"The Ronan Report" provides insight about the activities at the Western Maryland Health System in Cumberland, Maryland, and about the changes taking place in healthcare today from a CEO's perspective.

Friday, March 30, 2012

Bringing That Personal Touch To Health Care

My, are times changing.  It wasn't that long ago that the great majority of care was delivered in the acute care setting.  Now, and as I have written on my blog for the last year, care can be delivered in so many different settings.  Today, I am blogging about a concept that the Western Maryland Health System and six other hospitals in Maryland are pursuing, Transitional Care.  The focus would be to target high-risk patients, primarily those patients with pneumonia, heart disease, diabetes, COPD and other chronic conditions.  Nurses function as caregivers, coaches and navigators.  They meet with patients before they are discharged from the hospital and then after discharge in the patient's home.  These Transitional Care Nurses make sure that the patient is set with their medications prior to discharge, appointments are set for follow up once the patient is discharged, transportation to doctor's appointments is available and that the patient is appropriately caring for himself to avoid readmission.  Most of the seven hospitals noted above are performing some form of transitional care, but by collaborating on such a venture, we could bring best practices to the program, benefit from the economies of scale through less duplication and potentially serve as a model for Maryland.  At WMHS, we have already demonstrated that case managing patients and bringing that personal touch to their care can not only reduce needless admissions, readmissions and expensive testing, but it can also reduce the cost of care and improve the quality of the care that is being delivered.

Thursday, March 29, 2012

Health Care Reform, What it is and What it isn't

Yesterday, the oral arguments before the Supreme Court on the Patient Protection and Affordable Care Act (aka, Obamacare) ended.  We won't know until June of the outcome of those arguments and their decision.  However, it is important to sort out what is reform.  Actually, it is the legislation now being tested before the Court, but it is also reform in how the delivery of care is provided.  Hospitals such as Western Maryland Health System are involved with changing how we do business.  You will continue to hear value over volume, most appropriate care in the most appropriate setting, reduced readmissions, less utilization of services, more clinic visits, more care provided in the home, etc.  We have designed our three-year strategic plan around health care reform, but not the reform contained within the legislation.  We are converting our health care delivery model to one of reduced cost, better quality and less volume from a model focused almost exclusively on the provision of acute care services and higher utilization of procedures and testing.  Obamacare may not survive in its entirety, but there is no going back to the traditional approach to the delivery of care.

Wednesday, March 28, 2012

So Much For The Do Not Call List

Usually when I am home and the phone rings, I screen the call to see who is calling.  If it's identified as out of area, a toll-free number, a private caller, the Republican National Committee or any political candidate, I don't answer the call.  This past weekend was different; for the fun of it, I answered every call. 

I can tell you that the International Firefighters Association doesn't like to be challenged; they can be nasty.  I guess I would be nasty too, in a defensive kind of way, if I were a charity collecting money for firefighters and they were getting less than 30% of what is being collected.  I told the RNC that they wouldn't get a dime until they support candidates who will do a better job in Washington DC (less gridlock) and start putting pressure on Rick Santorum to get out of the campaign.  Lots of calls, lots of challenges by me of the callers; actually it was kinda of fun. 

However, I am curious.  What ever happened to the Do Not Call List? I signed up several years ago and it's like it doesn't exist.  When you challenge the caller by telling them that you are on the list not to call, they tell you that you have had a past relationship with the organization or better yet, given them money in the past.  I think not.

Tuesday, March 27, 2012

Act of Valor

This past weekend, I saw Act of Valor for the second time.  Pamela wanted to see the movie since I saw it alone while she was in Virginia Beach moving our Naval Officer daughter into her new apartment.  I told Pamela that it was great, but not really her kind of movie......romantic comedy, it isn't.  Anyway, after seeing the movie, she loved it and I was wrong AGAIN.  What she found so unbelievable was the ease in which someone would throw themselves on a grenade in order to save the lives of their men.  Now we both recognize it was a movie, but again, anyone in uniform in this movie wasn't a Hollywood actor, they were a serviceman or woman so it is part of Navy Seal training.  Pamela mentioned this observation to our daughter who said that she has received training on how to fall on a grenade.  The things that our children try to keep from us.  It is truly amazing what the Navy Seals, along with all servicemen and women, do for us day in and day out.  When you see a movie like this one, it is hard to comprehend the dedication, the selflessness and the sacrifice of our military and their families.

