Again in Harvard Business Review
http://hbr.harvardbusiness.org/2002/04/look-before-you-lay-off/ar/1
Look Before You Lay Off
by Darrell Rigby
"Downsizing in a downturn can do more harm than good. Layoffs, the conventional wisdom goes, are a necessary evil during economic downturns. The problem is, the conventional wisdom is wrong. Researchers at Bain & Company analyzed the layoffs at S&P 500 companies during the early stages of the current downturn (from August 2000 through August 2001) and found that even as layoff numbers reached record levels, most companies weren’t downsizing.
"...Rather, a small group of poorly performing companies accounted for the vast majority of firings, and their experience shows that reactive downsizing can backfire.During the study period, companies with few or no layoffs performed significantly better than those with large numbers of layoffs."
Hospitals across the country are announcing layoffs to preserve cash/cut costs. Good idea? Are these jobs that begged to be eliminated earlier but were a distraction or are these jobs that will "just come back" in six months. Are boards pressuring to lay people off? Do you think it will make a difference?
Friday, February 27, 2009
How big is too big?
In this month's Harvard Business Review, Duncan Watts asks the question: "Too big to fail, or too big to exist?" "Having studied the dynamics of cascades in complex systems, I suspect that the most damaging ones are impossible to anticipate with any confidence. The solution may therefore be to make the system less complex to start with, in part by limiting how big companies are allowed to become."
He refers to banks and the financial services industry obviously, but brings us back to utility meltdowns that cascaded across several states affecting millions of people.
Is it time to apply this thinking to healthcare? How big is too big? When do economies of scale matter and at what risk? Is there a too big healthcare system? And what are the consequences of it failing. Is size actually protecting and stabilizing healthcare?
While this might seem a stretch, todays headlines in Wall Street Journal, New York Times and Modern Healthcare all refer to the steep drop off in stock prices for Medicare Advantage Insurers. When are health consumers at risk of organizations too big to exist?
He refers to banks and the financial services industry obviously, but brings us back to utility meltdowns that cascaded across several states affecting millions of people.
Is it time to apply this thinking to healthcare? How big is too big? When do economies of scale matter and at what risk? Is there a too big healthcare system? And what are the consequences of it failing. Is size actually protecting and stabilizing healthcare?
While this might seem a stretch, todays headlines in Wall Street Journal, New York Times and Modern Healthcare all refer to the steep drop off in stock prices for Medicare Advantage Insurers. When are health consumers at risk of organizations too big to exist?
Thursday, February 26, 2009
Dominos: pizza tracker!
I ordered a pizza on line last night. (Okay its not healthy but thats not the point.) I typed in my zip code, covered my virtual pizza with toppings and paid with a credit card (but it could have been cash). That is where the amazing thing happened. All the mystery went out of my pizza preparation and transport...The Tracker popped up on the screen. It turned colors as it went from identifying a location and transmitting the order, to preparation, to the oven, to the delivery vehicle in route to my front door....all on my tracker on my computer! I never had to worry that they lost my order, it was sitting somewhere not making its way onto the delivery truck. All I had to do was call my kids and say, I think its on its way, wash your hands as the light on the delivery bar went from red to blue!
Couldn't we give our patients and outpatient customers the same piece of mind that their orders are being scheduled and that we know where in the queu they are? Shouldn't we build confidence and reduce anxiety as part of our process? Can't we adopt the Pizza Tracker!
I have to give DHL, Fedex, UPS and others a nod for a similar experience. Scheduling and tracking doesn't seem to be rocket science anymore.
Don't get me wrong, I get those nice little digital reminders on my phone that I have an appointment coming up. But this seemed to share the process in a way that was, shall we say, transparent! After waiting from 6am until 7pm for agreement on my own discharge orders, I could have used the pizza tracker!
Couldn't we give our patients and outpatient customers the same piece of mind that their orders are being scheduled and that we know where in the queu they are? Shouldn't we build confidence and reduce anxiety as part of our process? Can't we adopt the Pizza Tracker!
I have to give DHL, Fedex, UPS and others a nod for a similar experience. Scheduling and tracking doesn't seem to be rocket science anymore.
Don't get me wrong, I get those nice little digital reminders on my phone that I have an appointment coming up. But this seemed to share the process in a way that was, shall we say, transparent! After waiting from 6am until 7pm for agreement on my own discharge orders, I could have used the pizza tracker!
Obama: health care reform = health cost reduction!
In his speech to a joint session of Congress Tuesday night, President Obama, as a prelude to saying health reform can't wait, sited health-care costs as the biggest problem. Cost are “one of the major reasons why small businesses close their doors and corporations ship jobs overseas” and “one of the largest and fastest-growing parts of our budget.”
