I have to say that his meeting with Republicans in Baltimore yesterday was encouraging as a person who wants to see health reform move forward. Check out the You tube video on the entire meeting. http://my.barackobama.com/page/m/55c10680/5055d6c4/fb02ea03/11886c20/1823048961/VEsE/
So after watching, are you inspired that 2009 is behind us and we are moving in a new direction....right into the mid year elections... That's what I was left with: its the absolute right thing to do but who among them on both sides of the aisle is courageous enough to really work together. The media 24-7 need for controversy will not allow this to last.
I also thought that some of the folks in that room, or at least the least cynical among them, must have wished he was in their Party. I think they would really rather work with someone like him than with one of their own leaders at this point. Again, maybe its because its so hard to find one! Luckily there is only one President, because there don't appear to be many leaders on either side of the aisle.
Saturday, January 30, 2010
Friday, January 29, 2010
Coming home from the hospital
No not after a day at the office. Coming home at 83 from a stroke and a month long stay. A joyous, frustrating and disorienting journey. With the best care in the world, it is a daunting transition to be back on your own. Not quite whole, with an infection on board. Courageous patients, wanting answers and scared of their future or lack thereof.
Just thinking of my mom and the incredible journey of her illness and her rehab. Thanks at the end of this week to all those who supported her. Its a bittersweet transition.
So difficult to think of all of those who make this transition daily without the kinds of support that they need. Skilled nursing care in this country needs some serious work; and assisted living is for the wealthy. Lots to think about once you are outside the acute system.
Got to be better answers than ignoring it. But ignoring it seems to be what we as a nation are attempting to do.
Just thinking of my mom and the incredible journey of her illness and her rehab. Thanks at the end of this week to all those who supported her. Its a bittersweet transition.
So difficult to think of all of those who make this transition daily without the kinds of support that they need. Skilled nursing care in this country needs some serious work; and assisted living is for the wealthy. Lots to think about once you are outside the acute system.
Got to be better answers than ignoring it. But ignoring it seems to be what we as a nation are attempting to do.
What if the culture of political correctness was lifted?
What if people could really understand and access Healthgrades and other data?
What if healthcare advocacy groups began to educate consumers on how to read the data?
What if the American Heart Association referred to specific specialists and hospitals and the diabetes association to only hospitals that had aggressive glycemic management of all inpatients?
What if doctors communicated by email to patients and patients could see all their records - take them home with them at every discharge.
What if?
What if every patient had access to the same quality of care?
What if quantity did not equal quality and access did not equal every thing?
What if every tertiary center could provide excellent primary care and every primary center could refer their patients to the best tertiary center?
What if it didn't cost more to do it right?
What if competition really has nothing to do with it?
What if healthcare advocacy groups began to educate consumers on how to read the data?
What if the American Heart Association referred to specific specialists and hospitals and the diabetes association to only hospitals that had aggressive glycemic management of all inpatients?
What if doctors communicated by email to patients and patients could see all their records - take them home with them at every discharge.
What if?
What if every patient had access to the same quality of care?
What if quantity did not equal quality and access did not equal every thing?
What if every tertiary center could provide excellent primary care and every primary center could refer their patients to the best tertiary center?
What if it didn't cost more to do it right?
What if competition really has nothing to do with it?
Tuesday, January 26, 2010
Leading, managing and following
Everyone is talking about President Obama's first year and the Health "reform" debacle in the same breath. Even the most dispassionate among us seem to sigh and ask "what do you think about it.....wasn't it just a mess". The mess could refer to healthcare but it also refers to a number of issues that were inherited by this presidency. No matter which, the president is an Executive; and the role of the executive is to lead and manage your way out of messes while not creating new ones.
So with all our talk about managing and leading, clearly leadership was lacking in the health reform drive and management was of the crisis kind!
Should we have seen this coming and what needs to change going forward?
