Dear friends,
As many of you know, I am a relative neophyte in the health care world, taking this CEO position just six years ago. Since then, it has been OJT (on-the-job-training) to learn this business while also using experience from other fields to enhance the working environment for our staff, upgrade the quality of the patient experience for those visiting our hospital, and also try to participate in a helpful way in the public policy debates of our time.
On this latter point, I have seen persistent comments from many observers about the flaws of the US health care system. Those flaws are indeed evident, and it is very healthy for society to focus on them to improve the situation. However, you often hear comparisons of the system in the US with the health care environments in other countries; and those countries are often described as being "ahead of us" on this or that aspect. Such comments, for example, point to greater levels of insured coverage for the population or stronger delivery of primary care.
I used to think that the main reason the US has not moved towards some of the European models of care had mainly mainly to do with the power of interest groups here that causes gridlock at both the state and federal level. And, indeed, I still would not deny the strength of those opposing forces. Yet, I often wondered, if our system is so flawed and "theirs" is so much better, wouldn't political leadership arise to break the logjam and move us in that direction? But, now, having had a chance to view several of those systems more closely, I see that the grass is not nearly so green as one might have thought. Each country has designed variations of insurance and coverage and access for its population, but each country is also going through the same kind of debates as are we -- in the hope of improving the equitable distribution of care, enhancing quality and safety, and increasing efficiency.
My purpose in mentioning this -- which to many of my more experienced and knowledgeable readers may not be news at all -- is not to get into a debate about the relative merits of each country's health care system. It is to make the point that there is a cadre of people around the globe with a strong commonality of interest in learning from one another for the sake of improvement.
When I was first invited to Iceland to meet with health officials from the Nordic countries, I was bemused that they thought I might have anything to offer in their environment of state managed systems. Yet I was told after my meetings there that several of our initiatives at BIDMC were of great interest and potential value in their hospitals. Ditto in the Netherlands. And, just this week, ditto in the UK.
As satisfying as that might be, these visits are even more valuable for me in providing a fresh perspective on issues at my own hospital and in suggesting particular ideas that we might want to borrow to improve how we deliver health care, how we make a better workplace, and how we relate to the community. Equally satisfying, there is a warmth and camaraderie among people engaged in the delivery of care that offers even a newcomer like me entry into the "club" of extremely well-intentioned people who devote their lives to alleviating human suffering caused by disease.
The point of all this rambling? Well, in a somewhat wordy manner, I write this as an open thank-you note to Lord Darzi, David, Ruth, Steven, Rachel, Tom and all their colleagues in the UK for allowing me the opportunity to be in their company, to share ideas, observations, perspectives, and, yes, even some poorly delivered across-the-pond jokes. Although it may not alway be emphasized in some of the press reports about your strategies and plans, your overwhelming sense of public service and desire to build the best possible health care delivery system for your citizenry is ringingly clear.
In our clumsy way here in the US, we pursue the same goal. Whether in a single hospital or for the country as a whole, we do not seek to design, a piori, the best complex system. Like you, we seek to discover it by honestly viewing and admitting our faults and errors in an open, blame-free environment in which respectful engagement leads to constant improvement. Thank you for letting me participate with you to learn from your experience.
Gratefully,
Paul
Tuesday, February 19, 2008
#3 in the world
More to come on my visit to the UK later, but for now the following observation: With about 1.4 million employees, the National Health Service is reportedly the world's third organization, after the Chinese army and the Indian national railway system. Imagine trying to manage process improvement for this group! Nonetheless, I learned of some remarkable innovations being employed and considered. Stayed tuned.
Sunday, February 17, 2008
Good morning, London!
Actually, it is still Sunday night, but I am writing this to ensure an early morning greeting to my friends and colleagues in London in anticipation of a lecture I am giving at Imperial College London at 18:00 on Monday at the Sir Alexander Fleming Building. I look forward to being with my UK colleagues to share information on approaches to lead change in institutions undergoing large-scale transformation. I have been asked to discuss ways of improving engagement with staff and patients, and making changes that increase patient satisfaction. Also, I am to explore ways of -- and benchmarks for -- measuring success in an academic medical center/academic health science center. The session is hosted by Lord Darzi of Denham, KBE, who has taken on a major role in the efforts to enhance the National Health Service.
My audience has already been very tolerant of me. I had previously asked them to read postings on this blog in anticipation of this lecture, and I now notice a loyal readership from the UK every morning as I check my blog statistics. I am looking forward to many questions and comments from the audience, in the hope we can use this occasion to draw on ideas from one another. Speaking of metrics, I suppose a measure of my success will be how many people in the UK continue to read the blog after the lecture!
Meanwhile, inspired by my friend in the posting below, I had a marvelous lunch of fish and chips today at the Sea Shell Restaurant on Lisson Grove.
My audience has already been very tolerant of me. I had previously asked them to read postings on this blog in anticipation of this lecture, and I now notice a loyal readership from the UK every morning as I check my blog statistics. I am looking forward to many questions and comments from the audience, in the hope we can use this occasion to draw on ideas from one another. Speaking of metrics, I suppose a measure of my success will be how many people in the UK continue to read the blog after the lecture!
Meanwhile, inspired by my friend in the posting below, I had a marvelous lunch of fish and chips today at the Sea Shell Restaurant on Lisson Grove.
Saturday, February 16, 2008
Central MA nostalgia: Dubbleyokas
A note from a very good friend in Worcester. You will either identify with it or not. Sorry if you don't.
Do you remember when we were kids occasionally getting a dubbleyoka? Not really having enough to do I have been in search for them for quite a while. I have even been buying farm fresh eggs from Suney's Pub on Chandler Street. They have great fish and chips on Fridays. Well, I had heard a rumor that Fairway beef (this is the Siegel family that used to run Boston Beef) had them -- so yesterday instead of buying eggs at Suney's, though I did have the f&c for lunch, I scooted over to Fairway and bought a 20 egg flat of Super Jumbos (that's right, Super Jumbos!) from Johnson's Egg Farm in Westminster -- ($3.49) -- I also bought some for one of my carpenters -- he is paying me back in coffee all next week -- good deal, huh? Well, these suckas are hug -- big as your fist -- I can't even imagine what they felt like coming out of the chicken. Oh my god! Anyway, I got up early, 5am this morning, to have a couple before work, and, lo and behold, as god is my witness, standing on the graves of our ancestors, two eggs -- two dubbleyokas!
Life is good! There is hope -- Obama can win -- a new day is dawning -- the icecaps are coming back -- peace is possible -- George Bush is history -- and I saw all that in a Circulon 9 incher right here on my stove top in little old Worcester, Mass.
And thanks for listening to me.
Do you remember when we were kids occasionally getting a dubbleyoka? Not really having enough to do I have been in search for them for quite a while. I have even been buying farm fresh eggs from Suney's Pub on Chandler Street. They have great fish and chips on Fridays. Well, I had heard a rumor that Fairway beef (this is the Siegel family that used to run Boston Beef) had them -- so yesterday instead of buying eggs at Suney's, though I did have the f&c for lunch, I scooted over to Fairway and bought a 20 egg flat of Super Jumbos (that's right, Super Jumbos!) from Johnson's Egg Farm in Westminster -- ($3.49) -- I also bought some for one of my carpenters -- he is paying me back in coffee all next week -- good deal, huh? Well, these suckas are hug -- big as your fist -- I can't even imagine what they felt like coming out of the chicken. Oh my god! Anyway, I got up early, 5am this morning, to have a couple before work, and, lo and behold, as god is my witness, standing on the graves of our ancestors, two eggs -- two dubbleyokas!
Life is good! There is hope -- Obama can win -- a new day is dawning -- the icecaps are coming back -- peace is possible -- George Bush is history -- and I saw all that in a Circulon 9 incher right here on my stove top in little old Worcester, Mass.
And thanks for listening to me.
Thursday, February 14, 2008
Fundraising on Facebook
The chart above is from an article on CrunchBase about Facebook, showing the growth in subscribers since the service was opened up to the world beyond students. Amazing quote: "Facebook users’ passion, or addiction, to the site is unparalleled: more than half use the product every single day and users spend an average of 19 minutes a day on Facebook. Facebook is 6th most trafficked site in the US and top photo sharing site with 4.1 billion photos uploaded."I became intrigued with the idea of using the Facebook cause feature as a possible fundraising tool for our hospital after I saw that a neighboring hospital had raised over $50,000 for one of its cancer programs in this manner. So last weekend I set up a cause, called Healing Music, to raise funds for our harp player and other musicians and sent a notice to some friends. It is has been fun to literally watch the viral marketing that results. I don't know if it will raise much money -- although it is a good cause and you should feel free to donate! -- but it is also an excellent way to inform people about a worthwhile feature of our hospital and to share a nice idea with other medical centers as well. (By the way, the fee taken by the people who run the fundraising application, less than 5%, is very reasonable, especially since it costs nothing at all to set up a cause.)
But, beyond this, the wall-to-wall conversations on Facebook can be really entertaining and illustrative of important cultural differences throughout the world. Here, for example, is a post-Super Bowl note from a Boston-bred relative to her good friend in New York:
You know what?! Fine. You won. Good playing. Catch a ball on your head and all that crap. But sending me an invite to join the "Giants fan club"? Not cool.
Learning to get the SPIRIT
More in our continuing series on BIDMC SPIRIT, our effort to enhance the work environment for staff throughout the hospital. Here are additional comments from people who have just gone through the train-the trainers training program. You can get a feel for both the excitement and the nervousness.
I really liked seeing how other areas of the hospital worked. It was nice having a hands on view of the hospital. It was a long day. The information was great, and you have to go over the material before you go out to try it but it is a long day and a lot to digest.
The process [for problem solving] is a plus. Being able to step back from the daily rush and think through an effective process. What’s needed is even more disciplines in this group.
What was great was learning how one problem can have implications in many other areas, something I never would have imagined. An issue is that a think we will need a little bit of handholding in our own areas, once this starts … help working through some problems until we are used to it.
Loved the trainers. They knew their subject. They were knowledgeable. I am not clinical and it was so interesting to see the work on the floors.
My worry is about the areas that are the suppliers to many areas. They are very gung ho right now but even in training they are getting lots of calls and I worry about them being overwhelmed. We need to develop supports for them from Day 1. Even now they are joking that “It’s 2:00 – SPIRIT training time – so my pager is about to go off.” We don’t want them to burn out … [Later in conversation same participant offered the following idea …] It would be helpful if some of the observation visits could take place in those supply departments. I think it would send two messages. The first is that it would help them be prepared to respond more effectively to calls re: real time root cause problem solving. Second, it would send the message that this is about you, too. And that’s important.
The positive was that we went out and did real problem solving on the floor. It was insightful. It was nice to see challenges that other areas face. It was a long day.
Getting out was great. We have never done that in our other trainings. Great. I need the bibliography that was mentioned – this is just a total shift for us – plus that list of tools / helpful hints for working with staff on real time problems. My barrier or worry is that problems that need to go to other areas [for investigation / solution development ] may take time, and may hit barriers. We may need to get back together once we start and look at how well that is working and revisit our efforts there.
I’m coming away from this today with real good tools to attack problems. The trainers were great. It’s good subject matter. It’s a long day but you probably have to do it in one day. Actually using the tools was great.
It was great. The best for me was being on my own floor and getting to use the tools from the AM in the afternoon. It helped me see things I was seeing differently, in a way the staff could see and feel as well … very helpful. It did help me to think about the roots of things, about why the problems I am seeing are occurring. To improve it, I would send ahead more background on change management coming in, and make sure we had more tools going out.
I liked having no choice about where I observed. Given my experience here, I wouldn’t have picked to go back to peri-op because I assumed I knew how everything worked. When I got back there of course I realized I didn’t know how it really worked.
What was great was that it was experiential. It fundamentally changes training. Great. Giving everyone one way to think about problem solving would be huge. As awesome a task as it sounds, it is totally worth undertaking. The negative was the eight hours is not enough to equip a manager to do it effectively. We need a log for the process of implementation itself. A place that issues and struggles can be called out and learning shared. A kind of help chain support for how to be better at it.
The diversity of this group was a huge plus. We need more prerequisites coming in. It’s a little loose at the end. Coming out of these trainings the managers are saying “Oh my G-d.” If we think about it, we could come out of the trainings with a clear sense of next steps that may help everyone come out feeling more positively.
This is really exciting. I didn’t know what to expect on the floor. It was easy to identify problems. If we do it, it will be incredible. If we can make it a way of life. The question is how to do this. One key thing we identified today was the issue of when managers are called [in the help chain] and they haven’t been trained yet, it can be worrisome. They might say they know “who” may have messed up and you want to rush to say “ no, no we’re looking for a system issue” … so that’s an issue and it’s hard to create safety in the moment.
The basic tenet of safety is key. Once established they (participants in problem solving) were much more forthcoming.
I was struck that doing this on a busy unit at a busy time, seemed overwhelming. But the more we circled back to staff as they were able to give us a minute the more things did move along. Seemed more possible.
At the start, so many things will be identified. For the first month, how should we prioritize? I am worried we are about to open Pandora’s box here.
One idea I had today that you may hear about is to once a year have a BIDMC Spirit Award. Something really meaningful. And done in a way that doesn’t convey the message that only this SPIRIT achievement counts and yours doesn’t matter …
It’s the issue of training that keeps me up at night. I don’t want to do this [act as trainer] until we are ready for prime time. We may need more support for a longer period from the people who’ve done this during their whole career.
This is my second time [training to be a trainer]. Last Thursday, my worry was the sense our staff have of handing over problems to you to be solved. Today, we scared several people. It was definitely not our intent. It’s just that people who have not yet been to orientation respond in the old way, as if “I did something wrong.” We are really going to have to work on that.
I am worried about tomorrow on my unit. I will talk to them about this experience today. I am not sure they are going to wait until March 1 to call out. It’s a good thing, I know. As they become more used to identifying problems, it will be a real burden to try to keep up and make this work.
There are tremendous tensions building up in the system about how we are going to be able to do this. Stating the obvious to people about these things is really, really important for leaders to do.
I was struck by how important it is to get the managers involved to work the staff, to not “jump the help chain” straight to the staff level. It’s what’s going to make sustainable solutions possible.
True safety comes in the moment, through the work itself. But can we prepare the culture? Can we have the managers understanding that they are important, they are vital, to work toward sustainable solutions?
I really liked seeing how other areas of the hospital worked. It was nice having a hands on view of the hospital. It was a long day. The information was great, and you have to go over the material before you go out to try it but it is a long day and a lot to digest.
The process [for problem solving] is a plus. Being able to step back from the daily rush and think through an effective process. What’s needed is even more disciplines in this group.
