Stroke Awareness

May is Stroke Awareness Month and since it's still May, allows me to comment.  The word “stroke” now has new meaning since my mother suffered a stroke in January of this year.  It's a little tough to do anything about it when you are over a thousand miles away.  Thank God for family, in this case, my sister.  Something told her to stop by my mother's home on her way to run errands.  She found my mother somewhat disoriented and having trouble walking.  My sister called me and I asked about any numbness or weakness? Yes, on her left side.  Any confusion? Yes.  Any trouble seeing out of one or both eyes? Yes, the left eye. Any dizziness?  Yes.  I confirmed what my sister thought.  She needs to get to the hospital ASAP.

Then the fun started.  Getting my mother to the hospital was quite the undertaking. It took my sister with me on the phone and then a call from my wife to get her to realize the seriousness of the situation. The dreaded call from daughter-in-law, who is, worse yet, a nurse, did the trick. Wife: "Doris, you are having a stroke; you need to go to the hospital now." Mother: "I'm fine."  Neither will admit to what was then said, but I think it went something like this.   Wife: "OK, if you would like to deteriorate into a vegetative state until you die that is certainly your choice but why put that burden on the rest of the family.”  Off they went to the hospital and a week later she was back at home doing very well aside from the loss of her peripheral vision in her left eye and some short-term memory loss that has since improved. My mother and my wife are fine; she still loves her like her own.

The point to all this is that time is of the essence when stroke symptoms are presented.  Receiving treatment within 4.5 hours can greatly reduce the risk of permanent damage.  So, know the signs: numbness, weakness, confusion, trouble speaking, trouble seeing, can't walk, dizzy, loss of balance or severe headache.  Call 911 for any of the above symptoms.

The Start of Summer

The official start of Summer begins on Monday, Memorial Day.  The beach, picnics, backyard barbecues, family get-togethers, fishing, boating, golf, and so on.  A great time of the year.  Unfortunately, what is lost is the true meaning of Memorial Day.  It wasn't until I became much older that I came to realize the significance of this holiday.  The holiday commemorates members of the US military who died in service to our country going all of the way back to the Civil War.  The significance has much greater meaning in my adult life, especially with a daughter currently serving in the military.  The sacrifices are unimaginable that these men and women make for us every day. 

A few years ago, I visited the WWII Memorial in Washington, D C.  I was so moved by this memorial and by what I experienced being there that day.  WWII veterans--there in wheelchairs or with walkers or canes; there with family, some alone.  But, what I found so moving was the recognition shown to these veterans.  Strangers coming up to them and thanking them for their service to our country and making that sacrifice.  That visit is one that I will remember for the rest of my life as it helped shape my appreciation for those who serve and for those who made the ultimate sacrifice in giving their life for this country and our freedom. 

On Monday, pray for those who serve currently, have served and have given their life for us.  Thank a veteran or a member of the military.  If your community has a Memorial Day observance, attend it, it is a great time for reflection and recognition.  Have a great holiday!

Personal Conviction

Yesterday, I wrote about the difficulty in taking a position, especially a difficult one.  But, I noted that as time went on, it has gotten easier.  So, what's the secret? A strong set of personal convictions, whether it's values, my faith or a connection to the community.

I started reading a new book on leadership entitled, "Exceptional Leadership" by Carson Dye and Andrew Garman.  The book identifies 16 characteristics of outstanding health care leaders.  It just so happens that the first characteristic is a well cultivated self-awareness, particularly living by a strong personal conviction.  (It's always nice to have immediate affirmation of something that I blog about.)  The book describes that personal conviction allows leaders to push through challenging times for the greater good, the health system, in my case.  As I noted yesterday, I have a strong set of personal values, as well as those of the health system, which guide and influence every decision that I make.  I am also fortunate to have a strong faith, greatly influenced by my wife, as well as a solid connection to the community that allows me to do what is best for WMHS and the region that we serve. 

