Christmas

Yesterday, I mentioned our Christmas families in my blog and the generosity of our staff.  We provided Christmas for nearly 100 families in our community.  WMHS departments and individuals sponsor families who come to us from a variety of sources and all are vetted in advance to be sure that each family is truly deserving, unlike the first family that I was involved in providing Christmas for early in my career.  

It was in a neighborhood in Pittsburgh that was abandoned except for this one house.  We arrived at 4 AM Christmas morning as arranged in advance.  The family was living in complete squalor.  There was filth everywhere.  When I turned on the lights in what could have been the dining room, there were families of roaches all over the walls.  I never saw so many roaches in my life.  We came with a truck load of gifts for the mother and 5 kids.  New bikes for each child, dolls, games and clothes.  The faces on these children were priceless.   Finally, a real Christmas. 

Not so fast.  It turns out that there was no vetting process by the church that gave us the name of the family.  Mom was a hard core drug addict who sold or traded all of the gifts for drugs within days of Christmas.   I learned a lot from that experience.  A reliable vetting process is key in making sure that we are helping families who are truly in need.  Many of us at WMHS have so much to be grateful for this holiday season and it was clearly demonstrated this Christmas through our Christmas Family project.

Have a very Merry Christmas and a joyous holiday season.  I will be taking a blogging break between Christmas and New Year's as I need to develop some more material.

Are You Serious?

For Christmas, WMHS provides a gift to every employee and we have been doing so for many years.  If affordability is an issue, it is something inexpensive, but it is done in conjunction with the holiday meal that I blogged about yesterday.  This year, as we did last year, we gave $25 gift cards to each employee from Martin's Supermarket.  Martin's is owned by Giant Foods and gives the health system a 5% discount, but this gift still costs the health system close to $60,000.  It is worth the amount of money based on the generosity of our employees during the holidays with the Christmas families that they sponsor and the good will that it brings from a most appreciative staff.   Last year, no problem with the acquisition; this year, not so fast.  Which brings me to the "are you serious" part. 

Our Community Relations Department contacted Giant Foods to arrange for the purchase and delivery of the gift cards.  Our person asked to have the cards delivered this week (the week before Christmas) and she was told that wasn't possible and the earliest delivery would be next Tuesday.  Our person said do you realize that this is a $60,000 order and it's for Christmas?  The person from Giant said yes but that was the best that they could do.  Our person asked to speak with her supervisor and she said please hold.  The supervisor never got on the phone but the rep said that we could pick the gift cards up at one of their local supermarkets over this past weekend, which we did.  Thank goodness, one of our more patient people handled the transaction.  I would have asked to speak with their CEO and congratulated him or her for their success in retail during such a challenging economic period that they didn't need a $60,000 sale.  Maybe, I still will!  With that said, it is still better than Wal-Mart who told us last year that there is no discount on a $60,000 gift card purchase since they already have very low prices and don't need to give a discount.  That was an easy one to walk away from with Wal-Mart’s arrogance; maybe next year we should pursue a gift card purchase with a local business that would be more appreciative of the business.

Holiday Meal

On Monday, WMHS held our annual holiday meal for our employees.  Our Food and Nutrition Services team prepared a wonderful meal that was served by the leadership of the organization.  It is a great time for me as CEO to reconnect with many of our 2200 or so employees.   The great majority of employees are so upbeat and appreciative of the amount of work that goes into the preparation and serving of the meal.  I have been serving formerly Christmas, now holiday, meals for over 30 years to employees and it is an event that I so look forward to each year. Thank you, John Wilson and your team, for a great day and a wonderful meal.

Crime at WMHS

Last week, I wrote about an increase in crime in the region.  It is important to know that crime, especially property crime, doesn't stop at the doors of the health system.  Our Security Department and the Cumberland police are investigating a series of thefts from patients and employees.  We offer to secure the valuables of our patients upon admission, but too few take us up on the offer.  For the most part, the thefts have been small amounts of cash stored in the patient's night stand.  Fortunately, Security has a pretty solid description of the individual from patients; a slightly built young white female with a head scarf.  We are also taking steps to better secure patient belongings in night stands if they refuse to place items in our safe, increase surveillance on the patient units and increase patient and staff education.  Employee thefts are routinely unsecured purses in unlocked lockers, unlocked desk drawers or unlocked file cabinets.  If employees would do a better job of securing their belongings, employee thefts would virtually be eliminated.   Our criminals must be extremely desperate to steal from patients who are at an extremely vulnerable point in their life.  We will be publicizing information about the thefts to heighten awareness and hopefully catch these individuals.

ACM Commencement

On Friday evening, I had the opportunity to attend the Allegany College of Maryland graduation for several hundred students.  This December graduating class had 66 nursing grads, wow!  One of the graduation speakers was a nursing student who for much of her life was homeless, living in shelters, under bridges, in parks, etc with her mother, who was a drug addict, and her younger brother.  In her speech, she spoke of a very hard life growing up, a life to which her mother eventually succumbed.  After her mother's death, she and her brother went to live with their grandmother.  Now at 24, she will be a nurse and go on to study for her Bachelor's degree in Nursing.  Her speech closed with the choices that each of us have in our lives; her mother made choices that eventually killed her.  Our graduate made a series of choices that should serve as an inspiration to all of us.  Congratulations, new grads and especially Aubrey Strachan.  God speed.

Transparency and Quality

This week, I had a briefing from one of our three internal fellows and her mentor on her six-month internal fellowship project, Transparency and Quality.  The project, which started in September, began as Transparency in Quality.  It became evident shortly into the project that both clearly have lives of their own.  Work is needed in both attaining the results as well as reporting the results.  Much work has been occurring on the attainment of quality, and now the reporting of our results is in our sights.   Our goal is to be transparent in our reporting of quality at WMHS by July 1, 2012.  Good or bad, we will publish our quality data internally and externally.  Currently, we are very limited in what we publish, but our quality data is out there for all to see, if you can find it.  The objective is to make us better.   We saw such improvement when we began publishing patient satisfaction data for all to see.  Our scores reached levels never attained at WMHS previously.  Our goal is to have best in class tools for reporting quality to our employees, our physicians, our board, our patients and our community.  The work done to date in both areas is thorough, comprehensive and most importantly, will increase accountability and ownership.  Currently, everyone's in charge of quality through the committee process resulting in no one being in charge or accountable, other than me and our Performance Improvement staff.  Our approach to quality and transparency will be a big step in getting better by sharing.  I am pleased with the progress that our internal fellow has made to date and look forward to the project's completion this spring.  More to follow.

