Happy 13th Birthday

Today is my cousin's 13th birthday.  She was born in 1960, but technically can lay claim to only celebrating thirteen birthdays.  Actually, she celebrates her birthday on the 28th of February when there isn't a leap year.  Just what the heck is leap year and why does it come every four years, you ask?  Well, it takes the Earth exactly 365 days, 5 hours, 48 minutes and 46 seconds to travel around the sun.  So, leap day is necessary every four years to keep us aligned with the four seasons.  It is also important to note that when we elect a US President; that occurs every leap year.  So, in celebration of Leap Year or Day, in this case, a very unique day on the calendar, do something different today.  Have fun!

Unlimited Vacation Time

Joe Reynolds is the owner of an event production company called Red Frog.  He provides a unique benefit to his employees, unlimited vacation days.  He says it treats employees like adults; it reduces cost by not tracking vacation days and it's a great recruitment tool.  Joe claims that it's not abused.  I have trouble believing Joe's claims.  I can't imagine providing such a benefit in this day and age within real businesses, and I don't consider myself a dinosaur.  I know that this benefit sounds very Generation Y-like, but I just think of the abuse that is currently out there related to the Family Medical Leave Act (FMLA).  Many employees could serve as experts in how to game the FMLA system and the abuse (all within the law) doesn't go over very well with their responsible co-workers.  I can't imagine unlimited vacation days with this group; their employers would never see them.  Maybe the unlimited vacation days’ concept is a great idea for boutique startups, but not real employers.  By the way, everyone at Joe's "company" gets to pick their titles, as well.  That's a lot of CEOs.

Harvard Business Review

I just read most of the recent issue of HBR (March 2012); this issue should be required reading for every level and branch of government, every Chamber of Commerce Board, every member of the C- Suite, every college and university president and list goes on.  Wow!  The issue contains articles on the importance of US competitiveness, the criticality of manufacturing, the challenges to our competitiveness, rethinking our approach to education (incorporating new tools), fixing our political system, reviving entrepreneurship and how GE is sparking their manufacturing renewal.  Our many competitive strengths as a nation seem to be waning a bit.  Our renewal is dependent on our business leaders taking the lead to address our weaknesses, i.e. our education system, information technology shortcomings, our declining aerospace and defense industries, much needed enhancements to our auto industry, just to name a few.  Government needs to follow with addressing our tax code, our declining infrastructure, over-regulation of business and paving the way for the work of our business leaders.  The Dean of Harvard's School of Business, writes, "our problems are huge, but not insurmountable; we can move forward even when it's difficult to craft political compromise and even in a climate where businesses are feeling public hostility."  The time for action is now.   Go out and get your copy of the March HBR and then be inspired to do something.

The Vulnerable Patient

Yesterday, I wrote about the vulnerable patient and the impact on our hospital and other hospitals.  There are solutions that we are pursuing for such patients.  First and foremost, we need to forge a relationship with our community in the care for such patients.  Many of these patients don't require hospital admission.  We need to work with them and our community partners on keeping them in their home.  Support them in their environment with personal care, home care, transitional care, medication management, better education of them and their families, meals on wheels and respite care.  We need to keep them out of the hospital unless they are truly ill and meet the requirements for an acute care admission.  We need to do a better job of advocating for such individuals and make sure that our elected leaders are aware of their plight and ours.  This issue is far from being resolved, but I think that we are on the right track at WMHS.   Even working to educate our staff and physicians on this issue is a great start.

There's a Hole in the Safety Net

Yesterday, I convened a meeting at the health system of a variety of professionals to talk about the vulnerable patient and how to support the needs of such patients without WMHS going broke in the process.  Previously, there were a multitude of agencies to assist; today, not so much.  The funding has been cut and many of the agencies that could assist previously are either gone or refocused in other areas where funding may exist.  The shelters are full, assisted living is too expensive and drug rehab funding has been severely cut.   Many of these patients have no one; no family, no friends or at least no one who cares; some are drug abusers; many have behavioral health issues.  As one physician in the meeting described these patients, "they are truly pathetic people who may not survive without that safety net." 

Unfortunately, hospitals no longer have the luxury of being that safety net; although legally, we may not have a choice.  Not only are we no longer paid for such patients, we are now penalized for caring for and keeping such patients in our hospitals.  Yet, we cannot discharge these patients until a safe discharge plan can be successfully executed.  Last month, there was an article in the NY Times about a hospital in NYC that had an illegal immigrant from China who was a patient for over 4 years, costing the hospital millions because no one would take the patient.  He was eventually placed in a rehab facility once the federal government certified him as a permanent citizen.   The hospital even offered to fly him back to China at their expense, but the Chinese government refused.  We deal with such patients all of the time.  Four years isn't the norm at WMHS, but it can be many months as for these vulnerable patients until we have worked through all of the legal requirements in getting such individuals placed. 

