public policy aspects of health care.  But, focusing on the complexities of this business while improving the health status of our communities, providing senior care or focusing on health care for families, especially children, just to name a few, may take a back seat while she gets the failed aspects of the ACA up and running.  ( I am on the record supporting the value-based care delivery aspects of health care reform, which are an integral part of the ACA.)  

Somehow this reminds me of the newly appointed Ambassador to Argentina, who admitted that he had never stepped foot in that country during his nominating hearing in February.  Call me crazy or old school, but related experience, knowledge and background need to be taken into consideration when such appointments are being made.  I hope that Ms. Mathews Burwell excels at her job, but I will have to wait and see.

Friday, April 11, 2014

Some Things That I Think That I Think At The End Of A Week

First, Happy 18th Anniversary, a day late.  The Western Maryland Health System was formed on April 10th 1996.  Wow, how time flies when you are having this much fun.  At least, it became a lot more fun several years after the formation of the System.  Those first three years were a nightmare, but on the positive side it was a character building experience for me personally.

While blogging about anniversaries, it was three years ago today that I started the Ronan Report.  I think that it's time to write a book; I certainly have enough material.

Congratulations to Dr. Jerry Goldstein, our new Chief Medical Officer.  Dr. Goldstein was appointed to the position this week and has done a great job as interim CMO over the last three and a half months.

We had a great meeting of the President's Clinical Quality Council this week.  A wonderful presentation on patient satisfaction as it relates to our physicians by Karen Johnson and some of the best practices around the state that could even make our scores higher by Cindy Bridges.  Rounding out the presentation was Karen Howsare on our Perfect Circle of Care.  Lots of great discussion, ideas and suggestions thanks to Drs. Allaway, Haas, Dusenbery, Lamm, Khanna, Zaman, Goldstein, Wolff, Chappell and Watkins.

At that meeting, it was also interesting to hear their reaction to the release of how much Medicare has paid to physicians.  Overall, the reaction was one of surprise, but more importantly, this will now bring a lot of scrutiny on what physicians are paid.  Investigative reporters across the country have been salivating to get their hands on this information.  By the way, the leader of the physician Medicare billing hit parade was a South Florida ophthalmologist who was paid $21 million by Medicare in 2012.  Oh,my!

What was surprising at the release of what physicians have been paid by Medicare is that payment information was never before shared in the 50 years of Medicare's existence.  Also, I have it on very good authority that at the time the Affordable Care Act was being created the American Medical Association, the drug companies, AARP, the American Hospital Association and the Catholic Health Association, just to name a few were told that "if you aren't at the table, that you will be on the menu" meaning if you don't support the ACA, life could be difficult for those you advocate for.  No surprise there; that's politics.  After all, I watch House of Cards, I know how these things work.

In closing and to add some amusement to my day, I am sitting at my desk finishing my blog and out my window is a woman sitting on the wall in front of the hospital smoking a cigarette with her feet comfortably positioned on our "No Smoking" signs.

Enjoy your weekend!

Thursday, April 10, 2014

Trivergent Health Alliance

The Alliance of health systems, Western Maryland, Meritus and Frederick, has finally arrived at a name for our new Alliance........Trivergent Health Alliance.

Congratulations to our own Clay Jones, who came up with the name.  In a previous blog, I asked for suggestions and got many,  Most, unfortunately, had already been trademarked.  Trivergent was available so we trademarked it and also secured a variety of domain names, i.e .org, .com.

The Alliance continues to make progress in that we are close to finalizing operating and service agreements; obtaining a tax ID number; signing contracts for new technology and consultative assistance; developing systems for tracking savings and allocating cost; issuing RFPs for banking and insurance; finalizing locations for services across the Alliance and developing a new logo for Trivergent Health Alliance.  There continues to be a lot of work ahead of us, but a great deal has been accomplished to date.  The individual work groups in Human Resources, Supply Chain, Pharmacy, Laboratory, Revenue Cycle and Information Technology have done an amazing job in creating an individual business plan for each area.  We are looking at over a $20 million annual dollar saving by year three across the Alliance.  This is a saving that we would not have been able to achieve as three independent health systems.