"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.

Tuesday, July 31, 2012

The Shelter Box

There was a great program at Rotary today on what is called the Shelter Box. The concept grew out of a Rotary Club in Cornwallis, England by a single Rotarian, Tom Henderson.  Around since the year 2000, these boxes are sent to areas around the world when a disaster has occurred.  The boxes contain a tent that sleeps 10 (see the photo of the assembled tent) and can withstand 60 mile an hour winds.  They also contain stainless steel pots and pans, blankets, sleeping mats, mosquito nets, iodine tablets, a water filtration system, a wood fueled cooking stove, a tool kit and a children's game packet.  Rotary has distributed over 120,000 since 2000 to 88 countries on every continent around the world.  Each box costs around $1000 to assemble and ship.  Rotary's goal is to serve 500,000 people  through 50,000 boxes.  Every Rotary Club throughout our district has been tasked with supporting at least one Shelter Box this year.  This is why I love being a Rotarian, "Service Above Self."

Monday, July 30, 2012

The Problem with Algebra

On Sunday, I read an article in the NY Times entitled "The Problem with Algebra.”  It was a great article and one with which I can personally identify.  The gist of the article is that every day there are millions of high school students and college freshman who struggle with Algebra.  College Algebra can be the single reason why a student drops out of college in their freshman year.  I can truly identify with this issue and it happened to me about 40 years ago.  As a freshman in high school I did well , (B+) in Algebra I.  I had a great teacher.  In my sophomore year, it was Geometry.  I passed Mr. Dietrich's class by the skin of my teeth.  He ran the class like a German prison camp; everyone in the class struggled.  Then it was onto Algebra II taught by our high school football coach.  I kept trying to figure out which one of us was more clueless about Algebra and unfortunately for me, I wasn't a football player.  While in Coach Kaline's class, it didn't take long to figure out how all of the football players passed and I didn't.  I failed the class and had to repeat it in my senior year, fortunately not with Coach, and I got a solid B.  Then onto college  and back to a lousy instructor (the Soccer Coach) and the same rut. I had what I thought was a brilliant idea: just change Algebra classes without formally telling anyone.  I convinced the new instructor that I would work it out with everyone, so she let me into the class.  I never got around to making the class change official.  At the end of the semester all hell broke loose, but I talked my way out of trouble and ended up with another B.  Anyway, as a nation, we need to get rid of mandatory Algebra classes (along with coaches who teach math) and focus on a more useful approach to the entire arena of mathematics.  Introduce general math, business math, statistics or even quantitative reasoning into high school and college and not make Algebra, Geometry or even Calculus required.  I would much rather have individuals with strong basic math skills (i.e. a cashier be able to make accurate change) rather than have them struggle through or even fail a required Algebra class.  Most students never have to apply any of what they learned in these classes again and many are forced to drop out of high school or college.  The question is who do we require all of this for, the student or continued prestige for the college or university?

Friday, July 27, 2012

Canadian Health Care for Foreigners

Today was one of those days when I was thinking of what to blog about.  I then read a blog from Paul Levy’s "Not Running a Hospital."  Paul is a blogger's blogger; he has been at it a long time and does a great job.

This morning, he wrote about his recent vacation trip to Canada.  While on vacation, one of the individuals with whom he was traveling injured himself swimming and the injury was serious enough that he had to be transported to a hospital.  Paul was well aware of Canadian health care and felt very comfortable with his friend being treated there.  What was unexpected, though, was that as a foreigner to Canada, the patient had to personally register and prove his or her ability to pay before being triaged, no exceptions.  So the patient had to walk to another part of the hospital to fill out a lot of paperwork, including a promise to be bound by the legal system of the province in the event of a malpractice claim even before being triaged.  Say what you want about our health care system (actually, with all of our faults, it's the best in the world, hands down) that would never happen.  Not only are there laws prohibiting it, family members can fill out the paperwork, all of that occurs in or adjacent to the ED and first and foremost, you are triaged before anything else.  The patient also needed a CT scan; however, that hospital didn't have one.  So, Paul and his group of vacationers had to drive their friend / the patient to a hospital 20 minutes away.  They arrived at the hospital only to be told that they needed to fill out all of the same paperwork again.  They convinced the registration person that they already had done so and they were told to go to Radiology unassisted.  Radiology was locked tighter than a drum.  They searched for someone to help them and finally found a custodian who helped them find a technician.  Paul blogged that the overall medical care in both hospitals was excellent.  He wrote that people were friendly and attentive.  Unfortunately, the rest of the experience left a great deal to be desired.  All that I can say is wow, what a difference in their ED experience and the Canadian approach to service excellence.

