With Sincere Gratitude

Today, is the last day that Kim Leonard and Kathy Burkey are board members of the Western Maryland Health System.  

Kim has been a board member since the creation of the Western Maryland Health System in 1996.  In fact, Kim served as the organization's first board chair and was able to maneuver the System through an extremely tumultuous few years.  With both personal and professional threats and losses, Kim's leadership through this nightmarish period was focused and inclusive.  He put himself out there and confronted challenge after challenge.  He was a rock and I will be forever grateful that he saw us through what was certainly the right thing to do and allowed WMHS to both flourish and prosper to the great benefit of our community.

Kathy Burkey joined the board shortly after the System was created and served as our second board chair for over 10 years.  Kathy and I worked together throughout that period and we both lived to tell about it.  There certainly were challenges that Kathy faced and met head on and, in many cases, to her personal and professional peril.  Kathy lost many clients based on decisions that people didn't understand at the time.  She lost many physician clients for clearly doing the right thing.  She led us through the separation from Ascension Health--certainly not an easy task (and the reason why both Kathy and Kim's board terms were extended due to the loss of almost half of our board) as well as the building of the new hospital.  She challenged us every step of the way and, as a result, the hospital was delivered on time and under budget; unheard of today as well as five years ago when it was completed.  

Today, I am a much better person and leader to have served both these individuals.  Both will be missed for their inclusiveness, their honesty, their tenacity, their intellect, their knowledge, their wealth of experience and most importantly, their wonderful senses of humor.


God speed, Kathy and Kim, from a most grateful health system and community.

Out with the Old and In with the New

I read a great article the other day on CEO leadership written by Bob Herman in Becker's Hospital Review, even though it was originally published in 2012.  The leadership suggestions can be applied to anyone in leadership, even though the article was intended for CEOs.  

The focus of the article is the new thought process for leaders, the long standing initiatives that we need to cast aside and the new ones that need to be adapted.  The dramatic changes in health care are dictating a whole new approach to leadership and some of the old vs new initiatives are very interesting.  The article is attached.


https://drive.google.com/file/d/0BytSBUSa-SIANS1hb2V0TjNYRFE/edit?usp=sharing

A Segment That Everyone Should Watch

My day starts around 5:30 each day.  Before I began the process to get ready for work, I begin each morning by reviewing emails that were received during the night.  On some occasions, like today, the information received can serve as blog material.  

Late last night, I received a video contained in an email from one of my closest friends, Lou Shapiro.  Lou is the President and CEO for the Hospital for Special Surgery in NYC.  Lou's email said that the video was worth watching even though it’s on a show that I probably don't watch on a station that it’s safe to say I never watch.  The piece is about 15 minutes long and it's an editorial by Lawrence O'Donnell, who has a show on MSNBC.  

Lou was right on both counts, but I am just as disenchanted with the Right as I am with the Left.  I am fast becoming a Radical Centrist.  I am sick to death of the polarizing opposites of the far Right and the far Left.  Politically, we need to have some common sense more centrally positioned to prevail in this country, but that's for another day and another blog.  The O'Donnell piece is very well done as it describes his painful ordeal from an automobile accident in the Virgin Islands, his immediate transport to NYC for treatment and care, his recovery and the wonderful people who he met in the process of his ordeal.   What is especially poignant about the piece is that here is a somewhat famous news personality who was never hospitalized in his life and finally got to experience what it was like to have caregivers inside a hospital apply their skills, training and abilities specifically focused on you and your full and complete recovery.  

His focus is the Hospital for Special Surgery, but it can be said of the great majority of hospitals across the US.  All too often, we hear some pretty horrible comments about hospitals through the media.  The piece was both refreshing and spot on; it should be required viewing for a whole lot of people.

http://www.msnbc.com/the-last-word/watch/lawrence-returns-discusses-his-accident-287481411836

Update on Terrell

I receive a lot of inquires each day as to the health status of my son-in-law Terrell and his bout with high grade osteosarcoma in his right leg.  I previously blogged about Terrell and Jessica's plight on March 11, 2014, shortly after the diagnosis that left everyone in shock.  

