PS ...

A few more things about my upcoming hop across the pond:

  • That's an imaginary internship at BIDMC (for now). Paul, call me...:)
  • The big Nederland move will happen in January 08.
  • If anyone is curious about the healthcare industry over there get in touch via email or the comments section.


Netherlands in the News: Rotterdam Here I Come...

There are times in life when you finally, FINALLY seem to be chugging merrily along, right on track with the goals you've set.

But just as you're patting yourself on the back for steering so brilliantly, God throws you one hell of a curveball.

Here I am, happily cozied up in DC with a rewarding job, challenging volunteer service for several nonprofits and Boards, plenty of interesting schmoozy-type events to go to, and damned if I didn't just find a really great Italian place.

Whammo...husband's contractor secures wonderful new positions in....drumroll please...The Netherlands.

And seriously - I've just finished the oh-so-fun application for an MHSA grad program at a great school, and have been happily daydreaming about my future internship with Paul Levy at BIDMC.

But let's squeeze this challenge until we can wring out a new opportunity...Perhaps I can finagle a joint independent design program with a Master's at Erasmus U, which has an Institute of Health Policy and Management?

Other than the amazingly thrilling opportunity to reinvent my professional self halfway across the globe in two short months, the move will have additional perks.

First - Husband's company is taking care of us...why didn't I go civil service or govt again? Somebody remind me?!

Second - Even when the major deity is throwing me a wicked curve she gives it a nice easy twist at the end.

Low and behold...turns out the Netherlands are a hot spot for healthcare modeling.

HHS Secretary Mike Leavitt is visiting The Hague after a stop in Switzerland early next month.

Check out this piece in today's New York Times, with an interesting introduction to the subject:

The Netherlands are being used as yardstick because the country has "solved two basic problems: moving from an employer-based system to one in which individuals buy their own insurance and subsidizing care for the poor" (W. David Helms, President - AcademyHealth, NYT).

Now, I can choose to be flummoxed by this astounding change of circumstance, or I can choose to be proactive and productive (aka I'll soak up everything I can about gezondheidszorg systeem van Nederland while we're there).

Hmmm....reactive, proactive, reactive, proactive...

That's an easy choice: Carpe diem.

Plus, I hear they have great tulips.


Best Practices: Best Buy Mgmt/Corp. Employees Work Anywhere

If you want to find really innovative best practices, it's often best to venture outside your own backyard.

You can pull plenty from other industries (witness the rise of "Disney" hospital programs and "lean" consultants who palm off kaizen platitudes).

The hot electronics retailer has established a ROWE - Results Only Work Environment - reports workforce.com.

Some staff (the firm is trying to figure out how to make this work with shift salespeople) can set their own hours. Even meetings are virtual.

For Best Buy, it's no longer about the rigorous, repeatable schedule - it's about what gets done.

Is counting the minutes of collective 'company time' as important as what we do for the company?

If the answer is no, doesn't it make sense we can work anywhere as long as we turn in a top-notch performance?

From the slant of my comment (and the fact that I successfully telecommuted and kept a virtual office for over a year) you can probably tell where I stand...but what do you think?

Is a results-only policy idealistic, realistic, or a little bit of both?

Of course, size and organizational complexity will greatly influence whether or not some employees can work offsite...if you have a large corporate HQ these staffers can more realistically work from anywhere than if you're a small community acute care facility with a relatively flat exec team.

But the question is still worth asking: could a similar strategy work in the hospital/healthcare setting?

Not yet - we're so behind the tech revolution that we'd be hard pressed to operate in a virtual world without physical constraints.

Even if hospitals were interested in transitioning to some part time/hourly telecommuters or 'consultant' positions, how would they start?

The good news is that there's a logical genesis...with a total transition to EMRs/EHRs, your Medical Records, coders, billers, etc. could all work from anywhere as long as connections were secured and files backed up using an outsourced provider like Carbonite (or back up files using onsite servicers, wherever they're hosted).

