It's All About the Networks

Why are P2P social networks important in healthcare?

Docs network. Nurses network. Hospital administrators network.

But until relatively recently, patients didn't network.

"Users" of hospital and healthcare services, especially those challenged with mobility issues, lacked a convenient way to connect and share experiences.

Until, that is, people like Amy of Diabetes Mine decided they had valuable information to share, and built web-based platforms where first-person perspective data could be reciprocally distributed.

I like the idea of viral networking that coalesces around a specific healthcare-related purpose, both personally (as a patient) and professionally (as an early careerist in H/HC).

When I can tell what a networking site's goal is (and what they'll do with my information if I decide to register), I can select whether or not I would find time spent there valuable.

Obvious conclusion, no?

One would think. However, in analyzing emerging Health 2.0 companies (including sites in private Beta), I've encountered much more difficulty discerning motivation than I expected.

It should be, and has been, relatively easy to pick up on the primary goals of most sites ("become the best site for people with diabetes in Canada"), but it's much harder to discern secondary motivations centered around revenue gain.

Many of the sites seem to be gathering more data about users than necessary for a basic registration (on one site I actually had to enter conditions of interest before I was permitted to proceed), and this makes me a bit nervous.

When I see that a relatively newly birthed site gathering this much info about me already has large splashy animated ads from big pharma and other industry heavy-hitters, I'm wondering if you're really aiming to aggregate a ton of marketable data and then sell the firm, making money by sharing your users info. Most of us wouldn't find out our data had been sold until after the fact.

That's why a few new partnerships that expand functionality and combine user-bases in the wider social/professional networking world are so interesting.

These firms are laying out a roadmap of what works and what doesn't. H2.0 companies can follow their lead and then forge ahead once a strong user base is developed.

First, there's the Wall Street Journal and Facebook partnership (VentureBeat). One cross-vertical opportunity might be constructing a widget which lets your H2.0 users connect to favorite articles on MedScape, Blogspot blogs, Digg, etc.

WSJ and Facebook cross the age boundary to partner on widget — The venerable Wall Street Journal will be adding a new feature to its site showing readers which stories are popular with their Facebook friends that day, powered by a company called Loomia. Not the most likely-sounding partnership, but Andy Beal has some possible explanations. The most likely: “The WSJ is just desperate to attract some hip under 30-year old readers.”

Then there's Hoover's purchase of VisiblePath, a company-centric LinkedIn (also from VentureBeat). One cross-vertical opportunity might be the acquisition of other H2.0 sites that are struggling to pull in user-bases but have better platform functionality a la TaskBin (easier to use, better throughput via links/sign-ins, etc). From what I've seen, plenty of Health 2.0 sites could use some serious design/functionality help - EDs aren't the only healthcare areas with clogged throughput.

Confirmed: Visible Path acquired by Hoover’s — Visible Path has been a sort of low-key competitor to LinkedIn, offering a corporate social networking experience centered around companies rather than individuals. We mentioned late last year that it might have been picked up by a large corporation, which turns out to be Hoover’s, a well-known resource for information about companies. Visible Path, based in Foster City, Calif., had raised a total of $22.4 million, but the acquisition price was not disclosed. Hoover’s also announced that it has launched Hoover’s Connect, another business social network.

Yes, I use LinkedIn, regularly. I have a Facebook page, which I use very seldom and am considering nixing. I do not have a MySpace page.

I use LinkedIn because it actually has helped me stay in touch with people I've only met virtually (other Idea Crossing Innovation Challenge judges, for example).

So, H2.0 companies, or H/HC firms looking do integrate consumer-centric H2.0 practices, here's my recommendation, and it's blindingly simple - be sure you offer an easy-to-use networking functionality with a purpose.

That purpose, and appropriate privacy safeguards, should be clearly stated to engender trust in patients/users.

I'll go a step further and say for your most active, involved users you should also include a statement regarding revenue, and how you do NOT expect to earn it by selling my data. (Yes, this issue is a big deal - this isn't the first time I've talked about it, and it probably won't be the last - Click here to read my Open Letter to Health 2.0 Companies).

We healthcare consumers are a notoriously fickle lot, and if your functionality provokes even a vague sense of distrust, we'll jump ship and wait for the next best site to come along.

If you have a concept for an H2.0 site in the works, never fear - there's money out there to fund your H2.0 venture (VentureBeat), and from inside the industry:

Clarian Health Partners launches VC unit with $25M – Clarian Health Partners, an Indianapolis hospital chain, launched a venture-capital arm, Clarian Health Ventures, with an initial $25 million investment. The release is here.