Hospitals are now being required to be responsible for the health of the population that they serve.  In order for that concept to be successful, there needs to be a faster way to get our vulnerable patients into the most appropriate care setting.  If that doesn't happen, hospitals will not be able to sustain the losses created by having patients who are in need of care, just not acute care.

He's Wearing Us Down

I spent a long weekend in South Carolina and drove home yesterday.  I marveled all of the way home at the increased gas prices since last week.  Gas in Virginia and South Carolina was the least expensive in the $3.78 range for premium.  North Carolina and West Virginia were higher in the $3.85 range for premium, but then you arrive in Maryland and it was over $4 a gallon.  Other states weren't even close yesterday to Maryland's price for gas and, yet, the Governor wants a 6% sales tax phased in over three years on an already exorbitant tax rate of $0.235 cents per gallon.  So, how is he wearing us down?  My speculation is that the Governor wants a 1% increase to the sales tax.  A sales tax increase on the surface looks a lot less onerous than another increase in the gas tax, especially when the per gallon cost of gasoline is expected to exceed $5 this spring.  It will be interesting to see how it all plays out.

Hello My Name Is..........

Have you ever heard of Scott Ginsberg?  He is the author of "The Nametag Principle."  For over 4000 days, Scott has worn a "Hello My Name Is Scott" name badge.  It started in college when he attended an event that required a name badge.  After the event, he kept the name badge on and has worn it every day since.  What is so interesting is how many people have approached him over the years, the new friends, the contacts and yes, the weird looks, but most importantly, it gave people the opportunity to say "hello.”  Scott says you don't need to wear a name badge to get noticed.  He says be receptive like you are wearing a name tag; when people see you as approachable, all sorts of opportunities open up.  He says decide what you makes you unique and leverage it.  Lastly, have confidence in your identity; find some way to tell the world who you are.

People Don't Sue Doctors That They Like

There is a new book out entitled, "Personality Not Included” by Rohit Bhargava.  In his book he writes that people don't sue doctors that they like.  That statement got my attention since I had a conversation with a friend yesterday who was recently diagnosed with prostate cancer.  He has decided to have the prostrate removed surgically, the old fashion way, no robotic surgery for him.  He thoroughly researched it and decided that there are too many complications with the robotic surgery versus the traditional approach.  He has narrowed the choice of surgeons down to two.  One is the best in the city where he lives, but plain and simply put, the guy is an ass.  The second isn't as experienced, but highly recommended and a nice guy.  I got to thinking how easy it is to be nice to people and how you get so much in return.  I have dealt with many doctors in my career and once you are out of the major tertiary care setting, i.e. academic medical centers, large well known urban hospitals, etc., your chances of finding a personable one are far greater.  Don't get me wrong, there are still asses in rural health systems, doctors and others, but the numbers are far less.  Also, it is true; you have a far greater chance of not being sued if you are honest and personable.  So, you would think that more doctors, as well as the rest of us, would come to realize that and conduct ourselves more appropriately with whom we come in contact both professionally and personally.

Personal Responsibility

There were two news stories that caught my attention this week.   The first was the one about the Triple Bypass Burger causing a heart attack in a customer at the Heart Attack Grill in Las Vegas.  The second story was an investigation into the death of Whitney Houston.  Both of these stories involve trying to focus the responsibility elsewhere rather than where it belongs.  I will give you that if Whitney Houston's death is the result of a single physician or pharmacy prescribing or distributing a host of different types of drugs, then prosecute away.  However, that scenario is highly unlikely.   Addicts with money and means use a plethora of sources and ways to obtain their drugs.  They use bodyguards, handlers, agents, assistants," uncles" and "cousins" to get their drugs legally and illegally; it doesn't matter.  As for the blame for the burger heart attack, that rests with the individual and not the Heart Attack Grill.   Unfortunately, the food police are now pressuring the restaurant to drop the 6000 calorie burger from its menu.  Would I eat at the Heart Attack Grill?  Nope.  Is it crazy that people go there and attempt to eat a 6000 calorie burger?  Heck, yeah.  But these people have a choice and they choose to eat there.  Just as Whitney Houston had a choice, she chose to marry Bobby Brown, who got her hooked on drugs.  Maybe the authorities should be pursuing him instead of the physicians and pharmacists.

