Thursday, February 21, 2008

London subway map

From several speeches given by Lord Darzi, demonstrating inequalities in the effectiveness of the public health system within London. I think this is a particularly effective graphic showing the decreased life expectency between the wealthier districts of the city compared to the less wealthy.

In case you can't read the numbers, male/female life expectancy drops from 77.7/85.2 years in Westminster to 70.7/78.4 in Canning Town. (The source of data is London Health Observatory using Office for National Statistics data. The diagram was produced by the Department of Health.)

Again, I present this not be create a debate about the merits of the British and US health care systems. After all, a similar map could be presented along the Red Line or Orange Line routes in Boston. I offer it mainly to express my appreciation of the willingness to be open and present numbers like this so the public can fully engage in the improvement process at the NHS.


Anonymous said...

That's a very interesting graph!! Thanks for sharing.

I'm curious to know what comments your London readers have on this depiction. Any Londoners out there?

Anonymous said...

Other than obvious socio-economic demographics, it would be interesting to see a detailed map showing the locations of waste treatment facilities, polluting factories, highly travelled diesel truck routes, and other environmental health hazards that are usually located in lower-income and predominantly ethnic minority neighborhoods.

Anonymous said...

Yep, I'm a Londoner by birth and residence and it's a stunning and provocative graphic. The key thing to understand is that the life expectancy gradient is mainly due to wider socio-economic inequalities and NOT to variation in access to health care.

Having said that, Darzi's report on London's health care did make me sit up and think - even though I thought I knew a lot about public health. The two big messages I took from it were 1. we have to look East - London's demographic centre of gravity is shifting that way but health service provision is lagging behind and 2. the main barrier to change is not professional resistance (as usually claimed) but NHS estate - the land and buildings currently available are not the land and buildings one would really like to have.

Anonymous said...

This is not a response to one of your blog postings. As an employee of BIDMC, I’m using your blog as an opportunity to anonymously alert you to what I view as a major hospital-wide issue.

You are the leader of a world-class medical center that does so many good things for our patients and the community. Ground-breaking research and innovative medical care takes place at the hospital everyday. Leadership is clearly dedicated to making sure the care given at BIDMC is second-to-none. However, that same leadership does not always show the same dedication to their staff.

As an employee, it is apparent that managers are hired for their expertise in the trade of their department and not for their experience in managing people. A friend of mine in HR always says “People leave their bosses, not their jobs.” Knowing that it takes happy employees to successfully run a business; shouldn’t all businesses make employee satisfaction a priority?

Paul, when you set annual goals with members of leadership, do the goals ever revolve around staff development or employee satisfaction….. or, are they always clinical or operational priorities?

Last year, all employees at BIDMC were asked to fill out an employee satisfaction survey. I’m aware of negative feedback from multiple departments. Now that you have this information, what is the plan for turning the table? Shouldn’t upper-level managers be trained on the basic skills to effectively manage teams? Since employee satisfaction is a foundation to any successful business, shouldn’t there be a mandatory training for managers on how to make it happen?

You may not see these problems from the vantage point of a CEO, but believe me, they exist. What is being done to address these issues?

Anonymous said...

Dear anonymous,

Thank you for your comment. Before responding to your points, let me just say that the fact that you have written this comment anonymously and chosen to post it in this way makes me wonder if, in fact, you work at our hospital -- because people at the hospital know that they can always approach me directly on this kind of issue, and that I welcome those communications. I raise this point only because, as you know, the people at SEIU are taking many steps to disparage out hospital, and so (unfortunately), I have to wonder whether your choice to raise this issue in this way is just another page from the union's playbook.

Nonethless, the points you raise are legitimate in ours and other organizations, and I am pleased to address them on the merits. It is often the case that managers in large organizations are not particularly well trained in aspects that are important. Our recent employee survey showed a variation in the ability of managers, and, yes, we are working with those who need to improve in areas you have cited as well as other areas. Employee satisfaction is an absolute priority, as you can see from actions we have taken and decisions to engage in programs like BIDMC SPIRIT, whose main purpose is just that.

Now, if you have particular parts of the hospital in which this is a concern, please feel free to email me or drop a note off at my office (anonymously, if that is your choice).