Clarian aims to make early-stage investments that will benefit its parent company and to support economic development and innovation in Indiana. The fund expects to make initial investments in the range of $250,000 to $500,000, and as much as $3 million over the life of an investment. Clarian’s first investment was in the cancer-biomarker biotech CS-Keys, which we covered yesterday.

As an example of how to do a health networking site the right way, I provide Exhibit A: the Health on the Net Foundation's HON Code for medical and health websites.

Not all of the 8 principles will apply, depending on your business model, but I suggest you pay close attention to the "Privacy" and "Financial Disclosure" recommendations, in addition to the Advertising Policy.

Oh, and always, always identify authors of your content and cite sources when appropriate.

Yes, Health Management Rx is HONCode compliant.

It took me 3 tries to fulfill all the requirements. HONCode has made this a better site, and me a better blogger for requiring me to reexamine the purpose of the blog and my motivation for blogging.

Exhibit B: I'm Too Young For This.org.

You can easily find the site's purpose, and look at funders by clicking on the "Our Supporters" tab.

Plus, founder Matthew Zachary has organized a site that dares to counterattack the debilitating effects of cancer with sarcasm and dry humor.

The fact is, decreasing global economies of scale have made it easy to build an H2.0 site, and integrate it into your brick and mortar hospital model. The issue now is how you build a site with a clearly stated purpose that invites users to demonstrate trust?

Luckily, examples are out there. Please excuse me while I go poll my social network to find some more.

Another First for California...

Medicinal marijuana in vending machines.

And to think I was thrilled to see Apple machines dispensing IPods...

What Consumers Can Do to Prevent Medication Errors

Read this article on MSNBC.com.

Sometimes I feel like there's not enough plain talk in medicine. So let's cut to the chase.

If you're conscious and cogent as a patient, you CAN assist your care team in preventing serious medication errors.

Can you prevent every error? Of course not. You don't have the knowledge your docs and nurses do. You do, however, have an opportunity to pay attention.

If you'll be out of it for a bit after a procedure, you can designate a family member/friend to assist.

Of course, you can't always predict when something will go awry (unplanned admission via ER/trauma, post-op fever or other complications, etc).

For this reason before any surgical procedure (or procedure with sedation etc.) I designate an advocate (usually the person who will be in the waiting room and will either stay in the hospital with me or drive me home).

Usually this is my mom, a super-nurse, or my husband, a super guy. My family knows if I'm unexpectedly injured, my husband and mom are designated advocates and decision-makers. They've both read my living will, and are aware of my beliefs regarding life support, resuscitation measures, etc.

If an admission or procedure is planned, however, it's much easier to lay out a process for learning your medication dosage and schedule, and tracking whether or not you're being given the correct meds.

As a patient, here's a system that's worked for me.

1. During rounds, I ask the physician to slowly repeat the names of all meds he/she is prescribing.

I repeat this procedure for each doctor on my care team (you may have different meds prescribed by different doctors).

If necessary, ask them to spell it out for you.

If you've had an adverse reaction to a medication the physician mentions in the past, NOW is the time to bring it up. Again. Even if a sensitivity/allergy is well-documented in your chart/plan of care.

Yes, I realize you may look and feel like a bit of a dolt. Yes, I realize docs have far better things to do with their time than spell out medications for me.

They will have far more time to treat other patients if I help prevent the costly complications of a med error.

2. When a nurse enters the room with meds, I ask him/her to please identify each pill (by name) and the strength/dosage.

If the nurse will not or can not identify a med, I can refuse to take it until she/he can do so. Note: You can always refuse a medication/treatment, even if its AMA - in which case the nurse should educate you about the risks of doing so. It's not a light matter to refuse treatment, so think carefully before doing so.

Only once in 3 inpatient hospital stays has a nurse responded to my medication ID request with anger/frustration, replying "it's your pain pill."

Usually the nurse will be extremely helpful, sometimes even offering further explanation, such as "This is Tylenol Number 3 PO - your doctor WhiteCoat has prescribed it for post-op pain every X hours. If you take it now, it will begin to work its way into your system before the physical terrorist gets here."

3. If you're really anal (or have a relative who's a nurse/doc/NP/really nosy at your bedside) you can write down the meds you're given (name, dosage) and the times they're administered.

This is particularly helpful for stepdown periods or other transitions between meds.

If I begin to develop a reaction to a new med for instance, I can refer caregivers to the list and read that I was given XYZ about 45 mins ago, and I noticed onset of symptoms 10 mins ago.