If you are struggling with your own personal convictions or you are having a hard time applying them, ask for someone to guide you.  I have had many mentors over the years and they have been wonderful.  They have helped to shape my values and my faith and most importantly have made me a better person.  All you need to do is ask.

Taking a Position

I was recently asked, as a CEO, how difficult is it to take a position for the good of the organization, but one that may not be shared by my board, the community, the medical staff or the employees.  First off, if my board is not in a favor of a position that I take, chances are my position will change unless it runs contrary to my values and those of the System.  I will tell you that it has gotten easier over the years, but it can be really difficult, especially for new managers. 

When we consolidated the two hospitals to form the Western Maryland Health System, it was a time in my life that being liked by everyone was important to me.  That changed virtually overnight.  Death threats, unkind treatment toward my wife and daughters, letters to the editor every day in the newspaper, the anonymous letters calling you every name in the book and the list goes on. During that time, I learned a great deal about myself and about people.  I realized that it was impossible to be liked by everyone and that it was my job to make difficult decisions.  If the decision was best for the System, then so be it.  As for people, many don't like change; but if you effectively communicate and educate, many will come around.  For those who don't, they either eventually come around or choose to no longer be associated with your organization, as was the case with the affiliation.

Site Selection

Last week, I had the opportunity to speak with a site selection coordinator for a company looking to locate to our community.  Should this company locate in Western Maryland, it would be wonderful for economic development.  One hundred professional jobs right from the start.  The coordinator's questions were mostly around workforce.  Recognizing the differences between our businesses, he was still very impressed with our ability for workforce development in Western Maryland. 

We are so fortunate to have Allegany College of Maryland (ACM) and Frostburg State University (FSU).  I described the number of graduates who are employed at WMHS from both institutions and that if we need courses, a curriculum, a certificate program or a degree track, we can always count on both.  The number of allied health professionals who graduate from ACM and are employed at WMHS is amazing.  We help out with scholarships in a variety of areas.  There was a need for a Baccalaureate degree in Nursing and FSU came to the rescue, complementing the two-year Associate degree program at ACM. 

One of the clear advantages of working in a more rural community is that everyone helps each out for the betterment of the region.  Thank you, ACM and FSU.

CRISP

In an effort to improve the care that we deliver to patients, WMHS is part of the Chesapeake Regional Information System for our Patients (CRISP).  This is a statewide health information exchange that shares health information among hospitals, labs, physician offices and other health entities.

The CRISP health information exchange will allow physicians and caregivers to have access to a patient's medical history across Maryland.  We started exchanging data with CRISP earlier this month.  Protecting patient information is a priority for CRISP, but patients can opt out of the health information exchange if they prefer.  Exchanging health information was a long time in coming, but it is great that it is now here.

Commencement

This weekend marks the Spring Commencement at Allegany College of Maryland for graduating Nurses, Pharmacy Techs, Rad Techs, Med Techs, OTAs and PTAs.  We are so fortunate to have Allegany College and the School of Allied Health Professions across the street from our new hospital.  Locating the new hospital across from the College and the Allegany County Health Department certainly made a world of sense in order for ease of access for students and instructors, but also as shrinking health care dollars drive the Health System and the Health Department to collaborate on programs, services and other patient / client needs.

Congratulations to the new grads and, on behalf of our patients, thanks to their instructors for the quality of their education and training.

Taxing Mileage

It was never my intent to criticize leadership of any type through this blog, but I read an article in Newsmax recently and I have to comment on it.  Through the Department of Transportation and the Office of Management and Budget, the Federal government is looking to create the Surface Transportation Revenue Alternatives Office.  The purpose of this $300 million taxpayer expense will be to track the number of miles driven by Americans. 

Where is the outrage from those who criticized the Bush Administration repeatedly for the invasion of our individual right to privacy as that Administration dealt with the war on terrorism.  Through the mileage tax initiative, the Feds would track our every move and then we would pay for that invasion every time we went to fill up at the gas pump. 