Crime In Allegany County

Yesterday, I received from our physician recruiter a link to a website showing crime statistics for Allegany County, MD.  I looked at it and said, "no way."  So I went to alternate sources to verify the data.  Actually, the website was accurate.  I knew that crime had risen in our region but was blown away to find out that we have substantially more crime than most Maryland cities.  In fact, we are only safer than 6% of the cities in the US.  Now, much of our crime is property related,  but violent crime rose to its current level in the early 1990's and has stayed constant.  Fortunately, our murder rate has remained very low at 1.3 per thousand up until last year when rose to 5.5 per thousand.  I still think that it's  a safe place to live and raise children, but such stats are somewhat disconcerting.  We are lucky to have the caliber of law enforcement that we have in that they do solve violent crimes pretty quickly.  Within the last few weeks there were a series of robberies at gas stations, culminating with two home invasions over this past weekend.  That type of violent crime doesn't set well with the community and within days four suspects were arrested.   In closing, this statistical information is certainly worth having as well as being able to explain it to prospective professionals coming to our region.

Beheadings in 2011, You Can't Be Serious

I just read that a woman was beheaded yesterday in Saudi Arabia for sorcery and witchcraft.  I am not joking.  I can't imagine in this day and age that a woman could be beheaded for such ridiculousness.  I know that sorcery and witchcraft, along with blasphemy, are punishable by death in Saudi Arabia.  Although no details are available in this case, I have read that sorcery is usually identified with someone in Saudi Arabia who has demonstrated their right to freedom of speech or religion.  Saudi Arabia continues to practice an extreme version of Islam with lots of actions demonstrated by citizens every day in the modern world punishable by death.  I am truly amazed that in 2011 that such executions are occurring in what is supposed to be a civilized country.  Where is the outrage?  Amnesty International said that they were deeply shocked and called for a halt to any further executions, although the number of executions has tripled this year to date with 79.  I know that this is a leap, but I can't think of a better reason to drill for oil in the US and partner with Canada on the Keystone XL pipeline.  We should be making every effort to separate ourselves from a country that practices such barbarism.

The Wild Ride of Health Care

Hold onto your seats is the message for anyone involved with health care.  We are all in store for a wild ride.  Talk about an industry that is changing dramatically and virtually overnight.  I have always said that trying to change anything in health care is like trying to turn an aircraft carrier; it takes quite a bit of time.  That doesn't seem to be the case today.  There is some good news from the financial crisis that our country has been experiencing; it is that quality and efficiency in health care have finally become the critical focus of payors, especially Federal and State governments.  Insurers are buying hospitals and hospitals are once again buying physician practices and, to some extent, getting into the insurance business by working directly with companies on the health and care of their employees.  Integration is rampant in health care and that can be a good thing. 

As I have written here before, WMHS is now operating under a new and different payment methodology that focuses on the value of the care that is being delivered with the patient being the center of care delivery.  We previously were paid based on volume of admissions, tests, procedures, patient days and the list goes on.  There was little in what we did that was based on quality and efficiency.  Then we saw the zero sum gain in Maryland related to potentially preventable conditions, core measure success, readmissions.  If we were successful in each area, then we were paid incentives; if we weren't, we lost money in rates.  Lose a million dollars in rates for poor performance and it is interesting to see what happens.  In addition to performance improvement and being rewarded for such performance, going forward, we are now paid very differently based on the quality and the efficiency of the care delivered.  The ride will continue to be wild especially until everyone is on board with all of the changes ahead in US health care.  Stay tuned.

Correctness Continues to Run Amok

The Defense Department continues to label the 2009 Fort Hood shooting as work place violence and not an act of terrorism.  Thirteen service men and women were killed and dozens were wounded by an Army Major who was both a psychiatrist and a Muslim follower of the now deceased American-born cleric, Anwar al-Awlaki.  In fact, the Army Major, Dr. Nidel Hasan shouted "Allah akbar" (God is great) as other al Qaeda terrorists exclaim at the time of their attack.  Not your everyday work place violence chant.  Other attacks against US service men have been labeled as crimes such as drive by shootings, as was the case in Little Rock outside of an Army Recruiting Station of two service men.  Their shooter also inspired by al-Awlaki.   Yet, our Defense Dept. is calling it anything other than what it is.  These shooters have been identified as heroes from within al Qaeda from where they draw their inspiration.  If it walks like a duck, quacks like a duck, it's a duck..........call it what it is and in these instances, they are acts of terrorism.  Call them homegrown acts of terrorism if you prefer, but don't minimize the threat such acts are to our men and women in uniform.

Political Correctness is Out of Control

Since the weekend, there has been a collection of news stories that make, at least,  me wonder what the hell is happening to our country.  First, there was the 9-year-old boy who called his teacher "cute" and was suspended for two days for improper conduct.  Really?  I would have been home schooled from about the second grade because of teacher crushes and I was taught by nuns until the seventh grade.  Then there was the high school quarterback in Massachusetts who was penalized for lifting his fist in the air (excessive celebration and taunting) as he ran for a touchdown, costing his team a state championship.   The rules are the rules, but come on.  He didn't turn around and taunt the defenders; he's a kid who got excited on his birthday, no less, and he would have won the game with that touchdown.  And now, I just read that a high school in NJ censored all HOLIDAY music for a young children's program removing any reference to God, Jesus, Santa, Christmas and Hanukah.  What's left?  Thank God (or that non gender supreme deity who is everywhere) for snow and reindeer or are they too closely related to Christmas and soon to be banned in Jersey?  Where has common sense gone? My father used to say the world is nuts and he has been dead for over 22 years.  What would he be saying today?

Antietam

Someone was describing the other day what happens at Antietam National Park,  just north of Sharpsburg, MD, this time of year.  I found it fascinating that for the last 25 years volunteers light over 23,110 luminaries to commemorate the number of casualties during our nation's bloodiest one-day battle on September 17, 1862.  Apparently, this event occurs the first Saturday of every year and for some unknown reason this is the first that I have heard about it.  You would have thought that during my 22-year stint in Maryland that I would have come across that information.  Well, maybe it's not that surprising in that it took me 20 years to get to Antietam National Park and it was by accident that I happened by and stopped.  Shame on me!  Antietam is just as hollowed and as sacred as I found Gettysburg to be many years ago.  A visit to Antietam next December has already been added to my bucket list.