Likewise if you begin to develop breakthru pain, you can maintain a better timeline of which medications are not working for you.

I used this medication schedule at home after discharge as well.

It was very useful in tracking meds, not missing doses, setting alarms for night doses, etc.

We'd also note my pain level on a scale of 0-10 after each dose.

This helped me to step down off pain meds to good old Ibuprofen 24 hours after a bone graft procedure.

I *knew* I was ready because I had the actual data of decreasing pain right there in front of me. For patients who are hesistant to step down, keeping this schedule with corresponding pain measurements may be extremely helpful.

Again, this system worked for me. I don't believe this will work for everyone. I'm not saying it's universally applicable.

But for those of us interested enough in our own care and willing to work with our nurses and docs, who are working very hard to get us well, this is a rough plan of action you may wish to consider.

If I'm someday admitted to a hospital and I don't have to ask, ever, what medications I'm being given because the nurse enters and announces the dosage straight out (after checking my ID verbally and double-checking via my RFID ID bracelet), I'll know the era of e-patients, H2.0, and consumer medicine has finally arrived.

Considering Wellness Initiatives? DOL Cracks Down

Click here to read a summary at Human Resource Executive Online. (HRE Online also has a nice piece on medical tourism and barriers to widespread adoption here).

Last month, DOL's Employee Benefits Security Administration issued a letter outlining regulatory guidelines for wellness programs.

Here is the DOL News Release with the relevant Bulletin (Field Assistance Bulletin 2007-04) and contact Gloria Della, Phone Number: 202.693.8664.

Click here for the actual Field Assistance Bulletin.

From the article:

"The guidance letter effectively plugs a loophole that could have allowed programs to discriminate against people with health problems that are beyond their control," says Tom Bixby, a partner in the Health Law practice group at Neal Gerber Eisenberg, a Chicago law firm.

The loophole comes into play because while the Health Insurance Portability and Accountability Act does not allow employers to charge different premiums for different employees (thin vs. overweight, for example) in employer-paid health plans, supplemental coverages could circumvent HIPAA.

Some employers have used supplemental coverages to offer "discounts" or "credits" to employees following specific "healthier" paths -- for example quitting smoking or losing weight.

Currently, there are exceptions from strict HIPAA regulations for wellness programs -- permitting financial incentives of up to 20 percent of the cost of coverage per employee. But the supplemental coverages, which are not part of HIPAA restrictions, could be used to as a way around that number while, at the same time, penalizing those who can't meet certain criteria."

Want to Know What the Dutch Think About Healthcare Reforms in Holland?

Read this interview with Dr. Roland Bal, of Erasmus University & MC, titled "New Healthcare System, New Problems."

Here's the intro:

"Exactly two years ago the Dutch healthcare system underwent drastic changes aimed at limiting the costs of healthcare and increasing freedom of choice. What have been the results so far? It is starting to look as if premiums continue to rise, while insurance packages are shrinking. Moreover, health insurance companies are increasingly deciding where and by whom their customers are treated by setting up insurer-financed healthcare centres."

It seems there is worldwide concern for our uninsured (and corresponding international interest in the policies/procedures we enact to address the issue).

When asked if Holland is heading for a situation like the one in the US, Bal replies:

"But then on a much smaller scale. There are 47 million people uninsured in the US. That is a much more serious problem. But you do see that the numbers have been growing over the past years here as well.”

The Netherlands struggles with the same issues as US providers, including continuous improvement of the care environment.

What do you think has to change in the current system?

“In any event much more attention must be focused on the quality of care. The ministry now feels that the sector should take care of that itself. The government sets all sorts of requirements on the field and then sends outs the inspectorate. But if the government feels it is so important, it should also invest a great deal in it. One of the major risks of liberalisation is that more and more focus comes to lie on costs. Of course it is possible to reduce costs, but that comes at a price, namely that you sacrifice quality. The one-sided incentive focused on costs at the moment, also doesn’t motivate the people who work in healthcare. And, ultimately, I also think that quality simply comes at a price.”

The most valuable part of the interview? The closing reminder that somehow, somewhere, someone has to pay for all this healthcare and quality improvement.

And guess what? Holland is focusing on how to make sure that payer is the consumer. It IS our health - do you agree the burden of payment for care should be ours?

And the consumer pays?

“Yes, in the end the consumer will have to foot the bill in one way or other. Either via tax, or via insurance.”