Monday, March 26, 2012

But It's Free

Over the weekend, I received a call from Potomac Edison regarding receiving my "free" home energy conservation kit.  I said that I have energy efficient light bulbs, power strips and water conservation devices for my showers, so I don't need the kit.  She said "but it's free."  I said nothing is for free, what's the catch? She said the state of Maryland has mandated that Potomac Edison offer these kits to their customers.  I said how generous of Potomac Edison; so you are covering the cost of this "kit" at no cost to the customer?  She responded, "No, it's already in your rates."  I said, "So I am already paying for it, whether I take it or not? “ She said, "Yes."  What a deal.  Thank you, Maryland state government.  You always know what's best for me.

Friday, March 23, 2012

Geography Does Matter

First off, I forgot about yesterday's blog until I was walking out the door after a long day that started at about 3:30 AM.  Lots of meetings, including a Finance Committee meeting and a Board meeting.  So, my apologies. 

In this week's issue of Modern Healthcare, there is an article "For better or worse - Where you live affects the type of healthcare you're going to get."  The article describes the first-ever scorecard on local health system performance done by the Commonwealth Fund. It tracked 43 indicators covering 4 dimensions of care: access, prevention and treatment, cost and avoidable reuse and, lastly, health outcomes.  There are strong geographic patterns of performance with the Northeast and Upper Midwest being in the top quartile and the Deep South being the lowest performing region in all categories.  Allegany County, Maryland, received a top quartile score overall with access and prevention \ treatment scoring in the top quartile, cost and readmissions scoring in the third quartile (obviously there is room for improvement) and health outcomes scoring in the second quartile.  In both the areas of cost \ readmission as well as health outcomes, there are numerous initiatives underway at WMHS to bring almost immediate improvement to these areas.  The results were a pleasant surprise and it shows that all of our efforts in changing how we do business are finally paying off.

Wednesday, March 21, 2012

Another One Bites the Dust

As a health system, we go to great lengths to protect the privacy of our patients.  We are constantly reminding our employees of preserving and protecting patient information.  You routinely hear of famous people's patient information being breached and sold to tabloids.  At WMHS, we continually run audits to determine if such breaches occur.  Not that George Clooney has ever been hospitalized at WMHS (and I couldn't tell you if he was), but we do get local VIPs and we will audit their electronic records to ensure that access has been limited to those involved with that patient's care.  Our number of breaches has been reduced dramatically over the years as all System employees know that if you breach confidentiality of a patient you will be terminated.  I make that perfectly clear at New Employee Orientation and then every opportunity thereafter of our policy and how seriously it is taken.  Of late, any such breaches have been the result of employees who have friends, acquaintances or family members as patients and they access their records.  It doesn't matter if you are checking grandma's lab results just to make sure that she is OK.  If you do and you don't have the need to know that information in the course of your position at WMHS, you are fired.   As I noted earlier, the numbers of breaches are very few each year; however, I am striving for none.

Tuesday, March 20, 2012

Happy First Day of Spring or Is It Summer?

Today is the first day of spring.  Wow, what a winter.  I shoveled small amounts of snow only twice this winter, and that's it.  In the fall, I had the snow blower serviced for that harsh winter that was expected.  It has been already stored for next winter.  Instead of the first day of spring, it really feels like the first day of summer.  These temperatures are June temps not March temps.  I live at an elevation of around 2500 feet above sea level and everything blooms usually a little later, as it is.  Not this year, virtually everything in my yard is two weeks ahead of schedule.  Also, I celebrated my birthday on Saturday, yes, St. Patrick's Day (Barry Patrick Ronan born on March 17 in the evening into an Irish Catholic family.  My father called to tell his family of my birth during their St. Patrick's Day party.  Can you imagine the hangovers in that family the next day?)  Anyway, I digress. This was the warmest birthday that I remember living in the Northeast.  Amazing.  Anyway, Happy Spring.  Enjoy the warmer temperatures and the longer evenings.

Monday, March 19, 2012

A Bit of Hypocrisy If You Ask Me and Cokie

Last month, I had the opportunity to meet, as well as to hear speak, Steve and Cokie Roberts.  Steve was a reporter for the NY Times and Cokie was an ABC News correspondent.  Both are now free-lance columnists and are on the speaking tour.  They gave a great perspective on the upcoming election, politics in Washington, health care and the world in general.  During her presentation, Cokie took a shot at Steve's former employer, the NY Times.  She pointed out that they take on Wall Street, bankers, CEOs and pretty much anyone with money, but yet continue to run daily ads for $25,000 watches, $900 shoes and $700 purses.  She said that it annoys the heck out of her; me too!  What happened to having principles and values as well as being responsible for what you report and advertise.  I recognize the importance of high-end advertising; but then don't take a holier than thou approach against those who are the 1%.  If it wasn't for the 1% there wouldn't be the need to advertise for such expensive goods. 

