Physician Hospital Relationship

As we address changes in healthcare, one area of focus is the importance of the physician hospital relationship.  Now that pay for performance has become critical for hospitals, WMHS had to figure out a way to align incentives for physicians since the federal and state governments are mandating pay for performance initiatives.  Monies are at risk with strong performance reaping both benefit and reward and hospitals being penalized for poor performance.  As a result, we need our docs on board in order to be successful.  At WMHS, we are creating the CEO's Clinical Quality Council whereby I appointment six physicians who are the leaders in improved quality and performance and they in turn recommend six other physicians.  The twelve physician members of the Council are compensated for their time and will serve as the conduit for rewarding those physicians who are the best performers.  There is a pot money made available for the Committee to allocate based on pre-established criteria and improved quality outcomes.  This approach so far has the endorsement of government and is not in violation of the Stark  Act.  We will begin this approach next month at WMHS and I will keep you posted on the success as well as with the lessons learned.

Where's the Loyalty and the Leadership?

I read with great interest last week about the resignation of Jim Riggleman, the Manager of the Washington Nationals.  This is a risky blog since Jim played baseball at Frostburg State University and is the beloved adopted son of Western Maryland.  Unfortunately, I have a big problem with Jim's recent actions.  You are currently under contract, your team just won 11 of 12 games, fans are jumping on board in support of a notoriously lousy team, everyone in baseball is starting to take notice and you make it all about you.  Where is the leadership in putting your team and loyalty to that team first?  You have a contractual agreement with the ownership that YOU signed, honor it.   You are tired of being a doormat for the last 10 years, but no one else signed those one year agreements.  Jim taught us all a valuable lesson.  You live by the sword, you die by the sword.  Whose bluff was called last week, just ask Davey Johnson, the new Nationals manager, this week.  Going forward, Jim will be lucky to even be considered for another one year contract in major league baseball.

Growing Your Own

Congratulations to Chris Ackerman, the recipient of the Ted Wolfe Medical Scholarship.  The $200,000 scholarship will include all expenses related to tuition, fees, books and accommodations during medical school and any costs related to his residency.  The primary requirement is that Chris returns to Cumberland and practices here for the same numbers of years that WMHS funded his education and training.  Chris is a part-time WMHS employee in Registration and is also the son of Pam Ackerman, our director of Home Care and Hospice.

Let's Talk Meetings

Last week, we completed our quarterly Let's Talk meetings with the WMHS staff.  These meetings are the equivalent to town hall meetings for employees.   We have a series of meetings throughout the week whereby I give a presentation on the state of the system and then open it up for questions, comments, rumors or concerns.  For this set of meetings, Tom Dowdell, COO, covered two of the meetings as I was out of town; thanks Tom.  The entire executive team is in attendance along with the Compliance Officer to listen and to raise any issues that they feel may be important.

It is routinely time very well spent for both groups and myself.  It is especially important for the staff to know what is happening related to health care reform and payment reform and how each will impact WMHS in the coming fiscal year.  The meetings included a presentation on the newly approved strategic plan, wage and benefit adjustments, employee fundraising campaign results ($240K raised with 26% of our employees participating), the WMHS successes of FY '11 in physician and advanced level practitioners recruitment (70 in the last two years); pt. satisfaction results exceeding target in every area; door-to-provider times in the ED at 24 minutes on average last week, door-to-balloon times in the Cath Lab at 36 minutes; details on our new Wound Care program expansion and the addition of two hyperbaric O2 chambers; two new primary care centers opening in the Summer and Fall;  all of the IT infrastructure improvements (physician order entry, electronic health record, new systems in the OR, ED and Home Care), doubling the capacity of the Observation Unit, the expansion of our Carelink program and our efforts in improving employee and community wellness. 

In closing, I had the opportunity to show the attached cartoon as an illustration of how important it is to ready for anything and, in our case, it's change.

Delta

I rarely fly Delta Airlines and wasn't too pleased that it was the airline selected by our travel agent for our trip to Canada, especially after hearing that the servicemen and women had to pay extra baggage fees.   I always thought that Delta stood for Don't Expect Luggage to Arrive.  Although I have never experienced my luggage being lost by Delta, I went along with what I had always heard and certainly wasn't pleased with their fees for military personnel.  

But, I have to tell you that I couldn't have been more pleased with every aspect of the air travel.  They were on time, very accommodating, and couldn't have been nicer--from the ticket agents, gate agents, flight attendants, pilot and, yes, luggage handlers.  No lost luggage; in fact, it arrived in baggage claim pretty quickly.  I would fly them again without hesitation provided Corporate doesn't institute any additional draconian policies.   Thanks to the frontline Delta employees for your part in making my vacation memorable and being a model for service excellence.