My problem isn't the right to privacy issue, it is the attack on rural America.  Those of us in western Maryland live it every day.  The goal in Annapolis is to keep their playground in the mountains, green and pristine with little to nothing being done for economic development and growth in the region.  But I digress.  Rural America has to drive great distances in many cases for the simplest of chores, doctor visits, grocery shopping, trips to WalMart, visits to relatives, taking kids to college and the list goes on. In both Washington, DC, and Annapolis, Maryland, the voting blocks within the urban centers are critical to their re-election, but for the most part they walk to work and to shop, they take public transportation and don't drive as much.  However, they do sit in traffic.  Hopefully, Washington can add a pay-by-the- minute taxing component to the Surface Transportation Revenues Alternatives Office for city dwellers idling in traffic.

Employee of the Year

Congratulations to Emma Brashear as the WMHS Employee of the Year.  Emma was chosen from a dozen wonderful employees who are doing some unbelievable things at WMHS as well as for their communities.  These people, as well as their colleagues, are military reservists,  PTA members, parish nurses, firefighters, EMTs, church leaders, service club members, not-for-profit board members, United Way volunteers and the list goes on.  Emma has been described as an “angel from heaven” and one who goes the extra mile for anyone.  As a 22 year employee, she is a shining star among a galaxy of stars.  Congratulations to Emma and the 11 Employees of the Month who live our Mission and Core Values each day.

The Solo Practitioner

A few weeks ago, there was an article in the NY Times, "Family Physician Can't Give Away Solo Practice" written by Gardiner Harris.  This article should be mandatory reading for every solo practitioner.  A very sobering read on the future of the family doctor, who populates our cities and towns across America.  These very special people are struggling to survive in today's economy and will become extinct in a few years once the electronic health record becomes mandatory for doctors to be paid.  Last week, I blogged about the role of the hospitalist and that the number of physicians giving up their hospital practice has forced our hospital to double the physicians in our hospital medicine program.  The physician in the attached article now has to see three patients per hour to cover his ever rising costs and four patients an hour to make a profit based on reductions in what is he is paid.  Now you have the rest of the story and stay tuned for more.  The upcoming changes related to physician practice will be many, and I am not so sure that all will be for the best.

California

Last week, Pamela and I were in San Diego to celebrate Lauren's promotion from Ensign to Lieutenant JG.  While there, I saw an economy that didn't appear to be struggling, but certainly a state in distress.    Sure, there were people begging at almost every intersection (nothing new) and most were dressed better than the average Californian.  What I find especially fascinating are those talking on their cellphones behind the "Will Work for Food" signs.  But, the shopping malls were packed and the restaurants at capacity every night.

The “state in distress” part comes in the form of the condition of the roads, which was horrible.  Thank God that it doesn't snow in San Diego as winter would have made them far worse.  The sales tax in San Diego is already 8.75% and set to go higher.  (Cities and counties can set their own rates up to 10.75%.)  Trash strewn on the roads and highways was another indicator of a state in trouble.  Then, I read locally that Gov. Brown is planning to release as many as 40,000 prisoners from the state penal system over the next three years, a plan that he fought as Attorney General a year ago.  What a difference a year makes. 

I was thrilled that Lauren's upcoming assignment will be with an Amphibious Assault Group in Little Creek, VA, as she will be heading closer to home.  Now I am excited for a whole other reason, her safety.  And I thought the state of Maryland was in trouble.

Forty Years of Service

This afternoon we will celebrate our employees and their service to the Western Maryland Health System.  Of particular note and celebration are the 18 employees who will be honored for 40 years of service.  Wow!  What a milestone for these individuals and our organization.  I have been involved with Service Award Recognition for over 30 years when I received my first 5-year pin.  I have never seen anything close to 18 employees receive a 40-year service award.   Congratulations, folks.