Finally, back to my first point. The results of the employee surveys were widely shared with people throughout the hospital. When you say that you are "aware of negative feedback", you once again use language that makes me indicate that you are not actually an employee. Ditto when you say that the leadership of the hospital does not show a dedication to the staff, after saying nice things about the mission of the hospital. The structure of your statements is exactly parallel to that used by the SEIU in its various letters and other publications.

Finally, it is hard to imagine any employee would say "You may not see these problems from the vantage point of a CEO". That is union-organizing corporate-campaign-speak. In six years, no one has written a comment like that to me, even when they have sent me notes with complaints and concerns.

Perhaps I am mistaken in my response, but you can easily clear that up by contacting me directly.

Anonymous said...

Thanks for your response, much appreciated. I AM an employee, scout's honor! I actually DO NOT support the SEIU and have admired how you've handled their dirty tactics. I can see however how you may have thought this was from them.

You are very approachable indeed. However, when one has a problem with their leadership, it is intimidating, no matter how approachable your CEO is, to find a risk-free outlet to voice such issues. You are the CEO, have relationships with leadership, and that will always be intimidating to someone like me--- a person whose never spoken directly to you. However, I will consider contacting you directly as you kindly offered.

Let me just speak from the heart for a moment before doing that.....

I TRULY love working at BIDMC, I wouldn't be there if I didn't. The issue is that management so often takes the joy out of my job by being bad people managers. The real frustration comes when you look at how very smart these people are---they are experts in their specific areas, without a doubt. Despite their intelligence, many members of leadership lack the basic team building skills that help to establish a solid foundation for departments and programs.

The reason I wrote in is because I believe this problem is fixable! I think if you were all of our direct managers everyone throughout the hospital would feel valued ... unfortunately your tide up with other things. :) Seriously though, if you made this issue a focus with leadership I think change would happen. I think the SPIRIT project will help, but also feel that it has to be a more personal focus between you and leadership directly to really get things moving. Something as simple as asking members of leadership to share their approaches to staff/team development at a management meeting would go a long way. Perhaps you'd even consider making it a subject of one of your daily blog posts?

Some people just inately have the ability to bring people together, you are one of them. I'm requesting this of you --- Please find a way to share this talent with your management team. Find a way to make them realize how important it is. Find a way to make your management care about it just as much as you do.

I truly believe that team building is the foundation to success at any company, especially in a health care setting. Without this strong foundation, nothing built on top of it will ever feel sturdy or secure. Does this make sense?

Thanks Paul for listening. I, and the rest of the staff at BIDMC, know you really do care.

Anonymous said...

Thanks very much. I think we are on the same wavelength in many respects. The problem you mention is true in many organizations. As I noted, at BIDMC the surveys gave clear indications of which managers need exactly the kind of training you mention. It is not surprising that many do, in that -- as you mention -- their professional advancement was often related to specific technical skills and experience, as opposed to the kind of attributes that help them be better managers.

So, we do plan to pursue this and have already done so in several cases. Also, BIDMC SPIRIT has the potential to help in several respects, too, although it is not the whole solution.

Please drop by any time . . .

jessica lipnack said...

I've wondered why you permit anonymous posting. Many bloggers don't, myself included. I think it invites a certain kind of impolite/anything-goes "opinionating" (no, it's not a word). I also wonder why people post anonymously. I don't get it. These same people would never wear a mask in person or disguise their voices on the phone. Forgive me if you've covered this previously and I've missed it.

Anonymous said...

What you say is true, Jessica, but I guess I permit anonymous comments on this blog because there are some opinions out there that will never be heard if people are required to add their name. I have made the decision that I would rather have those opinions out on the record than not ever seeing them.

Now, I agree that it can lead to some unpleasant comments, and it can also permit so-called "innocent" questions or comments that are in fact clever attempts to push a certain political agenda. But, hey, that agenda is out there anyway, so we might as well all undertsand it.

It can, though, (as has prompted your comment) result in the interesting type of exchange exemplified in the back-and-forth you have just read. If I think that an anonymous commenter is representing a certain organization and hiding behind the anonymity to do so, I will suggest it outright, while still addressing the merits of the comment. I hope I do so in a respectful manner.