Economic Development in Calgary, Alberta, Canada

We flew into the Calgary and were amazed at the amount of new housing that was being constructed along with new roads and highways.  New houses starting at $300K are directly related to the growth in the oil and natural gas industry.  Those in Maryland opposed to Marcellus Shale drilling may want to reassess their opposition.    I also read that Western Pennsylvania has the second greatest housing growth in the US second to only the greater DC area due to the increase in federal jobs.  Why and how in Western PA?  The rapid expansion of Marcellus Shale drilling.

Generous to their Wildlife in Western Canada

Driving along Highway 1 from Banff to Calgary, we passed under about half dozen overpasses that have been constructed to allow the wildlife to cross over the highway.  Miles and miles of fences run along the highway in each direction to direct the wildlife to the overpass.  These overpasses are beautifully constructed.  Each is about 100 feet deep and beautifully landscaped with large rocks, grass and trees.  Quite an expense and undertaking, but one that makes a lot of sense to protect the wildlife and those driving along Highway 1.

Encountering a Grizzly Bear

Our first evening in Jasper was uneventful until my wife and a friend went for an evening stroll around the lake.  The friend's husband and I were admiring fabulous art in a shop in the lodge where were staying.  We were to catch up with our wives later.  When attempting to meet up with our wives, I called my wife on her cell phone to find out where she was.  A very excited spouse answers the phone telling me about the grizzly bear being chased by a female game warden that she is seeing run across an area just ahead of her.

By the time I catch up with her, she is talking to the game warden who is trying to keep two grizzly bears and a sow and her cubs away from the adjacent golf course.  The bears have found that the grass on the golf course is the greenest since it's the equivalent to early spring there.  That is one tough game warden even with a sidearm and a shot gun around her shoulder.

So, the next morning I head out for a walk around the lake.  As I am walking, in the same bear sighting area from the night before, I ran into a young man running.  He stopped to ask if I saw a bear on the path that I just exited.  I said not this morning, but there was one last night in the area.   He said that he was told by some hikers that they had seen a bear on the trail that I had just come from.  He ran along that trail very quickly back to the Lodge.  I continued along the trail that was taking me further into the woods and away from the lake.  I thought to myself this is pretty dumb-- there is a bear in the area and I am out here alone.  I turned around and started back.  I got back to the trail where the bear was sighted minutes earlier and on the trail was a steaming pile of scat (bear feces).  I made a very quick exit from the trail.  So, thank goodness, I missed the bear and only got to see its scat.

Oh Canada

Last week, I had the opportunity to visit the Canadian Rockies for vacation. This region is a magnificent part of the world.  After seeing such places of grandeur, I have trouble understanding how some feel that such beauty evolved and was never created.  We spent a week in Banff, Jasper and then Lake Louise.  Lots of hiking up and down mountains, taking in the sights, encountering wildlife, taking hundreds of photos, meeting people from all over the world and enjoying lots of great food and drink. There were many great stories and wonderful memories that I'll share as part of this week's blogs.

 

The League

The League for Crippled Children, soon to be simply The League, has its biggest fundraiser of the year today in Western Maryland; a golf tournament, of course.  But, it is a very well done tournament and deservedly so.  The work of these folks is just short of amazing. What they do for children in our area and across the nation is wonderful.  They are a dedicated, generous and compassionate group of people with one goal in mind, the quality of life for that child.   Thank you all for what you do.

Meta Leadership

What the heck is meta leadership?  During Admiral Thad Allen's presentation he spoke of Meta leadership.  It is providing a structured approach to leadership, usually in a crisis situation.  The key is providing effective leadership first in your own silo and then across all silos. 

The whole approach to incident command during a crisis or disaster now requires reaching across organizations, institutions and entities that are all involved in the coordinated response to the crisis or disaster.  It is very difficult to achieve success when one is focused on the performance of their particular group and not on the response from the many entities that are involved.  Or when one tries to take charge and is not in a position to do so. 

We recently saw this up close and personal when we participated in a disaster response drill across the State of Maryland.  The meta leader, if you will, is the Public Health Officer  who has to get Public Safety, numerous fire companies, many police departments, State Police, many EMS providers, the Hospital, 911 Communications, city and county governments, the many local jurisdictions in the county, funeral directors and the list goes on all heading in the same direction.  Thank goodness that critiques are a key part of any actual disaster or even a drill.  Meta leadership will be the order of the day as a result.