Last week, the NY Times hypocrisy raised its ugly head yet again.  They ran an anti-Catholic ad, but refused to run a comparable ad denouncing Muslims.  (By the way, I didn't agree with running either ad.)  The Times stated that they would not run the ad now in order to protect our servicemen and women.  Really?  Wasn't the NY Times the first media outlet to run the Wikileaks stories, putting servicemen and women, diplomats, intelligence operatives in danger throughout the world?  It is amazing that we allow them to get away such irresponsibility in journalism.

Friday, March 16, 2012

The Need for More Servant Leaders

Yesterday, I wrote about servant leadership and how I like to think that I am a servant leader.  Today, I want to blog about the need for more servant leaders, especially within the Western Maryland Health System.  Last August, we conducted an employee engagement survey.  For the most part, the results were good and, in some cases very good, but not great.  We have had teams of people focused on identifying ways to bring improvement to those areas where we didn't score as well as we should have.  This week, we had a findings and recommendations report from the five teams.  Overall, the reports were good and the recommendations were solid.  But, when you hear about leaders not following the Service Excellence Standards, lacking the skills to effectively handle conflicts, playing favorites and leaders being unapproachable, it is alarming.  Yikes, in this day and age to have leaders described as not leading by example, ignoring our Service Excellence Standards, not rounding, holding department meetings or daily huddles, it is time for a "come to Jesus meeting" as one of my previous bosses would say to me.  We are in the process of planning our quarterly leadership conference for all WMHS leaders and you can bet that the keystone address will be on servant leadership.

Thursday, March 15, 2012

Servant Leadership

I have written on occasion about Servant Leadership and how critical it is to the business of health care.  It is the most appropriate style of leadership even for the hospital or health system CEO.  I like to think that I am servant leader; however, I may miss to mark from time to time.  How do you recognize a servant leader?  Well, they are individuals with humility, patience, kindness, respectfulness, selflessness, forgiveness, honesty and commitment.  They are the ones with an ego, but it is focused on the team and the team's accomplishments. They are the leaders who have a desire to serve; actually a much needed characteristic for any leader within the health care field.   More personally directed, as a servant leader, I like to think that I am more engaged with staff; I am mission and values focused; I have walked in the shoes of the hourly employee, the supervisor, the manager, the department director, as well as the young executive and, now, the more senior executive.  I guess the most important aspect of my approach to servant leadership is that I want to do it.  It is who I am.

Wednesday, March 14, 2012

The Heat Is On And Is Near The Boiling Point

I attended a meeting with other Maryland hospital CEO's and Board Members yesterday.  During the meeting, the discussion got around to the expectations of individual hospitals and health systems in the communities that we serve as a result of the financial crisis facing Maryland and the rest of the country.  There was a clear consensus that hospitals have become a critical "go to" component for virtually everyone.  As the State of Maryland cuts funding of programs and services, health departments are now partnering to a much greater extent with hospitals to keep programs and services alive.  Other not-fo- profit organizations are seeking hospitals to make up for declines in charitable giving through requests for funding as well as assuming programs.  Cities and counties are asking hospitals for fees in lieu of taxes to keeping government services running.  Politicians are zeroing in on hospital executives and board members for personal political donations to keep their election / re-election campaigns going.  Physicians are asking to be employed by hospitals in record numbers or at least kept as whole as possible as they see their income continuing to shrink.  The list goes on.

Relying on hospitals for funding in lieu of the business community is going to come to a screeching halt very soon as all payers including Medicare, Medicaid, Blue Cross, other insurers and private payers continue to seek ways in reducing what they will pay hospitals for the care that has been delivered.  (In many cases, they do not pay.) Hospitals are altering the way that we do business, but as the State of Maryland attempts to balance their budget, they continue to reduce the rates that hospitals can charge as well as cut programs and services for the poor and disenfranchised.  Balancing the budget on the backs of hospitals has become a convenient approach for Maryland government over the past several years.  We continue to be hit with reductions in revenue to the tune of millions of dollars.  Considering that old adage, "no margin, no mission," hospitals can't continue to be all things to all people.

Tuesday, March 13, 2012

It's Working

Yesterday, I had the opportunity to welcome our newest employees at their orientation.  There were about 45 new employees in attendance.  At one point in my welcoming remarks, I ask each employee to introduce themselves and to give a perspective on how they will fulfill the Health System's mission of Superior Care For All We Serve.  I was amazed at the enthusiasm of the majority of the group, especially the first work morning after losing an hour of sleep.  There were great answers to the question: you heard care for; be the best; getting meds to the right patient and in the right dose; clean the patient's room to prevent infection; serve those in need and the list goes on.  Our new approach to selection and on boarding of employees is working and it is confirmed after each orientation session.