What was great was learning how one problem can have implications in many other areas, something I never would have imagined. An issue is that a think we will need a little bit of handholding in our own areas, once this starts … help working through some problems until we are used to it.
Loved the trainers. They knew their subject. They were knowledgeable. I am not clinical and it was so interesting to see the work on the floors.
My worry is about the areas that are the suppliers to many areas. They are very gung ho right now but even in training they are getting lots of calls and I worry about them being overwhelmed. We need to develop supports for them from Day 1. Even now they are joking that “It’s 2:00 – SPIRIT training time – so my pager is about to go off.” We don’t want them to burn out … [Later in conversation same participant offered the following idea …] It would be helpful if some of the observation visits could take place in those supply departments. I think it would send two messages. The first is that it would help them be prepared to respond more effectively to calls re: real time root cause problem solving. Second, it would send the message that this is about you, too. And that’s important.
The positive was that we went out and did real problem solving on the floor. It was insightful. It was nice to see challenges that other areas face. It was a long day.
Getting out was great. We have never done that in our other trainings. Great. I need the bibliography that was mentioned – this is just a total shift for us – plus that list of tools / helpful hints for working with staff on real time problems. My barrier or worry is that problems that need to go to other areas [for investigation / solution development ] may take time, and may hit barriers. We may need to get back together once we start and look at how well that is working and revisit our efforts there.
I’m coming away from this today with real good tools to attack problems. The trainers were great. It’s good subject matter. It’s a long day but you probably have to do it in one day. Actually using the tools was great.
It was great. The best for me was being on my own floor and getting to use the tools from the AM in the afternoon. It helped me see things I was seeing differently, in a way the staff could see and feel as well … very helpful. It did help me to think about the roots of things, about why the problems I am seeing are occurring. To improve it, I would send ahead more background on change management coming in, and make sure we had more tools going out.
I liked having no choice about where I observed. Given my experience here, I wouldn’t have picked to go back to peri-op because I assumed I knew how everything worked. When I got back there of course I realized I didn’t know how it really worked.
What was great was that it was experiential. It fundamentally changes training. Great. Giving everyone one way to think about problem solving would be huge. As awesome a task as it sounds, it is totally worth undertaking. The negative was the eight hours is not enough to equip a manager to do it effectively. We need a log for the process of implementation itself. A place that issues and struggles can be called out and learning shared. A kind of help chain support for how to be better at it.
The diversity of this group was a huge plus. We need more prerequisites coming in. It’s a little loose at the end. Coming out of these trainings the managers are saying “Oh my G-d.” If we think about it, we could come out of the trainings with a clear sense of next steps that may help everyone come out feeling more positively.
This is really exciting. I didn’t know what to expect on the floor. It was easy to identify problems. If we do it, it will be incredible. If we can make it a way of life. The question is how to do this. One key thing we identified today was the issue of when managers are called [in the help chain] and they haven’t been trained yet, it can be worrisome. They might say they know “who” may have messed up and you want to rush to say “ no, no we’re looking for a system issue” … so that’s an issue and it’s hard to create safety in the moment.
The basic tenet of safety is key. Once established they (participants in problem solving) were much more forthcoming.
I was struck that doing this on a busy unit at a busy time, seemed overwhelming. But the more we circled back to staff as they were able to give us a minute the more things did move along. Seemed more possible.
At the start, so many things will be identified. For the first month, how should we prioritize? I am worried we are about to open Pandora’s box here.
One idea I had today that you may hear about is to once a year have a BIDMC Spirit Award. Something really meaningful. And done in a way that doesn’t convey the message that only this SPIRIT achievement counts and yours doesn’t matter …
It’s the issue of training that keeps me up at night. I don’t want to do this [act as trainer] until we are ready for prime time. We may need more support for a longer period from the people who’ve done this during their whole career.
This is my second time [training to be a trainer]. Last Thursday, my worry was the sense our staff have of handing over problems to you to be solved. Today, we scared several people. It was definitely not our intent. It’s just that people who have not yet been to orientation respond in the old way, as if “I did something wrong.” We are really going to have to work on that.
I am worried about tomorrow on my unit. I will talk to them about this experience today. I am not sure they are going to wait until March 1 to call out. It’s a good thing, I know. As they become more used to identifying problems, it will be a real burden to try to keep up and make this work.
There are tremendous tensions building up in the system about how we are going to be able to do this. Stating the obvious to people about these things is really, really important for leaders to do.
I was struck by how important it is to get the managers involved to work the staff, to not “jump the help chain” straight to the staff level. It’s what’s going to make sustainable solutions possible.
True safety comes in the moment, through the work itself. But can we prepare the culture? Can we have the managers understanding that they are important, they are vital, to work toward sustainable solutions?
Wednesday, February 13, 2008
To write or not to write
So, here's the moral dilemma. Three of your favorite bloggers -- Jessica Lipnack, John Halamka, and I -- were invited to attend tonight's performance of Julius Caeser at the American Repertory Theatre in Cambridge, MA, and then blog about it. This is part of an experiment by ART to link into social media and other outlets to expand the experience of the actual stage performance. We were given free tickets and were told we could write anything we want.
Even before the performance, I felt a bit awkward. Truthfully, I have not gone to the ART in years because I gave up several years ago after attending many shows that I thought were pretty awful. But, I figured this would be fun and, hey, maybe it was time to give the company another chance. Nonetheless, I expressed concern: What if I didn't like the show? Was I somehow obliged to say nice things because I had been given a free ticket?
We were assured otherwise. No obligations. No conditions.
Well, let's just say that I was disappointed. The show had poor pacing. And, as we would say in music, it had no dynamic variation.
But the writing was really spectacular. This fellow Shakespeare deserves a lot of credit.
There was one segment in particular that made me and the person behind me gasp as we heard it. It is Act III, Scene 1, right after Caesar is murdered. After Brutus suggests that they bathe their hands in Caesar's blood, Cassius says:
Stoop then, and wash. How many ages hence
Shall this lofty scene be acted over,
In state unborn and accents yet unknown.
I think we gasped because we were reminded of how many times political aggression and murder are undertaken by people couching their actions in terms of bringing liberty to the population, but who really are driven by the same desire for power as their predecessors. Shakespeare's theme from hundreds of years ago has been replayed over and over again through the centuries, even to our own time. Thanks to the ART for the vivid reminder.
Even before the performance, I felt a bit awkward. Truthfully, I have not gone to the ART in years because I gave up several years ago after attending many shows that I thought were pretty awful. But, I figured this would be fun and, hey, maybe it was time to give the company another chance. Nonetheless, I expressed concern: What if I didn't like the show? Was I somehow obliged to say nice things because I had been given a free ticket?
We were assured otherwise. No obligations. No conditions.
Well, let's just say that I was disappointed. The show had poor pacing. And, as we would say in music, it had no dynamic variation.
But the writing was really spectacular. This fellow Shakespeare deserves a lot of credit.
There was one segment in particular that made me and the person behind me gasp as we heard it. It is Act III, Scene 1, right after Caesar is murdered. After Brutus suggests that they bathe their hands in Caesar's blood, Cassius says:
Stoop then, and wash. How many ages hence
Shall this lofty scene be acted over,
In state unborn and accents yet unknown.
I think we gasped because we were reminded of how many times political aggression and murder are undertaken by people couching their actions in terms of bringing liberty to the population, but who really are driven by the same desire for power as their predecessors. Shakespeare's theme from hundreds of years ago has been replayed over and over again through the centuries, even to our own time. Thanks to the ART for the vivid reminder.
Tuesday, February 12, 2008
You can take your $15 fee and ... !
In the past, I have sometimes used this blog to refer to articles from medical journals when I felt they had broad public interest. Sometimes, those articles have not been available to the general public because they were only available by subscription. From time to time, commentors to this blog have complained about this. I have let those comments go by without reply.
But, finally, I have had enough. I want to state this clearly and directly: When a respected medical journal issues a press release about a given article that has important public policy ramifications but does not make available the full text of the article, it is a bad thing. It inhibits full public understanding of the issue and makes us beholden to other people's interpretation of the article. It is inconsistent with the general principle of academic discourse and also is counterproductive in facilitating an informed debate on issues.
Here is today's example, from the Journal of the American Medical Association ("JAMA"). Last week, I received the following email from the AAMC (Association of American Medical Colleges):
The Feb. 13 issue of JAMA will include an article on a new study examining the status of institutional conflicts of interest policies at U.S. medical schools. The study was undertaken by the AAMC and Massachusetts General Hospital, and provides the first national data on medical school policies and practices for dealing with institutional financial conflicts of interest. Susan Ehringhaus, associate general counsel for regulatory affairs in AAMC's division of biomedical and health sciences research, is the lead author on the article.
This topic is clearly of great public interest and import, and so I asked the question of whether the full article would be available for reading upon publication. The answer I received today was, "No." Checking the JAMA website, I confirmed this. I can read the titles, the authors, and a short abstract. But I can't read the article and reach my own conclusions about the methodology employed, the assumptions made, and the results.
I can even read a press release issued by the AAMC about the article. But I can't read the article and reach my own conclusions about the methodology employed, the assumptions made, and the results.
Tomorrow, I may be able to read newspaper reports about the article. But I can't read the article and reach my own conclusions about the methodology employed, the assumptions made, and the results.
Oh wait, I can, if I pay $15 (plus tax) for the privilege of having 24 hours of access to the article, and only from the computer I am currently using.
Please understand that I do not begrudge journals that need to charge subscriptions to stay in business. But I find it upsetting when a respected journal issues an occasional article about an important public policy issue and does not allow wide and unhampered circulation. Surely, allowing open access on such a matter can only enhance the reputation of the journal. Restricting it is totally unnecessary and, beyond the mercenary aspects, feels elitist and condescending, a reputation the medical profession does not need to reinforce.
But, finally, I have had enough. I want to state this clearly and directly: When a respected medical journal issues a press release about a given article that has important public policy ramifications but does not make available the full text of the article, it is a bad thing. It inhibits full public understanding of the issue and makes us beholden to other people's interpretation of the article. It is inconsistent with the general principle of academic discourse and also is counterproductive in facilitating an informed debate on issues.
Here is today's example, from the Journal of the American Medical Association ("JAMA"). Last week, I received the following email from the AAMC (Association of American Medical Colleges):
The Feb. 13 issue of JAMA will include an article on a new study examining the status of institutional conflicts of interest policies at U.S. medical schools. The study was undertaken by the AAMC and Massachusetts General Hospital, and provides the first national data on medical school policies and practices for dealing with institutional financial conflicts of interest. Susan Ehringhaus, associate general counsel for regulatory affairs in AAMC's division of biomedical and health sciences research, is the lead author on the article.
This topic is clearly of great public interest and import, and so I asked the question of whether the full article would be available for reading upon publication. The answer I received today was, "No." Checking the JAMA website, I confirmed this. I can read the titles, the authors, and a short abstract. But I can't read the article and reach my own conclusions about the methodology employed, the assumptions made, and the results.
I can even read a press release issued by the AAMC about the article. But I can't read the article and reach my own conclusions about the methodology employed, the assumptions made, and the results.
Tomorrow, I may be able to read newspaper reports about the article. But I can't read the article and reach my own conclusions about the methodology employed, the assumptions made, and the results.
Oh wait, I can, if I pay $15 (plus tax) for the privilege of having 24 hours of access to the article, and only from the computer I am currently using.
Please understand that I do not begrudge journals that need to charge subscriptions to stay in business. But I find it upsetting when a respected journal issues an occasional article about an important public policy issue and does not allow wide and unhampered circulation. Surely, allowing open access on such a matter can only enhance the reputation of the journal. Restricting it is totally unnecessary and, beyond the mercenary aspects, feels elitist and condescending, a reputation the medical profession does not need to reinforce.
Another type of poll: Is it accurate?
I am not taking sides. I am just wondering.
While we are talking below about social media, does it mean anything that Barack Obama has over 500,000 members in his Facebook group and Hillary Clinton has just over 110,000?
John McCain, by the way, has 58,000.
While we are talking below about social media, does it mean anything that Barack Obama has over 500,000 members in his Facebook group and Hillary Clinton has just over 110,000?
John McCain, by the way, has 58,000.
Grand Rounds is up
David Harlow provides a Valentine's theme this week on Grand Rounds. Nicely done!
Monday, February 11, 2008
What's your social media score?
Well over a year ago, John Bell published a blog entry that gave people a chance to measure their company's social media score. As I re-read the checklist this week, I realized how much progress BIDMC and our staff and I had made in this regard. I also noted how little progress many of my colleagues in the health care industry had made. Meanwhile, other industries (and politicians) are zooming along and incorporating social media into their advertising, marketing, communications, and internal operations.
Just for fun, I compare the answers I would have given for BIDMC in late 2006 with what we would answer today.
Does anyone within the company already blog? (including personal blogs). Yes/yes. (2006/2008)
Do any of these existing bloggers post on business related issues (vs. personal blogs)? Yes/yes.
Has senior management stopped making jokes whenever a junior staffer mentions the word "wiki" in a meeting? No/yes.
Have you ever invited customers or stakeholders to a company meeting just to hear their perspective? No/yes.
Have you ever published public information - done an interview, released some news, said something publicly - without prior written approval from the legal department? Yes/yes.
Is Web publishing decentralized in your organization. No/yes.
Do you have RSS feeds on your corporate Web site? No/no.
Does your communications team value more than big media clips? No/yes.
Does your company reward entrepreneurial behavior from within the organization? Yes/yes.
Does your C-level leadership (CEO, CMO, COO, etc...) understand the difference between Robert Scoble and Bob Lutz? No/yes.
Has your marcom team read 30 blog posts from at least 10 blogs over the last two weeks? No/yes.
Has your marcom team downloaded and watched/listened to audio or video podcasts? No/yes.
Yes to 0-4 questions: Your organization is not ready.
Yes to 5-8 questions: Your organization is ready to listen.
Yes to 8-12 questions: you are probably more ready than most.
Summary for BIDMC: 2006 -- 4 yes; 2008 -- 11 yes.
But let's ask some more questions that were not included in Mr. Bell's original survey:
Do you regularly survey employees and rely on majority rule for matters of corporate significance? No/yes. (2006/2008)
Do you regularly post clinical information (e.g., on infection rates) on your corporate website for the world to see? No/yes.
Do you post results of Joint Commission accreditation surveys on your corporate website for the world to see? No/yes.
Do you post the results of patient satisfaction surveys on your corporate website for the world to see? No/yes.
Do any senior managers in the company post their profile on Facebook and communicate with staff through this medium? No/yes.
Have you pretty much given up on purchasing newspaper ads and rely instead on social media for marketing and communication. No/yes.
Just for fun, I compare the answers I would have given for BIDMC in late 2006 with what we would answer today.
Does anyone within the company already blog? (including personal blogs). Yes/yes. (2006/2008)
Do any of these existing bloggers post on business related issues (vs. personal blogs)? Yes/yes.