First, it was thought to be a tear in the knee, then a benign tumor, only to then get the worst possible news.  Since then, Terrell has had ten weeks of chemotherapy that required a three to four day inpatient stay for each treatment.  Then, surgery that required the knee to be replaced along with 5 inches of his femur.  He was hospitalized for a few days after surgery but has been home for two weeks and is making great progress of late.  

Early on after discharge, Pamela, who is an RN and providing care, assistance and oversight over these two weeks, said that her heart was breaking to see Terrell in that state.  However, since last week he has made great progress under the watchful eyes of his caregivers—-Jessica, his mother Paula, and Nurse Ratchet of One Flew Over the Cuckoo's Nest fame aka Pamela, who can be a task master.  That leg is now weight bearing, he can straighten it and he can bend it 90 degrees.  I attached a photo,  The 39 staples will be removed today.  After seeing the photo, Terrell's nephew shared it with everyone and he had the best line, "that's where they sewed up his robot leg.”  

All is as well as can be expected, but this week is crucial with meetings with his orthopedic surgeon and his oncologist. Also, Terrell is resuming chemotherapy at the end of this week and it is anticipated to continue into October.  Keep them both in your thoughts and prayers.  Thanks.

We Could Do Better

The other evening, I dropped Pamela off to get in line at the movie theater while I parked the car.  The line was pretty long and the 18 commercials, 12 previews and six "turn off your cell phone" reminders were about to begin prior to the movie starting.  As I met her in line, there was a young man two or three couples ahead of us.  He and his girlfriend or wife were at the ticket window and he asked if there was a discount for members of the active military and was told no by the  two 17-year-olds working the ticket window.  Here, this young man, who was still active military, had two prosthetic legs; one would safely assume that if he is still active duty, he lost his legs defending our country.  

Ever since that episode, I have been kicking myself for not reacting faster and paying their way into the movie as a grateful American for the sacrifice that he has made for me, my family and this country.  It was a great lesson for me and I can tell you that should a similar situation occur in the future, I will be ready.  There should also be a standard policy for every business of some kind of discount for active duty military.  What these individuals and their families go through for all of us is amazing and we should better demonstrate how grateful we are as a nation.

I Am Not Native American, But I Am Irish

I just read an article that the US Patent Office has cancelled the trademarks of the Washington Redskins because they are disparaging to Native Americans.   Really?  I mean absolutely no offense to Native Americans, but when is this era of political correctness (PC) going to end?  For just as many Native Americans who are offended by the team name, there are just any many who could care less.  If folks are so offended by the Redskins team name, why is it the 8th most valuable franchise of any sport in the world?  Shouldn't the masses be boycotting and protesting at every game?  (But they're not.)  

With all of that being said, I think that it's high time for me to jump on the PC bandwagon.  If this era of PC that doesn't appear to be ending anytime soon, I am considering legal action against the University of Notre Dame and a request to have their trademarks cancelled because they are disparaging to Irish Americans.  The moniker of the Fighting Irish shows a leprechaun in an ever fighting stance which, in my opinion, I find offensive as it denotes that we Irish are all drunks who are always looking for a fight after a few too many Guinness stouts--talk about disparaging and derogatory toward my heritage. 

Sound silly, well of course it is, after all, it’s about sports and the Washington franchise has been around since 1932.   Of course, my remarks about Notre Dame are tongue in cheek but it gets to the ridiculousness of changing all of these team names, mascots, etc. issues just to satisfy political correctness.

There You Go Again

There was an article in yesterday's Washington Post reporting on US health care as being the least effective and most expensive compared to other industrialized nations.  The report released by a "respected" think tank, the Commonwealth Fund, ranks the US dead last at #11.  Our spending per capita is $8,508 compared to Norway, which is the second most expensive at $5,669.  This particular think tank continues to be a strong proponent of socialized medicine so one might think that the data and analysis may be a bit skewed toward those countries that have a national health program.  If I am not mistaken, all of the remaining ten countries have some form of socialized medicine, scoring very high on the equity factor.  