Thursday, July 26, 2012

Bath Salts: The New Drug of Choice

Now these are not the kind of bath salts that one can buy at Bath and Body Works; they are synthetic drugs that can be purchased legally over the counter.  They are chemicals that look like cocaine, but are not intended for human consumption; however, they are being sold as such and have become the new drug of choice.  They are legal because as soon as the main ingredients are banned by law, the manufacturers in Pakistan, Afghanistan and other such countries change one molecule or compound and the ingredient can be called something else.  There is no dosage and for $20 you can get high for a day, three days, end up in the Emergency Room, in the Intensive Care Unit or dead.  You can smoke it, snort it, inject it, insert it rectally or swallow it. 

The WMHS ED is averaging two overdoses per day as these have a profound effect on the central nervous system and the cardiovascular system.  We have had patients end up in ICU, near death as a result of the synthetic drug or their actions while in an enraged state resulting from the drug.   We have had teenagers, pregnant moms and even a grandmother in the ED due to an overdose.  We have had a 130-pound young man who overdosed on bath salts and in such a rage that he jumped through glass windows of the homes of strangers; it took three large men to subdue him then transport him to the hospital. 

A new bath salts convenience store recently opened about two miles from my house so I ride by it every day.   Each time, day or night, the parking lot is almost full.  Their patrons are of all ages, sizes, shapes and colors.  Even the County Sheriff went in uniform and purchased bath salts to prove a point.  We have to figure out a way to get the message out as to the dangers associated with bath salts and other synthetic drugs without introducing young unassuming teens with an insatiable curiosity to this newly crowned drug of choice.

Wednesday, July 25, 2012

WMHS Patient Portal

In August, WMHS will introduce the ability of patients to access their medical information through our newly created patient portal.  Once you register and your account is activated, you will be able to directly access information in your medical record, including test results and a host of other information online through our website.  We will first rollout the opportunity to register to our employees, but once we are sure that the portal is working properly, we will allow all of our patients to register.   You, as well as any family member that you give permission, can access your information at any time once you register and authorization is provided.  Knowing that such information is readily available, patients will be able to make faster, more informed decisions related to their care or the care of a family member.  Although all hospitals will be required to allow such access to your medical information in the future, WMHS is well ahead of hospitals in this area.

Tuesday, July 24, 2012

Sure Sounds Like the Death Penalty to Me

The NCAA announced their sanctions against Penn State University yesterday.  Although no one has ever asked me, I am a staunch opponent of sanctions impacting a program going forward.  In Penn State's case, the $60 million fine and setting aside Coach Paterno's victories for 14 years were fine although I am still choking over the $60 million fine, wow!  I do have a problem with impacting scholarships and the post-season ban.  I am tired of coaches like John Calapari who get in trouble with the NCAA, in his case a basketball program, and simply move onto another university's basketball program.  People like Calapari should be banned from the sport for a period of time.  Why do they have to impact a program going forward, especially in Penn State's case?   There is a new president, a new athletic director, a new football coach and newly recruited players now at PSU trying to rebuild a football program after a horrific scandal.  The NCAA says that their sanctions are far short of the death penalty (shutting down the program for a period of time); wanna bet.

Monday, July 23, 2012

Improving Community Health

One of the triple aims of healthcare reform is improving the health of the community we serve.  This is nothing new for us at WMHS.  We have always taken great pride in our community outreach efforts over the years.  However, it is great to see that we are adding more programs and services to meet this goal.  Our weekly internal newsletter today included information about upcoming meetings for our recently rejuvenated bariatric support group, our newly formed chapter of Save a Leg Save a Life Foundation, and our long-time Look Good Feel Better program for female cancer patients.  There were also reminders about our weekly on-site Farmers’ Market and our annual drive to collect school supplies and clothes for area youngsters who need a helping hand.  I’d say that’s a lot of activity this week to create a healthier community.

Friday, July 20, 2012

Who in Their Right Mind

It's Friday and it's been a rather challenging week so, it's time for a little levity in today's blog.  Attached is an authentic photo and advertisement from the Hammacher Schlemmer catalogue for the Barbecue Dining Boat.  For the ridiculously unreasonable price of $50,000, plus an additional $3000 for shipping, you can have a 12-foot in diameter boat with a built in barbecue grill, a table with recessed place settings, seating for 10 people, an 11-foot umbrella and a motor that has a maximum speed of 2.5 nautical miles per hour.   This is where the "who in their right mind" would purchase a $53,000 "it's not even a boat" boat.  The Barbecue Dining Boat has to be the dumbest idea that I have seen in long time.  For $50,000 you can purchase a plethora of very nice used power boats and for anywhere from $25 to $400 you can purchase a grill that is outfitted for use on a boat.  I can't imagine the embarrassment of cruising along a lake at 2.5 miles per hour, with 9 other people and all of us choking on smoke every time the lid from the grill is opened while other boaters go zipping by in a real boat.  What will Hammacher Schlemmer think of next?

