Garbage Day

Tuesdays and Fridays are garbage pickup days in my neighborhood.  I marvel at the number of people who don't have garbage cans and simply place their kitchen garbage bags at the curb.  As I drive to work, I see the same people picking up trash in front of their homes garbage day after garbage day.  These people put their trash out the night before. During the night, animals tear through the bags, scavenger what they can and leave a mess.  I wouldn't mind it if it was the occasional neighborhood cat, but I live in a development set in the foothills of a small mountain with an elevation of 2250 ft.  I share the neighborhood with bears, bobcats, birds of prey, dogs and cats.   It would take one time for this to happen to me and then I would invest in a garbage can.  Wasn't it Einstein who said "Insanity is doing the same thing over and over again and expecting different results."  That's my neighbors and these aren't dumb people, well at least, usually.

CEO's Stop Campaign Contributions

I received an attachment to a Facebook posting last week about an initiative led by Howard Schultz, the CEO of Starbucks.   Over 100 CEOs have signed on to stop all political campaign contributions to the President, Presidential contenders, and members of the House and the Senate until the gridlock in Washington, DC, stops.  Mr. Schultz is asking everyday Americans to join the initiative.  It will be interesting to see if such an approach has any impact.  Interesting, nonetheless, and I hope that it gets their attention.

Healthy Lifestyle

A few weeks ago, I wrote a blog about what I had done to lose weight and live a healthier lifestyle.  I then asked the WMHS Dietitians to validate my recommendations.  The following is a response from Theresa Stahl, RD, LDN.  I guess that I was on the right track. 

Congratulations, Barry, for leading by example in promoting a healthy lifestyle for our staff and community!  I was excited to read the health and nutrition tips that have helped you to personally lose 25 pounds over the past few months.  

As a registered dietitian who has been counseling people on healthy eating and providing weight loss tips for over 25 years, I recommend many of the same tried and true healthy habits.  These include:

·         Exercise regularly – 30-60 minutes most days of the week

·         Drink plenty of water – 8 glasses per day is a good estimate, but one’s actual needs may be more or less depending on age, sex, weight, health, activity level and weather.

·         Choose whole grains, such as whole wheat bread, bran cereals, barley, and oatmeal. 

·         Eat plenty of fruits and vegetables - make half your plate fruits and veggies.

·         Choose healthy protein sources at meals, such as fish, chicken, turkey, lean beef or pork, beans, nuts, low-fat or non-fat dairy or soy products, and eggs.

·         Decrease unhealthy fats, such as trans and saturated fats, such as those found in many processed foods and high fat meats. 

·         Limit empty calorie foods, such as sodas, cakes, cookies, pies, candy and other sweets.

These are healthy habits for life.  We all know there are many paths to weight loss, but adopting healthy habits that promote a healthy weight for a lifetime is the key to long-term success. 

Readers may be interested to know that there is an organization that tracks people who have succeeded at long-term weight loss.  The National Weight Control Registry (http://nwcr.ws/) is tracking over 5,000 individuals who are 18 or older and who have lost at least 30 pounds and maintained that loss for one year or more.  They have found that successful individuals have certain habits in common.  The majority of them eat breakfast every day, watch less than 10 hours of TV per week and 90% exercise, on average, about 1 hour per day. 

Basically, what we’re looking for as nutrition professionals is not the latest trend in dieting, but true permanent change in eating behavior.

The Science of Mushrooms and Golf Balls

The other day I read Paul Levy's blog on the Eastern MA Mushroom Crop that reminded me of a mushroom story of my own.  Last Sunday, I played 18 holes of golf.  Prior to this year, I would golf, poorly, a few to a handful of times each year.  It wasn't until this year, after my wife took up the game last August, that I am now playing a couple of times a week.  I am really enjoying it now that I have gotten much more serious about the game.  I have been taking lessons from a great instructor and my game has improved dramatically.  Up until this year, I had never broken 100, which by the way is the average score for US golfers.  I am now consistently shooting in the nineties from a low of 92 to a high of 99.  