Challenge of the week: If you had to put a plan to move 10 percent of your workforce to telecommuting in the next annual plan, how would you do it? Bonus points if you can figure out how to move 25% ...


Hospital Administrators: Required Reading

McKinsey offers great newsletters with juicy content at a great price (who can beat gratis?).

If you're not already signed up (or if everyone in Decision Support isn't peeling through this weekly source for nuggets of wisdom), sign up here.

This innovative management piece by Gary Hammell and Lowell Bryan is a MUST read.

Without a doubt, it's the best coverage on today's innovation challenges (and how to actually prioritize, plan, test, retest, and roll out) I've seen.

Read the article and then examine how your organization is harnessing the wisdom of crowds by tapping into invididual, non-exec talent.

Hint: If the answer is "I don't know," you'll need more help than this article...

When I was an analyst/consultant for a startup think tank, in our early stages we were all 'home' based telecommuters who communicated via email and Instant Messenger.

IM allowed for the instantaneous sharing of ideas, the speed of our 'conversations' and decision-making time-limited only by how fast we could type.

Did we waste time chatting? Sure - just like we sometimes do in the office environs. Did we save time bouncing ideas off each other? Of course.

We saved so much time, in fact, that analysts were able to do things like complete 40 page best practice studies in 3 days....imagine the revenue per employee in that firm.

One metric I used to track performance informally was whether each employee made back their salary each year, failed to generate their own paychecks, or blew the payscale out of the water with the funds they brought in (either via research that gained us new members or selling the concept of our services to new members).

If you had to break revenues generated per employee, how would you do it? Is it an impossible task in our market?


Patient Perspective: What I Want to Wear in the Hospital...

Click here to read about snuggly, single-use Bair Paws gowns...mmmm!

No more alienating my nurses by requesting 50 layers of heated blankets fresh from the warmer...for those of you who've been under general anesthesia you know there's almost nothing worse than waking up feeling like you've emerged from surgery in the middle of the next Ice Age.

From the press release on eMediaWire.com (and if you're not using eMediaWire, well, what's your excuse?):

"Using a handheld controller, patients can adjust the temperature either warmer or cooler, depending on their personal preference.

Just the fact that we prewarm every patient ensures the speediest recovery we can give them,” said Leslie Decker, O.R. Supervisor at the Surgery Center on Soncy in Amarillo, Texas.

“They’ve been prewarmed with the Bair Paws System in pre-op and we keep them warm during the surgical procedure with it.

With its clinical capabilities, the Bair Paws warming unit offers prewarming benefits before surgery and can also be used for comfort warming in both pre- and post-op settings. In addition, the gown is fully compatible with Arizant’s Bair Hugger warming units for the demanding clinical needs of the OR and recovery."

If parent company Arizant Healthcare Inc. is publicly traded I'll be looking into buying more than their blankets...


Career Changers: Consider Home Health...

According to Forbes, the future of students interested in home health looks bright. The question is - how do we get students interested in home health?

Click here to read the article.

The Bureau of Labor Services estimates 350,000 additional positions (a 56 percent increase) in the sector by 2014.

For those of us who abhor being stuck in a cube at a 9-5 job, the relative freedom and variability of a home health position offers an economically viable alternative to desk-jockey-land.

It's also a good transition point for mid-career jumpers joining the medical field and pursuing advanced degrees in medicine/nursing/healthcare administration...flexible schedules provide the chance to gain industry experience and earn a paycheck while still in school.

In the home health field, time spent with each patient may well be more than new graduates would gain in a hospital setting. Additional interaction time can help increase confidence levels prior to joining a fast-moving, highly stressful acute care team.

The aging active boomer population, with increasing consumer purchasing power, may see home health as a more desirable choice than extended hospital care after surgical procedures.

The growth of personal concierge type services is a trend crossing sector lines into healthcare - personal doc agencies who make house or office calls operate on the fringes of a consumer-driven movement.