The Auxiliary

On Sunday, I had the opportunity to thank the WMHS Auxiliary at their Holiday Tea for their contributions to our health system throughout the year and to wish them a blessed holiday season.  The work of these women and yes, they are all women, is remarkable.  From the employee socials to the book sales to their fulfilled $1M pledge for the new hospital to the running of the Gift Shop and so much more.  The Auxiliary works tirelessly on behalf of our organization and we don't always take the time to thank them for what they do.  So, ladies, please accept a most sincere and heartfelt thank you for your 2011 accomplishments and contributions to our health system.

The Holidays Part II

On Friday, I blogged about the start of the holidays and getting into the holiday spirit.  The ability to enhance that spirit came on Friday evening with the Health System's holiday party for board members, physicians and upper-end donors to our Foundation.  What a party!  The Food Service staff once again outdid themselves as has been the case year after year.  The party gets better each year and attendance grows year after year.  All of the food is prepared on site by an extremely talented group of employees.  I love when I am asked the question, "Who does the catering for this wonderful party?  I have to get their name."  Guests can't believe that such an event can be delivered by the "kitchen staff."  Let me tell you, it is the holiday party of the season and one that everyone wants to be invited to.  An invite is easy,  just contribute at the $10,000 level or higher, become a physician or be invited to serve in some governance related capacity at WMHS.  Although I thanked our Dietary staff throughout the evening and after the event was over, I can't recognize them enough for the outstanding effort in delivering the party of the holiday season.  Great job, everyone!

The Holidays

Yesterday was the monthly department director's meeting at WMHS.  It is always held on the first Thursday of the month.   It was a little difficult to get into the holiday spirit this early in December, but we figured out a way.  At every meeting, we spend time on recognition of departments and individuals.  We were quickly put in the holiday spirit as one of our employees was recognized for her role during the recent Santa parade at the Country Club Mall.  During the parade, one of the participants went  into cardiac arrest.  The daughter of one of our nurses was attending the parade and knowing that her mother was shopping at the Mall, called her.  Our nurse rushed to the scene and began CPR.  Another employee knew where the AED was located and our nurse shocked the man back to life.  What a great way to start off the holiday season.

Congratulations, Ruthie Stonebreaker

Yesterday, I had the pleasure of attending Ruthie Stonebreaker's retirement reception at WMHS.  Up until today, Ruthie had worked at the first Sacred Heart Hospital and then the second location on Haystack Mountain and most recently at the Western Maryland Regional Medical Center.  The significance of Ruthie's retirement is that she has worked for us for 47 1/2 years in Environmental Services.  What an amazing tenure.  I asked Ruthie what she was going to do in her new life of retirement and she said that she has no plans.  She said, "in fact, I could be back to work next week".  What an amazing woman who has seen a great deal and has been a part of an evolution in health care in Cumberland.  Thank you, Ruthie, and God speed. 

Thank You, Secretary Panetta

Yesterday, I read an article in the Navy Times regarding Defense Department cuts and the impact on the Navy.  Currently, my daughter is on a 4-month deployment for her, but an almost 11-month deployment for her ship.  The article was about the expected increase in deployment time for all ships going forward to be more in the 10 to 12 month range rather than the traditional 7-month time frame.  The increase is due to the number of ships that will be taken out of service by the Navy for budgetary reasons.  In my opinion, not a good time to reduce the size of our Navy as China is dramatically growing the size of theirs, as well as with all of the unrest throughout the world.  Anyway, with the downsizing of the number of ships to what some say is pre-WWII levels, comes the downsizing of the fleet.  Lo and behold, hundreds of Navy Chiefs were notified yesterday that they will be leaving the Navy.  This notification will be the first of many in not only the Navy, but throughout our armed forces.  Is this the smartest move at this point in time?  I guess time will tell.  By the way, what a nice Christmas present for those Chiefs and their families.

Anti-Aging Eating

OK, I just learned that as you age your skin begins to dry out.  I guess that I really never thought of it.  Apparently, you can head off that drying out process by eating more fish, avocados, olives and walnuts.  Any foods that have omega-3 and omega-9 fatty acids and monounsaturated fats will do the trick.  Vitamin D decreases wrinkling of the skin so eat more broccoli, papaya and kiwi.  Oysters are high in zinc and help keep your skin plump and firm.  I guess these tips fall under the category of keeping you looking youthful.  Other suggestions for keeping that youthful appearance would be to moisturize daily and sleep 6  1/2 to 8 hours a night.  Getting old seems to be getting tougher and tougher.

Corporate Responsibility

A few months ago, I wrote about how pleased I was with Delta Airlines based on travel to and from the Canadian Rockies.  Well, today I am not so pleased after reading a blog regarding their position to support the National Vaccine Information Center by running a NVIC ad on their flights. 

The last thing we need is for more people to opt out of getting vaccines and immunizations, especially children.  Both are the greatest wellness initiatives that we have in our arsenal to fight illness and disease.  The NVIC uses emotion, movie star endorsements and very little science in their anti- immunization campaign and less than concrete advice in their anti-vaccine campaign.   They recommend that one cover one’s mouth when coughing and to wash their hands, as both should be sufficient.  Tell that to a toddler or a parent where consistent availability of running water may not be an option.  One would think that a company with the size and reputation of Delta would have consulted experts on both sides and made a more informed decision.  I can’t believe that they could arrive at such a decision being armed with all of the facts or recognize the controversy and don’t take any position.

Where Have Our Leaders Gone, Part 2

As a continuation from Wednesday, now for the rest of the story.  The crisis in Washington is an abject failure of leadership, starting with the President.  For the President, the Speaker of the House and the Senate Majority Leader to in one continuous motion to throw up their hands and then begin pointing fingers at each other is a disgrace and an embarrassment.  These are our leaders, who have been elected to do what is best for our country and our citizens, not what is best for them to get re-elected.  To entrench themselves in absolute positions with no compromise puts this country in dire straits. 