Thursday, July 19, 2012

A New Term

Yesterday, I had the honor to have been sworn in by the Allegany County Clerk of the Court for my second 6-year term as a board member of Allegany College of Maryland.  It is hard to imagine that it has been 6 years, but it has been truly a rewarding experience.  Just being on the campus for meetings and activities that require a board presence is invigorating.  Participating in graduation ceremonies and hearing the stories of those students who have overcome unbelievable obstacles to attend college and ultimately graduate is an honor and a pleasure.  Working with dedicated faculty and administrators is always a benefit to me in that I always learn something during my interaction.  I am so fortunate to be a part of this great organization.  Thank you, Governor O'Malley, for my reappointment.

Wednesday, July 18, 2012

Healthiest Community Challenge

Last evening, I had the honor of attending Cumberland’s Mayor and City Council meeting to present the Healthiest Community award.  They received a traveling trophy and a check for $2000.  The City of Cumberland, along with the towns of Lonaconing, Piedmont and Westernport, participated in the Healthiest Community Challenge sponsored by WMHS.  The community that lost the most weight, increased their physical activity and improved their diet would be selected as the winner.  In addition, an individual award would be presented to the individual participant who made the greatest progress in these areas.  The winner of the individual award was Bill Skidmore of Cumberland, who lost 14% of his body weight.  The mayors of each city took the challenge seriously and performed exceptionally well.  Through this challenge, we took a major step in addressing obesity, high blood pressure and diabetes in our area.  In fact, the City of Cumberland voted to use their winnings to advance the health and wellness of the City's employees and residents.  Congratulations, Mayor Brian Grimm.

Tuesday, July 17, 2012

The Transparent Leader

Last night, I read an interview in Success magazine with the former CEO of Dial Corp, as in soap.  Herb Baum is also the author of "The Transparent Leader".  He defines a transparent leader as someone who does the right thing regardless of the consequences.  It's about being honest and open in everything that you do as a leader. 

In the interview, Herb tells a story of an individual who epitomizes a transparent leader.  While CEO at Dial, Herb was on vacation in London and received word that, Reuben Mark the CEO of Colgate, was urgently trying to reach him.  Herb was not pleased as he thought that it was a hostile takeover attempt and here he was on vacation.  He finally returned the call to learn that Reuben was in possession of Dial's marketing plan for the coming year.  Colgate was number 2 in the market to Dial's number 1 at the time.  Dial had given the marketing plan to their salespeople and one who had left the company to go to Colgate gave it to his supervisor at Colgate.  The supervisor called the CEO, who told him not to look at it and to send it to him immediately.  Reuben assured Herb that he hadn't looked at it as it would be a violation of Colgate's Code of Ethics and he was returning it to Herb directly.  Wow, if only the leadership at Penn State had practiced transparent leadership; where would they be today? 

At WMHS, we have a set of Core Values that we take very seriously.  My expectation is that every decision that we make is based on our Core Values of Integrity, Innovation, Compassion, Accountability, Respect and Excellence.  I can only hope that I, along with our leadership, model ourselves after Reuben Mark as the epitome of a transparent leader in everything that we do.

Monday, July 16, 2012

A Culture of Criticism

I read an article this AM that got me to thinking.  The article was written by a physician about the culture in hospitals.  Overall, we are doing well at WMHS.  We have successfully blended the various cultures of Memorial and Sacred Heart Hospitals since we have moved into the new hospital.  But, there is an aspect that can be improved upon and it is how we feel about and treat each other.  Don't get me wrong, when push comes to shove, our folks respond exceptionally.  In life and death and other challenging situations, teamwork abounds.  However, in our everyday work life, we aren't as respectful of each other as we should be.  We perform wonderfully with patients and their families (we have the satisfaction scores to prove it); we just need to work on how not to generalize about the other guy.  None of us can successfully exist without the other.  The surgeon needs the internist, the physician needs the nurse and we have to rely on Materials Management, Finance, Registration, Medical Records, IT, Food Services, Environmental Services and the list goes on.  Being respectful of each other is one of our Core Values and is a Service Excellence standard.  Exercising and demonstrating respect toward one another will simply put us over the top in bringing our culture to where it needs to be.

Friday, July 13, 2012

The Freeh Report is Free Advice

Once the Freeh Report was released yesterday morning concerning the Penn State / Sandusky mess, I asked our Corporate Compliance Officer to review the report with special emphasis on the recommendations.  I want to use this 267-page report as a benchmark against the policies and procedures of WMHS to ensure that we are appropriately positioned to act should a situation of comparability (God forbid) occur at this health system. 