We want our healthcare, like other services, to be accessible to us wherever and whenever we desire.

Although many hospital systems have home health agencies, these organizations face the same succession planning challenges as larger systems - and it may be even more difficult to recruit home health aides and nurses, as well as administrators willing to take on the logistical challenges involved in running such a group.

Anyone need a job?

States Lack Adequate Delivery for Women: Female Consumers Still Face Glass Ceiling in Healthcare

Guess we're still getting the short end of the proverbial stick in some things...

Check out coverage of the issue by Amanda Gardner in Wednesday's Washington Post, titled "U.S. Women's Health Care Still Falls Short."


Gardner summarizes findings of "Making the Grade for Women's Health: A National and State-by-State Report Card" published by the National Women's Law Center and Oregon Health and Science University.

Nationally, we are failing to deliver adequate healthcare to women (I'd argue we're failing to deliver adequate healthcare to many more demographics, but that's a post for another time).

States, the District and the nation were graded based on 27 benchmarks developed by US Dept. of HHS "Healthy People 2010" agenda.

Hitting 3 out of 27 benchmarks is a poor showing, but there are bright spots, including the following:
  • percentage of women 40 and over getting regular mammograms
  • percentage of women visiting the dentist each year (!)
  • percentage of women 50 and over screened for colorectal cancer

It's important to note NO state received a "satisfactory" grade, but Vermont, Minnesota and Massachusetts received "satisfactory minus" grades this year. 2 years ago 8 states made the cut.

DC, West Virginia, Texas, Tennesse, South Carolina, Oklahoma, Mississippi, Louisiana, Kentucky, Indiana, Arkansas, and Alabama failed.

My new hometown of DC placed 44th, with the highest rates of HIV/AIDS, heart disease, and breast cancer death.

No state met the goals for health insurance; nationwide almost a fifth of women (18 percent ages 18-64) are uninsured.

The only indicator that worsened universally? Shocker: obesity.

If you want to lose weight - move to Hawaii: only 16.7 percent of women on the islands were overweight. For lower blood pressure - try Salt Lake: 17.7 percent of women in Utah had high BPs.

Meanwhile, 46 states scored worse in diabetes.

Another result detailed in the study is interesting, especially with regard to the current debate over a nationally provided, federally funded healthcare coverage program...the ONLY 2 policy goals met by all states in the program were Food Stamp participation and Medicaid coverage for breast/cervical cancer treatments.

Anyone still doubt the need for comprehensive, proactive wellness management programs?

And will each state's Department of Health please, please pick up a copy of the study and start managing against the 27 benchmark indicators?

27 things to save the life of women across the country. I don't know what's worse, that we're only counting 27 things or that we fail miserably at most of them.

National Women's Law Center.


Ben Affleck's A Union Man...

Berry interesting...

Verbatim from the Boston Business Journal here:

SEIU members in Boston have "enlisted" actor (and Cambridge native) Ben Affleck, who will meet with hospital workers and Mayor Menino to endorse unionization efforts by the Local 1199.

"SEIU members in Boston support a resolution that the Boston City Council will consider on Tuesday asking hospital CEOs to sign pledges that they won't "intimidate" hospital staff trying to form unions or spend patient care money in campaigns against secret ballot elections. "

"Hospitals say the measure is one-sided and unnecessary. They say fair elections are already ensured through a process established by the National Labor Relations Board that allows both sides to make their cases. "


Best Practices: DC's Council of the Whole

Assignment: Read the brief below. Then answer the following questions.

The District of Columbia's Council Chairman Vincent Gray has created a group for DC residents 21 and under to share their thoughts on challenges facing the District.

Article: DC Council: Youths Invited to Testify at Hearing (scroll down)
By Nikita Stewart, The Washington Post, District Briefing, Friday, October 12, 2007;
Page B04Summary:

The Council's Committee of the Whole will hold its first youth hearing at 10 am tomorrow, part of an effort by Chairman Vincent Gray to hear about the District's problems from the perspective of young people. The hearings will be held once a month and will be limited to youths 21 and younger.