Educating the Patient Part Two

The next area of focus has to be the mid-level practitioner.  I am now getting calls from patients and their family members about the care that they are receiving from a physician's assistant or a nurse practitioner.  I hear "Why should I have to pay this bill, I never saw a doctor."  When I ask if the care was appropriate, they respond, "I guess so, but I never saw a real doctor." 

Physician's assistants or PAs work directly under the supervision of a physician.  So, for example, if you visit our Rapid Medical Evaluation area in our Emergency Department and you are cared for by a PA, he or she is consulting with a physician regarding every aspect of your care. 

In Maryland, nurse practitioners are licensed to practice without any physician supervision.  These individuals are well trained and will be practicing in primary care offices in our community in the near future.  Soon, you will be seen by a nurse practitioner for your primary care needs.  This change allows WMHS to provide greater access for patients who have been unable to see a physician due to a shortage of primary care docs in our area and across the country.

Educating the Patient Part One

It has become so obvious that those of us in health care need to do a better job of educating our patients.  I have written before about our internists and family medicine docs moving exclusively to an office practice.  As a result, when one of their patients is hospitalized, the patient's care transitions to a hospitalist.  All too often, I hear in the community that the Health System is making the patients be seen by the our doctor. 

At the time the change was being made, we asked the physicians to inform their patients as to why they were making such a change.  We drafted letters for them to send to their patients and included brochures on the Hospital Medicine Program.  Effective?  Nope!  We are now running ads about the hospital medicine program in the newspaper, Tweeting about it, and putting it on our Facebook page.  There have been newspaper articles written about it and our staff has even been doing infomercials on the radio.  We have found that it is our responsibility to communicate such changes, and there will be lots to come.

Admiral Thad Allen

Last week, I had the distinct pleasure to hear Admiral Thad Allen speak to an audience of primarily health system CEOs and board members.  His topic was leading during a crisis.  He recounted the numerous challenges that he faced during both the Katrina Hurricane disaster and the BP oil spill.  It is unbelievable that one individual led this country successfully during both of these horrific events in our recent past. 

Did he do it alone?  Of course, not.  But, what a leader.  He is the type of leader that you would follow anywhere.  He has a commanding presence through his take-charge attitude, but more importantly, you respect the hell out of him because he was the one individual responsible during both incidents.  He recognized that he served at the will of the President and for whatever reason (i. e. political) could have been fired at any time. 

One key piece of advice from Admiral Allen was "Be transparent and if you can't be transparent, be honest.”  He so well demonstrated that advice during the many press conferences for each crisis.

Share the Housework

I just read that women whose spouses share the housework feel far less stress.  Thirty married couples who both hold a full-time job and have at least one child were studied.  Saliva samples were taken to measure cortisol levels, a hormone that can affect sleep, weight and the immune system.  The bottom line, share the work and have a happier wife. 

Quite frankly, I didn't need to read a study in the Journal of Family Psychology to know what can set off my wife.  Thirty-five years of marriage did the trick.  It took a while, but to this day if she makes dinner, I do the dishes and clean up the kitchen or at least offer.  I try to at least help out with chores, but please note, we stopped keeping score a long time ago.  My advice to husbands--start helping out or at least offering, especially if you both work; it will go a long way.

Blown Away

The cover of the latest issue of Modern Healthcare, the trade magazine for the healthcare industry, shows St. John's Regional Hospital in Joplin, MO.   The title was aptly put as "Blown Away." The devastation was unbelievable.  I can't imagine the challenges that the CEO, Lynn Britton, and his executive team are dealing with each day.  What WMHS has learned is that we need to go to school on the St. John's experience.  We are at minimum, doing a tabletop disaster drill exercise in an effort to model our response and identify our shortcomings should we face such an unimaginable crisis.  Joplin, MO, you continue in my thoughts and prayers.

Change

It is amazing to see the amount of change that is happening in health care in general and at WMHS.  Arnold Bennett, a British novelist, wrote, "There is nothing wrong with change, if it is in the right direction."  Today at WMHS, we are involved with some pretty dramatic changes related to quality improvement, greater efficiency, process improvement, elimination of waste, greater transparency, increased value, reduction of costs, budget cuts and shortfalls, care delivery in the best setting and improved health and wellness of the population.  A lot of change that is heading in the right direction and change that will keep WMHS viable.

