"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.

Wednesday, February 27, 2013

What's Good for the Goose is Good for the Gander

The title of my blog is a saying that I used to hear from my mother all of the time. What it means is what is good for one is good for the other; usually referring to men and women. The origin of the saying is the same sauce is good for both the goose as well as the gander (the male).  For today's blog, it's related to politicians and everyone else. 

I have to complete a financial disclosure form for the State Ethics Commission for my position as a college board member. I have to disclose any potential conflicts of interest, family members who are employed by the College, financial transactions, business interests, gifts received or real estate holdings. I have no problem in completing such an application annually. My issue is with politicians, who I am sure have to complete a similar application whether for the State or the Federal Government. How is it that they complete it, but many are in violation of it? Whether their violations are through influence peddling, buying access to politicians, ignoring laws related to lobbying or advancing legislation that brings them some advantage or blocking legislation that  runs contrary to their interests, it happens everyday as a means of doing business. Yet, if I did it, I could be fined or even jailed in my role as a college trustee. 

The latest to strike a nerve for me is the group Organizing for Action that is reportedly selling access to the President. What is interesting is that the reports are coming from the NY Times and the Washington Post, normally not critical of the President, and any his affiliated organizations.  Although denied by the White House, donors are reporting that they have given $500,000 for quarterly meetings with the President. This initiative is a way around campaign finance laws and needs to be examined.  In Maryland, I have blogged in the past about the ability of those in leadership positions who are trial lawyers in the Senate being able to block any initiatives related to tort reform.  In any other venue, that's a conflict of interest, but not in politics.  Where are the ethics or the accountability in government and where have our leaders gone?  Disturbing to say to least.

Tuesday, February 26, 2013

Smoke Free Campus

Yesterday, I had the opportunity to visit another health system that is a smoke free campus.  I got out of the car and starting walking to the entrance and noticed two patients or visitors quickly extinguish their cigarettes and two employees waiting for the parking shuttle do the same thing.  I guess that I looked important enough for them to think that I was going to ask them to put their cigarettes out.  So much for a smoke free campus.  But, then again who am I to judge.  I see a lot less folks smoking on our campus at WMHS and never an employee,  but I am sure that we have our offenders, especially those who attempt to hide while they smoke.

Unfortunately, its just outside my office window in my direct line of sight.  In fact, today as I was driving to a meeting outside of the hospital.  I drove alongside a guy who was walking down the driveway next to my office smoking.  I didn't have the heart to tell him to put his cigarette out.  You see, he was walking in the pouring rain without an umbrella and I said to myself, buddy, if you need a smoke that bad, have at it.  The bottom line is so far so good at WMHS, but there is still work to be done.  We seem to be doing better than at least one other smoke free health system.

Monday, February 25, 2013

A Much Slower Pace

I have been in South Carolina for the past week and I have come to realize that the pace is so very different between the North and the South.  I know that Maryland is technically in the South, but from a pace perspective, you would never know it.

I took a car to the dealer for servicing last week for an 11 AM appointment.  I arrived at 10:57 and waited and waited to be able to pull into the service bay.  Finally, I got out of my car and stood with my arms folded.  At that point, two service reps came out and said that they would be with me in a minute.  They went back into their offices and continued their very jovial conversations with the customers who they were helping.  No hurry to get the cars to be serviced out of the drive up bay.  I finally got to interact with a service rep about 15 minutes later.  He said to me, "you aren't from around here are you?"  I replied that I wasn't.  He said that it appeared that I was used to a different pace.  I said that I was,  but that I also looked at it from a service excellence perspective.  What I am used to is that as soon as you pull into the service bay there is someone there to check you in and move the car out of the service bay.  It was more efficient, but I explained that their approach seems to work for the slower pace in the South.  It all worked out and we were laughing and joking by the end of our interaction. 