President Obama's leadership and management "chops" were achieved on the campaign trail. In a campaign, just by the name, there is usually a very clear solitary objective (not as simple as "win") such as get enough votes to get elected. Put out a clear message that attracts voters and build the momentum of true believers into a movement that people in the center can buy. The leadership in that campaign was evident - clear messages, consistent messages, vision. People could grab on.
The management challenge of a campaign is to get as much out of people who believe in you as you can. Move people who agree with you to do more. Convince a few more to believe. You are always working with believers.
When the President moved to manage the government and lead the country, he had the whole bunch: believers, tag alongs and nay sayers and enemies. He has to manage all of them or manage the percentage that assures his agenda doesn't get derailed.(usually 100%). Ask a risk manager about percentages and they will tell you that there can be no defects! You have to manage those that want to derail you as much as the rest.
Leading by clear crisp messages, limits and consequences was also missing. It was clear what we were buying in the election - change in how we govern, how we communicate and relate to the world etc. But in the healthcare debate, The message was not able to be understood by one and all. What are we trying to do. Cover everyone, manage our resources better, level the playing field, privatize, "publicize". There were no lines in the sand, no sacred cows, no clear message. No one was managed. Everyone was a free agent.
I recommend that if he is to salvage this, he tell Congress that he has no intention of approving anything that does not have 1, 2, and 3 and that is the line in the sand. If those aren't important to the public, he won't get it, and if it is, watch out obstructionist congressmen!
Obama is a learner - his learning curve needs a few mentors. A little more Drucker and a little less Abraham Lincoln.
So with all our talk about managing and leading, clearly leadership was lacking in the health reform drive and management was of the crisis kind!
Should we have seen this coming and what needs to change going forward?
President Obama's leadership and management "chops" were achieved on the campaign trail. In a campaign, just by the name, there is usually a very clear solitary objective (not as simple as "win") such as get enough votes to get elected. Put out a clear message that attracts voters and build the momentum of true believers into a movement that people in the center can buy. The leadership in that campaign was evident - clear messages, consistent messages, vision. People could grab on.
The management challenge of a campaign is to get as much out of people who believe in you as you can. Move people who agree with you to do more. Convince a few more to believe. You are always working with believers.
When the President moved to manage the government and lead the country, he had the whole bunch: believers, tag alongs and nay sayers and enemies. He has to manage all of them or manage the percentage that assures his agenda doesn't get derailed.(usually 100%). Ask a risk manager about percentages and they will tell you that there can be no defects! You have to manage those that want to derail you as much as the rest.
Leading by clear crisp messages, limits and consequences was also missing. It was clear what we were buying in the election - change in how we govern, how we communicate and relate to the world etc. But in the healthcare debate, The message was not able to be understood by one and all. What are we trying to do. Cover everyone, manage our resources better, level the playing field, privatize, "publicize". There were no lines in the sand, no sacred cows, no clear message. No one was managed. Everyone was a free agent.
I recommend that if he is to salvage this, he tell Congress that he has no intention of approving anything that does not have 1, 2, and 3 and that is the line in the sand. If those aren't important to the public, he won't get it, and if it is, watch out obstructionist congressmen!
Obama is a learner - his learning curve needs a few mentors. A little more Drucker and a little less Abraham Lincoln.
Thursday, January 14, 2010
GO it alone...don't
I keep reading about the go it alone strategy for small hospitals...bucking the trend of consolidating with large systems. And I don't buy it. Which is ironic because it was my idea in the first place! I was CEO of a small innercity hospital that had little future unless it consolidated its political capital in the community, breaking off from the big system, not to go it alone but to make it more nimble in forming local partnerships that allow it to leverage its overhead and politcal capital (there is no economic capital in a 100 year old building, with 65% medicaid in a bankrupt state). At best in a really good year without prior year adjustments, you can generate 3% that is $3million. Okay, what are you going to renovate for $3 mil a year.
The reasons to go it alone
1. To merge with someone else!
The reasons to not go it alone.