Monday, March 12, 2012

Celebrity Apprentice

I don't usually watch any of the Apprentice TV shows as I am not a fan of Donald Trump.  He is obviously very successful, but at what cost and by what means?  I lean more toward the servant leader and not the top-down driven, win-at-all-cost, egotistical, condescending leader who enjoys be referred to as "the Donald."

As last night's episode came on, I decided to stay and watch it with Pamela, who is a fan of Celebrity Apprentice.  This version of Apprentice is where individuals of notoriety, actors, comedians, singers and models compete against each other to benefit a pre-selected charity. In this episode, the men's team led by comedian, Adam Corolla, lost.  You get to bring two members of your team back to the boardroom to face the Donald, his "chip off the old block" son and his equally spoiled daughter, who both for having all of that money appear to be the unhappiest people alive.  At this point in the show, one of the three is fired.  Being the project manager, Adam took full responsibility for the loss and decided not to bring anyone back to the boardroom to be fired.  Not good enough for the Donald; he had fired two people for that episode, Adam and Michael Andretti.  Michael got fired because the Donald said at the beginning of the show that he should be the team leader and the team decided to go with Adam.  The Donald's show, his rules. 

Quite honestly, I was very impressed with Adam's decision.  He took the responsibility for the loss as any good leader should.  Normally there is finger pointing among the team members, including the project manager, blaming everyone but themselves. I have come to realize that the show is extremely beneficial, especially for any leaders who may be tuning in.  The benefit is to watch the show and do pretty much the opposite of what the Donald dictates and demands.  I have come to realize that he is more of a shameless self-promoter and an entertainer, than a leader.

Friday, March 9, 2012

You're Killing Us

Recruitment of professionals continues to be a challenge for rural health systems and hospitals across the country.   Being two hours from a major city and an international airport is clearly a negative when you are attracting physicians, advanced practice professionals, other highly skilled clinicians and executives to an area.  We have done a good job over the years and the building of a new hospital has helped greatly with recruitment.  You point to the overall better quality of life, no traffic, the beautiful outdoors, nice people and the tenure of our physicians and staff. 

However, recruitment has become more difficult of late.  There are declining numbers of prospective candidates for the various hard to recruit for positions and new restrictions on recruiting foreign-born physicians to underserved areas make it additionally challenging to recruit to our area.  As a result, it is critical that we promote the assets and advantages that we have to offer.  Our City fathers are making that more difficult with the increased number of plighted properties throughout the region.  I can assume that the economy has impacted the number, but the condition of some is deplorable, especially those in high traffic areas.  One in particular is located just off of the interstate and it is the first property that you see as you get to the downtown area.  One structure caught fire in December and sadly three women lost their lives.  Today, there is a partially burned structure sitting there.  Next to it is an occupied house that could be better described as a large shack with junk cars, trailers and a host of other types of garbage surrounding the property.  Bringing prospective candidates to town will continue to be a challenge for a host of other reasons so a little help from those in charge of addressing blight in the city and county is in order.

Thursday, March 8, 2012

Unnecessary ED Visits

This AM, I read a post by an internist regarding the initiation by Washington State Medicaid that they will no longer pay for unnecessary ED visits, retrospectively.  Welcome to Maryland.  Although Medicaid hasn't initiated that restriction (but they are talking about comparable approaches) everyone else has.  We lose money on virtually every Level I and Level II visit to our ED.   We are required to treat every patient who comes through our doors; the law says so.  If patients are triaged and determined to be non-emergent, try not treating them and getting them to seek care in an urgent or primary care setting.  The media is already vilifying hospitals for such "aggressive" tactics, even though we are losing our preverbal shirts on "unnecessary" visits.  And, it's only a matter of time before State Legislatures will begin passing bills prohibiting hospitals from employing such tactics.  We are taking steps to keep these patients out of the ED.  We are using care managers to work with our frequent flyers (those patients who are repeat visitors for unnecessary care to our ED).  We are also looking at the social aspects of these frequent flyers and trying to address those needs.  Population health continues to be a focus of hospitals in an effort to get our citizens healthier.  The bottom line is that I find it interesting that our government has shifted this problem to hospitals and doctors because they (the government) can't afford it and in the process have tied our hands.  Health care continues to be both an interesting and challenging business.