Has senior management stopped making jokes whenever a junior staffer mentions the word "wiki" in a meeting? No/yes.
Have you ever invited customers or stakeholders to a company meeting just to hear their perspective? No/yes.
Have you ever published public information - done an interview, released some news, said something publicly - without prior written approval from the legal department? Yes/yes.
Is Web publishing decentralized in your organization. No/yes.
Do you have RSS feeds on your corporate Web site? No/no.
Does your communications team value more than big media clips? No/yes.
Does your company reward entrepreneurial behavior from within the organization? Yes/yes.
Does your C-level leadership (CEO, CMO, COO, etc...) understand the difference between Robert Scoble and Bob Lutz? No/yes.
Has your marcom team read 30 blog posts from at least 10 blogs over the last two weeks? No/yes.
Has your marcom team downloaded and watched/listened to audio or video podcasts? No/yes.
Yes to 0-4 questions: Your organization is not ready.
Yes to 5-8 questions: Your organization is ready to listen.
Yes to 8-12 questions: you are probably more ready than most.
Summary for BIDMC: 2006 -- 4 yes; 2008 -- 11 yes.
But let's ask some more questions that were not included in Mr. Bell's original survey:
Do you regularly survey employees and rely on majority rule for matters of corporate significance? No/yes. (2006/2008)
Do you regularly post clinical information (e.g., on infection rates) on your corporate website for the world to see? No/yes.
Do you post results of Joint Commission accreditation surveys on your corporate website for the world to see? No/yes.
Do you post the results of patient satisfaction surveys on your corporate website for the world to see? No/yes.
Do any senior managers in the company post their profile on Facebook and communicate with staff through this medium? No/yes.
Have you pretty much given up on purchasing newspaper ads and rely instead on social media for marketing and communication. No/yes.
Sunday, February 10, 2008
Life Disrupted, a preview
Fellow blogger Laurie Edwards from A Chronic Dose is working on a book, to be published by Walker and Company in July, entitled Life Disrupted, Getting Real About Chronic Illness in your Twenties and Thirties. I was asked to review it and, without giving away lots of it, I want to tell you that is it beautifully written and will be extremely helpful both to young people with chronic illness and their friends, families, and associates.
Here is one excerpt that I found particularly moving, from a chapter entitled "Salient Suffering":
Suffering doesn't make you a better person, in the sense that a person with these challenges is somehow more noble or "good" in a moral way. But I think there's another dimension to this notion of being a better sufferer, one stripped of greeting-card-inspired platitudes and skewed interpretations of what it means to live with illness. The more you suffer, the more you are able to recognize suffering in others. The fact that our experiences make us privy to this knowledge is a privilege I think gets lost in the "suffering saint" attributes of illness, but what we do with that knowledge is what really counts. We're not better people because we can empathize with someone's struggle with infertility or migraines or because we can nod our heads in understanding when someone is frustrated about a diagnosis or a side effect. However, if we are able to channel accumulated patient experiences in a way that somehow makes a positive impact on someone else in a similar situation, then there is something redemptive about our suffering.
Here is one excerpt that I found particularly moving, from a chapter entitled "Salient Suffering":
Suffering doesn't make you a better person, in the sense that a person with these challenges is somehow more noble or "good" in a moral way. But I think there's another dimension to this notion of being a better sufferer, one stripped of greeting-card-inspired platitudes and skewed interpretations of what it means to live with illness. The more you suffer, the more you are able to recognize suffering in others. The fact that our experiences make us privy to this knowledge is a privilege I think gets lost in the "suffering saint" attributes of illness, but what we do with that knowledge is what really counts. We're not better people because we can empathize with someone's struggle with infertility or migraines or because we can nod our heads in understanding when someone is frustrated about a diagnosis or a side effect. However, if we are able to channel accumulated patient experiences in a way that somehow makes a positive impact on someone else in a similar situation, then there is something redemptive about our suffering.
Saturday, February 09, 2008
Life in Balad, aka Mortarritaville
Excerpts of a note, reprinted with her permission, from Major Kristin Messer, one of our nurses on duty providing medical care to the wounded in Iraq:
Hi Everyone,
Well, we've been here for about three weeks now and I think I'm finally "settled" in and trying to get used to things. For those of you who don't know where I am, it's at Balad Air Base/LSA Anaconda. It's about 20 miles northeast of Baghdad, right in the middle of the Sunni Triangle. Its nickname is "Mortarritaville" because it's mortared on daily basis. Luckily for us, the bad guys have lousy aim!!
When we first arrived, I didn't think I'd make it. There were four of us in about a 10 x 10 room, all working different shifts, so not much sleep. Then there was the noise of the constant Black Hawks, Chinook helicopters (those are the huge Marine helicopters), F16s, C17s, etc. that literally rattle your room as they go overhead. I'm sort of used to that now and I can sleep through some of it. The bathrooms and shower (called "Cadillacs") are about a 300 yard walk from the room. So there you are in the middle of the night, having to go to the bathroom, up on a top bunk, with no ladder. Not wanting to slither quietly out of the top bunk and then have to don your PT (physical training) gear for the 300 yard walk out in the cold, you lie there debating with yourself, "Should I get up, can I hold it until I get up?" Ultimately, the bladder always wins. After a couple of those nights, I've decided to cut myself back to just three-four liters of water a day and to stop drinking liquids by 7 pm...no debates with myself since!! When the two other people in our room finally left (about a week later) and we were able to unpack and have a little more space it was much better.
Since the moment we arrived, we were put to work, 12 hours/day for about a week and a half without a day off. We're now able to take some time off. We work four 12 hour days, have a day off, work four 12 hour days and then on call for a day...and then the schedule repeats itself. When we walk back and forth to work, we have to wear our kevlar gear or IBA (individual body armor) that weighs 43 pounds, along with my trusty 9mm weapon at my side. At first it felt as though it weighed a ton, but you sort of get used to it...now it feels like about 10 pounds. My goal when I got here was to do at least one push up by the time I leave here with the IBA on...I'll take pictures to prove it!! This place is probably a bit like a minimal security prison...you're only allowed to wear two outfits: either your regular uniform or your PT gear and that's it! And you get three lousy square meals/day...actually I bet real prisoners get better food! Our housing units (there like the worst trailers you've ever seen), are lined with sand bags on the outside and then surrounded with 20 foot concrete barriers around the different sections of trailers. Surrounding the entire housing area is a security fence with razor wire on top. We get in and out of the complex through a security gate with a combination...so we let ourselves out and then we let ourselves back into the 'prison' after our shifts. The base itself is quite large. It's Air Force, Army, Marines, civilians and third country nationalists. There are about 35,000 of us here.
Our water supply here is fed by the Tigris River and apparently all the pumps/filter systems that feed the base are ancient and in desperate need of major repairs. So in part of letting the Iraqi's take their country back, they are fixing all the equipment. The down side of this is that they didn't warn us when they were going to start and they work slowly. The result?? Four straight days without water for 35,000 people. That means NO SHOWERS! It's now back in small amounts so we are allowed to shower on "even" days. However, those showers are "3 minute combat showers." In other words, get wet, shut the water off, lather up, rinse off...that's it. The shower stalls themselves are probably about a foot square in diameter. Now there is truth behind "don't drop the soap." If you do and then try to bend over and pick it up, you knock your against the wall and your butt hits the faucets. You can't even put your arms up to wash your hair without your elbows hitting the walls! From what were told, this repair could take 3-4 weeks! I can't wait to be able to take a shower without shutting the water off, being able to move, not wear flip flops, stay in there for more than 3 minutes and not have to walk a quarter of a mile to get there! But that's not going to happen until I get back.
It's especially picturesque around here when it rains. This time of year is considered their rainy season, but honestly, it really hasn't been that bad. When it does rain, even drizzle, it is miserable. The terrain here is just dirt and rocks and since there's no drainage/sewer system, the dirt turns to thick, sticky mud. When you step in it, it's like quick sand with suction cups, it sucks your foot right in. Then when you try to walk on the rocks to get rid of the mud, the mud then becomes super glue-like and all the rocks stick to your shoes. So you're walking around with all kind of rocks on the bottom of your shoes trying to balance yourself...not too safe. I've already twisted both ankles by snapping them on rocks I never saw. One resulted in a fall...I went from an upright position to flat on my face in an instant...thank God the ground was dry and no one witnessed it. My first thought? Dear God, I hope I can get up with this flak vest that weighs 43 pounds!! I think it was the thought that someone might see me and I popped right back up!
The hospital here is fairly new, with out 360 people working here. The majority of our patients are Iraqi's...both good and bad. It's tough taking care of the insurgents! The hospital has a helipad right outside where I work (it's actually 4 pads in one area) and we have Black Hawks and Chinooks landing all day long. From the helipad, you can see the perimeter wall about 200 yds. away. I am still wondering what genius in the military thought to build a hospital that close to the perimeter!! Now that it's been here for two years and they're realizing its close proximity to the "wire," they're building a double, reinforced, steel & concrete roof over the hospital!
I began this e-mail yesterday, but was unable to finish, so hopefully I can finish today...yesterday was a bad day. We've had some good days and some bad days and I'm praying that yesterday was the worst. Unfortunately, we had three American troops come in, who were killed in action. When they were entering a home, it was booby trapped with IED's and three of the eight men were instantly killed. I will never be able to erase those images. When a fallen troop is bought in, they have a beautiful ceremony here in the ER that is called "Fallen Angel." The first time I witnessed it was on our second day here and I was praying that I'd never have to see it again. Unfortunately, that has not been the case. In the middle of the Super Bowl, we had 3 KIA's come in and instantly, it puts everything into perspective, the game didn't matter, the water shortage didn't matter and neither did the lack of communication that we've become some reliable on. None of it mattered. What mattered was the reason we're all here. When we lose a troop or a KIA comes in, everyone gets in a big circle around the body in the ER, the Chaplain says a prayer and then a huge American flag is unfurled by an honor guard. The flag is then tucked around the body, then everyone stands at attention and salutes as the body is taken out. No matter how many times you see this, it doesn't get any easier and there's never a dry eye in the place. When it's three at once, it's even more difficult. I pray that we don't have any more of these.
I hope and pray that this note finds you all well and please keep praying for our troops.
Talk to you all soon.
Kristin
Hi Everyone,
Well, we've been here for about three weeks now and I think I'm finally "settled" in and trying to get used to things. For those of you who don't know where I am, it's at Balad Air Base/LSA Anaconda. It's about 20 miles northeast of Baghdad, right in the middle of the Sunni Triangle. Its nickname is "Mortarritaville" because it's mortared on daily basis. Luckily for us, the bad guys have lousy aim!!
When we first arrived, I didn't think I'd make it. There were four of us in about a 10 x 10 room, all working different shifts, so not much sleep. Then there was the noise of the constant Black Hawks, Chinook helicopters (those are the huge Marine helicopters), F16s, C17s, etc. that literally rattle your room as they go overhead. I'm sort of used to that now and I can sleep through some of it. The bathrooms and shower (called "Cadillacs") are about a 300 yard walk from the room. So there you are in the middle of the night, having to go to the bathroom, up on a top bunk, with no ladder. Not wanting to slither quietly out of the top bunk and then have to don your PT (physical training) gear for the 300 yard walk out in the cold, you lie there debating with yourself, "Should I get up, can I hold it until I get up?" Ultimately, the bladder always wins. After a couple of those nights, I've decided to cut myself back to just three-four liters of water a day and to stop drinking liquids by 7 pm...no debates with myself since!! When the two other people in our room finally left (about a week later) and we were able to unpack and have a little more space it was much better.
Since the moment we arrived, we were put to work, 12 hours/day for about a week and a half without a day off. We're now able to take some time off. We work four 12 hour days, have a day off, work four 12 hour days and then on call for a day...and then the schedule repeats itself. When we walk back and forth to work, we have to wear our kevlar gear or IBA (individual body armor) that weighs 43 pounds, along with my trusty 9mm weapon at my side. At first it felt as though it weighed a ton, but you sort of get used to it...now it feels like about 10 pounds. My goal when I got here was to do at least one push up by the time I leave here with the IBA on...I'll take pictures to prove it!! This place is probably a bit like a minimal security prison...you're only allowed to wear two outfits: either your regular uniform or your PT gear and that's it! And you get three lousy square meals/day...actually I bet real prisoners get better food! Our housing units (there like the worst trailers you've ever seen), are lined with sand bags on the outside and then surrounded with 20 foot concrete barriers around the different sections of trailers. Surrounding the entire housing area is a security fence with razor wire on top. We get in and out of the complex through a security gate with a combination...so we let ourselves out and then we let ourselves back into the 'prison' after our shifts. The base itself is quite large. It's Air Force, Army, Marines, civilians and third country nationalists. There are about 35,000 of us here.
Our water supply here is fed by the Tigris River and apparently all the pumps/filter systems that feed the base are ancient and in desperate need of major repairs. So in part of letting the Iraqi's take their country back, they are fixing all the equipment. The down side of this is that they didn't warn us when they were going to start and they work slowly. The result?? Four straight days without water for 35,000 people. That means NO SHOWERS! It's now back in small amounts so we are allowed to shower on "even" days. However, those showers are "3 minute combat showers." In other words, get wet, shut the water off, lather up, rinse off...that's it. The shower stalls themselves are probably about a foot square in diameter. Now there is truth behind "don't drop the soap." If you do and then try to bend over and pick it up, you knock your against the wall and your butt hits the faucets. You can't even put your arms up to wash your hair without your elbows hitting the walls! From what were told, this repair could take 3-4 weeks! I can't wait to be able to take a shower without shutting the water off, being able to move, not wear flip flops, stay in there for more than 3 minutes and not have to walk a quarter of a mile to get there! But that's not going to happen until I get back.
It's especially picturesque around here when it rains. This time of year is considered their rainy season, but honestly, it really hasn't been that bad. When it does rain, even drizzle, it is miserable. The terrain here is just dirt and rocks and since there's no drainage/sewer system, the dirt turns to thick, sticky mud. When you step in it, it's like quick sand with suction cups, it sucks your foot right in. Then when you try to walk on the rocks to get rid of the mud, the mud then becomes super glue-like and all the rocks stick to your shoes. So you're walking around with all kind of rocks on the bottom of your shoes trying to balance yourself...not too safe. I've already twisted both ankles by snapping them on rocks I never saw. One resulted in a fall...I went from an upright position to flat on my face in an instant...thank God the ground was dry and no one witnessed it. My first thought? Dear God, I hope I can get up with this flak vest that weighs 43 pounds!! I think it was the thought that someone might see me and I popped right back up!