Wow, talk about digression; back to the mushrooms.  With the hot steamy weather that we have been having in western Maryland, I have never seen so many mushrooms.  They are now growing in the fairways, in the rough, on the fringe of the greens, everywhere at the local country club.  It's not tough enough to find my ball a lot of times, but now it is virtually impossible.  As you drive down the fairway, when I am lucky enough to hit it there, it looks like a driving range.  Amazingly, most of the mushrooms are the size of golf balls.  I wonder if there is something to the science of the size of golf course mushrooms being the size of golf balls at least at my golf course. Let me know if you think that I am onto something.

Docs Promoting Healthy Lifestyles

As we work to promote healthier lifestyles among our patients, we need to better utilize our physicians in this process.  We need to have our docs be the message bearers that their and our patients need to live their lives based on health and wellness focus.  A tall order, yes ,but one that has merit.

At WMHS we are undertaking a series of initiatives to reduce hospital admissions, especially readmissions.  We are pulling out all stops to encourage healthy eating, exercising, quitting smoking and the list goes on.  Take quitting smoking among pregnant women, we need our OBs to take a stand and widely publish that stand.  We have one of the highest rates in the state and many of the young pregnant women just don't get it as to the effects that smoking have on the unborn child.  This will be quite the undertaking, but so worth it if patients embrace a healthier lifestyle.

Treat Heart Attack Patients More Rapidly

Yesterday, throughout the media was the announcement of the improvement from 2005 of 90 minutes for the average patient to have an angioplasty, a procedure to unblock a clogged artery, to 64 minutes in 2010.  WMHS for FY' 11 was at 68 minutes.  The 60-minute plus time frame was thought to be unachievable 5 years ago by the experts.  Hospitals, including WMHS, are now far exceeding the 60- minute time frame.  Aiding WMHS has been the ability for EMS to activate the Cath Lab from the field.  Don't you just love process improvement initiatives?

"Ready for New Challenges"

I just read this morning that the president of Standard & Poor's is stepping down as he is "ready for new challenges."  Wow, that took longer than I thought.  The same article commented on the recent downgrade of the US credit rating by S&P and added that neither Moody's nor Fitch has lowered their rating of the US.  Did anyone think that either agency would consider a downgrade of the US credit rating after a DOJ investigation into S&P for improperly rating mortgage securities and the president of S&P is forced to resign?  I, for one, thought that S&P did the right thing by downgrading the US credit rating, but to what end?  This isn't a coincidence on the part of the Obama Administration.  Do the right thing, but be prepared to suffer the consequences.

FY2011 Accomplishments

Last week, I blogged about the negative outlook for hospitals, physicians and the health care industry.  Today, some good news especially for our employees, physicians and the communities that we serve.  Attached are the accomplishments of the Western Maryland Health System during the last fiscal year ending June 30.  Amazing people doing some amazing things.

To view the list of accomplishments, click here!

OOPS!

Boy, am I in trouble. In yesterday's posting I mentioned "Crazy, Stupid Love" as a movie to see. Why I am trouble is that I named the former Michael Scott from "The Office" fame as Steve Carey not Steve Carell. My daughters are very big fans of Steve Carell and "The Office" and they will give me a very hard time since they think that I have an impeccable memory. It's very good, but impeccable would be a stretch. So, I google Steve Carey just figure out why that name popped into my head and that I didn't give it second thought as I re-read my blog before I posted it.
There are 25 individuals named Steve Carey in Linkedin and only one who is an actor. Steve Carey, the actor's latest work, are you ready, a pornagraphic remake of Hansel and Gretel. So, it's certainly not that Steve Carey. I am at a loss for that memory blip aside from rapidly advancing old age. Strange.

An Apology

I just learned that yesterday's posting didn't occur due to a glitch. This was my first missed blog. Sorry.

So, on a more personal note since it is Saturday, I accompanied my wife to three movies in the last week. All chick flicks, two of which, I thought, were of the romantic comedy variety. First was Crazy Stupid Love with Steve Carey. It was funny and had a decent storyline. It was entertaining and I enjoyed it. Next was The Help and it was excellent, but not a romantic comedy. According to my wife who read the book, it was great and the movie tracked closely to the book. I am still amazed that anyone could treat people like "The Help" were treated and that was happening in the 60's. Growing up in the 60's, I guess I lead a sheltered life. Now for the last movie and probably the last that I will see for a while. I, or should I say, we were under the impression that "One Day" was a love story and if you watched any previews thought that it was on the order of a romantic comedy. Well, it isn't. It was well done, but what a downer. I go to the movies to be entertained not to be put in a depressive state. After all, I am in health care where there is little good news based on attacks from just about every side, every day. When I go to the movies I want to leave feeling good, that sure as hell wasn't the case yesterday. So, husbands beware: do your homework before your wife calls and says, "can you you seek out early to go to a movie".

