Avoiding a Borders Outcome

Another one bites the dust.  I was somewhat surprised to read last week that Borders was forced to liquidate and close its stores.  This business will be completely shut down by September for one simple reason, it failed to change.  Apple, Amazon and Barnes and Noble figured it out, but Borders didn't. 

In healthcare, change is happening pretty dramatically.  Our business is changing at a fast and furious pace, which is pretty remarkable since little changes at that pace when it involves hospitals.  Making a change within our industry, check that, within our hospitals and health systems, is like turning an aircraft carrier on a dime--it just doesn't happen.  However, we have had to adapt to payment reform in Maryland that has changed at a pretty rapid pace over the last few years.  Fortunately for those we serve, many of us are doing so and making it happen at a record pace.  I worry about those who are slow to adapt or change.  Borders’ closing isn’t the end of the world since many others have adapted and will continue to do so, but in health care it isn't that simple.    We serve communities, towns, cities and multi- state regions, we can't afford to not change.

Employee Satisfaction

If you ever wondered how strong the link is between patient satisfaction and employee satisfaction, let me assure you that they are inextricably linked. 

During FY10, WMHS was experiencing financial challenges after moving into the new hospital.  The payment environment in Maryland changed dramatically and we had just moved into the new hospital.  Lots of new technology, yet it still wasn't being used to its level of design and capacity.  We struggled and it impacted employees.  We reduced the size of our workforce through attrition and turnover leading up to the opening of the hospital, but it wasn't enough. 

During the second half of FY10 and the first half of FY11, there was excitement with the new hospital and finally being able to benefit from years of planning.  But there was uncertainty due to the financial challenges and the employees were concerned.  That directly affected patient satisfaction.   We worked to reassure staff in the early part of FY11 that the decisions made in planning the operating budget for the year were good ones and that we had turned the corner through our adjustments.  Also, the board took on patient satisfaction as its priority for the year.  Our scores dramatically improved in the second quarter of FY11 and have remained there.  It is a lot of work but it's worth it.

Employing Physicians

The trend has once again returned for hospitals and health systems to employ physicians.  Hopefully, we all learned a great deal from this colossal mistake of the 90's.  I would like to think that we have at WMHS, as we are once again employing docs in record numbers.  What we have to do is to make sure that that employing select physicians is the right thing to do under healthcare reform on a national level and payment reform in Maryland.  However, not every physician fits into that category and employing every doc could be a problem.  Make sure that you think through that hiring decision well in advance.

The Leadership Playlist

The Western Maryland Health System is creating a Leadership Institute, which I will write about from time to time.  Recently, all members of senior management were asked for their favorite top ten books on leadership, aka our leadership playlist.  There are a lot of great books on leadership that are available.  There are some relatively new titles available, but many have been around for years and are still current with their message and contents.  My list is as follows and pretty much in order of preference.

Built to Last by Jim Collins

The Seven Habits of Effective People by Stephen R. Covey Silos,

Politics and Turf Wars by Patrick Lencioni

Servant Leader by Ken Blanchard

Good to Great by Jim Collins

The Speed of Trust by Stephen M.R. Covey

The 21 Irrefutable Laws of Leadership by John Maxwell

The Five Temptations of a CEO by Patrick Lencioni

Strengths Finder by Tim Roth

The Top Ten Mistakes Leaders Make by Hans Finzel

The average Fortune 500 CEO reads two management / leadership books per month.  The average manager reads one a year.  Above is a good list with which to start.

Jobs for Life

The other day, I read in USA Today that death is the primary threat to job security in the Federal Government. Last fiscal year, the Federal Government fired 0.55% of its employees while the private sector fires on average 3% of its workforce each year.  The Federal Government has many, many talented employees, but it also has marginal employees at best who are there for life.  They perform just enough to get by to keep their job. 

I am curious as to what the rate is in Maryland.  Based on what I have experienced in my 21 years in working with State of Maryland agencies and departments, there are many highly experienced and talented state employees.  However, there are also many who are worse than marginal but are politically connected. There are far too many "assistants to the assistants" created to satisfy political patronage in state employment.

Looking for places to reduce costs, I have a few suggestions:  Firing any employee is difficult; however, there are circumstances that warrant termination.  I have had employees who have been previously fired come back and thank me for that "wake up call."  Termination should never be taken lightly but the Federal Government could learn quite a bit from the private sector

To read the article as it appeared in USA Today, follow the link below:

http://www.usatoday.com/news/washington/2011-07-18-fderal-job-security_n.htm

Players vs Pretenders

I just read an interesting article, Players vs. Pretenders, in Success magazine.  The article by John Maxwell asked what kind of followers do you lead-- people who look the part or do their part?  How do you spot a pretender?  They have a selfish mindset; they are position conscious; they are job hunters; they only promise the goods and, lastly, they are interested in their own success.  As for the players: they have a servant's mindset; they are mission conscious; they are job happy; they deliver the goods and lastly, they love to see others succeed.