As I write this blog, I am in an airport in the Charleston, SC.  We learned that our flight to DC was going to be delayed about 30 minutes due to service issues with our plane coming from its last destination.  It was amazing as to the reaction.  People who were impacted by the delay with their connections in DC casually got up walked up to the gate agent and began the process of changing their flights.  Up North, the scene would have been very different.  Loud sighing, complaining and anger would have been the order of the day. The difference was amazing.  Eventually, I plan to retire to the South and it will take some time to get used to the slower pace, but I think that I am going to like it.  Everybody is so nice.

Friday, February 22, 2013

The Shooter

I recently read the article in Esquire entitled "The Shooter."  The article was based on a series of interviews with the Navy Seal who shot Osama bin Laden.  That Seal, who remains unidentified, has left the Navy after 16 years of service without any pension or health insurance.  There are no economic safeguards for any of these individuals who, on their way to every mission, never expect to return home alive.  Here is a Navy Seal who is truly a hero in every sense of the word and yet he has to remain unidentified; otherwise, he and his family will be killed.  For such heroism, there should be a fund or a foundation to support these men from a grateful nation.  Instead, he was offered the government's witness protection program where he could have given up everything to obtain a new life of driving a truck in Milwaukee.  Since he and his wife are now heading for divorce (as is the case with most Seal marriages), he had to decline or never see his children again.  After the interview with Esquire, he is now being investigated by the Department of Defense as to whether or not he broke any secrecy laws.    So much for that grateful nation.  How about taking the $25 million dollar reward money that was never awarded for the information leading to the capture or death of bin Laden and setting up a trust fund for the members of Seal Team 6?  Whenever one needs examples of how not to do something, isn't amazing that one can always find a plethora of examples from government.

Thursday, February 21, 2013

Knowing Albert

All over the media today is the story about Albert Lexie, who shines shoes at Children's Hospital in Pittsburgh, PA.  Albert has been shining shoes since 1981 at Children's Hospital and to date has contributed over $200,000 to the hospital.  I had the privilege of having Albert shine my shoes when I worked at the hospital next door to Children's Hospital.  Albert would stop by my office each week and shine my shoes.  I was one of Albert's first customers outside of Children's Hospital.  When I moved to another hospital across the City, I tried to convince Albert to start shining shoes at that hospital as well, with his contributions still going to Children's Hospital.  He politely declined as that would have taken Albert out of his comfort zone of the hospitals in the Oakland section of Pittsburgh.   Albert is a very special individual who deserves all of the national recognition that he is getting today.

Wednesday, February 20, 2013

When Did We Get So Screwed Up?

Last Sunday in his sermon message, the pastor talked about growing up in the 50's and 60's during a much simpler time, a time when you knew right from wrong.  I then arrived home from church and picked up the newspaper to read about protests in Los Angeles in support of a homicidal maniac who killed two innocent people and two police officers doing their job, threatened the lives of others, taunted the father of the daughter whom he murdered in cold blood and put countless lives in danger for days and days.  As a society, when did we get so screwed up?  How can anyone in their right mind protest in support for such a monster?  The protesters said that they don't condone his killings, but objected to what led to his killing spree.  His acts were the same as a disgruntled employee who kills his boss and co-workers.  Is it just me or when someone murders people after they have been disciplined or terminated, the actions taken by those in charge seem to be well placed.  The outcome is tragic, but obviously the murderer had issues that led to his termination.  During the manhunt, there were some who were calling this maniac, a folk hero.  Really?

 My wife keeps reminding of an old hymn with the words, "I am but a stranger here, heaven is my home."  As each day goes by and I read of the craziness occurring around us, I find myself wishing for those simpler times.