We have a $15 trillion dollar deficit with Republicans not budging on tax revenues and the Democrats still wanting to spend dollars that don't exist on social programs while touting their support of the "Occupy Everywhere" demonstrators. All of this is going on while the President runs for re-election, with his concept of leadership being the generator of political attack soundbites is mind-boggling.  All of these so-called leaders need to be replaced with individuals who are dedicated to addressing this crisis and returning our country to a position of economic stability.  As for the Super Committee, reconstitute it with members of the House and Senate who are not running for re-election and see what happens.  A lack of leadership, in this case, is crippling a country.

Happy Thanksgiving

This week, I received a Thanksgiving message, gift and invitation from Senator Ben Cardin.  The invitation was to contribute to his re-election campaign.   Hello, we are in Maryland, where Democrats outnumber Republicans 5 to 1 and you are a seated Senator who is very well liked, even by me, a Republican.  It also doesn't hurt that you are a Pitt alum, just as I am.  But, you need money, why?

Anyway, the gift was a Thanksgiving recipe for the Cardin Family Sweet Potato Casserole.  So, that gift got me to thinking.  I am going to share with you a recipe for Thanksgiving turkey leftovers and my daughter's favorite meal.  Enjoy!

Turkey Devonshire

Ingredients:

Leftover Turkey

Bacon

Toasted Bread

Cheese Sauce*  (any basic cheese sauce recipe will do)

Preparation:

1. Fry / microwave / bake bacon (two strips for each serving)

2. Toast bread (one piece per serving)

3. Place cold turkey slices and cooked bacon on toast

4. Pour cheese sauce on top

5. Place in the broiler for about two minutes* (Be careful, the plate should be placed on a trivet or heat resistant surface as it is hot coming out of the broiler and served immediately)

Simple and easy.  The above recipe takes about 30 minutes total from start to finish. 

Heat up the rest of the leftovers, add cranberry sauce and serve.

Happy Thanksgiving!

Where Have Our Leaders Gone?

The title of this blog I took from my father-in-law, who said that would be the title of his book if he ever got around to writing one.  He didn't, but if he did, it would have been about the steel industry.  He ran a foundry in Latrobe, PA, and blamed the collapse of the industry on the failure of management, surprisingly not the steelworkers.   In fact, he predicted it years before it happened.   It took me a while to figure that out, but I eventually did.  He would say every time the union would demand something, management would give it to them.  In many instances, there was absolutely no business sense involved in caving to the demand.  It was management that ruined the industry--not the unions.  Eventually, the industry couldn't compete against foreign steel because of wages and benefits provided to the steelworkers, who, after never being told "no," felt that management was bluffing when plants were first threatened with closure and then eventually closed for good.  When I lived in Pittsburgh, I would sometimes go to bars for lunch, to eat not drink, and there would be the steelworkers everyday waiting for the steel mills to reopen as it would was only a matter of time.  Unfortunately, the steel mills remained shuttered and never reopened.   So, a lack of leadership crippled an industry. That was a long explanation for a blog title, so you'll have to wait to Friday for the actual blog.

The Kennedy Assassination

Yesterday, I blogged about a joyous anniversary, the opening of the new hospital.  Today, not so much.  Forty-eight years ago, I was nine years old and in the 4th grade, boy have I gotten old.  On that brisk November day just after lunch, we returned from the school yard.  We had just settled into our desks for afternoon instruction and word came over the loudspeaker for the Sisters to turn on the classroom televisions.  At that point, we learned of President Kennedy's assassination.  I think everyone was in shock.  Sister Theresa cried while the class stared at the TV trying to understand which was pretty challenging for 8 and 9 year olds.  Within 30 minutes of learning of the assassination, we were all told to gather up our belongings and to go straight home.  The President Kennedy's death didn't really hit me until I got home and saw my Irish Catholic father standing in the kitchen crying.  I had never seen my father cry before.  It was certainly a day of many firsts and one that I will never forget.

Happy Anniversary Western Maryland Regional Medical Center

Two years ago today, WMHS moved into a brand new state-of-the-art hospital.  It seems like yesterday and the facility still looks like it was yesterday.  The facility is in great shape.  We have had a few areas where the product didn't hold up, mostly flooring, but in those areas where it was a problem the flooring has been swapped out.  We also have taken the initiative to replace carpeted areas with tile flooring due to wear and tear or staining.  Otherwise, it is amazing as to how well the new building and all of its operating systems have held up. 

Clearly, the continued success is directly attributable to a visionary Board of Directors; great design team, Hord Coplan and Macht; a great construction team, Barton Malow / Mascaro; great leadership from the C-Suite to Kevin Turley to Jo Wilson and a wonderful staff of employees and physicians who planned and operationalized the new hospital.  Happy Anniversary and congratulations on a job very well done. 

Credibility Book Discussion

Earlier this week, I wrote about the book that the leadership team is reading, "Credibility, How Leaders Gain and Lose It, Why People Demand It".  The WMHS Leadership Institute held 8 book discussions on chapters 1 and 2 over the last two weeks.  I participated in a session with about 20 other leaders in the organization on Wednesday.  It was an hour very well spent.  Going in, I was a little concerned that with my attendance, those leaders would be reluctant to speak and participate.  Not the case.  It was a great exchange, even with some talking about not being able to effectively articulate the vision for the organization and their department to their employees.  Then, having others providing suggested approaches on how to get that staff better engaged.  Everyone seemed to get something out of the discussion and they all loved the book. I am now looking forward to the chapter 3 and 4 discussion.  Great job, Jeanie Seifarth in putting this altogether and Mark Kerns in effectively leading a session with me at the table.

The Great American Smokeout Day

Today is the 36th Great American Smokeout Day sponsored by the American Cancer Society.  The year of origin for the Smokeout Day was 1975 when I was still smoking about a pack of cigarettes a day.  I started at age 16 for the sole reason of being cool.   The day my mother found my cigarettes stashed in my closet was a very uncool day.  I can still hear her screaming at me.  My father, who was a smoker from age 15 to 52 and who died at age 62 of a two-pack a day of Pall Mall's related death, laid out the ground rules.  No smoking in the house and no smoking in front of your mother; that lasted 2 years.  I then smoked to age 21. 

My quitting had nothing to do with the Great American Smokeout; I quit 3 months prior.  It had to do with a woman.  I had met Pamela, my wife of 35 years, five months before and I was still smoking.  I decided to relocate to Pittsburgh where she lived.  On the several day trip from Miami to Pittsburgh, with a stopover in New Jersey to visit my parents, I caught a horrible cold.  Every time that I caught a cold, I would stop smoking.  However, this time after the cold was over I had one cigarette and it tasted horrible.  The desire for a cigarette was gone and I haven't had one since. 