Which are you?  Hopefully, the player since pretending takes a lot more time and can be really tiring.  According to Maxwell, pretenders exist in every organization (hopefully, they have all been weeded out at WMHS).  They can slow down an organization, steal momentum, damage relationships and live for themselves.

Volunteering

Yesterday, I wrote about our parish nurses, all of whom are volunteers.  According to the Dept. of Labor, over 40% of people give of their time and energy because a friend, co-worker or someone already involved with an organization asked.  Become a volunteer if you haven't already.  If you have, influence someone close to you to volunteer with you.  It can be so very rewarding.

The Parish Nurse

The first new program created at the Western Maryland Health System in 1996 was the Parish Nurse Program.  In 15 years, the program has grown to 89 parish nurses and 11 health ministers serving 60 churches in our area.  There had been more churches a few years ago, but due to consolidations in the Catholic Parishes and Methodist Churches, there are fewer churches today.  Nevertheless, these nurses and health ministers are touching so many lives and encouraging parishioners to live a healthier lifestyle.  They promote wellness of the mind, body and spirit not only on Sundays, but every day of the week.  They do monthly blood pressure checks, maintain healthy lifestyle bulletin boards at the churches, visit hospitalized parishioners, sponsor blood drives, share health resources, support local and global causes, perform global ministry, hold health fairs, perform funeral home visits, teach/explain/educate and the list goes on.  These are special people performing special work.

Making Healthy Choices

At the Western Maryland Health System, our goal is a healthier lifestyle for our staff and our community.  To start, here are some tips for a healthier lifestyle and healthier eating from me, personally.  I lost 25 pounds over a few months by following these tips.

First, start walking 30 minutes a day.  Drink 8 glasses of water per day.  Next, eliminate or reduce your sugar intake.    Rid your diet of white flour or any flour that is not 100% whole grain or whole wheat. Also, get rid of or reduce the trans fats and the saturated fats.  Start eating good carbs and protein.  Good carbs include mixed salads, oat or bran bread, whole grain pasta, pretty much any vegetables, apples, pears, peaches, plums, grapefruit, oranges, kiwi or apricots.  Protein would include lean roast beef, flounder, eggs, turkey, tuna, nuts, orange roughy, halibut, salmon, lean ground beef, chicken and nuts.  Avoid eating sauces, condiments, dressings and toppings.  I didn't eat any potatoes, rice or pasta unless it was whole grain or bread / rolls that weren't oat or bran.  It worked for me.   Our Dietitians may have a different approach, and I will have them give their recommendations in a future blog.

Nursing Scholarship

Recently, my wife and I met with the Foundation Executive for the local college.  We decided to start a full scholarship for a non-traditional Nursing student and wanted to know how to do it.  It turned out to be very easy and we agreed.  Last week we received 8 applications and essays to review.  Most didn't fit our pre-established criteria for a non-traditional student; however, two applications stood out.  It would be a very tough decision to select just one.  Pamela was on the phone with her mother catching up and mentioned the scholarship.  Without hesitation she said," let me fund the second student."  Problem solved, just like that.  Can't wait to make the announcements.  It is so rewarding to be able to truly make a difference in someone's life and, in this case, two individuals and their families.

Bob Murray

Last Friday, I learned of Bob Murray's resignation as Executive Director of the Health Services Cost Review Commission.  Bob said that the time was right both personally and professionally.  He has served Maryland so very well over the last decade, including WMHS.  Bob was always fair in his negotiations with us and, through his leadership, paved the way for WMHS to become a total patient revenue hospital last July.  Thanks, Bob, for all that you have done for the rate-setting system and WMHS.

Falling on Deaf Ears

At a recent Patient Safety Meeting, I received a report on the progress that we are making with reducing our readmissions.  The good news is that we have been successful.  However, I was amazed to hear about the many patients who are discharged but have no idea as to what their discharge instructions state.  Many of these patients are just anxious to get home.  Fortunately, our Carelink Coordinators are assisting newly discharged patients during their follow up calls to the patients.   Nevertheless, we need to do a better job of informing patients of what they have to do once they are home to avoid needless trips back to the hospital and potential readmissions.