The hospital here is fairly new, with out 360 people working here. The majority of our patients are Iraqi's...both good and bad. It's tough taking care of the insurgents! The hospital has a helipad right outside where I work (it's actually 4 pads in one area) and we have Black Hawks and Chinooks landing all day long. From the helipad, you can see the perimeter wall about 200 yds. away. I am still wondering what genius in the military thought to build a hospital that close to the perimeter!! Now that it's been here for two years and they're realizing its close proximity to the "wire," they're building a double, reinforced, steel & concrete roof over the hospital!
I began this e-mail yesterday, but was unable to finish, so hopefully I can finish today...yesterday was a bad day. We've had some good days and some bad days and I'm praying that yesterday was the worst. Unfortunately, we had three American troops come in, who were killed in action. When they were entering a home, it was booby trapped with IED's and three of the eight men were instantly killed. I will never be able to erase those images. When a fallen troop is bought in, they have a beautiful ceremony here in the ER that is called "Fallen Angel." The first time I witnessed it was on our second day here and I was praying that I'd never have to see it again. Unfortunately, that has not been the case. In the middle of the Super Bowl, we had 3 KIA's come in and instantly, it puts everything into perspective, the game didn't matter, the water shortage didn't matter and neither did the lack of communication that we've become some reliable on. None of it mattered. What mattered was the reason we're all here. When we lose a troop or a KIA comes in, everyone gets in a big circle around the body in the ER, the Chaplain says a prayer and then a huge American flag is unfurled by an honor guard. The flag is then tucked around the body, then everyone stands at attention and salutes as the body is taken out. No matter how many times you see this, it doesn't get any easier and there's never a dry eye in the place. When it's three at once, it's even more difficult. I pray that we don't have any more of these.
I hope and pray that this note finds you all well and please keep praying for our troops.
Talk to you all soon.
Kristin
Friday, February 08, 2008
Thursday, February 07, 2008
Trainees report back and train trainers
As promised, I want to keep you up to date on our experiences as we implement BIDMC SPIRIT, our process improvement program of the sort described by Steve Spear. We are now at the stage of orienting people and training the trainers, the people on our staff who will train over 600 staff members in the techniques of calling out problems and pulling together help teams to solve them. We are assisted by some folks from a firm called Value Capture, which was founded by Paul O'Neill based on his experience at Alcoa.
After the first session, as part of an effort to improve the orientation and training sessions themselves, the group leader asked:
“Tell me one thing that was great or positive about today/SPIRIT so far … and one thing that was negative or is worrying you.”
Here are the replies:
Great: The observations, the real time problem solving and action plan development. The wonderful openness of Donna (director) and her team. Some of the role plays. Today was an incredibly useful exercise. The train the trainer approach is the right one. Scary to think about doing the training, but workable. As valuable as the Value Capture people are it’s important that we show we really own this in as many ways as we can. What was bad or am I worried about? It’s a long day! The chairs were bad. The room. We are training several hundred people, but only a small portion by March 1st. I am worried we will not have enough people ready with the language and the tools. But somehow I think it will work out. We need to manage expectations and the anxiety. We need to tell people we will not be great at this at first … but it will be a start.
Ditto to everything above. Great was the observation and work on the areas we went to – that was the highlight. We called out that the PACU role play should be further simplified (told as a simple story, holding discussion until end). I also agree about changing the room.
I came in with skepticism … a lot of skepticism … and I am leaving feeling a lot better, less skeptical. Going through this was transformative. My worry is that there are still 1,000 things to learn … will we be ready? Should we cut our teeth by piloting this in a few units first?
Great: The observation and the hands on problem solving. The willingness of the staff to participate! They were really ready. They knew about SPIRIT from Paul’s messages. My worry is the same. Do we really have the readiness to train? Will management be ready. Should we ramp up from a pilot?
Great: I was pleased to see the staff’s wariness melt and the problem solving process become fun! I worry that we have to get it deep enough down to the front line staff level. Use the code team example – have an outsider who wears the lanyard who can come and help – objective eyes in an observer – together with maintaining the transparency. Those are the keys to make it safe.
I see that this could be so incredible. But I worry there on the same count. Will we be able to be fully engaged and work staff through the barriers … to really get this rolling. I am somewhat overwhelmed by the number of problems. I don’t want to let staff down. We want it to work for them.
I see the positive culture change here. I loved the value of outside eyes for problem solving. We need to add the additional helpful hints, watch outs, useful phrases to help managers approach this w/employees in real time.
This is transformative. In the middle of doing the work on the floor today it hit me. Earlier in the day, I was hung up on the connection between the log and problem solving, and then it hit me – Is this a tool or is it about a new process and way of thinking about problems. It’s the latter.
Great: It’s simple steps … we laid it out easily and we followed it. Not easy to do but still good. It’s easy to understand (the method). What worries me? We have different skill levels in the organization. I worry about will it be used at a level that it will be used well? I’m worried about time. I worried that we’ll be able to take time away from other things, especially when it’s patient care. I need more tools as a trainer. I’d like more exposure to the help chain; we didn’t have to use it in our problem.
The observation opportunity was fantastic. We struck gold with our group and problem and the staff we worked with. What’s positive is we are pushing decision-making closer to the people who do the work. I worry about training. I need more problem solving exercises to feel comfortable as a potential trainer. Also, I think this is OK/great in departments with a participatory culture, but in departments with different norms if not implemented and supported well it could be quite harmful to the people. We need to think about the involvement of coaches/outside eyes.
I went from being skeptical on the (problem solving) log to feeling it could be very useful … and applied to all kinds of problems. The last module on the log was very useful.
In terms of worries: We have not been good enough messaging that this process is for hunting and fetching problems. We’ve got to be clear about what this is for. And also for the other systems that we are preserving.
Keep in mind, it’s hard when a few things are still blurry. But consider how this is being designed as a process to improve as improvements are suggested. It’s already been improved and will continue to do so.
Have Paul continue to message directly to the staff on this. They hear him. He is such a popular figure. He is clear. They also listen because he doesn’t fill up our e-mail with too many things.
I’d like another review session, to help prepare as a trainer (in addition to the planned development sequence – just a couple hours to go over the design, etc).
After the first session, as part of an effort to improve the orientation and training sessions themselves, the group leader asked:
“Tell me one thing that was great or positive about today/SPIRIT so far … and one thing that was negative or is worrying you.”
Here are the replies:
Great: The observations, the real time problem solving and action plan development. The wonderful openness of Donna (director) and her team. Some of the role plays. Today was an incredibly useful exercise. The train the trainer approach is the right one. Scary to think about doing the training, but workable. As valuable as the Value Capture people are it’s important that we show we really own this in as many ways as we can. What was bad or am I worried about? It’s a long day! The chairs were bad. The room. We are training several hundred people, but only a small portion by March 1st. I am worried we will not have enough people ready with the language and the tools. But somehow I think it will work out. We need to manage expectations and the anxiety. We need to tell people we will not be great at this at first … but it will be a start.
Ditto to everything above. Great was the observation and work on the areas we went to – that was the highlight. We called out that the PACU role play should be further simplified (told as a simple story, holding discussion until end). I also agree about changing the room.
I came in with skepticism … a lot of skepticism … and I am leaving feeling a lot better, less skeptical. Going through this was transformative. My worry is that there are still 1,000 things to learn … will we be ready? Should we cut our teeth by piloting this in a few units first?
Great: The observation and the hands on problem solving. The willingness of the staff to participate! They were really ready. They knew about SPIRIT from Paul’s messages. My worry is the same. Do we really have the readiness to train? Will management be ready. Should we ramp up from a pilot?
Great: I was pleased to see the staff’s wariness melt and the problem solving process become fun! I worry that we have to get it deep enough down to the front line staff level. Use the code team example – have an outsider who wears the lanyard who can come and help – objective eyes in an observer – together with maintaining the transparency. Those are the keys to make it safe.
I see that this could be so incredible. But I worry there on the same count. Will we be able to be fully engaged and work staff through the barriers … to really get this rolling. I am somewhat overwhelmed by the number of problems. I don’t want to let staff down. We want it to work for them.
I see the positive culture change here. I loved the value of outside eyes for problem solving. We need to add the additional helpful hints, watch outs, useful phrases to help managers approach this w/employees in real time.
This is transformative. In the middle of doing the work on the floor today it hit me. Earlier in the day, I was hung up on the connection between the log and problem solving, and then it hit me – Is this a tool or is it about a new process and way of thinking about problems. It’s the latter.
Great: It’s simple steps … we laid it out easily and we followed it. Not easy to do but still good. It’s easy to understand (the method). What worries me? We have different skill levels in the organization. I worry about will it be used at a level that it will be used well? I’m worried about time. I worried that we’ll be able to take time away from other things, especially when it’s patient care. I need more tools as a trainer. I’d like more exposure to the help chain; we didn’t have to use it in our problem.
The observation opportunity was fantastic. We struck gold with our group and problem and the staff we worked with. What’s positive is we are pushing decision-making closer to the people who do the work. I worry about training. I need more problem solving exercises to feel comfortable as a potential trainer. Also, I think this is OK/great in departments with a participatory culture, but in departments with different norms if not implemented and supported well it could be quite harmful to the people. We need to think about the involvement of coaches/outside eyes.
I went from being skeptical on the (problem solving) log to feeling it could be very useful … and applied to all kinds of problems. The last module on the log was very useful.
In terms of worries: We have not been good enough messaging that this process is for hunting and fetching problems. We’ve got to be clear about what this is for. And also for the other systems that we are preserving.
Keep in mind, it’s hard when a few things are still blurry. But consider how this is being designed as a process to improve as improvements are suggested. It’s already been improved and will continue to do so.
Have Paul continue to message directly to the staff on this. They hear him. He is such a popular figure. He is clear. They also listen because he doesn’t fill up our e-mail with too many things.
I’d like another review session, to help prepare as a trainer (in addition to the planned development sequence – just a couple hours to go over the design, etc).
Karma on line
Almost a year ago, I wrote about Daja Wangchuk Meston and his marvelous book called Comes the Peace, My Journey to Forgiveness (Free Press, 2007). Now, he and his wife Phuni are featured on Boldfacers. Watch the video.
Wednesday, February 06, 2008
$75 million? Thanks, but I'd rather not donate.
A recent article about an election-year campaign by the SEIU prompted me to go through my notes from a meeting almost two years ago. The scene was at Boston's Parker House Hotel, on May 23, 2006, where Senator Kennedy had invited all of the Boston area hospital CEOs to meet with Dennis Rivera and several other members of the SEIU leadership. I haven't written about this before because I wasn't sure of whether the contents of the meeting were supposed to be public, but now that the SEIU has said the same things publicly, I am comfortable reporting them.
At the meeting, Mr. Rivera said that the SEIU needed $100 million to educate the American public and run a national campaign on the patient access and universal coverage issue. He explained that the union did not have that large sum of money and therefore needed it from the hospitals. He also said quite clearly that there would be an effort to elect Democratic candidates and defeat Republican candidates.
The announcement this week reiterates and confirms his remarks. The dollar amount is $75 million instead of $100 million, but perhaps it was just a rounding error two years ago -- or maybe they have already spent a portion of the difference between the two numbers. And sure enough, during the Presidential campaign and in other local and gubernatorial races, the SEIU has likewise supported Democratic candidates who agree with its point of view.
All this is legal and above-board, so I am not raising that issue. Indeed, you and I may personally agree with some or all of these political aims. However, at a time when Massachusetts -- with the closest thing to a universal access law -- is trying to control the growth of health care expenses, I am hard-pressed to see why hospitals, insurers, and consumers in Massachusetts should support a union effort to add an additional tax on our health care system and its workers to provide dollars to support a national political agenda and support for particular candidates. I am not as familiar with other states, and I wonder if the same concerns might arise there.
Of course, if you happened to disagree with the SEIU's political goals, you might have an additional reason to be concerned about this use of funds from the health care delivery system. But, even if you agree completely with the union's objectives, do you support this means of raising revenue?
At the meeting, Mr. Rivera said that the SEIU needed $100 million to educate the American public and run a national campaign on the patient access and universal coverage issue. He explained that the union did not have that large sum of money and therefore needed it from the hospitals. He also said quite clearly that there would be an effort to elect Democratic candidates and defeat Republican candidates.
The announcement this week reiterates and confirms his remarks. The dollar amount is $75 million instead of $100 million, but perhaps it was just a rounding error two years ago -- or maybe they have already spent a portion of the difference between the two numbers. And sure enough, during the Presidential campaign and in other local and gubernatorial races, the SEIU has likewise supported Democratic candidates who agree with its point of view.
All this is legal and above-board, so I am not raising that issue. Indeed, you and I may personally agree with some or all of these political aims. However, at a time when Massachusetts -- with the closest thing to a universal access law -- is trying to control the growth of health care expenses, I am hard-pressed to see why hospitals, insurers, and consumers in Massachusetts should support a union effort to add an additional tax on our health care system and its workers to provide dollars to support a national political agenda and support for particular candidates. I am not as familiar with other states, and I wonder if the same concerns might arise there.
Of course, if you happened to disagree with the SEIU's political goals, you might have an additional reason to be concerned about this use of funds from the health care delivery system. But, even if you agree completely with the union's objectives, do you support this means of raising revenue?
Tuesday, February 05, 2008
More on fetching and work-arounds
Some colleagues and I had a chance today to spend some time with Steven Spear, from MIT and the Institute for Healthcare Improvement, who is an expert on the kind of process improvement program we are trying to carry out at BIDMC. That he had terrific and useful insights was no surprise to those of us who have read some of his work.
Steve also made mention of research carried out by Anita Tucker, from Harvard Business School, in which she spent many hours observing nurses in hospitals. (I did not find this particular study, but here is one that summarizes it.) Her conclusions were consistent with my own observations and the points I made in my staff email back in November -- and many comments I received from our staff after that email. Professor Tucker found that nurses who encounter problems or impediments on the hospital floors generally will invent a quick work-around to solve those problems. This makes sense. First of all, they are really busy and just need to get the problem solved. Secondly, most organizations do not provide a way to call out problems and have them solved in a timely or effective fashion. Unfortunately, this pragmatic approach to problem-solving leaves systemic problems untreated and, indeed, aggravated by an additional layer of work-arounds.
As Steve has written in his studies of Toyota and reviews of other high performance organizations, the common characteristic of these organizations is not in their ability to design perfect and complex production or service delivery systems. Rather, it is their ability to discover great systems. They do this by managing their work flow to encourage people at all levels to call out problems; to "swarm" together to solve those problems; to share this process of discovery with others in the organization so that the solutions are diffused widely; and to cultivate the skills of people throughout the organization to be involved in this kind of constant improvement.
It was heartening to hear this reinforcement for the kind of program we are beginning at our hospital, which was named BIDMC Spirit in our own election campaign. I feel like we are on the right track. Now comes the simple (hah!) part -- doing it. Our first training session was held today. Stay tuned for further developments.