Red Alert for Hospitals

No matter what side you take in the current political debate regarding the Federal debt issue, the bottom line is that there isn't enough funding to support the expansion of our population as the baby boomers age and the cost of providing health care increases.  As an industry, we need to brace ourselves for significant payment reductions from Medicare and Medicaid, but also from commercial and private insurers.  In addition, we need to change how we deliver care. 

WMHS is coming off of one our best financial year's ever;  however, we are stepping up our plans for driving cost out of the system through ongoing process improvement.  Chris Van Gorder, CEO of Scripps Health in San Diego, put it succinctly, "the debt ceiling challenge for our country has created a new and unexpected challenge for us."  Under this challenge, hospitals could close or eliminate services and physicians could stop seeing Medicare patients beyond those who have stopped already.  If the super committee of 12 can't come up with a plan, then Medicare will be cut by $50 billion in payments to hospitals and $11 billion to physicians beginning in 2013.  We have to improve processes and eliminate process variation in the delivery of care ASAP.

Good Corporate Neighbor

I continue to be amazed by the involvement of our staff in their communities.  Our employees spend countless hours volunteering their time to churches, schools, scouts, athletic groups, fire companies, ambulance squads and the list goes on.  Our senior management team alone serves on the boards of twenty six local agencies / organizations.  They also serve on state wide commissions, boards and committees.  These individuals work 10 to12 hours a day at the Health System and still find time to effectively serve a host of other organizations.  Truly, a great group of people.

Another Wonderful Story

I just learned of another wonderful act of caring and kindness demonstrated by one of our employees.  The other evening one of our employees, Sherry Thompson, RN, was leaving to head home after another long day in Same Day Surgery.  As Sherry was getting on the elevator, she saw a woman hitting her head against the elevator door, screaming and almost completely out of control.  Sherry asked if she could help.  The woman's fiancé who was in his forties was being brought to the ED in full cardiac arrest and she was trying to find the ED.  Not only did Sherry bring her to the ED, but she stayed with her for three hours giving her comfort, encouragement and prayer since no other family were available.

We truly have extremely special people at WMHS.  Sherry, thanks for living our Core Values each day.

GE and China

Throughout each week as I come across potential blog material, I save it and read it over the weekend.  One item that I saved was a blog from Jack Cafferty of CNN.  The subject of this particular blog was concerning GE and the message that it is sending to America by closing its X-Ray Division in Wisconsin and moving it to China.  It is extremely hard to believe that a CEO who serves on the President's Jobs Creation Council is creating jobs in another country and investing $2 billion in China to do so.  GE will create research centers throughout China.  GE has been a very successful company in the US and has been a mainstay of our economy over the years.  As a customer of GE, I gave pause after I learned that they didn't pay any US income taxes on $5B in profits from US operations and $14B in total profits for all of last year.  I think that I need to rethink my relationship with GE.  There couldn't be a better time in US economic history when this country could use a boost such as the one that GE is planning to export to China.

Breast Cancer Fundraising

Recently, I read an article about fundraising by the Susan M. Komen for the Cure.  I have always been in awe of the Komen Foundation for what they have done for women through breast cancer awareness and that they are a fundraising machine.  However, the beginning of the article was about a new fragrance called Promise Me.  The article was critical of the group's founder for hawking the perfume on a home shopping network and that the perfume's fragrance can cause nausea, dizzy spells and headaches after chemotherapy treatments in cancer patients.  Not that patients would necessarily wear the perfume after chemotherapy, but just being around the fragrance may cause a reaction.  The good news is that the Komen Foundation is asking the perfume's manufacturer to "reformulate the perfume to remove any irritating scents.  The sad news is why didn't they come up with such a formula from the start. 