Tuesday, February 19, 2013

The Fast Approaching Sequestration

On March 1st, the health care industry has been warned that a 2% cut is coming as part of sequestration, the deficit reduction agreement proposed by the President last year.  One would think that with that kind of pressure, Congress and the President would be burning the midnight oil getting to a resolution.  Instead, Congress is on recess (actually they have only worked ten full days since returning from the holidays) and the President was in Florida on a long golfing weekend up until last evening.  No sense of urgency and no need to be accountable to the American people; they will simply return from their time off and resume the finger pointing that has plagued our nation since 2010.  Hell, the President and the Congress couldn't get it right even when the House and Senate were Democratically controlled from 2008 to 2010.  The problem is that we like our Senators, Congressional Representatives and even the President individually so we keep voting for them election after election.  I think that it's time that we looked at what they have accomplished as a body, virtually NOTHING.  All of which should be a great embarrassment to them as a group and as individuals.  Washington, DC, could learn so much from how boardrooms and executives deal with a crisis.  We reach consensus, we solve problems and we work to protect our organizations and the people who we serve.

Monday, February 18, 2013

Keystone Pipeline and Canada

The other evening after dinner at a local restaurant, Pamela and I stopped at the restaurant's bar for a drink.  Next to Pamela was a gentleman from about 200 miles north of Toronto.  Pamela and I vacationed in the Canadian Rockies two summers ago; it was one of those dream vacations and we told him how beautiful western Canada was and how wonderful the people were. 

We also talked about how amazed we were when we flew into Calgary.  There was an obvious economic boom occurring--all attributed to oil.  There were new highways, high-end housing developments and new businesses opening up everywhere.  That is the same oil now awaiting delivery via the Keystone Pipeline.  Because there is so much oil and they can't get it to a port with the Keystone Pipeline being held up by the Obama Administration, economically Canada is no longer in the best shape.  They have billions and billions of dollars’ worth of oil with no place at the present for it to go.  The Canadians thought that their oil reserves would be an economic boom for both the US and Canada, but that didn't happen. 

The US talks about no longer being dependent on foreign oil, but unless that oil is going to magically appear in our gas tanks, it looks like our dependency on oil from the Middle East will continue.  The Canadians are now looking to build a pipeline to eastern Canada; however, they really need either our west coast or the Gulf of Mexico.  Their oil needs to get to China and India if it's not going to the US.  Maybe if the current Administration can figure out a way to tax the new oil, the Keystone Pipeline will become a reality and our friends to the north will once again look at us more favorably.

Friday, February 15, 2013

Paula Deen

I am not a regular reader of People magazine; however, I was waiting for Pamela and it was about the only thing to read.  In that issue was an article about Paula Deen and her family and their success in losing weight.  Remember back in 2011, Paula Deen admitted that she had type 2 diabetes and she was roundly criticized for still recommending unhealthy cooking while have diabetes.  I wrote a blog about that story and felt that Paula could pretty much do what she wanted.  If she wanted to cook unhealthy meals while having type 2 diabetes, so what.  Since then, Paula, her husband and two sons have lost a combined weight of 178 pounds.  They have changed their approach to eating by embracing a healthier lifestyle.  They did it though portion control, reduced carbs, more vegetables and exercise.  She also said that it is so much easier when everyone is doing it and if she and her family can do it, anyone can.  Good for you, Paula.

Thursday, February 14, 2013

Happy Valentine's Day Except in Orlando, Florida

This morning, I was in a grocery store and watched four high school students picking out Valentine's Day cards and flowers before they headed off to school.  They were all over the store, shopping with a vengeance and making sure that they got the right card, flowers and boxes of candy.  It actually was kind of cute as to how excited and enthusiastic they were. 

Then, a little later, I sat down and read the newspaper.  In the paper is an article about two high schools in Orlando, Florida, banning the exchange of any gifts, cards or flowers "in order to maintain our instructional focus and avoid distraction."  You have got to be kidding me.  I guess the good news is that the principals didn't make it that if you brought a card for your Valentine that you would have to bring one for every student so no one felt left out.  So much for the joy and happiness that Valentine's Day is supposed to bring.