Steve also made mention of research carried out by Anita Tucker, from Harvard Business School, in which she spent many hours observing nurses in hospitals. (I did not find this particular study, but here is one that summarizes it.) Her conclusions were consistent with my own observations and the points I made in my staff email back in November -- and many comments I received from our staff after that email. Professor Tucker found that nurses who encounter problems or impediments on the hospital floors generally will invent a quick work-around to solve those problems. This makes sense. First of all, they are really busy and just need to get the problem solved. Secondly, most organizations do not provide a way to call out problems and have them solved in a timely or effective fashion. Unfortunately, this pragmatic approach to problem-solving leaves systemic problems untreated and, indeed, aggravated by an additional layer of work-arounds.
As Steve has written in his studies of Toyota and reviews of other high performance organizations, the common characteristic of these organizations is not in their ability to design perfect and complex production or service delivery systems. Rather, it is their ability to discover great systems. They do this by managing their work flow to encourage people at all levels to call out problems; to "swarm" together to solve those problems; to share this process of discovery with others in the organization so that the solutions are diffused widely; and to cultivate the skills of people throughout the organization to be involved in this kind of constant improvement.
It was heartening to hear this reinforcement for the kind of program we are beginning at our hospital, which was named BIDMC Spirit in our own election campaign. I feel like we are on the right track. Now comes the simple (hah!) part -- doing it. Our first training session was held today. Stay tuned for further developments.
Monday, February 04, 2008
The ethics of CEO blogging
Last week, the Harvard Medical School Division of Medical Ethics held a session on the ethical issues surrounding blogging by a CEO, particularly the CEO of a health care institution. Local examples were this blog and the one published by Charlie Baker, CEO of Harvard Pilgrim Health Care. Unfortunately, I could not attend, but I received a note from one of the attendees who told me about some issues that had been raised. I'll report on that and add the comments I would likely have made if I had been present.
One of the discussants identified four domains that he thought of as important in thinking about the ethics of a CEO blog, and about which he posed some questions:
1. Voice: Is the CEO blogger blogging as an individual or as the voice of the organization? Charlie's blog is hosted in the HPHC website and linked to HPHC marketing materials. Yours is on Blogger and not linked to the BIDMC site. But when the CEO speaks, what he or she says can't be separated from the organization.
My reply: Whenever I give a speech, or testify before a legislative or regulatory body, or give a media interview, or write an article (for this blog or a journal) people assume that I am speaking from a position of authority and responsibility for the organization. That is just something that cannot be avoided. I do my best to be aware of the institutional consequences of what I say, regardless of the forum.
2. Authenticity: Who is speaking? Is it a real human being speaking, or an avatar created by a ghost writer? Are comments posted as received or are there schills setting up softballs and deletion of tough questions? In other words, is it a real voice and a real discussion?
Reply: I think my readers know that the posts are mine alone. Certainly, the media relations people and lawyers at BIDMC know that! Likewise, the comments are yours alone. I post them all, unless they contain bad language or personal medical information or private personnel information. I keep looking for those softballs, but they are few and far between.
3. Reliance: From a legal perspective, to what extent does CEO blogging create obligations for the organization or claims that outsiders can make?
Reply: See #1 above. Concerning claims, there is little I say on the blog that does not exist in some other form in the hospital (or in my speeches, articles, or elsewhere) and therefore could be used by attorneys as discoverable information in a legal proceeding.
4. Privacy: When Charlie or you draw on communications from patients/members, even if these are de-identified, should consent be asked for from the person(s) involved?
Reply: I ask for consent from patients or their loved ones who write to me. I also de-identify the stories, unless the person involved prefers otherwise. I do not generally ask for consent to use material a staff member sends me about an issue or a process (for example, this one), but I would of course ask permission to print anything related to the personal life of a staff member.
One of the discussants identified four domains that he thought of as important in thinking about the ethics of a CEO blog, and about which he posed some questions:
1. Voice: Is the CEO blogger blogging as an individual or as the voice of the organization? Charlie's blog is hosted in the HPHC website and linked to HPHC marketing materials. Yours is on Blogger and not linked to the BIDMC site. But when the CEO speaks, what he or she says can't be separated from the organization.
My reply: Whenever I give a speech, or testify before a legislative or regulatory body, or give a media interview, or write an article (for this blog or a journal) people assume that I am speaking from a position of authority and responsibility for the organization. That is just something that cannot be avoided. I do my best to be aware of the institutional consequences of what I say, regardless of the forum.
2. Authenticity: Who is speaking? Is it a real human being speaking, or an avatar created by a ghost writer? Are comments posted as received or are there schills setting up softballs and deletion of tough questions? In other words, is it a real voice and a real discussion?
Reply: I think my readers know that the posts are mine alone. Certainly, the media relations people and lawyers at BIDMC know that! Likewise, the comments are yours alone. I post them all, unless they contain bad language or personal medical information or private personnel information. I keep looking for those softballs, but they are few and far between.
3. Reliance: From a legal perspective, to what extent does CEO blogging create obligations for the organization or claims that outsiders can make?
Reply: See #1 above. Concerning claims, there is little I say on the blog that does not exist in some other form in the hospital (or in my speeches, articles, or elsewhere) and therefore could be used by attorneys as discoverable information in a legal proceeding.
4. Privacy: When Charlie or you draw on communications from patients/members, even if these are de-identified, should consent be asked for from the person(s) involved?
Reply: I ask for consent from patients or their loved ones who write to me. I also de-identify the stories, unless the person involved prefers otherwise. I do not generally ask for consent to use material a staff member sends me about an issue or a process (for example, this one), but I would of course ask permission to print anything related to the personal life of a staff member.
Sunday, February 03, 2008
Quality and bond ratings
As non-profit corporations enter the tax-exempt bond market to sell debt (i.e., borrow money) in support of their clinical, research, and teaching missions, they receive credit ratings from Moody's, Standard and Poor's, and Fitch. The people at these rating agencies conduct a thorough review of the many business aspects of each hospital or hospital system that is issuing debt and give a grade as to its credit-worthiness. This grade has a direct and real impact on your cost of borrowing and thereby on your ultimate cost of providing service to the public.
Recently, Moody's issued a report entitled "Clinical Quality Initiatives Have Positive Long-Term Impact on Not-for-Profit Hospital Bond Ratings". Here is a publicly available excerpt:
From a credit perspective, a not-for-profit hospital's focus on a quality agenda can translate into improved ratings through increased volume and market share, operational efficiencies, better rates from commercial payers, and improved financial performance. Like many strategies, we recognize that realizing financial returns from a quality strategy may require large capital costs and incurred operating losses in the short term. However, over the long-term, a hospital's focus on quality will be viewed as a credit positive if greater patient demand and financial improvements materialize. Many not-for-profit hospitals are launching strategies to improve evidence-based clinical outcomes and patient safety, which we view as the two key facets of a strategy aimed at improving quality. The effort to improve quality is a major component of most hospitals mission to provide the best patient care possible.
And another:
Moody’s anticipates that in the short-term, strategies to improve quality and patient safety will likely reduce operating results for many hospitals as the tools and steps to implement the strategy may require adding costs faster than benefits are realized. However, hospitals that eventually demonstrate a sustainable link between quality investments and better clinical outcomes will likely gain competitive advantage, thereby improving financial performance and possibly their bond ratings.
This is an interesting point of view and one worth watching over time, to see if these financial results materialize. I have to admit that our decisions to adopt audacious quality improvement targets actually were not driven by this kind of business strategy. They were driven, plain and simple, by a desire to do a better job taking care of patients, a fundamental goal of the organization. Further, as I have noted:
The main value of transparency is not necessarily to enable easier consumer choice or to give a hospital a competitive edge. It is to provide creative tension within hospitals so that they hold themselves accountable. This accountability is what will drive doctors, nurses, and administrators to seek constant improvements in the quality and safety of patient care.
That being said, I certainly would not mind if the trends projected by Moody's turn out to be true -- and their analysts surely are more knowledgeable than I because of their broad industry experience. In the meantime, over the next few months, CareGroup -- the holding company that owns BIDMC, New England Baptist Hospital, and Mount Auburn Hospital -- plans to issue bonds to finance important patient improvements at the hospitals (like a new Emergency Department at BID~Needham) and to take advantage of low interest rates to refund older outstanding debt. We were pleased to note that a January 30, 2008, bond rating by Moody's for the forthcoming bond issue had the following paragraph:
CareGroup's hospitals have set high standards to meet quality initiatives in their pursuit of transformational change. CareGroup's three major hospitals have been included in a pilot program established by Blue Cross and Blue Shield of Massachusetts to reduce unnecessary procedures and transform the delivery and quality of care provided. To that end for example, BIDMC is holding itself publicly accountable to certain standards and scorecard measures that providers nationwide have historically never before publicly disseminated. We applaud all these efforts and believe it could be a differentiating factor for CareGroup in its market.
Recently, Moody's issued a report entitled "Clinical Quality Initiatives Have Positive Long-Term Impact on Not-for-Profit Hospital Bond Ratings". Here is a publicly available excerpt:
From a credit perspective, a not-for-profit hospital's focus on a quality agenda can translate into improved ratings through increased volume and market share, operational efficiencies, better rates from commercial payers, and improved financial performance. Like many strategies, we recognize that realizing financial returns from a quality strategy may require large capital costs and incurred operating losses in the short term. However, over the long-term, a hospital's focus on quality will be viewed as a credit positive if greater patient demand and financial improvements materialize. Many not-for-profit hospitals are launching strategies to improve evidence-based clinical outcomes and patient safety, which we view as the two key facets of a strategy aimed at improving quality. The effort to improve quality is a major component of most hospitals mission to provide the best patient care possible.
And another:
Moody’s anticipates that in the short-term, strategies to improve quality and patient safety will likely reduce operating results for many hospitals as the tools and steps to implement the strategy may require adding costs faster than benefits are realized. However, hospitals that eventually demonstrate a sustainable link between quality investments and better clinical outcomes will likely gain competitive advantage, thereby improving financial performance and possibly their bond ratings.
This is an interesting point of view and one worth watching over time, to see if these financial results materialize. I have to admit that our decisions to adopt audacious quality improvement targets actually were not driven by this kind of business strategy. They were driven, plain and simple, by a desire to do a better job taking care of patients, a fundamental goal of the organization. Further, as I have noted:
The main value of transparency is not necessarily to enable easier consumer choice or to give a hospital a competitive edge. It is to provide creative tension within hospitals so that they hold themselves accountable. This accountability is what will drive doctors, nurses, and administrators to seek constant improvements in the quality and safety of patient care.
That being said, I certainly would not mind if the trends projected by Moody's turn out to be true -- and their analysts surely are more knowledgeable than I because of their broad industry experience. In the meantime, over the next few months, CareGroup -- the holding company that owns BIDMC, New England Baptist Hospital, and Mount Auburn Hospital -- plans to issue bonds to finance important patient improvements at the hospitals (like a new Emergency Department at BID~Needham) and to take advantage of low interest rates to refund older outstanding debt. We were pleased to note that a January 30, 2008, bond rating by Moody's for the forthcoming bond issue had the following paragraph:
CareGroup's hospitals have set high standards to meet quality initiatives in their pursuit of transformational change. CareGroup's three major hospitals have been included in a pilot program established by Blue Cross and Blue Shield of Massachusetts to reduce unnecessary procedures and transform the delivery and quality of care provided. To that end for example, BIDMC is holding itself publicly accountable to certain standards and scorecard measures that providers nationwide have historically never before publicly disseminated. We applaud all these efforts and believe it could be a differentiating factor for CareGroup in its market.
Saturday, February 02, 2008
A simple idea for hand hygiene
From one of our Emergency Department doctors comes this very sensible and simple approach that could be used by doctors in almost every setting -- both to remind themselves to practice correct hand hygiene and to reassure patients that they have done so:
After much personal trial and error, I finally came up with a successful solution to the hand-washing issue. The key for me is incorporating a preset routine into my introduction whenever I walk into a room to meet a patient, much like the pre-shot routine of a golfer or a basketball player shooting a free throw. My routine is...”Hello, I am Dr. Jones. I am going to wash my hands as we get to know each other. What brings you to the ER today?” I teach this type of routine to my residents as well.
After much personal trial and error, I finally came up with a successful solution to the hand-washing issue. The key for me is incorporating a preset routine into my introduction whenever I walk into a room to meet a patient, much like the pre-shot routine of a golfer or a basketball player shooting a free throw. My routine is...”Hello, I am Dr. Jones. I am going to wash my hands as we get to know each other. What brings you to the ER today?” I teach this type of routine to my residents as well.
Voices of Slaves
A friend forwarded this link from PBS to me. She notes: If you haven't seen this, it's worth exploring. It's the WPA recordings of former slaves. Beautiful and heartbreaking and uplifting.
Friday, February 01, 2008
Social media in the military
This is a really fascinating post on Jessica Lipnack's blog about Lt. Gen. Bill Caldwell's proposal to allow, nay encourage, military personnel to use blogs and You Tube and other social media to tell their stories.
Helping Immigrants
I once heard a great interview with historian Arthur Schlesinger, Jr. by Chris Lydon, a former WBUR public radio broadcaster. It was on the occasion of the publication of his last book, and Chris asked him what was the most important lesson he had learned from studying American history. It was something like this: "Never underestimate the tendency of the American public to become xenophobic."
I thought this was a striking statement. It came without pause or hesitation and so was clearly "top of mind" for Schlesinger. And, as we have watched political debates about immigration and immigrants during the past Congressional session and now during the Presidential primaries, we see it raised over and over.
There is a group in this state called the Massachusetts Immigration and Refugee Advocacy Coalition (MIRA) that provides information, support to immigrants, and political advocacy in support of the desire of people from around the world to have a chance to live the American Dream. A few weeks ago, a number of us joined to hear from Senator Kennedy and thank him for his efforts on behalf of this cause. We also heard from a young mother who described events that took place during an immigant raid in New Bedford last year. As Senator Kennedy remarked, there were things that happened in that raid that one could not have believed possible in this country.
I don't often use this blog to ask your support for political causes, but I do so now and hope you join many of us to help this organization.
I thought this was a striking statement. It came without pause or hesitation and so was clearly "top of mind" for Schlesinger. And, as we have watched political debates about immigration and immigrants during the past Congressional session and now during the Presidential primaries, we see it raised over and over.
There is a group in this state called the Massachusetts Immigration and Refugee Advocacy Coalition (MIRA) that provides information, support to immigrants, and political advocacy in support of the desire of people from around the world to have a chance to live the American Dream. A few weeks ago, a number of us joined to hear from Senator Kennedy and thank him for his efforts on behalf of this cause. We also heard from a young mother who described events that took place during an immigant raid in New Bedford last year. As Senator Kennedy remarked, there were things that happened in that raid that one could not have believed possible in this country.