In his budget submitted to Congress yesterday, Obama asked for a health fund of over $600 billion to fund his new programs, but staff said that did not cover the cost of the full program in the ten year budget. Cost reduction and "efficiencies" will be needed to fund the program.
Universally, institutions appear to be in the process currently of ratcheting down costs in an effort to stabilize balance sheets and bottomlines. Will there need to be an end to competition as the solution and a return to 60s style health planning to meet these goals? How are Boards being prepared to think differently in this environment?
In his budget submitted to Congress yesterday, Obama asked for a health fund of over $600 billion to fund his new programs, but staff said that did not cover the cost of the full program in the ten year budget. Cost reduction and "efficiencies" will be needed to fund the program.
Universally, institutions appear to be in the process currently of ratcheting down costs in an effort to stabilize balance sheets and bottomlines. Will there need to be an end to competition as the solution and a return to 60s style health planning to meet these goals? How are Boards being prepared to think differently in this environment?
Tuesday, February 24, 2009
Spending on hospital care to double in 10 years to $1.4 trillion and consume 20.3% of GDP
In an article posted February 24, 2009 - 5:59 am EDT, "Growth in healthcare spending expected to slow: CMS" By Jennifer Lubell in Modern Healthcare, http://www.modernhealthcare.com/article/20090224/REG/302249977
CMS estimates that "the growth in national healthcare spending is projected to slow in 2009...The study... estimates that healthcare spending will have reached $2.4 trillion by 2008.
"In other trends, growth in spending on hospital care is expected to slow to 5.7% in 2009 from 7.2% in 2008, as a result of slower private spending growth for hospital care. Over the next 10 years, spending on hospital care is expected to reach nearly $1.4 trillion, up from a projected $746.4 billion in 2008.
"Growth in spending among public payers is expected to accelerate from 6.4% in 2007, ... driven largely by faster growth in Medicaid enrollment and spending. By comparison, private health spending growth is expected to fall to a 15-year low of 3.9% in 2009, The CMS predicts the growth rate in national health spending will rise again in 2011 as economic conditions improve."
Does this mean greater pressure for Medicaid to pay its full cost+ in all states? In many states, Illinois being one that I am familiar with, Medicaid seriously underpays all providers other than the "high DSH" hospitals that are completely dependent on Medicaid for their survival. Private funding makes up the bottomline for these providers. With shrinking private funding will hospitals ramp up pressure to get Medicaid rates closer to Medicare in anticipation of a single payor? Can your community afford 20.3% of the GDP in health? Or are you in a community where that is already the case.
See full article in Modern Healthcare under quick references below.
CMS estimates that "the growth in national healthcare spending is projected to slow in 2009...The study... estimates that healthcare spending will have reached $2.4 trillion by 2008.
"In other trends, growth in spending on hospital care is expected to slow to 5.7% in 2009 from 7.2% in 2008, as a result of slower private spending growth for hospital care. Over the next 10 years, spending on hospital care is expected to reach nearly $1.4 trillion, up from a projected $746.4 billion in 2008.
"Growth in spending among public payers is expected to accelerate from 6.4% in 2007, ... driven largely by faster growth in Medicaid enrollment and spending. By comparison, private health spending growth is expected to fall to a 15-year low of 3.9% in 2009, The CMS predicts the growth rate in national health spending will rise again in 2011 as economic conditions improve."
Does this mean greater pressure for Medicaid to pay its full cost+ in all states? In many states, Illinois being one that I am familiar with, Medicaid seriously underpays all providers other than the "high DSH" hospitals that are completely dependent on Medicaid for their survival. Private funding makes up the bottomline for these providers. With shrinking private funding will hospitals ramp up pressure to get Medicaid rates closer to Medicare in anticipation of a single payor? Can your community afford 20.3% of the GDP in health? Or are you in a community where that is already the case.
See full article in Modern Healthcare under quick references below.
If Your Type A personality doesn't meditate...
Any break in a stress cycle every 90 minutes for 1-2 minutes is beneficial! So for non-meditation types, a play list of Rock is attached under wellness.....Just move out of your zone every 90 minutes....called Recovery time! Your body and mind will appreciate the effort and discipline. If that playlist doesn't work for you, create your own - its free! And will make teenagers in your life sit up and respect you more! Enjoy!
Meditation: Take a stress-reduction break wherever you are
STRESS KILLS! Even for those of you who are on the extremes of perfect emotional intelligence, healthcare leadership comes with stress and many female leaders don't adequately attend to it for themselves. We are adding a blog section on wellness links to make it as easy as saying Om to begin stress reduction today. Also attached today is an article on meditation from the Mayo Clinic. This is by far not the most radical but its a start! 20 minutes of concentrated quiet finding your center is not impossible.
"Meditation — Learn quick and easy ways to meditate, no matter where you are. "
http://www.mayoclinic.com/health/meditation/HQ01070
Even better would be a few Yoga or tai chi moves in your office or out on the front lawn for all the healthcare community to see your example! Too Much for now, okay, maybe in your office and next year we will see you leading the charge.