Wednesday, February 13, 2013

Shutting Down Electronic Communication

I am torn after reading an article about managers being more effective by learning to shut down smart phones, iPads, laptops, etc. when they aren't at work.  The article says that we need to take a break to get recharged during the evenings, nights and weekends.   Personally, I can't do it, but now I feel guilty with the expectation that when I send an email or a text message over the weekend that it be responded to before Monday AM.   Fortunately and selfishly, all of my direct reports pretty much respond immediately.  Quite frankly, being in a health care system that operates 24 /7, there is always a lot going on.  Much can happen during the night and certainly on weekends.  I guess that I will have to reassess my approach as well as my expectations without impacting the expectations of those counting on us who are working during the nights and weekends.

Tuesday, February 12, 2013

The State of the Union

Tonight is the State of the Union Address. From a health care perspective, I would hope that President Obama would cover the following:

Steps that he is taking to better align incentives among providers, with everyone focusing on a value- based health care system.  We need Federal action to break down the barriers that impact meaningful coordination of care between physicians and hospitals.

What he is doing to reduce the amount of regulations that hospitals must adhere to; right now, the number exceeds 122,000 and it's climbing.

That he will stop making cuts to Medicare on the backs of providers and allow us to change the delivery of health care, which is needed desperately, by focusing on improvements in quality, patient safety and affordability.  Such changes can't be done overnight.

Gives hospitals credit for what we have accomplished to date in bringing down the cost of health care.  Health care spending has been at historically low levels for the last three years.

Greater emphasis on funding for mental health.  So far, the focus has been on gun control.  Not enough is being said or done in the area of addressing mental health issues earlier and more comprehensively.

Lastly, tort reform needs to be addressed nationally as a way of ridding the courts of frivolous lawsuits and by eliminating the cost of defensive medicine.

Monday, February 11, 2013

Dr. Ben Carson

Over the weekend my daughter, Lauren, suggested that I watch a video of Dr. Ben Carson's speech to the National Prayer Breakfast.  It was 27 minutes exceedingly well spent.  His speech was moving, inspirational and thought provoking.  Dr. Carson spoke of his rise from poverty to become a world renowned pediatric neurosurgeon.  He gave his perspective on health care, education, political correctness and our economy.  I would encourage everyone to watch the video of his speech, then go out and apply what he shared with us in our own lives, both personal and professional.

Friday, February 8, 2013

Flawed Perceptions

On Monday morning when I arrived at the office, there was a voice mail message from an angry family member of a patient.  I listened to the message and although I was called worse and repeatedly threatened during the call, being called a dirty rotten, no good son of a bitch got my attention.  The individual went on to say that because WMHS had no surgeon on call over the weekend, his family member had to be transported to a tertiary care center.  I immediately looked into the complaint and learned that the family member was missing a few very important details.  First off, we always have a surgeon on call and, in this case, two were consulted.  Both surgeons felt that due to the severity of the patient's condition, the patient needed to be transferred to a major tertiary care center.  That was successfully accomplished.  I then asked for follow up to occur with the spouse of the patient since I couldn't follow up with the family member as it would have been a breach of patient confidentiality.  The follow up occurred and the spouse was thrilled with the care that the patient received while at WMHS and fully supported the decision to transfer the patient.  The spouse was very apologetic for the family member's behavior.  

Now the dilemma that we deal with every day:  the perception in the community.  This angry family member probably told a lot of people about our shortcomings related to the care of this patient, and that information was dead wrong.  We continue to hear about poor care,especially being provided in the ED; and many times when pressed, the response is "I heard it from a friend of a friend of a friend."   As a health system, we clearly recognize that we are not perfect and are striving to provide the best care for every patient every time.  But, we also have lots of work to do in changing such perceptions.  However, we have great team in place to get that job done.

Thursday, February 7, 2013

Wanting to Have Your Cake and Eating It, Too

Rarely do I criticize other hospitals and health systems; heck, health care is tough enough.  However, there is a Catholic hospital in Colorado that is fighting a wrongful death case of a mother along with her twin babies.  Related to the death of the babies, the hospital has been using a defense based on Colorado law that states that an individual isn't considered alive until after birth.  Unfortunately, that defense conflicts with beliefs of the Catholic Church, which state that life begins at conception.  You can't have it both ways.  They need to "man up," if you will, and adhere to the teachings of the Catholic Church.  I also find it especially hypocritical of the bishops of Colorado who have to be looking the other way as this case proceeds. What I find interesting is that the hospital won the case twice, but it is now under appeal by the plaintiff in the Colorado State Supreme Court. 