I don't often use this blog to ask your support for political causes, but I do so now and hope you join many of us to help this organization.
Thursday, January 31, 2008
Ready Resolve at NYU
Here is a really neat program at NYU's Tisch Hospital. Employee volunteers (each one serves for one hour per day for one week every other month) visit patient rooms and conduct a quick on-the-spot survey of patient needs and follow up to solve a series of common problems -- do the phone and TV work properly; are the room and bathroom clean; did you get the meal you ordered. The Ready Resolvers either fix or call in any problems imediately. The responding departments are responsible for resolving the problems within two hours. If they cannot fix the problem right away, they send a staff member to visit the patient to explain in person.
This began as a pilot in June on three units, with 27 volunteers. It was expanded in August to 4 additional units, with 63 volunteers.
Interesting, too, that the Ready Resolvers started to uncover problems that were systemic in nature, that require further hospital-wide work.
I like this idea. If you work in a hospital, here or elsewhere, do you?
This began as a pilot in June on three units, with 27 volunteers. It was expanded in August to 4 additional units, with 63 volunteers.
Interesting, too, that the Ready Resolvers started to uncover problems that were systemic in nature, that require further hospital-wide work.
I like this idea. If you work in a hospital, here or elsewhere, do you?
Organizational wiki
This is a request for advice. As I have noted below, we are engaged in a major process improvement and staff engagement process we now call BIDMC SPIRIT. We are designing a system that will enable staff people throughout the hospital to call out problems that they see while doing their everyday work, and then have help teams focus in on those problems, do root-cause analyses, and construct sensible solutions and diffuse them throughout the organization. This process, in part, relies on experience from Toyota, but it also uses some newer work done by other organizations.
Our folks are excited and intrigued by this and are starting to get engaged. Among other things, we plan to conduct formal training in the approach for about 600 people -- roughly 10% of our staff -- to create a core group from whom the process will spread.
Because this is a really new approach to things for an academic medical center of our size, one of my goals is to make sure that people feel they can also participate in the actual design and implementation. For example, I'd like for the training and communication process to be modified from suggestions of people as it proceeds, so that we refine it and keep things clear and relevant as we implement the program.
In essence, I want to create the organizational equivalent of a wiki -- a process that is organic during its implementation as a result of multiple and transparent contributions by the participants themselves. Think about that as allowing the people in the hospital to enhance the process improvement process itself even as that process is being rolled out. Think about it further as an incredibly and intentionally democratic design approach that puts great faith in the staff to know what will be most effective in teaching themselves about the program, for the benefit of one another. Now, add on to that characterization the fact that this needs to occur in a real-time manner and in multiple languages (English, Spanish, Creole, and others) and across multiple job categories so that all people feel confident that their points of view are heard and respected in a culturally sensitive manner.
We have some ways we are employing to do this, but I would love to hear from others -- whether in the medical field or elsewhere -- who might have tried this and can provide stories or references to their work. Please don't focus solely on computer information systems: Remember that lots of our people do not regularly look at a computer.
Our folks are excited and intrigued by this and are starting to get engaged. Among other things, we plan to conduct formal training in the approach for about 600 people -- roughly 10% of our staff -- to create a core group from whom the process will spread.
Because this is a really new approach to things for an academic medical center of our size, one of my goals is to make sure that people feel they can also participate in the actual design and implementation. For example, I'd like for the training and communication process to be modified from suggestions of people as it proceeds, so that we refine it and keep things clear and relevant as we implement the program.
In essence, I want to create the organizational equivalent of a wiki -- a process that is organic during its implementation as a result of multiple and transparent contributions by the participants themselves. Think about that as allowing the people in the hospital to enhance the process improvement process itself even as that process is being rolled out. Think about it further as an incredibly and intentionally democratic design approach that puts great faith in the staff to know what will be most effective in teaching themselves about the program, for the benefit of one another. Now, add on to that characterization the fact that this needs to occur in a real-time manner and in multiple languages (English, Spanish, Creole, and others) and across multiple job categories so that all people feel confident that their points of view are heard and respected in a culturally sensitive manner.
We have some ways we are employing to do this, but I would love to hear from others -- whether in the medical field or elsewhere -- who might have tried this and can provide stories or references to their work. Please don't focus solely on computer information systems: Remember that lots of our people do not regularly look at a computer.
Wednesday, January 30, 2008
Free transfers on the T. Not.
A complaint registered with me by one of our employees who takes a trolley line from Brookline and then connects with a bus at Newton Highlands to get to work at our Needham hospital.According to the MBTA website:
Bus and Subway transfers are discounted when you use the CharlieCard. With a CharlieTicket, the full fare, plus the surcharge will be deducted from the stored-value on your CharlieTicket when you board the bus or subway.
With a CharlieCard, simply board the first vehicle of your trip and the corresponding fare is deducted. When you transfer, the faregate or farebox will automatically recognize you as a transferring customer, and deduct the additional transfer fee, if any. When transferring from a lower-priced service to a higher-priced service, like Local Bus-to-Subway, the price of your transfer is simply the difference between the two fares ($0.45). When transferring from a higher-priced service to a lower-priced service, like Subway-to-Local Bus, there is no cost to transfer.
Not quite so, remarks our friend. Apparently, your CharlieCard is time-stamped when you first get on the trolley line, and if the time you enter the bus is more than a certain number of minutes afterward, the discount doesn't work. Ditto on the return trip. A bus driver told this passenger that the second ride has to begin within 20 minutes of the first ride.
I don't know if the driver was correct, but -- as locals will tell you -- the trolley ride itself is likely to be more than 20 minutes, and if you have to wait for the bus connection, it might be 40 minutes or more before you actually get on the bus. Ditto on the return.
Apparently you can write to the T and ask for a refund if the transfer discount doesn't register. But that takes a couple of months to process. And, who wants to do that every day?
So, if this is all true, why would the people at the T be so concerned about a transfer having to occur within a certain number of minutes? Are they really worried about people "abusing" the system by, say, stopping for coffee en route to their destination? Do they think someone will hand off his or her card to another passenger at the junction of a rail and bus line and use it later in the day?
And, if it is not true that there is a specific allowable time interval, why doesn't the discount work?
Ads for the public schools?
While I know we have been talking about hospital advertising, I happened to notice an ad for the Boston Public Schools on the "T" while I was riding to work this morning. My first reaction was, why should the public schools spend time and money and effort advertising? Don't they have better things to spend their money on?
But then, I thought about it differently. The schools in Boston went through a very troubled period, and they have made a lot of progress over the last few years. Why not place some ads to remind people of this progress and give both students and the community a sense of confidence and pride? Perhaps it will enhance the atmosphere for hiring graduates of those schools, or give businesses a reason to get more engaged with them, or some other good thing.
So, image advertising for the public schools? Sure, why not!
But then, I thought about it differently. The schools in Boston went through a very troubled period, and they have made a lot of progress over the last few years. Why not place some ads to remind people of this progress and give both students and the community a sense of confidence and pride? Perhaps it will enhance the atmosphere for hiring graduates of those schools, or give businesses a reason to get more engaged with them, or some other good thing.
So, image advertising for the public schools? Sure, why not!
Bill's donuts, and more
One of my favorite authors writes, in anticipation of Super Tuesday:
Amidst the endless debating, debacles, and the super duper dissing, it’s easy to forget that even politicians must eat.
I therefore urge you to read this fun little piece I’ve written for CHOW.com. It probably won’t help you decide who to vote for, but you might learn something you never knew about our hungriest presidents. Bon appétit!
This reminds me, by the way, of an important and cogent piece of advice (please excuse the vernacular) all candidates should be given when running for office, "During a campaign, never miss an opportunity to eat or pee, because you never know when you will have your next chance and it can be a really, really long day."
Amidst the endless debating, debacles, and the super duper dissing, it’s easy to forget that even politicians must eat.
I therefore urge you to read this fun little piece I’ve written for CHOW.com. It probably won’t help you decide who to vote for, but you might learn something you never knew about our hungriest presidents. Bon appétit!
This reminds me, by the way, of an important and cogent piece of advice (please excuse the vernacular) all candidates should be given when running for office, "During a campaign, never miss an opportunity to eat or pee, because you never know when you will have your next chance and it can be a really, really long day."
Tuesday, January 29, 2008
e-patients online
Patient Dave, er e-Patient Dave, led me to the this website, entitled e-patients.net, because health professionals can't do it alone. This is a really fascinating blog about patient empowerment. Among other things, you will find there an "e-patients white paper" explaining their philosophy and approach. Emblematic of the site, you can either read the white paper as a PDF or participate in it as a wiki.
The site apparently began as a follow-on to the work of Dr. Tom Ferguson, who invented the term e-patients to describe individuals who are equipped, enabled, empowered and engaged in their health and health care decisions. He envisioned health care as an equal partnership between e-patients and health professionals and systems that support them.
There is a lot to read and absorb on this site. Please check it out.
The site apparently began as a follow-on to the work of Dr. Tom Ferguson, who invented the term e-patients to describe individuals who are equipped, enabled, empowered and engaged in their health and health care decisions. He envisioned health care as an equal partnership between e-patients and health professionals and systems that support them.
There is a lot to read and absorb on this site. Please check it out.
Drug ads, men, and football
A bit more on advertising, this time about drug companies, with her usual dry humor, by Monique Doyle Spencer in today's Boston Globe.
Monday, January 28, 2008
Seeking hospital frequent fliers
This came in today's email. Say what you want about hospital advertising, this has to be the strangest thing yet -- a frequent flier program for hospital purchases! I quote it exactly: I couldn't make this up. Your thoughts?
Orlando, FL - January 28, 2008 - Paquin Healthcare Companies, Inc. today announced the launch of its new hospital-based customer loyalty program. The program, referred to as My Healthy Rewards, is a way of rewarding hospital's customers for using their products and services and engaging in wellness activities.
"We are pleased to announce the availability of My Healthy Rewards. This loyalty program will play a vital role in the success of any comprehensive healthcare retail strategy by increasing customer loyalty and repeat sales," said Tony Paquin, founder and CEO of Paquin Healthcare Companies, Inc.
My Healthy Rewards members can accumulate reward points based on their retail purchases, utilization of hospital or clinical services, or other healthcare related or wellness activities. As reward points accrue, members may receive award certificates, special offers, merchandise discounts and special sale notifications. There is no limit-the more consumers shop, the more they earn.
The loyalty program is just one part of a consumer healthcare strategy that enables hospitals to promote their brand and provide excellent service.
Proceeds from healthcare system retail outlets provide financial support for the development of high quality healthcare in their communities. This program enables members to contribute to the well-being of their communities by using their rewards card when shopping for healthcare products and services.
The company announced that the program will initially be deployed at 27 hospitals locations and is expected to generate at least 500,000 members in its first year.
Orlando, FL - January 28, 2008 - Paquin Healthcare Companies, Inc. today announced the launch of its new hospital-based customer loyalty program. The program, referred to as My Healthy Rewards, is a way of rewarding hospital's customers for using their products and services and engaging in wellness activities.
"We are pleased to announce the availability of My Healthy Rewards. This loyalty program will play a vital role in the success of any comprehensive healthcare retail strategy by increasing customer loyalty and repeat sales," said Tony Paquin, founder and CEO of Paquin Healthcare Companies, Inc.
My Healthy Rewards members can accumulate reward points based on their retail purchases, utilization of hospital or clinical services, or other healthcare related or wellness activities. As reward points accrue, members may receive award certificates, special offers, merchandise discounts and special sale notifications. There is no limit-the more consumers shop, the more they earn.
The loyalty program is just one part of a consumer healthcare strategy that enables hospitals to promote their brand and provide excellent service.
Proceeds from healthcare system retail outlets provide financial support for the development of high quality healthcare in their communities. This program enables members to contribute to the well-being of their communities by using their rewards card when shopping for healthcare products and services.
The company announced that the program will initially be deployed at 27 hospitals locations and is expected to generate at least 500,000 members in its first year.
The votes are in!
Lots of you seem interested in the inside story on managing change in the hospital, and I am happy to share what we are doing on the chance it might be informative to those in other organizations. For those who are interested, here is a follow-up to my Thanksgiving staff email on our process improvement program for BIDMC. We conducted an election to name the program, with unlimited nominations "from the floor" and a preliminary ballot to narrow the field to seven finalists. Asking the staff to name the program is just the most visible part of encouraging their participation in its design and implementation. Here's today's email announcing the winner:
Subject: The votes are in! BIDMC SPIRIT takes first place!
Hi,
In an election that has set a national standard for voter turnout and lack of negative campaigning, and a full week before Super Tuesday, we have a winner in our naming contest for the new BIDMC process improvement program.
Almost 2000 votes were cast, and the run-away winner was:
BIDMC SPIRIT (Solutions Promoting Improvement Respect Integrity & Teamwork)
Please stay tuned over the coming weeks for more about this initiative -- further explanation, training, and experimenting. Remember, the goal of BIDMC SPIRIT is that we want every BIDMC staff member to be able to answer these questions with a resounding "Yes!" every day:
Am I treated with dignity and respect by everyone I encounter, regardless of role or rank in the organization?
Am I given the knowledge, tools and support that I need in order to make a contribution to my organization and that adds meaning to my life?
Did somebody notice I did it, i.e., am I recognized for my contribution?
I'll tell you right now that we are inventing something new here. Sometimes it will feel chaotic, inefficient, or downright dumb as we do this: You will probably question my judgment many times over for even trying it. But, let's give it a chance and see what we can do together with the right BIDMC SPIRIT!
(By the way, will the person who suggested this name please contact me?)
Sincerely,
Paul
---
Wow, within minutes, I have already received the following comments back from the email:
Good morning, Excellent choice, that was my choice. Have a great day. Thank you.
--
Whoever named this did a great job....
--
Congratulations on running a great campaign
--
BRAVO!! Congratulations.....
--
wow.........I finally picked a winner....now if I could only make up my mind about the democratic primary..........
--
Junior Seau said this week over and over again the same thing you did -- "let's just give it a chance, everyone just needs a chance" -- and look where he is now!!!!! I voted for this one too!
--
I am very excited the BIDMC SPIRIT was selected! I had suggested it during the original polling process… but I am glad that so many people resonated with it!
--
I would love to have an active role in this campaign of BIDMC SPIRIT.
--
An abbreviation better than WMD.
--
Love the name.
---
And this really nice one later on:
Although I cannot take credit for the name or idea of this program, I think it is an important concept. I am happy to know that this is going to be implemented and feel as though everyone will benefit from it in the end (especially the patients). From my perspective, there is nothing more rewarding than taking care of individuals during a time of need. We will all experience this vulnerability at some point in our lives. The key (again in my opinion) is to deliver quality care in a supportive, nurturing environment. It is evident that happier employees ultimately equals a more positive work environment which in turn equals quality care.