Now, for the interesting part.  Unbeknownst to me, Pamela hated cigarettes and the harm that they caused. She never said anything during our 4 dates in Miami nor in the almost daily letters that she wrote until I moved to Pittsburgh.  After I moved to Pittsburgh, she told me that she really wanted this relationship to work and didn't want her dislike for cigarettes to impact our future together.  She said that she prayed about it every day from the time that I told her that I was moving to Pittsburgh until after I arrived.  She said that she left it in Lord's the hands.  After I arrived, she quickly noticed that I stopped smoking and inquired why.  I told her about the cold and that I tried to resume smoking after the cold, but the taste and desire for a cigarette were gone.  The Lord works in mysterious ways at least he did for Pamela and me.  So, take advantage of today's message on the Great American Smokeout.  If you are still smoking, quit as was revealed today that President Obama quit, but it took 5 years.  The other option, pray about it, worked for me.

Decline in Admissions

The number of admissions to Maryland hospitals has dropped over the past several years.  For the FY ending June 2011, admissions at WMHS were down about 5%, which mirrors the state average.  Part of the admissions decline is in response to payment reform in Maryland, but the other part can be attributable to the efforts to improve the health care delivery system.  We have been working to ensure that the most appropriate care is being delivered in the most appropriate setting.  Routinely, patients who needed care and treatment beyond the Emergency Department were often admitted to the hospital; now they may receive care in our Observation Unit or discharged and followed up at home or in one of our clinics.  Lots of changes are happening as we try to stay on the forefront of care being delivered in a different way.  Stay tuned.

Credibility

At WMHS, our leadership group is reading, "Credibility: How Leaders Gain and Lose It, Why People Demand It" by Kouzes and Posner.  Recognizing that the average Fortune 500 CEO reads 24 management / leadership books per year and the average manager reads one per year, we have stepped up commitment to leadership development through the creation of the WMHS Leadership Institute.  One area of focus is reading a book a quarter.  We buy the book, distribute it to our supervisors, managers, directors and VPs and then hold book discussions usually based on two chapters in the book.  The timing of this book is incredible with the horrific situation at Penn State.  With credibility as the cornerstone for effective leadership, quite a few folks at PSU could have greatly benefited from this book.  As the new leadership at Penn State begins to form and address the many challenges ahead, they may want to start with reading this book and taking to heart the acronyms DWYSYWD (Do What You Say You Will Do) and DWWSWWD (We Say We Will), as both drive superior employee performance.

Veteran's Day

On Friday, we celebrated the 22 million living veterans in our country, including those who are affiliated with WMHS.  We had a breakfast for our veterans and those employees who have family members currently serving our country.  We were also fortunate to have a few patients and their families join us for the recognition.  This was year two for such recognition on Veterans Day and long overdue.  We can't do enough for these men and women who reportedly have service connected disabilities and a reported unemployment rate that is double the national rate of 9%.  Please take the opportunity to thank a veteran or a member of our armed services currently serving as every day should be Veterans Day as these a people who have sacrificed so much for our freedom. 

Look Out Healthcare, Here Comes WalMart, Again

I just read that WalMart is getting into the primary care business, adding to their previous ventures into retail clinics and prescription drugs.  They are seeking partners to propose low cost health care plans as they pursue their goal of being "the largest provider of primary care services in the nation."  After singlehandedly putting Mom and Pop grocery stores, pharmacies and other small town retailers out of business, their latest target is health care.  Hopefully, their efforts to take over primary care services in America will suffer from the same lack of success as their retail clinics and electronic health records.  I am sorry; I can't imagine receiving medical care from WalMart.  By the way, their other areas of interest in the health care arena include monitoring for asthma, sleep apnea, osteoporosis, allergies, diagnostic testing and lab services.

Limiting Outpatient Visits for Medicaid Patients

In their infinite wisdom, the Department of Health and Mental Hygiene in Maryland is proposing as a cost saving measure to limit the number of outpatient visits to ten per year for Medicaid patients.  A few weeks ago, I commented on that some states were limiting the number of inpatient days for Medicaid patients.  Maryland's approach is the same shortsighted planning as the other states.  Applying an arbitrary limit would disrupt the care for some of our most vulnerable citizens.  Individuals suffering from AIDS, mental health conditions, high-risk pregnancies and substance abuse would be harmed by limiting access.  These patients would delay treatment until they needed to be hospitalized or would seek treatment in the ER, generating a higher cost of care in both instances. This approach runs contrary to what hospitals are now trying to achieve by providing care in the most appropriate setting in an attempt to keep patients out of the hospital.  The Maryland Hospital Association has presented a five-point plan to create Medicaid savings that hopefully DHMH will embrace.

Maryland's Competitiveness

Yesterday, I blogged about the O'Malley administration beginning to embrace the business community.  Today, I will expand on areas where the state leads and where we lag related to our competitiveness. This information is based on a presentation to the Maryland Chamber of Commerce last week.  Maryland leads other states in workforce quality, access to capital, quality of life, fiscal stability and economic performance.  Where we lag would include high labor costs,  a greater tax burden, commercial energy costs that are higher than most (Maryland ranks 40th), an unfriendly liability and regulatory environment, 50th in mean travel time to work and 44th in cost of living.  Governor O'Malley's new focus on bringing and retaining businesses in Maryland is both welcomed and critical to our future.

Maryland Now Embracing the Business Community, What's Up With That?

All of a sudden, Governor O'Malley is reaching out to the Maryland Chamber of Commerce, of which I am a board member, to make Maryland more business friendly.  Well, it's about time.  Maryland has slipped to one of the most business unfriendly states in the country under Governor O'Malley due to high taxes and excessive regulations.  So under the "what's up" category, we just learned that yet another company has decided to move 625 jobs out of Maryland to one of the most business friendly States in the US, Virginia.  The Bechtel move comes after Governor O'Malley reached out to Bechtel to keep 1250 jobs in Frederick, Maryland, and was successful ,which is a good thing, but it wasn't enough to keep Bechtel's Global Operations Headquarters here.  Hopefully, the Governor finally gets it that creating and keeping private sector jobs in Maryland is critical to our future and that we can't exist off of our close proximity to DC and federal government jobs exclusively.