Now for the rest of the story.  I have blogged previously that the capturing of much of our quality data varies from state to state, let alone country to country.  For example, infant mortality is reported in this study and the definitions of what is infant mortality truly vary from state to state.  Also, in the US, we capture EVERYTHING while other countries do limited or selective capturing of data.  

The study doesn't mention individual outcomes where the US far exceeds other industrialized nations.  For cancers alone, the US ranks well ahead of the UK (which was first overall in the study with per capita spending of $3,405) in 22 of 23 different types of cancers.  

Also, have you ever been in hospitals in these other countries?  In many instances, they are a far cry from state of the art, what our patients have come to expect and on what our hospitals are rated.  Patient satisfaction, which is a major quality indicator for the US, isn't captured in the Commonwealth Fund's latest study.  If that were the case, how would the number one ranked country, United Kingdom, fare?  In recent years, I have read numerous articles about the poor care of its patients, wait times, limited resources, etc.   

Now, are we perfect in the US? No, but in recent years our numbers have improved dramatically in both what is captured in the Commonwealth Fund study and everything else.  The bottom line is that these studies really get to me when they are unfairly conducted and reported simply to push one's own agenda

You Need To Go To A "Real" Hospital (Really?)

From time to time, I hear from folks, sometimes even extended family members, that when you are ill you need to go to a major tertiary care hospital, aka a "real" hospital. Never mind that you are insulting the hell out of me as the CEO of medium-sized health system in rural Maryland; but quite honestly, it really isn't necessary.  

I will agree that if you have a rare illness or need to have an uncommon surgery or if your child has a serious illness, a tertiary care center or teaching hospital may certainly be a better option.  However, before you feel that it is necessary to transport mom or dad to one of those "real" hospitals consider the following experience.  

Recently, I had the opportunity to visit one of those so called "real" hospitals, an urban teaching hospital (not in Maryland), and it was, in a word, FILTHY.  I was amazed that in today's environment that such places exist.  It has to be an infection control nightmare, especially on a Trauma Unit.  The section of the hospital that I visited was relatively new, but not well maintained.  There was absolutely no attention to detail.  Clutter in narrow hallways, bugs in light fixtures, dirty air returns, stained ceiling tiles, stained floors in patient rooms that could have been removed with the swipe of a mop, dirty hallways and elevators, finish molding off of the walls and laying on the floor, bags of garbage being transported by hand through hallways and list goes on.  Not to mention the staff who could have been friendlier as you walked through the hallways.  

The care that was being provided to the patient I was visiting was very good, the nurses were well trained and friendly and the physicians seemed to be on top of their game.  However, my concern was infection based on the types of patients who were being cared for on that particular unit.

Every time that I visit another hospital, I try to take something away from the visit.  For this visit, I will be hardwiring rounding into every executive, director and manager's work life at WMHS.  Not only will we be interacting with patients and staff, but we will be continuing to assess the facility to ensure that it is clean and free of disrepair.  We will also ensure that the care that is being delivered to our patients is appropriate, safe and effective.

Advice From Thomas Friedman

Yesterday, I blogged about the speech by Thomas Friedman at the MHA Annual Meeting.  In his closing, he gave his five points for success in this new world of globalization, and they are as follows:

• First, think like an immigrant by pursuing opportunity with energy and vigor.  
• Second, think like an artisan; take pride in all that you do; be proud to put your name on your work.  
• Thirdly, think like a start up in Silicon Valley by always thinking in Beta.  The new innovators are always working in progress; always re-tooling. 
• Next, PQ + CQ > IQ; persistence and curiosity are always greater than intelligence.  
• Lastly, think like a Perkins waitress.  Friedman's favorite restaurant is a Perkins somewhere in the midwest and this one particular waitress gives extra fruit.  She acts entrepreneurially; she adds value; she gives something unique and extra. 

Actually, Friedman's presentation was both useful and beneficial, but pretty scary.  The changes are coming fast and furious, but if we don't keep up, we will be left behind.

Thomas Friedman / That Used to be Us

What a treat that a group of us had today while attending the Maryland Hospital Association's Annual Meeting.  Thomas Friedman, NY Times columnist, Pulitzer Prize winning author and author of the book, "That Used to be Us: How America Fell Behind in the World It Invented and How We Can Come Back,” was the keynote speaker.  Wow, what a great presentation!  