Thank you for supporting this program and also for taking the time to recognize the individual who is responsible for creating the name. You send a powerful message and it sounds like you are getting a positive response.
Subject: The votes are in! BIDMC SPIRIT takes first place!
Hi,
In an election that has set a national standard for voter turnout and lack of negative campaigning, and a full week before Super Tuesday, we have a winner in our naming contest for the new BIDMC process improvement program.
Almost 2000 votes were cast, and the run-away winner was:
BIDMC SPIRIT (Solutions Promoting Improvement Respect Integrity & Teamwork)
Please stay tuned over the coming weeks for more about this initiative -- further explanation, training, and experimenting. Remember, the goal of BIDMC SPIRIT is that we want every BIDMC staff member to be able to answer these questions with a resounding "Yes!" every day:
Am I treated with dignity and respect by everyone I encounter, regardless of role or rank in the organization?
Am I given the knowledge, tools and support that I need in order to make a contribution to my organization and that adds meaning to my life?
Did somebody notice I did it, i.e., am I recognized for my contribution?
I'll tell you right now that we are inventing something new here. Sometimes it will feel chaotic, inefficient, or downright dumb as we do this: You will probably question my judgment many times over for even trying it. But, let's give it a chance and see what we can do together with the right BIDMC SPIRIT!
(By the way, will the person who suggested this name please contact me?)
Sincerely,
Paul
---
Wow, within minutes, I have already received the following comments back from the email:
Good morning, Excellent choice, that was my choice. Have a great day. Thank you.
--
Whoever named this did a great job....
--
Congratulations on running a great campaign
--
BRAVO!! Congratulations.....
--
wow.........I finally picked a winner....now if I could only make up my mind about the democratic primary..........
--
Junior Seau said this week over and over again the same thing you did -- "let's just give it a chance, everyone just needs a chance" -- and look where he is now!!!!! I voted for this one too!
--
I am very excited the BIDMC SPIRIT was selected! I had suggested it during the original polling process… but I am glad that so many people resonated with it!
--
I would love to have an active role in this campaign of BIDMC SPIRIT.
--
An abbreviation better than WMD.
--
Love the name.
---
And this really nice one later on:
Although I cannot take credit for the name or idea of this program, I think it is an important concept. I am happy to know that this is going to be implemented and feel as though everyone will benefit from it in the end (especially the patients). From my perspective, there is nothing more rewarding than taking care of individuals during a time of need. We will all experience this vulnerability at some point in our lives. The key (again in my opinion) is to deliver quality care in a supportive, nurturing environment. It is evident that happier employees ultimately equals a more positive work environment which in turn equals quality care.
Thank you for supporting this program and also for taking the time to recognize the individual who is responsible for creating the name. You send a powerful message and it sounds like you are getting a positive response.
Sunday, January 27, 2008
On advertising
Your comments have been a little tame and complimentary lately, so it is time to throw some meat to the lions and stir up some discussion. This is about hospital advertising.
I opened up my latest version of Newton Magazine, a very nice local monthly publication edited by Jonathan Brickman that is targeted to one particular suburb of Boston. The ad on the inside cover is about an orthopaedic service offered by Newton Wellesley Hospital in collaboration with Massachusetts General Hospital. Page four has a full-page ad about diabetes from the Joslin Diabetes center. Page seven has a full page ad about heartburn and other digestive disease treatments at BIDMC. Then, of course, there are the smaller ads sprinkled through the magazine from practitioners in cosmetic dentistry, ophthalmic services, varicose veins, plastic surgery, concierge primary care, in-vitro fertilization, acupuncture, psychology, home care, assisted living, and cord blood banking. But for this post, let me focus on the hospital ads.
Putting on my consumer hat for a moment, I briefly had the same reaction that I have when I watch those drugs ads on television: Do these ads work? Well, we certainly know that the drugs ads work in creating demand for those products -- often to the dismay of doctors who do not really want to prescribe them. That has been documented.
To answer the question for hospitals -- "Do these ads work?" -- you need to consider their purpose. One purpose might be to encourage consumers to seek elective treatment for a condition about which they might not have considered treatment (e.g., that arthroscopic surgery for a knee injury) and another is to try to have them consider your particular hospital for the treatment they have chosen. Effectiveness for the first is hard to measure. Although insurance companies will tell you that many more people are seeking those elective treatments than ever before, it is hard to know if that is tied to marketing. Effectiveness for the second is equally hard to measure, although sometimes a hospital will be able to track a patient's initial phone call to a given ad.
Another purpose is to respond from pressure from your doctors and show them that you support their programs. Before I took this job, I talked with the head of a major Boston hospital who gave that as the primary reason for ads. "There is no evidence that ads work in creating business," he said, "but we need to keep our doctors happy." I have certainly felt that pressure in my place, and so I understand the desire to send a signal to your doctors -- who, after all, are essentially free agents who can easily change hospital affiliation -- that you support their practices.
Another purpose might be to educate the public about certain diseases and treatments. I think academic medical centers like to rationalize that they are offering this general benefit to the public in their ads, but, really, who would consider these one-page blurbs an effective means for such education?
I think the ads are posted mainly as a component of creating a broader brand identity. In this regard, hospital ads are remarkably similar to many other corporate ads. But unlike other industries that use it to drive sales, brand identity in the medical field is probably minimally important in generating and maintaining a sufficient level of clinical business. Perhaps more important, it helps create a mindset that the hospital has standing and stature and permanence in the community. This is important in attracting employees, enhancing physician recruitment and affiliations with other hospitals and physician practices, and generating interest from lay members of the community to serve on the hospital's governing bodies and to offer philanthropic support. These three purposes are actually fundamental to commercial viability in the health care world, especially for academic medical centers.
I would love to receive comments from other hospital administrators and marketing firms on what I have just said. And, of course, from the rest of you, too, who are now drooling at the prospect of offering a heartfelt opinion.
I opened up my latest version of Newton Magazine, a very nice local monthly publication edited by Jonathan Brickman that is targeted to one particular suburb of Boston. The ad on the inside cover is about an orthopaedic service offered by Newton Wellesley Hospital in collaboration with Massachusetts General Hospital. Page four has a full-page ad about diabetes from the Joslin Diabetes center. Page seven has a full page ad about heartburn and other digestive disease treatments at BIDMC. Then, of course, there are the smaller ads sprinkled through the magazine from practitioners in cosmetic dentistry, ophthalmic services, varicose veins, plastic surgery, concierge primary care, in-vitro fertilization, acupuncture, psychology, home care, assisted living, and cord blood banking. But for this post, let me focus on the hospital ads.
Putting on my consumer hat for a moment, I briefly had the same reaction that I have when I watch those drugs ads on television: Do these ads work? Well, we certainly know that the drugs ads work in creating demand for those products -- often to the dismay of doctors who do not really want to prescribe them. That has been documented.
To answer the question for hospitals -- "Do these ads work?" -- you need to consider their purpose. One purpose might be to encourage consumers to seek elective treatment for a condition about which they might not have considered treatment (e.g., that arthroscopic surgery for a knee injury) and another is to try to have them consider your particular hospital for the treatment they have chosen. Effectiveness for the first is hard to measure. Although insurance companies will tell you that many more people are seeking those elective treatments than ever before, it is hard to know if that is tied to marketing. Effectiveness for the second is equally hard to measure, although sometimes a hospital will be able to track a patient's initial phone call to a given ad.
Another purpose is to respond from pressure from your doctors and show them that you support their programs. Before I took this job, I talked with the head of a major Boston hospital who gave that as the primary reason for ads. "There is no evidence that ads work in creating business," he said, "but we need to keep our doctors happy." I have certainly felt that pressure in my place, and so I understand the desire to send a signal to your doctors -- who, after all, are essentially free agents who can easily change hospital affiliation -- that you support their practices.
Another purpose might be to educate the public about certain diseases and treatments. I think academic medical centers like to rationalize that they are offering this general benefit to the public in their ads, but, really, who would consider these one-page blurbs an effective means for such education?
I think the ads are posted mainly as a component of creating a broader brand identity. In this regard, hospital ads are remarkably similar to many other corporate ads. But unlike other industries that use it to drive sales, brand identity in the medical field is probably minimally important in generating and maintaining a sufficient level of clinical business. Perhaps more important, it helps create a mindset that the hospital has standing and stature and permanence in the community. This is important in attracting employees, enhancing physician recruitment and affiliations with other hospitals and physician practices, and generating interest from lay members of the community to serve on the hospital's governing bodies and to offer philanthropic support. These three purposes are actually fundamental to commercial viability in the health care world, especially for academic medical centers.
I would love to receive comments from other hospital administrators and marketing firms on what I have just said. And, of course, from the rest of you, too, who are now drooling at the prospect of offering a heartfelt opinion.
Saturday, January 26, 2008
Amy at Newsweek
Please read this really well done story on Newsweek.com by Amy Tenderich, the host of the Diabetes Mine blog (one of the best blogs out there.)
Friday, January 25, 2008
A quick trip to Cairo, and beyond
For those in Boston, I want to recommend a marvelous exhibition I saw last night at the Boston Architectural College on Newbury Street. But hurry, because it is only open until January 27. (I think it then travels to other cities.) As someone trained in urban planning, I found it particularly engaging, but I think it has general appeal, too.The show is put on by the Aga Khan Historic Cities program of the Aga Khan Trust for Culture. This program was established in 1992 to carry out conservation and urban revitalization projects in culturally significant sites of the Islamic world, undertaking the restoration and rehabilitation of historic structures and public spaces in ways that spur social, economic, and cultural development. In addition to restoration of buildings and monuments, the program engages in activities related to adaptive re-use, urban planning and the improvement of housing, infrastructure and public spaces. It also carries out related socio-economic development initiatives directed at upgrading local living conditions.
Here's one example. The picture above shows the creation of a huge urban park in Cairo. This link gives you more information about this project, a 74-acre park in the city's historic district. The site was previously a rubbish dump and landfill, which had grown so much over the centuries that it actually buried the city's external wall. A beautiful park has been constructed, which is visited by over 1 million people per year, and the wall and surrounding buildings have likewise been rehabilitated. Local workers, previously unemployed or underemployed, have been trained in reconstruction and rehabilitation and were hired to do the work.
Here is an excerpt from the exhibition brochure:
The exhibit provides insight into how the preservation of historic cultural and religious monuments serves as a catalyst for socio-economic development and how the revitalization of architecture can build bridges, not only between the past and the present in the Muslim world, but also between the Muslim world and the West.
“From Afghanistan to Zanzibar, from India to Mali, the Aga Khan Trust for Culture’s support to historic communities demonstrates how conservation and revitalization of the cultural heritage – in many cases the only asset at the disposal of the community – can provide a springboard for social development. We have also seen how such projects can have a positive impact well beyond conservation, promoting good governance, the growth of civil society, a rise in incomes and economic opportunities, greater respect for human rights and better stewardship of the environment.”
-His Highness the Aga Khan
Interoperability on a grand scale
Our "Geekdoctor", John Halamka, has been hard at work with many colleagues from around the country by chairing a group to create national standards for electronic data interchanges in the health care world. Yesterday Secretary of HHS Mike Leavitt announced the first set of such standards. I am attaching the entire press release. I don't claim to understand all technical technical aspects of this, but I do know that this in an important step along the way to full interoperability of medical information systems in the United States.
FOR IMMEDIATE RELEASE
Contact: Stacy Leistner
American National Standards Institute
(212) 642-4931
HHS Secretary Recognizes Products of HITSP Standards Work
Washington, DC, January 24, 2008: U.S. Department of Health and Human Services (HHS) Secretary Mike Leavitt recognized the first set of interoperability standards developed by the Healthcare Information Technology Standards Panel (HITSP). The HITSP advanced three of its “Interoperability Specifications” to help support the advancement of interoperable health records and a Nationwide Health Information Network in the United States aimed toward improved and more efficient care.
HHS Secretarial recognition of interoperability standards is referenced in an Executive Order (E.O. 13410) signed by President George W. Bush in August 2006 and promotes standards to be implemented in new and upgraded federal health systems. These standards will also become part of the certification process for electronic health records and networks.
“Safe and affordable healthcare depends upon the secure exchange of information among patients, providers, payers and government entities such as public health agencies,” explained Dr. John Halamka, HITSP chair and CIO of Harvard Medical School.
The HITSP “Interoperability Specifications” which pertain to three initial priority work areas (“Use Cases”) assigned to the Panel by the American Heath Information Community (AHIC), were accepted by Secretary Leavitt in December 2006 as interoperability standards in these areas:
§ Electronic Health Record (EHR) (e.g., the electronic delivery of lab results to providers of care),
§ Biosurveillance (e.g., data networks supporting the rapid alert to a disease outbreak), and
§ Consumer Empowerment (e.g., giving patients the ability to manage and control access to their registration and medication histories).
Each Interoperability Specification is an unambiguous “cookbook” that identifies the “named” standards and provides implementation guidance to all stakeholders exchanging the health care information specified in each Use Case.
The Secretary’s acceptance in December 2006 launched a year-long period of review and testing by healthcare providers, public health agencies, government agencies, standards developing organizations, consumers and other stakeholders. His recognition signifies the end of the testing period and the beginning of when federal agencies administering or sponsoring federal health programs will begin implementation.
“Recognition of the HITSP Interoperability Specifications is an important milestone” added Halamka. “Between the federal implications and the certification efforts of CCHIT, stakeholders will be motivated to adopt a standard way of sharing data throughout the Nationwide Health Information Network, leading to better healthcare for us all.”
During 2007, the HITSP continued its work by focusing on security and privacy constructs and a new set of Use Cases supplied by AHIC:
§ Security and Privacy constructs will help to keep patient health information secure in an electronic environment. The standards will also help to assure that this information will only be used by authorized personnel for official purposes, including electronic delivery of lab results to a clinician, medication workflow for providers and patients, quality, and consumer empowerment.
§ Emergency Responder-Electronic Health Record will track and provide on-site emergency care professionals, medical examiner/fatality managers, and public health practitioners with needed information regarding care, treatment, or investigation of emergency incident victims.
§ Consumer Access to Clinical Information will assist patients in making decisions regarding care and healthy lifestyles. Accessible information could include registration information, medication history, lab results, current and previous health conditions, allergies, summaries of healthcare encounters, and diagnoses.
§ Quality indicators will benefit providers by providing a collection of data for inpatient and ambulatory care, and will benefit clinicians by providing real-time or near-real-time feedback regarding quality indicators for specific patients.