NOLA, Part 2

I had the opportunity to see New Orleans by daylight.  Bourbon Street does so much better under the cover of darkness.  During the day, looks especially seedy.  Not very attractive women with piercings and tattoos dressed in a bikini top and a G-string trying to lure you into the too numerous to count Gentlemen's Clubs.  It doesn't matter that you are with your wife, she can come too!  Yeh, right.  Royal Street was a nice surprise with the very many antique shops with some amazing inventory. The food continues to be excellent.  We ate in Arnauld's last evening and what looks like a 1 star restaurant during the day is transformed into a 5 star restaurant at night. 

I mentioned yesterday my first experience with a beignet which is unique to NOLA.  If you haven't had one, it's fried dough drenched in powdered sugar (photo below). 

My visit to New Orleans ends tomorrow morning and I would probably return.  I won't stay at the Marriott in the French Quarter.  Very poor service orientation.  It's hard to imagine that Ritz Carlton with the highest level of service orientation of any hotel chain is owned by Marriott.  I have a suggestion for Bill Marriott, why don't you have the Marriott hotel managers attend the same Service Excellence program that WMHS attended conducted by the Ritz Carlton?

NOLA

I am attending a meeting in New Orleans, LA, through tomorrow.  My first visit to NOLA or Norlands and based on what I had heard, I was dreading it.  I am happy to report, so far so good.  Travel was uneventful since my last trip for a total of ten days, I didn't have luggage for four of those days thanks to the airline industry.  Hotel is fine, food is great and Bourbon Street was better than I expected.  I had my first experience with Beignets, fried dough covered in powdered sugar.  Not bad, but not great for the waistline.  All in all, I would return in the future.

Enterprise Risk Management

Risk management has been around for a very long time in hospitals.  Yesterday at WMHS, we embarked on a new approach, an enterprise risk management initiative.  We will assess every aspect of the health system to determine what and where the risks to the organization may be.  System-wide risk will be assessed starting with a review of the strategic plan and then priorities will be determined in areas of regulatory compliance, patient safety, internal audit and the list goes on.  As we get further into the initiative, I will blog on our progress.

The Grocery Store Tour

Beginning tomorrow, November 2, at Martin's in LaVale at 10 AM, WMHS will begin our free guided tour of one of our local grocery stores.  There are 4 other tours scheduled:   WalMart (11/8 at 2 PM), Food Lion in Cresaptown (11/9 at 2 PM), Food Lion in Frostburg (11/15 at 2 PM) and More for Less on Industrial Blvd (11/17 at 2 PM).  The intent of the tour is to learn how to make healthy choices when shopping for food for you and your family, as well as how to read food labels.  As WMHS takes the lead in our region for improving the health status of our population, the grocery store tour fits perfectly with our goal.  Thanks to Allison Heavner, a registered dietician at WMHS, for taking the lead on this initiative.

Reducing Medicaid Hospital Stays to 10 Days

Wow, what a headline in USA Today the other day.  Hawaii is limiting Medicaid inpatient admissions to 10 days and Arizona is going to 25 days. Do you think that it is going to prevent Medicaid recipients from not going to the hospital after they have used their 10 or 25 days? Nope.  The burden once again falls to the hospital.  Hospitals can't and won't refuse treatment or discharge patients on the 11th or 26th day; they will absorb the cost.  The question is how long can these hospitals incur such losses.  As states attempt to balance their budgets, they need to seek more creative solutions to this challenge. 

Cape Air

Yesterday, I wrote about my recent trip to Vermont.  I didn't pay much attention to the travel plans only that I didn't want to drive several hours from a large airport.  Great news, there are flights from Boston to Rutland.  We flew JetBlue to Boston.  I thought that the flight was continuing on JetBlue.  Nope, Cape Air.  We flew to Rutland and back on a 9-seat commercial plane.  The trip in was spectacular.  The trip back was a little disconcerting in that we flew from Rutland to Boston in a cloud.  Thank God for a great pilot and technology.  The trip went off without a hitch from start to finish.

New Payment Models in Vermont

I, along with Kim Repac, WMHS CFO, just returned late last night, actually early this morning, from Rutland, Vermont.  The Vermont Hospital Association, the State of Vermont and Blue Cross of Vermont held a conference for hospitals across Vermont as they seek new approaches to creating sustainable payment models in Vermont.  We were there to present our transition to a form of global budget under total patient revenue (TPR).  We learned a lot from the host of speakers throughout the day.  Our presentation brought the day of presentations at the 30,000 foot level to ground level as we were the only health system presenting on our successes as well as our challenges under the new payment methodology for the last year.  Met some great people in an area that very closely resembles Western Maryland.  Time well spent.

Improving Your Health System in 10 Minutes

Really?  This article title caught my attention yesterday in Becker's Hospital  Review.  Actually, a handful of speakers on a service excellence panel were given 10 minutes to tell the audience how to improve their health systems.  OK, that's better.  Improvements of the magnitude that hospitals need can be measured in months to years.  Some of the service excellence strategies that we have engaged in with our employees at WMHS have taken six months before we have seen any appreciable improvement and, fortunately for us, that improvement continues.  It can be done, but there is no magic bullet; although to be honest, when I saw the title, I was hoping for a breakthrough in service excellence that maybe we had missed previously.  Just goes to show you that it's never easy.

Well Positioned

I just read an article on the four priority strategies for health systems for the future.  The significance is that at this week's WMHS Board Meeting, I will present my assessment of Future Scan 2012 - 2016.  The presentation includes my perspective on what trends we will see in health care over the next 4 to 5 years.  The four priorities fit very well with the presentation since they are four areas that we are heavily engaged in currently.  The four areas are as follows:  aligning hospitals, physicians and other providers along the care continuum; utilizing evidence based practices to improve quality and patient safety; improving efficiency; and developing integrated information systems. 

WMHS leadership, including the physicians on our Clinical Quality Council, is heavily engaged in delivering care in the most appropriate setting and not necessarily the acute care setting. The Council and our staff are also focused on enhancements to quality and safety as demonstrated through our dramatic improvement in core measure results. We have engaged our process engineers with our middle and senior management to reduce redundancy and better standardize our processes. Lastly, we are deploying electronic medical records software, electronic order entry, e-Prescribing and e-Clinical Works in physician practices.  It is nice to have reaffirmation from time to time that we are on the right track.