People can sign up to testify by contacting Aretha Latta at (202) 724-8196.

1. Can you imagine what kind of input we'd gather if executives convened Council's of the Whole, composed entirely of patients under a set age, in the hospital setting? Or if we convened Council's of the Whole as H/HC advisory boards, composed solely of patients in general?

2. What would happen if we included the views of young patients and families in our Board/Strategic Planning meetings? Would your to-do list change? What items/topics do you believe would be added? What would be removed?

SEIU Gears Up for Something Big on the West Coast?

I receive job/event postings from the DC-based chapter of the Young Nonprofit Professionals Network listserve (you can sign up for local listings at ynpn.org).

Yesterday my inbox was flooded with 16 postings from the SEIU's United Healthcare Workers (most from the West region). Either whole divisions departed en masse or they're expanding...I haven't spoken with an SEIU rep at this point so I'm not sure what sort of programmatic vision this portends. I welcome an SEIU rep to contact me about this for a follow-up post.

California is an interesting area for H/HC policy and labor relations right now, as many of the nurses involved in the Sutter strike organized by the California Nurses Association return to work.

Some openings include: Communications Specialist (s) in LA & Oakland, Assistant Director (s) of Communications in LA & Oakland, Research Analysts in LA, Educator/Training Associate in Oakland.

If you know anyone interested in applying, replies/inquiries may be sent to:

Here's an example of a job description (see below).

What I find most interesting is that hospital/healthcare managers and execs should be doing many of the same things, e.g. determining policy/strategy needs, keeping working knowlede of the regulatory environment current, reviewing industry, scholarly, and governmental publications (do you have any support staff checking the Federal Register?), collecting/analyzing data (although probably more on the analysis side), and delivering presentations to advocacy groups, elected officials, community allies, etc.

Organization: SEIU United Healthcare Workers - West

Location: Oakland
Salary: $89,000 - $92,000
FT Regular
Job Description:
Legislative, Policy and Politics

SEIU United Healthcare Workers - West, the largest and fastest-growing health care union in the Western United States, with 140,000 members in all health care sectors throughout California, seeks an Assistant Policy Director to work either in its Oakland, CA headquarters or its Los Angeles office.


Work with officers, senior staff and Policy Director to determine policy needs and provide strategic policy support for the Union’s organizing and contract campaigns.

Analyze federal, state, and local policy initiatives and legislation and prepares briefing materials, response options, and recommendations for officers, senior staff and Policy Director.

Keep current with federal, state, and local statutes and regulations, industry trends, economic trends, and demographic trends that impact the design and delivery of health care.

Review industry publications, scholarly publications, and governmental reports; confers with SEIU California State Council staff, and SEIU International staff; meets with federal, state, and local legislative staff and agency officials; and consult with advocacy groups and professional organizations to inform them of the Union’s public policy positions.

Initiate policy research, collects and analyzes health care, fiscal, and economic data, and drafts white papers as necessary to develop and promote public policies supportive of the Union’s organizing and bargaining goals.

Prepare briefing materials and delivers presentations to governmental bodies, elected officials, advocacy groups, community allies, union members and staff, and a variety of public forums; occasionally participates in press conferences and conducts interviews with the media.


College degree with course work in health policy, public policy, or labor relations; advanced degree desirable with at least two years of related work experience.
Knowledge of public policy issues affecting health care financing and regulation.
Ability to analyze state and local policy initiatives accurately and to develop timely and appropriate responses.
Ability to prepare and deliver policy presentations before governmental bodies, elected officials, advocacy groups, union members and staff, and other interested parties.
Ability to establish and maintain effective working relationships with union members and staff, elected officials and staff, health care advocates, and other community stakeholders in health care policy decisions.
Ability to communicate effectively and work independently.
Ability to work long hours with tight timelines.
Previous knowledge of and experience with trade unions.