At its meeting on January 22, 2008, AHIC unanimously recommended the 2007 work to Secretary Leavitt. If the Secretary accepts the recommendations as reported; the requisite one-year period of review and testing for the new Interoperability Specifications will begin.
Nearly 400 organizations representing consumers, health care providers, public health agencies, government agencies, standards developing organizations, and other stakeholders now participate in the HITSP and its committees. Members work together to define the necessary functional components and standards – as well as gaps in standards – which must be resolved to enable the interoperability of health care data. Public comments are considered as the Panel develops its recommendations.
About HITSP. Operating under contract to the U.S. Department of Health and Human Services (HHS), the HITSP is administered by the American National Standards Institute (ANSI) in cooperation with strategic partners including the Healthcare Information and Management Systems Society (HIMSS), the Advanced Technology Institute (ATI) and Booz Allen Hamilton.
About ANSI. ANSI is a private non-profit organization whose mission is to enhance U.S. global competitiveness and the American quality of life by promoting, facilitating, and safeguarding the integrity of the voluntary standardization and conformity assessment system. Its membership is comprised of businesses, professional societies and trade associations, standards developers, government agencies, and consumer and labor organizations. The Institute currently administers five standards panels in the areas of homeland security, nanotechnology, healthcare information technology, biofuels and identity theft prevention and identity management.
FOR IMMEDIATE RELEASE
Contact: Stacy Leistner
American National Standards Institute
(212) 642-4931
HHS Secretary Recognizes Products of HITSP Standards Work
Washington, DC, January 24, 2008: U.S. Department of Health and Human Services (HHS) Secretary Mike Leavitt recognized the first set of interoperability standards developed by the Healthcare Information Technology Standards Panel (HITSP). The HITSP advanced three of its “Interoperability Specifications” to help support the advancement of interoperable health records and a Nationwide Health Information Network in the United States aimed toward improved and more efficient care.
HHS Secretarial recognition of interoperability standards is referenced in an Executive Order (E.O. 13410) signed by President George W. Bush in August 2006 and promotes standards to be implemented in new and upgraded federal health systems. These standards will also become part of the certification process for electronic health records and networks.
“Safe and affordable healthcare depends upon the secure exchange of information among patients, providers, payers and government entities such as public health agencies,” explained Dr. John Halamka, HITSP chair and CIO of Harvard Medical School.
The HITSP “Interoperability Specifications” which pertain to three initial priority work areas (“Use Cases”) assigned to the Panel by the American Heath Information Community (AHIC), were accepted by Secretary Leavitt in December 2006 as interoperability standards in these areas:
§ Electronic Health Record (EHR) (e.g., the electronic delivery of lab results to providers of care),
§ Biosurveillance (e.g., data networks supporting the rapid alert to a disease outbreak), and
§ Consumer Empowerment (e.g., giving patients the ability to manage and control access to their registration and medication histories).
Each Interoperability Specification is an unambiguous “cookbook” that identifies the “named” standards and provides implementation guidance to all stakeholders exchanging the health care information specified in each Use Case.
The Secretary’s acceptance in December 2006 launched a year-long period of review and testing by healthcare providers, public health agencies, government agencies, standards developing organizations, consumers and other stakeholders. His recognition signifies the end of the testing period and the beginning of when federal agencies administering or sponsoring federal health programs will begin implementation.
“Recognition of the HITSP Interoperability Specifications is an important milestone” added Halamka. “Between the federal implications and the certification efforts of CCHIT, stakeholders will be motivated to adopt a standard way of sharing data throughout the Nationwide Health Information Network, leading to better healthcare for us all.”
During 2007, the HITSP continued its work by focusing on security and privacy constructs and a new set of Use Cases supplied by AHIC:
§ Security and Privacy constructs will help to keep patient health information secure in an electronic environment. The standards will also help to assure that this information will only be used by authorized personnel for official purposes, including electronic delivery of lab results to a clinician, medication workflow for providers and patients, quality, and consumer empowerment.
§ Emergency Responder-Electronic Health Record will track and provide on-site emergency care professionals, medical examiner/fatality managers, and public health practitioners with needed information regarding care, treatment, or investigation of emergency incident victims.
§ Consumer Access to Clinical Information will assist patients in making decisions regarding care and healthy lifestyles. Accessible information could include registration information, medication history, lab results, current and previous health conditions, allergies, summaries of healthcare encounters, and diagnoses.
§ Quality indicators will benefit providers by providing a collection of data for inpatient and ambulatory care, and will benefit clinicians by providing real-time or near-real-time feedback regarding quality indicators for specific patients.
At its meeting on January 22, 2008, AHIC unanimously recommended the 2007 work to Secretary Leavitt. If the Secretary accepts the recommendations as reported; the requisite one-year period of review and testing for the new Interoperability Specifications will begin.
Nearly 400 organizations representing consumers, health care providers, public health agencies, government agencies, standards developing organizations, and other stakeholders now participate in the HITSP and its committees. Members work together to define the necessary functional components and standards – as well as gaps in standards – which must be resolved to enable the interoperability of health care data. Public comments are considered as the Panel develops its recommendations.
About HITSP. Operating under contract to the U.S. Department of Health and Human Services (HHS), the HITSP is administered by the American National Standards Institute (ANSI) in cooperation with strategic partners including the Healthcare Information and Management Systems Society (HIMSS), the Advanced Technology Institute (ATI) and Booz Allen Hamilton.
About ANSI. ANSI is a private non-profit organization whose mission is to enhance U.S. global competitiveness and the American quality of life by promoting, facilitating, and safeguarding the integrity of the voluntary standardization and conformity assessment system. Its membership is comprised of businesses, professional societies and trade associations, standards developers, government agencies, and consumer and labor organizations. The Institute currently administers five standards panels in the areas of homeland security, nanotechnology, healthcare information technology, biofuels and identity theft prevention and identity management.
Thursday, January 24, 2008
How to get a good start to the day
As CEO, you never know how your day will start. This one started very well, with the following two emails waiting in my inbox. I share them with you because they made me happy. They show how a single person in a hospital can make a difference to patients and also affect the reputation of the institution.
#1 -- Yesterday morning I brought my mother to the BIDMC for a routine colonoscopy that took place in the Farr Building. As a self-appointed "secret shopper," I made an observation I'd like to share with you. When we arrived on the 8th floor, we were met by a nurse who introduced herself as Michelle. Michelle is truly a credit to your organization and her profession. She conveyed a caring and calming demeanor toward my mother and also exhibited the same professional courtesy with every patient in the waiting area. Clearly, patient-centered care is highly valued by Michelle. It is a team member like her who helps make BIDMC a first-class institution.
#2 -- I had meant to send this email back in November but got busy with the holidays. First met Ms. Morris, Rabb 3 Radiology, eight years ago when my husband was a patient at BIDMC for surgery. I now see her yearly when I visit that department for ultrasounds. She goes out of her way to be accommodating, efficient and most pleasant. Going to that department is a pleasure because of her being there at the registration desk. She is a great representation of BIDMC. Thanks for having Debra at that desk.
#1 -- Yesterday morning I brought my mother to the BIDMC for a routine colonoscopy that took place in the Farr Building. As a self-appointed "secret shopper," I made an observation I'd like to share with you. When we arrived on the 8th floor, we were met by a nurse who introduced herself as Michelle. Michelle is truly a credit to your organization and her profession. She conveyed a caring and calming demeanor toward my mother and also exhibited the same professional courtesy with every patient in the waiting area. Clearly, patient-centered care is highly valued by Michelle. It is a team member like her who helps make BIDMC a first-class institution.
#2 -- I had meant to send this email back in November but got busy with the holidays. First met Ms. Morris, Rabb 3 Radiology, eight years ago when my husband was a patient at BIDMC for surgery. I now see her yearly when I visit that department for ultrasounds. She goes out of her way to be accommodating, efficient and most pleasant. Going to that department is a pleasure because of her being there at the registration desk. She is a great representation of BIDMC. Thanks for having Debra at that desk.
The votes are in -- Thank you!
Many, many thanks to all of you who voted for my blog in the Medgadget annual competition for best medical blog. I was very fortunate to win in two categories, Best Medical Blog and Best Health Policies/Ethics Blog. I am grateful to all who voted, but also want to express my deep appreciation for the others nominated in these categories, many of whom I read regularly. Special congratulations to all the other winners, but notably Dr. Val, and the Voice of Reason -- for Best New Medical Blog. If you haven't linked to Val's page, you really should check it out.
Wednesday, January 23, 2008
Red pills or black pills?
Sometimes you see a drug ad on TV, and when you think you hear something about its possible side effects, you are sure you heard it wrong. Such was the case when my wife saw an ad for a drug dealing with restless leg syndrome.
We thought we heard something like this: There have been reports of patients that have reported problems with gambling, compulsive eating, and increased sex drive. If you or your family members notice that you are developing unusual behaviors, talk to your doctor.
"Impossible," we said to one another. "They can't really market a drug that has these possible side effects, can they?"
Two days later, I am watching Jon Stewart and he is doing a comedy routine quoting from these ads.
Well, now that I had heard it from a reliable source, I did a little Google research and found an article on the subject from the journal Neurology, entitled, "Pathologic gambling in patients with restless legs syndrome treated with dopaminergic agonists."
Stewart wonders if we have this backward. He suggests that maybe we should develop a drug for compulsive gambling that has the occasional side effect of restless leg syndrome. Maybe he is more of a health care expert than I gave him credit for.
We thought we heard something like this: There have been reports of patients that have reported problems with gambling, compulsive eating, and increased sex drive. If you or your family members notice that you are developing unusual behaviors, talk to your doctor.
"Impossible," we said to one another. "They can't really market a drug that has these possible side effects, can they?"
Two days later, I am watching Jon Stewart and he is doing a comedy routine quoting from these ads.
Well, now that I had heard it from a reliable source, I did a little Google research and found an article on the subject from the journal Neurology, entitled, "Pathologic gambling in patients with restless legs syndrome treated with dopaminergic agonists."
Stewart wonders if we have this backward. He suggests that maybe we should develop a drug for compulsive gambling that has the occasional side effect of restless leg syndrome. Maybe he is more of a health care expert than I gave him credit for.
Tuesday, January 22, 2008
Chapter 93
As a non-MD, I don't often get to attend M&M (mortality and morbidity) conferences of our various departments. These are usually highly technical sessions where doctors discuss cases that have gone awry or otherwise have educational value for the residents and attendings.
I was invited to attend one today, though, where a special guest was present, the patient who arrived in the Emergency Department and went through an incredible medical process, leading very close to death. He and his mother were at the M&M to offer the capstone comments after the medical discussion. Back to that in a minute.
This was a very challenging case. A patient with many medical problems. A difficult diagnosis. A delay in the diagnosis that probably led to "coding" and a need to resuscitate the patient. For those of you who have not been through an M&M, you would be impressed by the candor of the discussion and the lack of blame and recrimination -- so that lessons from the case can be clearly identified and applied in the future.
The diagnosis was delayed because of "diagnostic anchoring," a topic discussed in Jerry Groopman's recent book, How Doctors Think. If you put blinders on the diagnostic path based on early indicators or predispositions, you will miss things that are important. That happened here. Luckily, though, the ultimate diagnosis was obtained in this case because the doctor in charge refused to close off other avenues of inquiry when the facts did not seem to support the initial presumption.
The successful resolution for this patient required incredible amounts of teamwork among emergency department doctors, internists, radiologists, pulmonologists, anaesthesiologists, respiratory therapists, transporters, and nurses. Here is a summary of the people and resources applied to this case.
•> 100 lab tests
•10 Electrocardiograms
•Continuous telemetry monitoring
•3 Chest X-Rays
•1 Echocardiogram
•2 Line placement procedures
•Seen by 9 physicians, 4 nurses
•Administered 12 medications
Back to the patient, a devout Muslim, who finished the case discussion by saying that he had woken up the next morning after dreaming about the number 93. He looked out the window to see the bright sun and blue sky and realized he was dreaming about Chapter 93 of the Holy Qur'an. I quote an excerpt:
The Brightness
In the name of Allah, the Beneficent, the Merciful.
I swear by the early hours of the day,
And the night when it covers with darkness.
Your Lord has not forsaken you, nor has He become displeased,
And surely what comes after is better for you than that which has gone before.
I was invited to attend one today, though, where a special guest was present, the patient who arrived in the Emergency Department and went through an incredible medical process, leading very close to death. He and his mother were at the M&M to offer the capstone comments after the medical discussion. Back to that in a minute.
This was a very challenging case. A patient with many medical problems. A difficult diagnosis. A delay in the diagnosis that probably led to "coding" and a need to resuscitate the patient. For those of you who have not been through an M&M, you would be impressed by the candor of the discussion and the lack of blame and recrimination -- so that lessons from the case can be clearly identified and applied in the future.
The diagnosis was delayed because of "diagnostic anchoring," a topic discussed in Jerry Groopman's recent book, How Doctors Think. If you put blinders on the diagnostic path based on early indicators or predispositions, you will miss things that are important. That happened here. Luckily, though, the ultimate diagnosis was obtained in this case because the doctor in charge refused to close off other avenues of inquiry when the facts did not seem to support the initial presumption.
The successful resolution for this patient required incredible amounts of teamwork among emergency department doctors, internists, radiologists, pulmonologists, anaesthesiologists, respiratory therapists, transporters, and nurses. Here is a summary of the people and resources applied to this case.
•> 100 lab tests
•10 Electrocardiograms
•Continuous telemetry monitoring
•3 Chest X-Rays
•1 Echocardiogram
•2 Line placement procedures
•Seen by 9 physicians, 4 nurses
•Administered 12 medications
Back to the patient, a devout Muslim, who finished the case discussion by saying that he had woken up the next morning after dreaming about the number 93. He looked out the window to see the bright sun and blue sky and realized he was dreaming about Chapter 93 of the Holy Qur'an. I quote an excerpt:
The Brightness
In the name of Allah, the Beneficent, the Merciful.
I swear by the early hours of the day,
And the night when it covers with darkness.
Your Lord has not forsaken you, nor has He become displeased,
And surely what comes after is better for you than that which has gone before.
New payment plan?
Blue Cross Blue Shield of MA is proposing a new optional model for physician and hospital reimbursement. Alice Dembner at The Boston Globe explains, and Bob Oakes at WBUR offers a radio version of the issues involved.
By the way, I have been wondering. Why is it called "reimbursement" in the hospital and physician world? In every other sector, we call it "payment". Can you imagine going to a grocery store and saying to the check-out clerk, "I'd like to reimburse you for this head of lettuce"?
By the way, I have been wondering. Why is it called "reimbursement" in the hospital and physician world? In every other sector, we call it "payment". Can you imagine going to a grocery store and saying to the check-out clerk, "I'd like to reimburse you for this head of lettuce"?
Subscribe to:
Posts (Atom)
