Clinical Quality Council

We had our second meeting of the Clinical Quality Council this week and I am thrilled with the group of physicians serving as members.  They were fully engaged, chomping on the bit to identify issues and projects, asking for ongoing education on clinical integration, penalties associated with potentially preventable complications, information on Maryland's Quality-based Reimbursement Methodology, evidence based guidelines, how to improve documentation and the list goes on.  One day after the meeting, I am hearing of these engaged physicians in the hospital talking about how they can really make a difference in guiding their colleagues toward improved performance and aligned incentives.  Awesome!

Health Care Spending

First and foremost, health care spending in the US is unsustainable. Changing how we do business and bending the cost curve are essential in solving this problem.  But, we need to stop comparing the US and what we spend on health care to other nations.  It is not a fair comparison.  Other nations do not have comparable regulatory oversight that we have in the US nor do they practice defensive medicine like physicians feel that they have to do in the US because of an ongoing feeding frenzy by personal injury attorneys.  Most other countries protect their physicians from frivolous lawsuits, but not the US.  Take Maryland, we have  personal injury attorneys who serve as President of the Senate and Chair of the State Senate's Judiciary Committee; tort reform doesn't have a fighting chance in Maryland.  Clearly, this is an argument for the Op Ed page and not the hospital boardroom, but let's compare apples to apples going forward.

Horrible Bosses

I have been working since I was 16, so I have had my share of bosses.  I have had some great ones; a few were wonderful mentors to whom I attribute my success as a leader.  I have also had some disasters for bosses.  Some who couldn't make a decision for love nor money.  Some whose leadership style was to concentrate the credit on themselves and distribute the blame among everyone else. I had bosses who lied, cheated and even stole (usually the credit). 

I had a new boss early in my administrative career who told me to take a signage package out of a new parking garage that was under construction.  I informed him that the signs were required by City code.  He said that the garage was for employees and that I misinterpreted the regulations.  He told me to revise the signage package to reflect a scaled down version.  I did and asked that he inform the CEO of the change.  He said that he would.  Shortly before the garage was to open, he and I were summoned to the CEO's office.  I was asked by the CEO why I scaled back the signage package knowing full well of the requirements.  I looked at my boss who was sitting in silence. I looked at him again and asked if he wanted to answer the question.  He said that he didn't know what I was talking about.  I accepted responsibility and said that I would rectify the situation immediately, which I did. That was also the day that I realized that I wouldn't be working for him very long.  After the meeting with the CEO, my boss thanked me for covering for him as he didn't want to look bad in front of the CEO since he was new to the organization and I had an established relationship. I suggested that his lack of support never happen again. It didn't, but there were many other occurrences where he pretty much showed himself to be a horrible boss.

The Cost of Regulatory Compliance

I heard an alarming statistic the other day that the current administration is responsible for an average of ten new Federal regulations per day since the President took office nearly three years ago.  The majority rest with the EPA and the Dept of Energy, but healthcare continues to have its share.  In fact, the cost of regulatory compliance in hospitals and health systems nationwide now averages 26% and some estimate as high as 40%.  In Canada, it is 3% and 10% in the United Kingdom.  Although regulations on both a state and federal level are necessary, that's a heck of a lot of money committed to ensuring compliance with the many regulations that we face each day.  Equaling frustrating is the number of regs that are vague or contradictory and always subject to misinterpretation leading to fines, damages and / or penalties.  It is interesting that regulatory compliance is rarely mentioned as a contributing factor to the high cost of healthcare.

Drug Testing

I just read an article yesterday regarding the State of Florida beginning a drug testing requirement for anyone receiving welfare benefits.  Governor Rick Scott's popularity has increased dramatically under the new law and a recent poll has 71% of Florida voters supporting the new law and 27% opposed.   Lots of challenges will occur in the form of repealing the bill and lawsuits however, Florida is off to a strong start.  Maybe the 28% who are opposed would feel differently after learning what the entitlements amount to for each recipient from both the State and the Federal Government.  I am told in Maryland, that in order to do better than an individual who is receiving the various welfare related entitlements that one would have to make greater than $14 per hour.  Let's see how many more States will follow.

Recognition

Coming off of our recent Employee Satisfaction Survey, even though the results aren't fully tallied, one area of focus is routinely, Recognition.  I glance at the book, A Carrot A Day by Gostick and Elton, from time to time as it suggests ways to recognize your employees.  Today's really hit home in that our Executive Management team discussed yesterday a higher level of stress in departments across the Health System of late based on how busy we have been.  The "Carrot" for today suggests that as managers we need to recognize the level of stress and figure out the best stress relievers for the situation.  Whether it's arranging massages through the local college's massage therapy program or stopping at the local Dairy Queen or in our case, the Creamery, for ice cream for the team, a little recognition can go a very long way.

Bending the Cost Curve at WMHS

Just what does it mean to say that you are bending the cost curve?  The cost of health care continues to increase for many reasons, but it needs to be reduced.  We have successfully reduced costs at WMHS by capturing the low hanging fruit, the easy stuff.  We have also implemented a Lean / Six Sigma program that has brought process improvement to the organization (and that work continues).  We are now pushing to improve outcomes, enhance quality and provide better access to patients, especially primary care.   Through our new payment system, Total Patient Revenue, we have virtually changed how we do business overnight.  We are reducing admissions,   working to deliver care in the most appropriate setting, reducing variation in how care and services are delivered, working to align incentives with our physicians around cost, quality and outcomes and focusing on wellness among our employees, their families and our community.  There is so much work to be done in addressing the cost curve, but the good news is that we are clearly on the right track and in many circles ahead of the game.