You're Fired

I just read yesterday that there is a growing trend among pediatricians in firing patients, well actually their parents.  More and more parents of children are refusing vaccinations due to concerns about autism.  I have blogged previously on this issue and shared my concerns about questionable research studies performed linking vaccinations with autism.  I applaud these pediatricians for their actions.  There is so much that can go wrong with these children, placing these physicians at great risk in caring for unvaccinated kids.

The Highly Valued Human Resource

In the most recent issue of Harvard Business Review, I read an article about selection and on boarding primarily of employees.  The article was about the CEO of the Gilt Group, Kevin Ryan, and how he approaches hiring.  Actually, the article and the description of his approach to selection were both interesting and refreshing.  He describes his role in the process and that he is heavily involved in the hiring of virtually every employee.  He highly values the all employees and feels that they are critical to the success of any organization. 

The refreshing part is his approach to the reference.  He says that most managers place too much emphasis on the resume and interview and much less value on the reference.  He will provide any information to another organization that is hiring one of his employees, past or current.  In turn, he expects the same.  He pressures any former employer listed on a perspective employee's resume as well as a reference for an accurate portrayal of an individual.  He also digs deep in a person's background and finds references who will speak candidly about a candidate.  He feels that the days of acknowledging simply whether or not an individual worked at an organization along with their employment dates are over.   We all need to "man up," if you will, and provide an accurate account of an individual's tenure at our place of employment.  We no longer have the luxury of making poor hiring decisions for our organization.  In this day and age, there is far too much at stake.

What a Weekend at WMHS (Sunday)

On Sunday at WMHS, we had a welcoming brunch for new physicians and advanced practice professionals.  We had a great turnout by the medical staff, nurse practitioners, our board members and administration.  The concept is not a new one, but one that hasn't been repeated for quite some time.  We decided to have the brunch based on the success of our recent recruitment.  In addition, George Garrow MD, who is our new Chief Medical Officer, was able to attend and meet board members and docs to whom he was not yet introduced.  A new twist to the brunch was the ability to identify your areas of interest, biking, hiking, golf, fine dining, etc.  Everyone participated and we will establish a data base and attempt to match areas of interest between attendees as well as future docs and advanced practice professionals joining WMHS.  My thanks to our Dietary staff for yet another great event; they continue to exceed my expectations event after event.  Also, thanks to Dotsy Malone, our physician recruiter, for the great job in putting the event together. 

What a Weekend at WMHS (Saturday)

On Saturday beginning at 6 AM, the process started to switch out our electrical breakers in five phases.  Much planning went into this time-consuming process that took over 10 hours to complete.  Electrical power is critical and essential to all that we do in treating and caring for our patients.  Because it was so well planned, the entire process came off without a hitch.  We had to work around an OR case and some emergency Interventional Radiology procedures, but at no time was any patient or staff member in jeopardy.  We even located the source of our original problem which required us to replace our breakers after an unplanned outage a few weeks ago.  Great job on the part of Jo Wilson, VP Support Ops, the facility staff and so many other individuals who put our patients before anyone and everything this past Saturday.  Another job so very well done at WMHS.  I will blog about Sunday's event tomorrow.

Keep the Government Away from my Health Care

I continue to be amused when I hear that the government needs to keep its hands off our health care, usually related to national health care reform aka Obamacare.  I am sorry to say that the US government and the government of all 50 states are playing an active role in our health care.  Currently, 56% of our health care is paid for by Medicare and Medicaid, not to mention the plethora of regulation that both levels of government subject hospitals and physicians to related to the provision of care.  I recognize that there are some distasteful aspects of health care reform, but, in some cases, our government is attempting to streamline the delivery of health care in an effort to bring improvement to a broken system of payment and regulation.

Jobs in Maryland

Governor O'Malley's budget calls for a slew of taxes in an effort to create jobs for Marylanders.  Hospitals are the largest employers in most communities throughout Maryland by employing 95,000 people statewide.  We have continued to create jobs during the most recent recession to address the dramatic changes facing our industry.  My message to the Governor is not to mess with what's working.  By cutting services to Medicaid recipients and continuing to tax hospitals, we will be forced to reduce jobs in our hospitals.  What the Governor needs to do is to figure out ways to adequately fund Medicaid into the future.  As Carmela Coyle, President of the Maryland Hospital Association, said recently, "Our Medicaid program needs to be built to last and so do the jobs that Maryland hospitals provide."

She's Back

Yesterday, I had the opportunity to experience what every American should get to experience at some point in their lives, a homecoming of our servicemen and women.  To witness the joy, the pride, and the excitement was a memory that I will cherish and never forget.  To see fathers (over 100 of them), after an 11-month deployment, seeing their newborn sons and daughters for the first time was wonderful.  It was a great day for the Ronan's, the men and women of the USS Bataan, their families and our country.  I included some photos, including my wife greeting our daughter, Lauren, as she finally made it off the ship.