New Observation Unit

As of today, if a patient comes to the WMHS Emergency Department and has symptoms requiring additional testing and /or evaluation, they will be placed in our new Observation Unit on 5 West. Our previous unit was part of the Pediatric Unit, but we quickly outgrew that space over the last year. The new unit is double the size and there is room to expand. There are spacious rooms equipped with the full amenities offered by WMHS. A typical stay in the Observation Unit can last from 12 to 48 hours. A highly trained staff of physicians, nurses, nurse practitioners and physicians assistants are assigned to the unit to care for our patients.

WMHS is making every effort to remain ahead of the health care reform curve and applying the rapidly expanding concepts such as the Observation Unit is allowing us to accomplish that task.

You've Been Selected

A few Sundays ago, a census worker showed up on our doorstep at home for a focused 2010 US Census Health Survey.  The survey lasted about two hours and was mandatory, after all, we were selected, like it was a great honor.  We were one of six families in Allegany County, Maryland to be selected.  Yep, you read it correctly, one of six out of a population of over 72,000 people.  Because of our chosen careers, my wife and I are fully covered for just about every illness imaginable and we have unlimited access to most any health care provider being in the field; fortunate for us, but not your typical family.  The census  worker was a nice enough guy, but I challenged him that the CEO of the local health system and his nurse wife and only a total of six families does not make a very representable sample.  I was given telephone numbers to call by the census worker to provide my input.  The quote, "falling on deaf ears", came to mind so why bother.   And the Federal Government says that health care is screwed up.

A Community in Need

Recently the WMHS senior staff received a preliminary report on the 2011 Community Health Needs Assessment, included in that report were the demographics of the region.  All that I can say is "wow, do we have our work cut out for us".  In Western Maryland, we have a higher poverty level, median household income is $36K, but in Maryland it is $51K.  We have a higher number of high school graduates, but fewer going on to college and a higher rate of illiteracy at 11% of the population.   We have limited diversity with 91.4% being caucasian and a very high elderly population.  In Allegany County, 18% of our population is over 65 compared to 11.8% in Maryland and 12.6% in the US.  With the strongest predictors of health and wellness being social, economic and environmental factors, WMHS is partnering with the Allegany Health Dept. in an effort to address those factors that influence health.  A tall order, but few others are stepping up.

Cover the Uninsured Week

For the last 8 years, hospitals supported events in their communities in an attempt to draw attention to the plight of the uninsured.  Now that the Affordable Care Act has been passed and by 2019, 34 million people are expected to be covered, problem solved.  Not so fast.....that leaves 23 million still uncovered by 2019, there continues to be legal challenges to the current reform law, and eligibility begins in 2014 and that's two and a half years away.  I think the demise of Cover the Uninsured Week was a little premature.

Motorcycle Helmet Laws

Talk about an eerie coincidence, in New York the other day, there was a protest against the motorcycle helmet law.  One of the protestors, who was riding his motorcycle without a helmet, was killed when he lost control of his bike and flew over the handlebars.  He died of a head injury and according to police, he would have survived if he was wearing a helmet.  I don't ride motorcycles, but I have seen head injuries caused by helmetless motorcycle riders.  I actually saw a dead motorcyclist with his brain matter on the asphalt after a motorcycle accident; needless to say he didn't survive.  Not a whole lot of fans of repealing motorcycle helmet laws in hospitals.  Not only do we see needless brain injuries and death, but also fall victim to malpractice suits when the surviving helmetless rider just isn't the same after the accident.  In states where it is legal to ride without a helmet, the legal community tells us that someone has to be responsible so, why not doctors and hospitals.

Better Care in Fiscal Year 2012

As we embark on a new fiscal year at WMHS today, our focus is addressing ways to improve the delivery of care as we try to deliver that care in the most appropriate setting.  So, where are we focusing since we have already tackled the "low hanging fruit"?  First, over utilization of services.  It would be nice to get some help on the medical malpractice front to make this a little easier.  Second, hospital associated infections. We actually had a complaint from a patient recently on too much hand hygiene on the part of our care providers.  What was remarkable was that the patient was hospitalized for an infection.  We will not apologize for too much hand hygiene in fact, it will be stepped up in FY'12.  Third, readmissions.  We have to reduce our readmissions system wide as this is one of our most significant areas for improvement.  We are already concentrating on our high risk DRGs.  Next  is process improvement.  We have incentivized our directors and our process engineers for interdepartmental process improvement.  Addressing operational efficiencies has great potential.  Lastly, continue to examine best practices throughout the industry, Maryland and through our recent affiliation with Premier's Quest initiative.  Lots to do, but it is all so crucial to our continued success.