The Penn State Board of Trustees paid millions of dollars to former FBI Director Louis Freeh and his law firm as Special Investigative Counsel to conduct an investigation into the circumstances that lead to criminal charges of sexual abuse of minors on the PSU Campus against Jerry Sandusky.   Attorney Freeh was also asked to provide recommendations regarding Governance, Oversight and Administrative procedures to prevent such incidents from occurring in the future.  The opportunity to review this report and use the recommendations as a benchmark to one's own organization should be considered by every board, compliance committee, ethics committee and CEO in the country.  There is an excellent lesson here for every board chair, committee chair and CEO.  The brand is always to be protected but at what cost?  If the leadership of PSU would have appropriately dealt with the situation when it first occurred in the late 90's, the University would have suffered a black eye that would have eventually healed in a short period of time.  Instead, they chose not to report the situation to the authorities, cover up the sexual assaults, take no action against Coach Sandusky and as a result, PSU, its reputation and its brand are now tarnished forever.  The former leadership at PSU also has to live with the fact that because of their cover-up, Coach Sandusky went onto sexually assault other young boys who are now scarred for life.  A tragic situation for all.

Thursday, July 12, 2012

Running When It's Hot and You're Old is CRAZY

Actually, even when you're young you should use your head when it's hot and you decide to go for a run.  However, I can't get over as to how dumb, yes, dumb, people can be.  Last week, I was on vacation.  I am sitting at the beach midafternoon (not running on the beach) pretty much people watching.  I was amazed at the number of people who were in their 60's and yes, even 70's, running on the beach with a temperature of over 100 and a heat index of about 107 degrees.  There was one guy whom I thought was rehearsing for a movie role as he ran, actually more like staggered, past me.  It was like he had just been shot and was attempting to get away from his assailant.  He was in his seventies, a big guy who was, again, more staggering than running, but grasping for every breath like it was his last.  Yet, he continued on with his run.  One would think that if you are going to run that you would choose a time that is at least cooler like early morning or late evening, not midafternoon.  Also, having a bottle of water is a good idea, but not this guy.  The closest thing that he had to water was the adjacent ocean or the sweat drenched shirt that he was wearing.  The "old" (dumb) guy was clearly putting his life in danger whether he knew it or not.

Wednesday, July 11, 2012

Enough's Enough, Get To Work

For the 31st time since the Affordable Care Act was signed into law, the House of Representatives is taking yet another vote to repeal the law.  Really?  The Republican controlled House may get a few Democrats to join them due to tough upcoming re-elections in their home districts, but the Democratic controlled Senate and the President won't budge.  So why hold such a vote for the 31st time?  For show.   What other entity can get away with not dealing with the most pressing issues that are facing their constituency, clients or customers yet deal with issues to promote themselves and their areas of interest.  Repeal away Obamacare, when you have the opportunity and the votes, but until then deal with the critical issues facing this country, such as the economy, job creation, what has become the new normal for unemployment at 8%, an overtaxed nation, immigration, the wars in Afghanistan and Pakistan, Iran, Syria, Europe,  and the list goes on.  There is a great deal of work to be done, so get to it!

Tuesday, July 10, 2012

Coming Soon

Later this summer, WMHS will bring a Diabetic Medical Home concept to fruition.  We will centralize all outpatient services for the diabetic community at WMHS.  We will provide group and individualized coaching, mentoring and teaching by nurse practitioners to our patients.  Dietitians, pharmacists, social workers, psychologists and care coordinators will also coordinate care with primary care physicians and specialists.
Diabetes is reaching epidemic proportions among the elderly and the middle aged in our community. The concept of our diabetic medical home is a much needed health and wellness initiative, and it is also one that will truly benefit our region.

Monday, July 9, 2012

Time to Reassess Your Grill Cleaning Tools

While on vacation, actually on the 4th of July, we were having a traditional cookout.  During dinner, my wife pulls out a 3-inch wire bristle from her cheeseburger (photo attached).  Fortunately she didn't consume it.  I read this morning that there are many patients now arriving at EDs across the country having ingested similar pieces of wire from a grill cleaning brush (see photo).  I didn't really think about it until Pamela was holding a piece of wire in her hand as to how dangerous a grill brush can be especially one that is falling apart.  For years, I simply used aluminum foil rolled into a ball with an oven mitt to clean the grill.  But, when Williams Sonoma came out with their grill cleaning brush, I had to have one.  It was much easier to use than tin foil.  I have resorted to the tin foil alternative once again after seeing the nearly ingested wire bristle and reading about how dangerous an ingested bristle can be to one's throat, stomach, intestines or other organs.  As the official "grill master," I would have felt horrible if anyone would have swallowed a wire bristle because of my lack of attention to detail.  So, use this blog as a wakeup call.  If you have a grill brush, especially one with a scouring pad component, toss it!  There is a lot of information out there as to how to properly care for your grill; start using it.