I was surprised to read in the same article about the criticism of the Komen Foundation for over- commercializing breast cancer and how other cancer groups suffer from the size and reach of the Komen Foundation. It is obvious as to the benefits that the Susan G. Komen Foundation has had on fundraising for breast cancer research (about $1.9 billion) and as previously noted, on the awareness factor regarding breast cancer.  Like others, I now question if they have gotten too large and insensitive from the hype and over commercialization of an organization that has saved countless lives and done wonderful things for so many women and their families.

The Plight of the Small Business

I was having dinner with a local business owner the other evening and he told me what his health insurance premiums were increasing by for the next coverage year.  When he told me, I almost fell off my chair.  He was told that his premiums were increasing by 50%.   FIFTY PERCENT!!  He was told that his premiums would not have to rise at all should he find another option more desirable.  He said, of course I am interested, sign me up.  He was then informed that under the new option his and his employees’ deductible would increase to (are you sitting down) $10,000.  TEN THOUSAND DOLLARS!!  He then tried to shop around to the two other health insurers available in our area only to be quoted higher amounts.

I wonder where the money is going because it sure isn't coming to hospitals and physicians.  We are given rate increases in the plus or minus 2% arena, yet blood, blood products, drugs, supplies, food, purchased services and the list goes on are all demanding higher price increases to keep up with inflation.  As we work to get cost out of the system, a lot of others in the health care industrial complex aren't.  By the way, my small business friend still doesn't know what he is going to do for health insurance coverage for himself and his employees.

The 300 Becomes 100

Last September as we rolled out an organizational goal of improving patient satisfaction, the WMHS Department Directors group was asked to provide the percentage, in their opinion, of health system employees who don't embrace service excellence.   They said that 13% of employees don't get it.   According to Quint Studer, the percentage of hospital employees nationwide who don't get, understand or care about service excellence is 8%.  The 13% became known as "The 300" (13% of 2300 is 299). 

According to literature, of the 300, 100 should leave the organization when confronted with their lack of commitment to service excellence standards.  Another 100 will improve and be viable employees and the remaining 100 will be a challenge since they don't think that they have a problem with service excellence.  The last third may be fine with patients and families but be horrible co-workers.  They may work at one speed and not be as responsive as they should be to patient needs.  They may not be warm and sincere in EVERY interaction, but only when it suits them. 

As we rolled out revised service excellence standards, the Department Directors group was surveyed almost a year later and asked the same question plus what is the percentage in their own department / patient unit.  On average within their own department or unit it was 4% and system wide it was 5%.  Considerable progress and we have the patient satisfaction scores to prove it; however, that still leaves 115 employees who are interacting with patients, family members and each other not embracing service excellence standards and making everyone else's job that much more difficult.

Webinars

As each day goes by, I grow more tired of email solicitations for webinars.  The webinar is a great concept, especially as a means of training and developing staff without spending a fortune on air travel and hotels. Unfortunately, what I have found is that they are the quickest way for attorneys and consultants to enhance or preserve their revenue stream.  I receive no less than twenty solicitations a day and those are the ones that get through the spam filter.   With each solicitation, I also wonder if the quality of webinars has gotten any better.  

I still embrace the concept; however, every one that I have participated in so far wasn't worth my time.  During webinars, I would sit in a conference room or board room with members of my team and we would look at each other in utter amazement that we had paid money for this wealth of "knowledge" that we already possessed.  In fact, in a number of instances we could have done a better job of presenting the webinar.  I am waiting for attorneys and consultants to pay me to attend webinars as they hawk their products and services.  Webinars have reinforced the adage that hiring a consultant is like giving your watch to someone for them to tell you the time and then charging you for that privilege.

Don't get me wrong, I value the knowledge, expertise and guidance provided by attorneys and consultants throughout my career as I have learned a great deal.  However, they need to take that same value and incorporate it into their webinars.

The AAA Rating Downgrade

Being a health care executive, I have an understanding of credit and bond ratings; at least I thought that I did.  I couldn't believe that it took until Friday for at least one of the rating agencies to downgrade the US AAA rating.  With our country close to its second recession, the overall debt burden that now exists, the $140 billion in monthly interest payments on that debt, the rising prices of basic goods, the anemic economic growth experienced over the last two years, the rapidly declining yield on investments, record debt levels in US households, the deficit of 10.6% of the gross domestic product and an unemployment rate of 9.1%, it makes one wonder what took so long for a downgrade.  The rating agencies don't give hospitals any leeway.  If we had comparable indicators in the negative, rest assured we would have been downgraded in a nanosecond.