1. Invest in consumer friendly IT and physician practice IT
2. Move to accountable care with a inpatient base that can be consolidated to make sense
3. Quality and safety mega leaps forward
4. Group purchasing
5. Group financing
6. Leadership and physician recruitment
7. Standards of Care that are current and state of the art
8.Need I go on!
The reasons to go it alone
1. To merge with someone else!
The reasons to not go it alone.
1. Invest in consumer friendly IT and physician practice IT
2. Move to accountable care with a inpatient base that can be consolidated to make sense
3. Quality and safety mega leaps forward
4. Group purchasing
5. Group financing
6. Leadership and physician recruitment
7. Standards of Care that are current and state of the art
8.Need I go on!
Happy New Year....14 days late!
I love this article! I hope you do too. I keep going back to it. For those in healthcare the ideas are simple, obvious and of course politically difficult because of the entrenched and bureaucratized economic interests and investments in the status quo. But don't think you can stop these. Some are consumer driven and will emerge. For the Non-healthcare citizen of the US, the rest are fascinating, seem to represent the best in what America has always been known for is innovating around our problems. So enjoy and hopefully be inspired.http://hbr.org/2010/01/the-hbr-list-breakthrough-ideas-for-2010/ar/1
For the mundane start out the new year with your files in place your desktop clean and a good look at how you are going to professionally and personally move your agenda forward, this article is right on. If you see yourself in the "didn't quite get it down last year" crowd pay attention to the observations...they are talking to you! http://blogs.hbr.org/cs/2010/01/three_questions_executives_sho.html
For the mundane start out the new year with your files in place your desktop clean and a good look at how you are going to professionally and personally move your agenda forward, this article is right on. If you see yourself in the "didn't quite get it down last year" crowd pay attention to the observations...they are talking to you! http://blogs.hbr.org/cs/2010/01/three_questions_executives_sho.html
Tuesday, January 12, 2010
Monday, January 11, 2010
Why is safety so elusive?
and with it, satisfaction.
Did you watch the news shows on Sunday on the terrorist plots and airport security? For a minute I thought they were talking about healthcare.
"Its about communication...they aren't connecting the dots...everyone has different pieces of the puzzle" and then...
"Heads should roll soon". "When the reports come out, he is going to have to take some action...and we should see heads roll". and then...
"This is costing millions of dollars and its not getting at the problem" and "somebody will get rich off this but the (general public)is frustrated and dissatisfied".
So, there is an opportunity for multiple systemic failures over millions of pieces of information from mulitiple sources and you fire the most expert people who could help fix the problem if only a process was put in place to fix the system. And in so doing, you spend lots of money buying information technology to combat the broken system without fixing the system and the customer is still frustrated because they don't know what is going on, who to talk to and why the system works this way.
It sounds like healthcare is actually a step ahead of the intelligence community in that supposedly we don't fire people for "mistakes" anymore. But apart from that it seems that we continue to throw technology and big money at problems of communication and analysis and who is incharge of the data. If no one is connecting the dots, which according to Dr.Jerome Groopman in his book How Doctors Think, we can't possibly be doing if Doctors only let patients talk for 18 seconds before they interrupt them. We may have to rethink the idea of primary physician and navigator in ways that will rock the subspecialty culture of medicine and healthcare. We may have to pay the primary to listen to the patient and then pay them to help the subspecialists connect the dots when they are involved.
Did you watch the news shows on Sunday on the terrorist plots and airport security? For a minute I thought they were talking about healthcare.
"Its about communication...they aren't connecting the dots...everyone has different pieces of the puzzle" and then...
"Heads should roll soon". "When the reports come out, he is going to have to take some action...and we should see heads roll". and then...
"This is costing millions of dollars and its not getting at the problem" and "somebody will get rich off this but the (general public)is frustrated and dissatisfied".
So, there is an opportunity for multiple systemic failures over millions of pieces of information from mulitiple sources and you fire the most expert people who could help fix the problem if only a process was put in place to fix the system. And in so doing, you spend lots of money buying information technology to combat the broken system without fixing the system and the customer is still frustrated because they don't know what is going on, who to talk to and why the system works this way.