Heart Healthy

The cost of caring for congestive heart failure patients has dropped dramatically as hospitals and providers seek alternatives for care of CHF patients.  The days of ER visits and the subsequent admission are much less these days.  Insurers, physicians and hospitals are  continually seeking ways to treat such patients in the most appropriate care setting starting in the home.   At WMHS, we have experienced similar successes and we are building upon that success as we make every effort to use the acute care setting as only one option for our patients.  We are finally applying the complete continuum of care that we have available for our patients.

Legalization of Marijuana

Can you believe that 50% of Americans support the legalization of marijuana?  I can't, but a recent Gallup survey says "yes."  Not surprising is that 62% of 18 to 29 year olds favor legalization.  What is surprising is that 31% of adults over 65 favor legalization.  What probably is happening is that these folks think that it's the same pot that they smoked as teens and young adults.  Also, today's parents seem to be afraid to tell their kids that they can't smoke pot because they did it when they were kids.   Today's pot is  more addictive and it reported to be ten times stronger than it was in the 70's and 80's.  It is also linked to disorders in the brain.  Parents need to try talking about the previous factors and tell their kids "NO" and, while they are at it, they can fill in grandma and grandpa on the dangers.

The Igloo

First it was the Civic Arena, then it was Mellon Arena, but it was always known as the Igloo, where the Pittsburgh Penguins played hockey.  At least it was until last season when Consol Energy Center was built across the street from the Igloo.  Recently, I was flying out of Pittsburgh and picked up the Pittsburgh Post-Gazette.  There was an article on the court challenge to preserve the Igloo.  A group known as Preservation Pittsburgh filed an injunction to stop the planned razing of the arena.  The suit said that redevelopment of the 28-acre site would be an economic boon for the area.  Let me try to understand this plan.  You are going to ask for federal dollars to prop up a 50-year-old building that was severely dated, in major disrepair and loaded with asbestos.  They wanted to preserve a landmark at the expense of 1200 housing units, 600,000 sq. ft. of office space and 200,000 sq. ft. of commercial space that would truly be economic development in a severely depressed area of Pittsburgh.  Preservation Pittsburgh actually called the City Officials lacking innovation and integrity.  Preservationists do have a place, but they need to know when to fold.  They have no concept of the cost involved with preserving aging landmarks and holding onto the past.  The city leaders in this case got it right.  What a shot in the arm for such an economically depressed area as the Hill District in Pittsburgh.

Interviewing for a Job

This is a true story, sad, but true.  We recently had two positions for which the Foundation Executive Director was hiring. There were over 60 applicants for these positions,  with the overwhelming majority being  young women.  Yesterday I picked on 18 to 24 year old men; today it's the ladies, although this blog could easily apply to the guys.  The jobs were posted on the WMHS website so the great majority of candidates were local.  However, the issue isn't a local one; it has become a societal one.

First order of business was to do an Internet search on each candidate.  Thank you, Facebook, as it has become a wonderful screening tool.  Some of the stuff posted on Facebook was unbelievable and access was easy. Sixty applicants quickly became twenty. 

Next, the screening interview.   The new attire for the interview has become a sweater and slacks, crop pants, big earrings and I mean big earrings (maybe to distract one from actually listening to some of the answers to some of the interview questions).  What happened to pant suits, dresses, even a skirt?  In some cases, you gave the benefit of the doubt on attire for the first interview, but now it's the second interview.........this is serious.  What to wear, what to wear.  I think I'll wear that same sweater and slacks or those crop pants.  This is the time to really set yourself apart, you made the cut.  It's down to three candidates and you get to work for the employer of choice for the region.  Wow, what these young women (and men) don't understand about making a favorable impression and truly setting yourself apart. 

Prepare for the interview.  Know the potential employer and understand the expectations of the job.  Do a mock interview with someone........be prepared.  The basic knowledge of preparing for an interview used to be obtained in the home, but that no longer seems to be the case.  It's not there, but somebody needs to take up the cause:  high schools, colleges, extended family, media, the Chamber of Commerce..........somebody, please and don't even get me started on the follow up thank note!

18 to 34 Year Old "Men"

I recently read a frightening statistic that more men between the age of 18 and 34 play more video games than 12 to 17 year olds.  I think that they call this the Peter Pan Syndrome, where these "men" never grow up.  OK, guys, don't you think that it's time to man up?  You should be going to college, working, at some point getting married and supporting a family. Isn't the number of single family households where the mother is raising the family staggering?

I am aware of family after family where the son has come back home to live so, Mom and Dad can help "Johnny" get back on his feet.  Actually, Johnny was never able to stand on his two feet since Mom and Dad were enablers from the start.    These men need to take control of their lives, but first Mom and Dad need to give them a swift kick in the rear end.  These men need to turn off the TV, put down the game controller, wake up before noon, start to network with responsible adults as Mom and Dad may not qualify, go to college (community college is a great opportunity), get to work (yes, you may have to start in an entry level position so, you can demonstrate that you have what it takes), but most importantly, begin to take some responsibility. 

Healthy Aging

Death is inevitable; however, we need to do a better job of helping our seniors, in some cases, soon to be all of us, age better.  They need to approach life based on a healthier lifestyle and we need to help them get there.  Wellness initiatives focused on the elderly will go a long way in minimizing the obsession with many of our seniors who wear their various illnesses as badges of honor.  Wouldn't you rather talk about how great you feel and the activities that you are participating rather than being bogged down with talk of your latest aliment.  I want to be like my mother-in-law, who at 85 years young, is an accomplished artist who still paints, golfs twice a week, has been preparing  meals for Meals on Wheels for the last 19 years, teaches an art class each week and remains very active in her church.   At WMHS, we reach out to our seniors with healthy aging initiatives through our Senior Suppers each month.  Maybe it's time to reach a little further and to help this generation that has earned our respect to age better.