The Partnership Strategy

Because so many uncertainties exist within our industry, hospitals will find it difficult to be successful going forward.  One strategy that some hospitals are finding success with is to partner or collaborate with others.  Partnerships between providers, payors, purchasers and even patients will be key.  So what's different today that will lead to our success versus previous attempts?  Some of those differences would include the innovative information technology of today, the ability to collect and share data, the ability to align incentives between hospitals and physicians and even payors, the strength of today's clinical leadership, the willingness of physicians to be champions, the knowledge and commitment of today's board members and the application of process improvement approaches throughout our organizations.  Is success guaranteed through these partnerships?  Nope!  However, success has a better chance to occur through these applications.

More Good News for Hospitals......Not Really

Hospitals continue to be squeezed from every direction.  Operating cash flow will continue to contract as payors move toward value based care; there will be significant limitations on fundraising due to the economy  and competition; investment returns will remain volatile; the cost of capital will continue to rise; there will be significant pressures on smaller hospitals and hospitals located in vulnerable markets (rural and inner city); the  significance of quality and size will only increase; consolidations of hospitals and providers will continue; IT requirements will continue to grow; pension pressures will continue for some; tax exempt status questions will intensify and health care reform uncertainties will continue to linger.  Wow, not great news, but it drives the point that as leaders we have to embrace change and prepare our organizations of a very different future.

Advice to Fellow Leaders

Recently, I read an article on hospital CEOs sharing advice to fellow leaders.  Some of the more salient points of that article included: deeply involve the physicians in strategy and operations; be patient centered; stay mission focused; promote change and be positive.  Certainly very good advice. 

No one asked me, but I would add:  be flexible in this ever-changing industry; stay ahead of the curve; develop strategies for a more engaged medical staff; continually assess all aspects of your operation, what continues to make sense and is contributing to the success of your organization; make your employees feel valued as it not only is beneficial to them and to you, but it will positively impact patient satisfaction;  prepare for a transition from a volume focused approach to patient care to a value focused one;  promote what your organization is doing in and for the community; continually stress your economic impact on the region; make sure that you have the very best people serving your organization, if you don't make changes and lastly (at least for now) work to strengthen your influence on health and wellness throughout your community.

Mandatory Flu Shots

It looks like I am going to be faced with an interesting dilemma regarding flu shots prior to the upcoming flu season.    The American Hospital Association and the Maryland Hospital Association are asking hospitals and health systems to impose mandatory flu shots for our employees.  Certainly a great way to reduce the incidence of flu nationwide, but it's not that simple. 

Personally, I get the flu shot each year and I have for as long as I can remember.  I can't think of a better way to protect yourself, your family and each other.  However, there are some who never get the flu shot because they never get the flu.  I have worked side by side with one of the C-Suite executives for the last 15 years. I can't remember her ever missing a day of work due to illness and she has never gotten a flu shot. 

Imposing such a requirement on staff will have its challenges.  However, we need to dramatically increase our vaccination rate one way or another.  More to follow

An Interesting Perspective

Over the weekend, I was reading excerpts from Juan Williams' new book, “Muzzled, An Assault on Honest Debate."  As you will remember, Juan Williams was fired by National Public Radio because he said that he becomes nervous whenever he gets on a plane and there are Muslims on the same flight.  An overreaction on NPR's part, yep!  Political correctness gone amuck, yep!  Anyway, in his book, Juan Williams gives a perspective on illegal immigrants that I found interesting.  He writes that the quickest path to US citizenship for illegal immigrants is to embrace what the US has to offer--not cross the border and celebrate your old language and culture almost to an extreme.  They want to have all of the benefits that come with living and working in the US, but refuse to assimilate into the American culture.  This "in your face" attitude does little to make a case for a path to citizenship.  Again, an interesting perspective and one that I embrace.  This country needs to secure its borders, and then create a path for citizenship for those who are already in the US, but respect that privilege