Homecoming

I have been waiting since October for today to come and it is finally here.  Lauren and her ship, USS Bataan, arrive today in Norfolk, VA, and we are here to meet them.  The Bataan has been on the longest deployment for a Navy ship in 40 years (11 months).  They were sent to first liberate Libya and then on to support operations in Iraq and Afghanistan.  Over the holidays, there were in smack in the middle of the Strait of Hormuz.  We were somewhat distracted over the holidays by Iran's threats to block the Strait, but it all played out well for the Bataan and the US.  It will be great to see Lauren.

Caring for a Loved One via Long Distance

This week marks a year ago that I was in Texas caring for my mother, who was hospitalized after suffering a stroke.  That was a long week while she was hospitalized for both her and the family.  What is amazing is that she is 85 years old, has fully recovered from the stroke, continues to live alone and is in relatively good health.  Fortunately, she listened to her family--although I come by my stubbornness honestly.  She finally allowed Home Care into her home to assess her surroundings for safety (i.e. falls, kitchen safety, bathroom safety, etc.) as well as to get her on the road to recovery.  The Home Care nurses were great and played a big part in her current favorable health status.  I recently learned that over 7 million Americans are cared for by family members via long distance.  Based on my experience, I would suggest getting there when you can to make sure that the living environment is safe.  Know what medications your loved one is taking.  Know the drug name, the dosage and the frequency.  Have key information such as the preceding drug info and your contact information available either in or on the refrigerator.  Make yourself known to the doctor and his or her team that are caring for your family member.  It is a new era and caregivers have become much more responsive to your requests for information.  Caring for a loved one long distance is tough but having that support system in place, along with the availability of information, can give you some peace of mind.

George W. Bush

At the Premier conference, I had the opportunity to listen to former President George W. Bush.  Wow!  Now in all honesty, I have been and continue to be a big supporter of his.  What is interesting is that there were those in our group who really disliked W before yesterday.  You ask how someone can go from not liking the man to now liking the man.  We all found him funny, engaging, honest, and able to make fun of himself and he came across as a regular person.  He evoked laughter, empathy and sympathy. 

He used his recent autobiography as the content of his speech and the follow up Q&A.  He spoke of leadership, the institution of the Presidency and the current work the both he, as a former President, and Laura are doing (freedom for women in the Middle East, eradicating cervical cancer in African women, raising money for veterans injured in the wars and training school principals to be better leaders).  He spoke of consciously not criticizing President Obama and his administration.  He talked about his legacy and the mistakes that he made.  He said that a President has to know what he doesn't know and must count on his appointed experts.  He still believes that the wars in Iraq and Afghanistan were the right thing to do in protecting our children, their families and their communities.  He also believes that TARP was necessary to avoid the second Great Depression.  He said that the toughest part of the President's job is putting young men and women in harm’s way due to war.  All in all, it was a most enjoyable hour.  I am now going to read his book, Decision Points, with a much better perspective.

Top Performers

I am currently attending the Premier Governance Conference and learning a great deal about the new direction of health care.  It is also great confirmation of what WMHS is working to accomplish.  The primary message has been that health systems need to change the delivery of care from inside (the organization) out.  We need to transition from the traditional delivery model to the new delivery model using the entire continuum of care.  We are striving to be a top performer through embracing quality and patient safety; enhancing a culture of excellence; aligning our goals with our strategy; strengthening our clinical leadership; educating, motivating and incentivizing our clinicians; providing the resources and removing the barriers for the transition of care; enhancing our visibility; communicating with our staff, clinicians, board and community and, lastly, holding our people and teams accountable.  There is a lot to do, but we are heavily engaged in evolving to be a top performer at WMHS.

Risk of Cardiac Death

I recently read an article in MedPage Today entitled "Risk of Cardiac Death Pretty Much Set by 55." This article means a great deal to me as my father died of congestive heart failure at age 62.  According to the article, if you have a clean bill of cardiovascular health by age 55, as a male your risk of death from heart disease is only 4.7% and 6.4% for women.  A clean bill of health would include not having any of the risk factors, which include: smoking, diabetes, treated or untreated high cholesterol or treated or untreated hypertension.  So far, I have none of these risk factors and I have surpassed 55.  Based on family history; father's death at an early age; paternal grandfather's death at 64; father's adult onset diabetes and his high BP, high cholesterol, high stress job and two-pack-a-day smoking habit for 36 years, now you can understand my relief.  I am not clearly out of the woods, but I am off to a good start.  Hopefully, you are faring just as well.