Wednesday, March 7, 2012

They Get It

So far, this has been an interesting and refreshing week.  On Monday evening, we had our Board Quality and Patient Safety Committee meeting.  This Committee, consisting of physicians, board members, C- Suite members and staff, is truly committed to the continued enhancement of quality patient care, the introduction of new ideas and initiatives related to quality and safety, as well as, complete transparency in the quality process.  The meeting is always productive.

Last evening, I, along with members of the WMHS Executive Staff, met with the Executive leadership of our emergency physicians group, MEP.  We meet at least annually with MEP to review what has worked throughout the year, what hasn't and what new ideas are in the pipeline for the coming year.  Wow, what an impressive group of physicians.  They truly get it.  They are forward thinking and they clearly recognize the value of our partnership.  We talked about how do we plan for the future and grow our relationship.  They have elevated the quality and delivery of emergency care at WMHS tenfold and continue to explore ways to bring that expertise and creativity to other components of the care delivery continuum.

Tonight, the President's Clinical Quality Council meets to discuss the progress of our four work groups that are focusing on coding and documentation; pneumonia as a high cost, high risk diagnosis group; physician communications and the creation of a gain sharing model.  This is a group that gets it, as well.  They are focused and energized.  They are committed to preparing our medical staff for the changes ahead and to ensure that none are disenfranchised as change occurs.

It continues to be a distinct pleasure to work with the above individuals as we virtually change how we do business, yet remain a viable health care system.

Tuesday, March 6, 2012

You Can't Have It Both Ways

I have been reading with great interest the articles on the NYPD "spying" on groups of young Muslims in the Greater New York area.  I am personally a proponent of the activity and the citizens of NYC who have been spared from thwarted attacks as a result should be grateful.  Some are, but some aren't.  You can't have it both ways.  You can't expect the police to do their job of protecting the City without the necessary ongoing intelligence.  I find it amazing that a City the size of New York has not been attacked resulting in casualties since 9/11.  If such surveillance and intelligence gathering didn't take place, who knows how many lives would have been lost as a result.  It is easy to criticize NYC Police Commissioner Kelly when there hasn't been an attack carried out since 9/11; however, people need to think about why no attacks have been successfully carried out.  How soon we forgot what happened on that horrific morning of September 11, 2001.

Monday, March 5, 2012

Transitioning From A Sick Care System

When we broke ground for the new hospital, we had a number of prominent speakers; one of which was Congressman Roscoe Bartlett.  Congressman Bartlett's message at the time was obviously his canned health care speech for that period of time.  Although it was not the best speech to give at the groundbreaking for a new state-of-the-art hospital, his message was very appropriate for today at WMHS.  The message was that hospitals need to transition to a health care system that focuses on wellness and keeping patients out of the hospital.  Again, not the best speech for our groundbreaking, but a timely message for today. 

In the near future, hospitals will be incentivized or penalized based on the health of the population that they serve.  That will be a tall order for WMHS based on the community health needs assessment results; however, a necessary aspect of what we do for our patients as we transition from volume-based care to value-based care. 

Still not the best message for a groundbreaking as there wasn't a mention of our challenging history in bringing three hospitals together in Allegany County; the economic impact of a new hospital being built in our region ($226M of which almost $100M was spent locally on wages, equipment, services, etc.); the new services that would be provided nor what we mean to the region with our many services, including one of nine trauma centers in Maryland.  So he missed the mark; his message was still visionary and ironic in that it fits so well with national health care reform of which the Congressman is not a proponent.

Friday, March 2, 2012

Three Priorities, Really?

I recently read a brief article in Inc. magazine on priorities.  The advice on priorities was provided by a very young CEO of a social media company.  Very simply put by her, "If you have any more than three priorities, you have no priorities."  Really?  She also applies that approach to her daily life.  Each day she writes down three goals for the day.  Great approach and advice for the average person.  However, it is hard to believe that a CEO of any organization can get away with three priorities in any aspect of their professional life.    My professional priorities are based on the health system's strategic plan.  The plan has FOUR strategic goals, a handful of supporting strategies for each goal and many tactics for each strategy.  All that we do at WMHS must fit into the strategic plan.  Application of that plan by senior and middle management throws that young CEO's approach out the window.  Having priorities is great advice and keep your number realistic, but don't limit them to three.

Thursday, March 1, 2012

The Three Job Interview Questions

Attached is a great article on the three true interview questions: can you do the job; will you love the job, and (my favorite) can we tolerate working with you?  It gets down to strengths, motivation and fit.  That makes the process a lot simpler for those of us who do the hiring.   At WMHS, we are now doing a much deeper dive with candidates to ensure that they have what it takes, will be a good fit in the organization and will be motivated to do a great job.
Top Executive Recruiters Agree There Are Only Three True Job Interview Questions