Hospitalists

As internists and family practice physicians in our community focus on their office practice and no longer admit patients to the hospital (their choice), I continue to hear in the community that WMHS is requiring inpatients to be seen only the health system's doctors.  Not true.  We have had to expand our hospital medicine program as a result of physicians making a business decision to focus on an office practice exclusively.  We have virtually doubled the number of hospitalists in the last year.  We have also added mid-level practitioners to the hospital medicine program to complement our physicians.  These men and women continue to change the face of medicine, and we are so appreciative to have them on our team.

Happy Nurses' Day

Today WMHS is celebrating Nurses' Day and this day should be up there with any national holiday.  What these women and men do for our patients and our Health System day in and day out is remarkable.  The care, the compassion, the knowledge, the experience, the sadness, the laughter, the mentorship, the commitment and the dedication--these are truly special individuals who deserve our appreciation and respect not just today, but every day.  On behalf of the Health System and our grateful patients, thank you, ladies and gentlemen, for all that you do.

Service Above Self

As Rotary International celebrates its 100-year anniversary, I have had the privilege of serving Rotary for the last 17 years.  I have served as our local club's president and I live the Rotary motto of "Service Above Self." But, I am not alone.  It is amazing as to the commitment of Rotarians to the practice of service above self in both their professional and personal lives.   I have come to admire the majority of these club members who are so engaged in every aspect of our community, whether it is through Rotary or not.  They serve without hesitation and make our community a better place to live and work.  Happy Anniversary, fellow Rotarians, and thanks for a job very well done!

Telling Our Story

Last November, my daughter, Jessica, left health care and joined the banking industry, well actually, the credit union industry.  She was the Director of Communications for the Maryland Hospital Association (MHA) and then became the Vice President of Corporate Communications for the South Carolina Federal Credit Union in Charleston, SC.  Through her mother and me, Jessica had been influenced by health care for her entire life so she gave it a shot right out of college.  Jessica was the recipient of several promotions at MHA and was even considering a health care opportunity in Charleston.  When the Credit Union opportunity presented itself, she accepted it.  Jessica said that a change was in order.  What she has found is that she now enjoys a great working relationship with the media being in a job that appreciates what the Credit Union does for the community.

Wait a minute, she was in health care.  What industry does more for its community than health care?  We save lives, we treat patients with care and compassion, we try to improve the health status of our communities, we provide free care, we support the health and social needs of our community and the list goes on.  What we don't do is tell our story as effectively as we should.  We do wonderful things for our communities, but for the most part, few know about it.  Another missed opportunity.

Living the Core Values

Every day, I look within my health system and see individuals accomplishing extraordinary things.  They save lives; they touch countless lives; they provide food to those in need and school supplies to needy kids; they serve patients with care and compassion; they diagnose cancer, heart disease and the list goes on.  These people live our Core Values of Integrity, Innovation, Compassion, Accountability, Respect and Excellence day after day.  I am both thankful and proud of these people for they are the Western Maryland Health System.

Strengths Finder

A few months ago, I read the Strengths Finder by Tom Rath.   Wow, what a great book, especially if you are looking to change, grow or enhance your personal / professional development. Subsequent to reading the book, I did the Strengths Insight.  What a great tool.  I have encouraged a number of folks to take advantage of this extremely valuable insight into oneself. 

The online assessment gives you your top five themes, with a description of each, your personalized Strengths Insight, questions to answer for increased awareness of your talents, ten ideas for action for each of your top five themes, questions to help you apply your talents and steps for you to take to help leverage your talents for achievement.  The ideas for action component is especially valuable as a way of applying what you have learned about yourself.  For example, one of my five themes was Futuristic.  I am inspired by the future and what could be. The description says that I inspire others with my vision for the future.

So far, pretty accurate and I hope that I inspire others with my vision.  I think in terms of possibilities and the coming months and years.  The coolest part of this insight is the Ideas for Action section where you are given tips, suggestions and ideas for successful application of a futuristic vision, how you can coach others, how you can inspire and harness the energy of others for a vision for the future, how to gain knowledge to fuel one's imagination and identify others who are like-minded and push each other to greater heights of creativity.