He spoke of the information technology revolution that has lead us from simply being connected to hyper-connected and from interconnected to interdependent.  IT has lead to total globalization in a few short years.  He said what has played out over the last ten years, took the invention of the printing press over 200 years to accomplish. IT has changed everything, and anyone can be an innovator.  

He told us that average is officially over.  One has to be at least above average with more skill and more tech savviness in order to succeed.  He said that Google no longer necessarily hires individuals with college degrees.  They hire people who can demonstrate what they can do with what they know.  In order to be successful, we have to be innovative and creative, ultimately contributing that extra unique value.  We are fast approaching a bar exam for every job.  Lawyers graduate from law school but they must first demonstrate just how much they know by passing the bar exam in order to be able to practice law.  We will have to show what we can do with what we know in order to be at least above average.  

Stay tuned for tomorrow I will continue to blog about the Friedman presentation; again it was great.

Security in the Emergency Department

Yesterday, consultants from Pinkerton were at WMHS for the report out from their April engagement to assess the security of our ED.  I recognize the vulnerability that exists for our staff while they are at work and I want to make sure that we afford them as much protection as possible.  

Some of the recommendations from Pinkerton included: increased installation of panic alarms for the registration and triage areas; improved lighting outside the ED; better control of visitors (limit to two); add a visitor pass system; add a dedicated security officer in the ED who remains in the ED; add additional cameras in the ED; improve signage for entry to the ED after hours; place large planters outside the ED to better protect treatment rooms with an outside wall from vehicles and better control of the four Forensic / Behavioral Health ED treatment rooms.  

After the discussion, some additional actions that will be taken ASAP include: personal panic alarms for every ED employee; name badges changed to include only the employee's first name and title and increase the use armed law enforcement officers assigned to the ED.  

The study verified a lot of what we already knew and was also complimentary of the security measures that were included when the department was first planned and designed.  It is my intention to create the safest environment for our ED staff in which to work.

Understanding Just What is a Public Health Issue

Last week, there was a Democratic candidates forum in Baltimore for the Maryland Governor's race.  Lt. Gov. Brown was a no show; but then again, he is leading in the polls by a pretty wide margin and his campaign is bringing in a lot of money.  He is the guy to beat so why would he want to have pot shots repeatedly taken at him by the other two candidates?  I kinda agree with his strategy.  

However, what got my attention from the forum were a couple of statements made by Heather Mizeur, a delegate from Montgomery County who is running for Governor.  She is proud of her role in preventing fracking from occurring in western Maryland.  She served on a stacked committee appointed by the Governor to ensure that the environmentally unfriendly process of natural gas fracking never happens, at least while this Governor is in office .  She claims that it is a public health issue and she is championing her opposition to protect Marylanders.  Yet, during the same forum, she is advocating for the legalization of marijuana in Maryland.  Her focus is the dramatic increase in tax revenues that would occur in Maryland through legalization.  But, isn't this a public health issue, as well?  She is going to legalize marijuana with little to no regard for such public health issues as driving fatalities (increased 114% in Colorado since marijuana was legalized); an increase in use of marijuana by youth (which grew in Colorado); a dramatic increase in adult use (which grew considerably in Colorado); a growth in ED visits due to marijuana use; an increase in exposure to children 0 to 5 (which resulted in a 200% increase in Colorado), an increase of marijuana users into drug treatment centers, and that many consider it a gateway drug (just to name a few).  

On a positive note, tax revenues increased substantially and drug arrests are down in Colorado, but it is too early to determine the financial impact on the public's health as a result of the legalization of marijuana.  Sounds like Heather's priorities are a bit skewed.  She should listen to what fellow Democrat, Gov. Jerry Brown of California said about legalizing marijuana, "I am not sure that legalizing marijuana is a good idea because the country could lose its competitive edge if too many people are getting stoned."  He continued, "how many people can get stoned and still have a great state or nation."  Exactly!  It's time for candidate Mizeur to re-visit her platform for a whole host of reasons.