How to Apply:
Email cover letter, résumé and list of professional references to:

Organization Web Site: www.seiu-uhw.org
Email replies to: recruiter@seiu-uhw.org


I'm Not Dead Yet (I Don't Want to Go in the Cart....)

Here's a great cartoon from artist Tom Toles, published in today's Washington Post.

The health care system IS tired, and sick - but luckily for us the illness isn't terminal.

Our medical-system-metaphor-guy is still sitting upright, breathing, and presumably speaking, so he'd hold up pretty well in triage.

It's only once the history & physical starts that we see fault lines under the surface.

So which side do you want to be on - the implacable doc or the hypochondriac splayed on the table?


Good News for Young Health Professionals...

H/HC workers around the DC metro area will soon have a better option for peer-to-peer professional development, thanks to David Salinas & co.

I met David this afternoon (at a Starbucks in our neighborhood - a truly 'millenial' style face-to-face) to talk about a startup organization (drumroll please).

The new Young Health Professional Society (YHPS) is being nurtured through the petri dish stages by a group of sharp, driven, passionate twenty-somethings.

Why should you care?

1. It's the best option out there for younger employees to develop managerial skill sets from inside the industry.

2. It will provide the most qualified candidates for your open positions - but recruit us early...as experienced change agents we'll have plenty of options.

3. It will act as a forum for HC firms, policy leaders, NGO lobbyists, societies, nonprofits, consulting firms, insurance providers, Big Pharma, hospitals, etc. to give Gen Yers and Millenials an idea of why we want to come work in each sector.

4. The DC area generates an amalgam of highly educated, extremely motivated young people from all over the world - YHPS will be a centralized means of communication with this elusive and active group.

The YHPS website is in development - more news to come!

Contact: David Salinas, dfsalinas@gmail.com.


Mr. Jacobs Gives it To Us Straight and Mr. Leavitt Paints a Pretty Online Picture

F. Nick Jacobs, CEO of Windber Research Institute and Medical Center, has a great 'day in the life of a hospital CEO' post for all of us interested in hospital administration.

Read it here. Thanks Mr. Jacobs (since I haven't yet been invited to call you 'Nick'...) - I still want the job.

It's not often a Cabinet member impresses the heck out of me with innovative thinking on their industry of choice. Coverage of Michael Leavitt's speech at Harvard's Kennedy School of Government had me cheering though. Read a review here.

We need to be able to compare cost and quality - gee what a concept! Good call Mike.

He did make one inference I find implausible...after evaluating costs for colonoscopies, Mr. Leavitt (Health and Human Services Secretary) decided to have his procedure in Utah, at a cost of approx. 3k. He found he'd pay close to 6k in DC. That's great - good consumer decision-making there.

However, Leavitt also comments "There is no reason why healthcare costs and quality can't be standardized across the country."

At this point I stopped nodding my head and started shaking it in denial. Quality Mr. Leavitt, can be standardized yes, to some extent.

JCAHO is working on this. They're also working on a sustainable revenue model built around consulting to help you improve your quality levels to meet their standards, but that's a talk for another time.

Some hospitals will be always rise to the top as market leaders though, and some will be mid-range, and some will always show poorly and be one step away from closing their doors.

Superior service is impossible to implement on a universal level with no variations. If this were the case, Ford would be just as great at kaizen as Toyota with some coaching and funds.

Theoretically, this is a great idea, but it just doesn't hold up in practice.

We don't pay the same for housing, a college education, or a gallon of gas everywhere across the country - regional differences persist in various markets based on supply and demand. How can we expect healthcare to follow a universal pricing model?

Now, the idea that within 8 years we'll be able to hop online and Google the lowest prices for healthcare goods and services may sounds nuts, but it's a future a few strong market drivers can help drop-kick into the realm of possibility.

The question is, will you be one of them?