Internal Fellowship Program

For FY 2012, the Western Maryland Health System is reactivating our Internal Fellowship program.  It's a program that provides structured opportunities for Bachelor's prepared employees who have been with the Health System for at least one year and seek advancement in the organization. 

Managers submit projects (i.e. a process improvement, a new service, a new product line) with a duration of six months and the selected fellows are matched with a project.  Members of Executive Management serve as mentors throughout the process.  The fellows perform their regular job responsibilities in addition to their fellowship project work.  They are paid a stipend after the project completed and presented.

The Internal Fellowship program won the Hospital Association of Pennsylvania's Achievement Award and brought WMHS our Service Excellence philosophy through a previous project.  It is a great way to identify talent, develop staff and to promote from within the organization.

Scenic Western Maryland

So how cool is it for Western Maryland to be named Maryland's Most Scenic Drive?  In Friday's USA Today, they identified the 51 most scenic drives state by state.  Maryland Life magazine choose the 90-minute drive along Interstate 68 through Western Maryland.  Thank you, Maryland Life!

Best Hospitals to Work in Healthcare

Last week in Becker's Review, I read an article on the 100 Best Places to Work in Healthcare.  What amazes me is that what these hospitals are doing for their employees is mirrored in many hospitals and health systems across the country.  These hospitals provide a wide range of benefits, they provide paid time off, they give raises, they recognize employees annually, they provide employee wellness activities, they provide tuition reimbursement, they support staff education, they have as pension plan, they have a 401K or 403B match, they promote from within, they provide incentives for employee health and wellness, they recognize employees of the month and year, they have employee benefits fairs, they have career ladders, they perform annual performance reviews for all employees, they offer an employee discount in the cafeteria, they offer scholarships to employees and their families, they offer free parking, they provide a socially just wage, they offer Weight Watchers, they have biggest loser contests for their employees with cash prizes, they provide discounts and payroll deduction for area fitness centers and the YMCA, they have smoking cessation programs, they have extensive on-boarding initiatives for new employees, they pay employees for physician recruitment referrals, they offer short and long term disability, they provide for comprehensive medical benefits, they offer life insurance, they offer accident, death and disability insurance, they provide access to a host of voluntary benefits, they offer an on-site pharmacy for employee prescription pickup, they link ongoing raise actions to organizational performance, they offer premium pay for evenings, nights, weekends and holidays, they have employee recognition for positive behavior, they have recreation events and bus trips, they offer discounted golf memberships to employees, they offer pre-tax flexible spending accounts for child care and health care,  they provide daily huddles for enhanced communications, they provide turkeys, hams or gift cards at Christmas, they offer on-site banking, they provide gifts to employees at milestone anniversaries, they provide free flu shots to employees and family members and  they recognize and memorialize deceased employees.  Some of these hospitals offer unique benefits and incentives due to the hiring competition in their market, their geography or their affiliation with a university which can set them apart.  But, what I find it especially rewarding is that at the Western Maryland Health System, we provide all of those benefits listed above to our employees.  Congratulations to the top 100, but rested assured, you're not alone. 

Beyond the Low Hanging Fruit

At the last meeting of the Health System Board, we had an interesting discussion about getting cost out of the System.  The Board has been well aware of what we have achieved over the years related to cost- saving initiatives.  However, as we attempt to effectively see our way through national health care reform and payment reform in Maryland, the question is, "where could there be additional savings?”

We are now dispatching our process engineers (aka our Blackbelts) throughout the organization to examine procedures and processes for Lean and Six Sigma opportunities interdepartmentally. We are even allowing departments to share in the savings through gainsharing initiatives. As we reinvent how we do business, which is now keeping our populations healthy and out of the hospital or at least treated in the most appropriate setting, we are making sure that WMHS is well positioned for the future.

Patient Satisfaction

At the July 2010 Health System board meeting, Board Chairman Dr. Donald Alexander announced that WMHS would be committed to a dramatic improvement in patient satisfaction during FY 2011.  Management then undertook a powerful transformation improving HCAHPS scores and the overall patient experience, using lots of training and education of staff, posting our scores on a monthly basis for all to see, extensively promoting our "Always" pledge to our patients, and setting our target for achieving a HCAHPS score to that of our competitor, which is possibly the best in a neighboring state. 

All of that effort began to payoff in November of last year and has continued since then.  WMHS has hit or exceeded that target of an overall rating of 70% when answering" Always" to the 18 HCAHPS survey questions.  We have been celebrating monthly with our staff and held a celebratory picnic in April for a full quarter of exceeding the target.  There is no doubt that there is a direct correlation between a satisfied employee and a satisfied patient.