Being in health care today, one has to have a vision for the future as this industry is changing by the day.  There is a great deal to manage and lead.  Executives have to have to be well grounded in the reality of today, but also have an eye on the future.

Infection Control

In January, my mother suffered a stroke and was hospitalized for a week.  Travel in the dead of winter was an experience, and it took me a day longer to get there due to flights delays and cancelations.  Once I arrived, however, what a great learning experience for me from the patient’s side of the house.  My poor staff at WMHS got bombarded with emails:  How do we handle this or that? Tell me we don't do this or that? I have an idea or a new way of doing something.  And, the list goes on.   I will blog from time to time about my time in my mother's hospital room as it was truly an invaluable experience. 

One area of significant note was infection control in the patient room.  Worst offenders by far are visitors, especially family members.  Fully clothed visitors, shoes and all, lying in bed with, and even without, the patient.  Bags of clothing, purses and suitcases on the floor and then placed on the bed with the patient.  Visitors propping up their feet on the bed with dirty shoes. (Have you ever been in a men's room and seen the floor below a urinal?). But my favorite one, which is encouraged by hospitals, was visitors assisting their mom, dad, grandma who was the patient but NEVER washing or even sanitizing their hands. 

As hospitals, we need to do a better job of educating visitors and family members on infection control measures.  That process has already started at WMHS.

Hand Washing

Recently there was an article in the NY Times by Tina Rosenberg on hand-washing in hospitals.  What caught my eye was the statement that "it is rare to find a hospital that has been able to keep the hand-washing rate above 50%".  Fifty percent, are you kidding me? 

At WMHS, we strive to have staff wash their hands at every possible juncture when caring for and treating our patients.  Staff are cleaning their hands from dozens to hundreds of times per day.  Our overall rate hovers around 80% and we are striving to do better month after month.   Through monitoring, we track and share performance data each month.  Not perfect, but there are limitations in all of the approaches.  We have found that our monitors take their role seriously and do a very good job of reporting compliance. 

This is an area that, as CEO, I have to play a very active role.  Infections kill patients and one very effective way to protect our patients is through hand-washing.  So, if you wash your hands, you are stopping the spread of infection through the quickest route to a patient and others.  It's a great start--not only in the hospital, but in your personal life. 

New Hires

At a recent conference, I heard the statistic that close to 50% of all new hires fail within the first 18 months.  It seems hard to believe, but when I think back to some recent hires in my own organization, that rate may not be that far off.  What is more surprising is that these new hires fail because of their attitude--not because they don't have the skill set to do the job.  We are working with some of our new hires right now to make them successful.  Should these people fail, the cost to the organization is significant so it falls to the leadership to create a development plan.  Our key focus now is on making sure that the new hire is the right fit for our health system.  I can't tell you the number of physician candidates that we have rejected over the years because of a series of "red flags" that pop up during the interview process.  It wasn't until recently that we borrowed from our physician recruitment process and changed our approach to selecting and on boarding new staff.  The selection team has to determine if the potential new hire will fit in our culture. 

We are currently searching for a Chief Medical Officer after the June 2010 retirement of Dr. Jim Raver.  Dr. Raver served WMHS so very well for 11 years and has continued to serve WMHS as a part-time physician in our hospital medicine program.  Rather than begin the search immediately, we used the first 6 months of the fiscal year to assess what skills would be needed by a CMO as we change our approach to the delivery of care based on payment reform in Maryland and health care reform on a national level.  We engaged the services of Witt Kieffer, an executive search firm, and they are preparing to present candidates.  In order to ensure that we have the right candidate, the interview team will be tasked with the responsibility to dig a lot deeper into the candidate's past behavior and attitude to ensure that our future CMO is the right fit for WMHS.  It's never easy, but can be so rewarding when we get it right.