The Impaired Nurse

Last week, Pat Noble, Executive Director of the Maryland Board of Nursing, spoke to our Nursing Leadership Group on Substance Disorders and the Impaired Nurse.  Pat shared story after story, all were true, but without specifics.   It is amazing as to the lengths that the impaired or addicted nurse will go to hide their addiction, but still satisfy it.  We learned of addicted nurses who have lost everything, their spouses, their children, their homes, their cars, but taking away their license to be a nurse was the final straw that lead to their rehabilitation.  We were also reminded that a nurses' license depends on him or her reporting any threat to a patient being committed by another nurse.  Addiction or impairment certainly qualifies.  It is in everyone's best interest for such reporting to occur, but most importantly for the patient whose care we are entrusted with as well as the addicted nurse.  At WMHS and at the Maryland Board of Nursing, both go to great lengths to support the rehabilitation of the impaired nurse.    Pat's approach to the Impaired Nurse is to be commended.  She is truly there to protect the patient, but also to save not only a nurse's career, but his or her life.  The presentation was enlightening and made me think how fortunate Maryland nurses are to have Pat at the helm.

Connecting with Your Community

In health care, we routinely inundate the public with indecipherable information.  We are notorious for acronyms, we use health-speak known to us, but no one else, the public doesn't understand their bills, they don't understand that physicians are independent and don't necessarily work for hospitals (although that trend is changing) and that hospitals need to better engage employers in our effort to drive value.  We need to do a better job of reaching out to the community and to those footing the bill for health care spending.  They need to know that payment reform has taken hold and change is upon us.  We need to educate them on value replacing volume,  that care doesn't necessarily need to be provided on an inpatient unit over a four-day period of time, what wellness initiatives exist for their employees and the criticality of quality in all that we do.

Health Fair 2012

WMHS is already starting to plan our next health fair for the Spring 2012.  This will be a health fair on "steroids."  We will model our event after the dental community's Mission of Mercy that I blogged about yesterday.   WMHS physicians, RNs, advanced practice professionals, technicians, pharmacists, therapists and the list goes on will provide care to anyone needing care in our region.  We will also use the event to educate the community on wellness initiatives and living a healthier lifestyle.  I'll keep you posted on our progress.

Mission of Mercy

Congratulations to the dental community in our region on receiving a $20K grant for their Mission of Mercy event.  This event is where dentists, hygienists, technicians and a variety of other health professionals provide free dental care, including extractions, for two days.  The event will occur later this month and it is the second annual.  Last year, individuals came from as far away as the Midwestern US to be seen.  It was a wonderful event last year, and hopefully year's event will be another overwhelming success.

Live Longer

Great advice from www.bluezones.com on how people from all over the world approach life:

1. Move Naturally - Walk, get physical activity naturally. 

2. Purpose Now- Know why you wake up in the morning, have purpose.

3. Downshift - Find time to de-stress.  Enjoy happy hour, rest, nap (not at work).

4. 80% Rule for Eating - Stop eating when you are 80% full.  Eat a big breakfast, eat with others, remove distractions and be mindful of what you eat.

5. Plant Slant - Limit meat to twice weekly.  Eat green, as well as nuts and beans.

6. Drink Alcohol - Enjoy 2 glasses of wine.  Drinkers out live non-drinkers.

7. Connect to a Faith Based Community - Engage with a church, synagogue, or other faith based entity.

8. Loved Ones First - Thrive with positive committed relationships.

9. Right Tribe - Choose healthy and supportive friends.

Numbers 1, 2, 3, 6, 7, 8 and 9 are no brainers for me.  4 and 5 will require some work.

Infant Mortality

In USA Today this week, there was an editorial on infant mortality and how the US ranks internationally.  Whatever the number, it is always too high.  We need to pull out all stops in keeping pregnant moms healthy, expanding pre natal care and giving guidance to new moms once they leave the hospital, as has been the case in Maryland. 

Now, I have to take issue with comparing the US to other countries.  Infant mortality statistics aren't reported consistently from state to state in the US, so how can we accurately report such statistics between countries.  And, for the US to rank below Cuba, I find that mind boggling.  A few years ago, a relative visited Cuba as part of a special education visit to discuss challenges, successes, etc., related to educating developmentally disabled children.  There were none.  Their idea of the developmentally disabled were children who were blind, deaf or couldn't speak.  The truly disabled don't survive.  (I will leave it to you to think about how that happens.)  So, we are going to compare our infant mortality statistics to Cuba, give me a break.  Also, countries that are now providing "clean surfaces" to deliver children rank better than the US, come on.  Does the US need to improve, most definitely, but don't rank us against countries that consistently undercount, manipulate or out and out lie and then chastise us for it.    Also, the counter point editorial in the same newspaper gives a great perspective on the inaccuracies and inconsistencies in the data.

Mobile Hospital

At WMHS over the last 24 hours, we have been using our mobile hospital for mass flu vaccinations of our staff.  The purpose was three fold: getting as many employees vaccinated at one time; to test the mass inoculation process and to put our mobile hospital to the test in the event of a catastrophic event.  As you can see from the photos, it is pretty big at 72 feet in length and 23 feet in width.  It can accommodate 16 patients at a time; it closely resembles a MASH hospital.    However, it actually assembles in minutes.  You roll it out, hook up the air pump and you're done.  It has hookups for HVAC, lighting and electric.  It also has a self-contained generator.  We have used the mobile hospital before to test the assembly, but have never used it for medical purposes, at least until now.  In the first 10 hours of operation, we vaccinated over 600 employees.  Great outcome, so far.

God Speed, Lauren

This afternoon my Naval officer daughter, Lauren, begins a scary, but necessary trip three quarters of the way around the world and across three continents.  She will leave Norfolk, VA, for Detroit, MI.  She will have a brief layover in Detroit and will then fly to Amsterdam, The Netherlands.  After a few hours in Amsterdam, Lauren will then fly to Nairobi, Kenya, and will arrive there on Wednesday night.  Her final LAND destination is Djibouti, Africa, where she will arrive at 1 AM on Thursday.  From Djibouti, she will be flown by helicopter to her ship somewhere east of Africa.  Her final destination is unknown to Mom and Dad and pretty much everyone else.  In fact, her whereabouts for the next 4 months will be unknown to us.  As a colleague said yesterday, when I was in the Army and we were deployed, we were part of a large group traveling abroad, never alone.  I can't imagine the stress around such a trip.  I was going to write that when I was 24, my toughest decision was what I was going to have for dinner or was I going out to party that night.   But then I remembered in reality, I had a pretty stressful job as Assistant Director of Materials Management for a large tertiary care hospital with a multi-million dollar budget and responsibility for a hundred or so employees. I was also finishing my degree by going to school at night.  However, that time in my life was still nowhere near as challenging as to what Lauren has to look forward to.  God speed, "little" Lauren, you are loved and will be sorely missed.