For women, the hormone balance provided by both meditation and yoga are increasingly mentioned in the popular media and among female physicians.
"Meditation — Learn quick and easy ways to meditate, no matter where you are. "
http://www.mayoclinic.com/health/meditation/HQ01070
Even better would be a few Yoga or tai chi moves in your office or out on the front lawn for all the healthcare community to see your example! Too Much for now, okay, maybe in your office and next year we will see you leading the charge.
For women, the hormone balance provided by both meditation and yoga are increasingly mentioned in the popular media and among female physicians.
Sunday, February 22, 2009
David Brailer suggests Obama jump start IT to make up for the lag
http://healthaffairs.org/blog/2009/01/14/complete-the-work-on-health-information-technology/
"President-elect Obama recently placed health IT among the critical infrastructures that are essential in the 21st century. He rightly recognizes that health care is one of our few remaining economic sectors where IT has not taken root. His health reform plan relies upon health IT to reduce costs and improve efficiencies. He has pledged $50 billion to bring health information tools into widespread use (which is $49,950,000 more than President Bush gave me to spend).
Now that we are well into the transition, reasonable questions to ask are, What should the President-elect do to get health IT into widespread use? What should he do differently from President Bush? What should he not do?
A Health IT Agenda For President Obama
First and foremost, President-elect Obama needs to address the growing chasm between the physicians and hospitals that have electronic records and those that do not. Most large and urban hospitals as well as larger physician practices are far along in using EHRs. Rural hospitals, nursing homes, and small physician practices lag far behind. They face many barriers, but foremost among them is the lack of capital to purchase and implement information tools. We were reluctant to offer government incentives for electronic records, preferring market forces to drive adoption as far as possible. Sales pipelines and hospital and physician budgets show that EHR purchases have slowed, indicating that the market wave has gone as far as it can."
How do you think government incentives should work to assure real progress? How much time and money is your organization devoting to IT? How much time and attention are you personally devoting to the stimulus bill?
"President-elect Obama recently placed health IT among the critical infrastructures that are essential in the 21st century. He rightly recognizes that health care is one of our few remaining economic sectors where IT has not taken root. His health reform plan relies upon health IT to reduce costs and improve efficiencies. He has pledged $50 billion to bring health information tools into widespread use (which is $49,950,000 more than President Bush gave me to spend).
Now that we are well into the transition, reasonable questions to ask are, What should the President-elect do to get health IT into widespread use? What should he do differently from President Bush? What should he not do?
A Health IT Agenda For President Obama
First and foremost, President-elect Obama needs to address the growing chasm between the physicians and hospitals that have electronic records and those that do not. Most large and urban hospitals as well as larger physician practices are far along in using EHRs. Rural hospitals, nursing homes, and small physician practices lag far behind. They face many barriers, but foremost among them is the lack of capital to purchase and implement information tools. We were reluctant to offer government incentives for electronic records, preferring market forces to drive adoption as far as possible. Sales pipelines and hospital and physician budgets show that EHR purchases have slowed, indicating that the market wave has gone as far as it can."
How do you think government incentives should work to assure real progress? How much time and money is your organization devoting to IT? How much time and attention are you personally devoting to the stimulus bill?
Interesting commentary on SEIU's Hospital Corporate Campaigns in Hospitals with High Employee Satisfaction
http://runningahospital.blogspot.com/2009/02/innocent-until-seiu-says-otherwise.html. This article highlights the havoc that the card-check legislation could bring to hospitals that have stable and professional workforces. It seems that while most would agree that it is often difficult to create policies that protect each and every associate, the current track record of SEIU is more about protecting SEIUs growing political power base.
http://www.chausa.org/Pub/MainNav/News/CHW/Archive/2008/1201/Articles/w081201d.htm In this Catholic Health World article (not well disseminated outside of Catholic Healthcare), Deborah Proctor outlines their thoughtful approach to protecting workers rights under the law by standing up to the corporate campaign against St. Joseph in Orange.
It might be interesting to know if there are proactive approaches being used with Democrats to dissuade them on the card check issue. The manufacturing and financial services industries do not appear to have the credibility to carry this water.
Friday, February 13, 2009
Is bad debt becoming your charity care?
According to the Kaiser Family Foundation, every one percentage point increase in the unemployment rate generates 1.1 million more uninsured persons and adds 1 million more Medicaid and State Children's Health Insurance Program beneficiaries.
As uninsured and underinsured numbers grow, should the CHA relook at its charity care policy?
As uninsured and underinsured numbers grow, should the CHA relook at its charity care policy?