I wrote the preceding blog on the weekend and saw an article yesterday that the hospital is no longer using Colorado law as their defense.  After a meeting with the three bishops of Colorado this week, the hospital officials said that they would no longer use the Colorado law in their defense.  The attorneys for the hospital were thrown under the proverbial bus and blamed for the defense strategy.  In reality, it doesn't work that way.  The leadership of any hospital has to be on board with any strategy that the defense will use in such a case.  Also, being part of a large system, the leadership at the top of that system also had to have green lighted the original defense strategy.  I am glad that they finally got it right--just in time for various dioceses across the country that are suing the federal government over the affordable care act under the premise that it violates the sanctity of life by holding employers to the contraceptive mandate.

Wednesday, February 6, 2013

Steve Forbes

Last week, I also had the opportunity to hear Steve Forbes speak.  He is the editor of Forbes Magazine and has been politically active for decades, including a past run for the presidency.  He was filled with great information.  Some his points were as follows:
·         The US will be re-linking the dollar to the gold standard rather than oil (at least gold keeps its intrinsic value as it has over the last 4000 years).
·         The banking industry is rivaling health care with its regulations.   As I have written in the past, health systems have to adhere to over 122,000 Federal regulations. Banks are closing as they can't keep up with new compliance requirements
·         The Senate is avoiding accountability by not passing a budget in over three years.

He also said we should be growing the economy rather than raising taxes. The US isn't alone in its "taxing not growing" problem, so are most nations.  (Spain's income tax rate is at 52%; Japan is at 55% with a 10% sales tax; and France is at 75%.  The French are emigrating to Belgium for a tax haven with its 50% rate).  Some states are beginning to cut taxes in order to focus on growth (NJ, NC, LA and KS). Forbes also spoke of his desire for a flat tax of 17%, no capital gains tax and no death taxes.  He said that the Gettysburg Address has 52 words, the Declaration of Independence 1300 words, our Constitution 7,000 words, the Bible written over centuries 773,000 and the US Tax Code over 9 million words with 14,000 changes in 25 years, and our tax code is out of control. 

As it relates to health care, Forbes said that there should be nationwide shopping for health care insurance with no restrictions on buying insurance; currently it falls within state boundaries.  He said more competitive insurance markets are needed.  Forbes said that technology is creating so many opportunities in health care and we should see an increase in medical tourism to Indian reservations because it is sovereign territory where many US laws are not applicable.  

Steve Forbes was filled with great information and even made the US Monetary Policy easier to understand.

Tuesday, February 5, 2013

Health Care in Scotland

I just returned from a series of meetings in Arizona.  One of the speakers was  Derek Feeley, Director General for Scottish Health and Social Care, the equivalent of Kathleen Sebelius (US Secretary of Health and Human Services), but for Scotland.  Wow, I thoroughly enjoyed his presentation.  The similarities between health care in the US and Scotland were amazing.  The only differences were that Scotland has a national health care system, they lead the world in liver mortality and they just reduced the wait to 50 days for elective surgery.  Otherwise, they are focusing on value not volume; bending the cost curve; attempting to change the expectations of those paying the bills and receiving the care; addressing population health; reducing the cost of care and improving the quality of care.  They are addressing the liver mortality issue by increasing the price of liquor as we do with tobacco products in the US.  Using the US and our tobacco tax as the model, Derek is expecting success is reducing the mortality rate. 

On the lighter side, I had the opportunity to speak with him after his program.  I asked if elevating of the price of liquor in Scotland would affect the price of single malt scotch that is exported to the US.  He laughed and informed me that there would be no impact on high-end scotch.  Their focus is what is deemed to be cheaper liquors even with the increased cost will not reach the cost of single malt scotch.  Good information to have on all counts.