It sounds like healthcare is actually a step ahead of the intelligence community in that supposedly we don't fire people for "mistakes" anymore. But apart from that it seems that we continue to throw technology and big money at problems of communication and analysis and who is incharge of the data. If no one is connecting the dots, which according to Dr.Jerome Groopman in his book How Doctors Think, we can't possibly be doing if Doctors only let patients talk for 18 seconds before they interrupt them. We may have to rethink the idea of primary physician and navigator in ways that will rock the subspecialty culture of medicine and healthcare. We may have to pay the primary to listen to the patient and then pay them to help the subspecialists connect the dots when they are involved.
Thursday, January 7, 2010
A shout out to the U of Michigan
I want to publicly thank the University of Michigan stroke center team for the care of my mom! Phenomenal care - amazing.
So how do they do it?
1. Everybody leads (The leaders and the best..from the fight song)- that is what a PT told me. The old school management is gone.
2. You can't beat the benefits - the nurses told us that they are so well compensated that they commute to work there
3. Don't tolerate mediocrity - nurses told us "no one lasts on this team if they aren't excellent and do things the right way"
4. Consistent attention to details - constant handwashing in front of families, calling the patient by name (not mom or honey), attention to pain, time with the patient - everyone seemed to be listening intently, computerized records -. Aggressive management of potential infections/setbacks.
5. Solicited feedback from family and role modeling care for family.
6. Constant updating the plan to fit the needs.
7. World class therapy.
8. Respectful interactions - residents introduced themselves and individually talked to the patient if they were not continuing on the team to reassure the patient.
9. Excellent transitions.
And last but by far not least, support staff in environmental services etc who seemed encouraged to interact with patients in friendly and professional ways.
What questions arose? In the midst of reform and the debate about pulling the plug on granny, was the care efficient. It was clearly effective - my 83 year old mother could not speak had weakness on the right side, was not comprehending basic questions and could not swallow. A weak later she is speaking, writing and walking (all slowly) and eating again (also slowly) and in rehab.
Her care included numerous CTs and vascular studies, intervenous lines and ng feeding, multiple respiratory treatments and xrays and therapy from speach to PT.
Alternatives - I for the life of me couldn't see any..it was efficient in terms of time between orders and procedures to treatment, no infections or complications related to treatment etc.
So all I can do is marvel about how great it is to have these folks when you need them! Thanks UM.
So how do they do it?
1. Everybody leads (The leaders and the best..from the fight song)- that is what a PT told me. The old school management is gone.
2. You can't beat the benefits - the nurses told us that they are so well compensated that they commute to work there
3. Don't tolerate mediocrity - nurses told us "no one lasts on this team if they aren't excellent and do things the right way"
4. Consistent attention to details - constant handwashing in front of families, calling the patient by name (not mom or honey), attention to pain, time with the patient - everyone seemed to be listening intently, computerized records -. Aggressive management of potential infections/setbacks.
5. Solicited feedback from family and role modeling care for family.
6. Constant updating the plan to fit the needs.
7. World class therapy.
8. Respectful interactions - residents introduced themselves and individually talked to the patient if they were not continuing on the team to reassure the patient.
9. Excellent transitions.
And last but by far not least, support staff in environmental services etc who seemed encouraged to interact with patients in friendly and professional ways.
What questions arose? In the midst of reform and the debate about pulling the plug on granny, was the care efficient. It was clearly effective - my 83 year old mother could not speak had weakness on the right side, was not comprehending basic questions and could not swallow. A weak later she is speaking, writing and walking (all slowly) and eating again (also slowly) and in rehab.
Her care included numerous CTs and vascular studies, intervenous lines and ng feeding, multiple respiratory treatments and xrays and therapy from speach to PT.
Alternatives - I for the life of me couldn't see any..it was efficient in terms of time between orders and procedures to treatment, no infections or complications related to treatment etc.
So all I can do is marvel about how great it is to have these folks when you need them! Thanks UM.
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