Thursday, February 12, 2009
WSJ.com - Report Sheds New Light on Nonprofit Hospitals
WSJ.com - Report Sheds New Light on Nonprofit Hospitals* This article will be available to non-subscribers of the Online Journal for up to seven days after it is e-mailed.
Wednesday, February 11, 2009
How do you keep up?
Not your spirits, although in this economy that would be a legitimate question, but how do you stay on top of all the information sources? What are your top priorities? New information, news, who is where? What topics are a must? Politics, Reimbursement, Cost, New Technology?
Is "bonus" a dirty word? Is there real performance in "pay for performance?
"$18 billion in bonus pay" screech the headlines. And for what?
The key question is not about how much but for what benefit, to the firm, and now with the global crisis, the US economy and even the world stage.
As healthcare executives, under the spotlight regarding tax-exempt status, (even if it has diminished in the glare of wall street issues), incentives and total compensation are a huge issue. Does that mean they are wrong? The real question is "are you getting what you are paying for?", "could you have gotten it anyway without the incentive?" and "can you explain it to the average American in 8 to 10 words across the headline of your local paper?". That is the real issue. Are the incentives crystal clear (transparent) to all involved as to what they are paying for.
It seems that this is a unique time to rethink this issue. We need greater leadership than ever, greater acccountability, productivity, creativity....are we paying for measurable progress that the community understands.
Can you see the headline?: CEO Jane Doe received 32% of salary for decreasing mortality at X by 50% in 9 high volume procedures. (19 words!) Try "CEO gets huge payout for exceptional quality report! (8 words - is more like what the paper will give you). Or "System rewards leaders for 15% market share gain". "Zero preventable accidents scores bonus for leadership"! "Hard choices provide security for those left behind."
Many companies are eliminating raises this year. Oil Companies, major players. I bet those employees would be willing to look at pay for performance.
How are you looking at bonuses/incentives differently?
The key question is not about how much but for what benefit, to the firm, and now with the global crisis, the US economy and even the world stage.
As healthcare executives, under the spotlight regarding tax-exempt status, (even if it has diminished in the glare of wall street issues), incentives and total compensation are a huge issue. Does that mean they are wrong? The real question is "are you getting what you are paying for?", "could you have gotten it anyway without the incentive?" and "can you explain it to the average American in 8 to 10 words across the headline of your local paper?". That is the real issue. Are the incentives crystal clear (transparent) to all involved as to what they are paying for.
It seems that this is a unique time to rethink this issue. We need greater leadership than ever, greater acccountability, productivity, creativity....are we paying for measurable progress that the community understands.
Can you see the headline?: CEO Jane Doe received 32% of salary for decreasing mortality at X by 50% in 9 high volume procedures. (19 words!) Try "CEO gets huge payout for exceptional quality report! (8 words - is more like what the paper will give you). Or "System rewards leaders for 15% market share gain". "Zero preventable accidents scores bonus for leadership"! "Hard choices provide security for those left behind."
Many companies are eliminating raises this year. Oil Companies, major players. I bet those employees would be willing to look at pay for performance.
How are you looking at bonuses/incentives differently?
Tuesday, February 10, 2009
Recession Advice: Stick to your values
"All of this stress means an increase in irritable, angry, demanding, stressed out patrons who are rubbing up against your irritable, angry, tired, stressed out staff."
http://librarianbyday.wordpress.com/2009/01/09/library-usage-will-go-up-during-a-recession-management-are-you-really-prepared/
From the local librarian, remember your associates!
- "make sure staff feel appreciated
- encourage open communication
- training (almost any it seems)
- provide clear goals and expectations
- encouraging a sense of team
- empowering staff
- be flexible with time and schedules"
http://librarianbyday.wordpress.com/2009/01/09/library-usage-will-go-up-during-a-recession-management-are-you-really-prepared/
Recession hits healthcare
"It's a myth to think hospitals are recession-resistant," says Sheryl Skolnick, an analyst with CRT Capital Holdings. "During the 2001-2002 recession there was the lowest demand for hospital services ever.
A large consumer survey conducted in February by Deloitte & Touche's Deloitte Center for Health Solutions found that only 11% of consumers feel they can handle upcoming medical bills.
http: //www.businessweek.com/technology/content/mar2008/tc20080324_828167.htm
A large consumer survey conducted in February by Deloitte & Touche's Deloitte Center for Health Solutions found that only 11% of consumers feel they can handle upcoming medical bills.
http: //www.businessweek.com/technology/content/mar2008/tc20080324_828167.htm
Welcome!
Having served in a number of institutions and watching busy CEOs and execs struggle to get the latest news and better yet, know what their colleagues are thinking about it, it seemed that the internet held a great opportunity. The Blog reserves the right to limit submissions overtime if the information based on comments is not particularly useful to the readership.This is meant to be your blog - more than data shared it is meant to stimulate thinking and reaction to the serious issues and the not so serious issues affecting the healthcare leader.
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