Quote of the Week - David Brailer, Health Evolution Partners

"I think health care is going through a 20-year transition, moving toward a major change in becoming a consumer-driven industry. We’ll not only be an influential shaper of those trends; we’re hoping to be a vehicle to deliver financial returns to our investors. So our investors believe that there are returns, and a firm like ours that focusing 100 percent on them is the way to make that happen."

Click here to read the full article at Digital Healthcare & Productivity.

Bad Target, Baaaaad Target

Ouch.

Very poor decision on the part of the otherwise esteemed Target PR team.

Target, I love you, but seriously???

Where Oh Where is Panda Bear?

Can anyone get through to Panda's blog?

Hope this isn't another medblogger exeunt...

Panda, hope things are well, and hope to see the site back up soon.

What's Next - Chinese Buy Struggling Hospitals?

Chinese firms are using the weak dollar to gain a competitive foothold in ownership of American firms (particularly in the manufacturing sector).

Check out this great article in today's Washington Post, by Ariana Eunjung Cha .

What's next? Chinese investment firms buying chunks of struggling American hospitals?

M&As involving US facilities and Chinese consultancies?

Not out of the realm of possibility for groups like Dorenforest...

For now, the trend seems to be American organizations (such as the Cleveland Clinic) partnering with Chinese hospitals, but my bet is we'll see news of Chinese firms purchasing stakes in US healthcare companies before the year is out.

I'd bet some hospitals have already been approached by Chinese organizations interested in more than just facility tours and professional educational exchanges...has yours?

If You're Going to Spring for Carbon Credits, Do it Right

Or just ask the US House of Representatives what kind of flack you're likely to catch for shoddy carbon usage accounting.

A hospital is like a fort - a self-contained mini-city that relies on outside commerce to keep things running.

It should be patently obvious that energy usage varies tremendously by size, number of employees (and by shift - have you examined the night/day differential?), average commute, number of suppliers using overland transport (and how many shipments you receive weekly) and a host of other factors.

You can't just pull carbon usage figures from hospitals (or other firms) of similar size and expect them to be realistic sums of your output. You also need to think carefully about how monies targeted for improving energy usage will be spent.

I've written before about the greening of hospitals via the Hospitals for a Healthier Environment program (soon to be renamed Practice Greenhealth) and other initiatives the US Energy Star program - both are good starting places for sensibly calibrating current energy usage before your leadership team sets goals for future reductions.

Also, if you're looking to adopt green initiatives because they'll save energy and money - let all of us know you like them because...they'll save energy and money.

Don't fool yourself (or your Board, or your various committees, customers, or employees) into thinking you're doing it solely to save those polar bears you saw drowning in An Inconvenient Truth.

While it's perfectly acceptable (and admirable) to have lofty motives in mind when moving your organization toward a more sustainable energy policy, it's disingenuous to present your aims as 100% pure morality candy when they also add significantly to the bottom line.

If you're looking to go carbon neutral or purchase some offset credits, for goodness sake please consult a team with experience calculating usage for a wide variety of industries.

I personally like TerraPass, but would love to hear about firms others are using to figure out smarter energy policies, including the purchase of carbon credits.

Hospitals on Fortune's 100 Best Companies to Work For List

Congrats to Houston-based Methodist Hospital System - MHS is #10 on Fortune Magazine's 100 Best Companies to Work For 2008.

Methodist placed in the top 10 with:

• 2006 revenue of $1,587 (in millions);
  
• 11% voluntary turnover;
  
• 11% job growth; and
  
• 10,481 employees (published count).

Methodist, in its 3rd year on the list, is also doing things right on their website. I stopped by to take a look at how they were promoting the Fortune win, read the article here, and submitted a comment at the bottom of the page.

After sending my feedback, I was given an opportunity to receive one of their publications (including magazines, e-newsletters) free.

It's easy to sign up for publications on other hospital sites, but they don't make it seem like a perk for interacting with the forum - interesting bit of marketing psych in action.

The page also gave me an opportunity to schedule an appointment, register for a class, see a list of departments, or contact the webmaster.

MHS earned top honors in part due to programs like "No One Dies Alone."

Methodist offers onsite gym facilities, but does not provide a discount for offsite memberships. For certain positions, MHS offers jobsharing, telecommuting, and a compressed workweek.

Excellent work Methodist; congrats on a well-deserved win. I look forward to reading my copy of Leading Medicine Magazine.

And how many hospitals do you know where an employee gives his boss a kidney?

They also outsource knowledge -offering international consulting services, including JCI certification prep. Methodist does not, however, have onsite child care facilities, for which other hospitals on Fortune's list were lauded.

Arkansas Children's Hospital, for instance, won a mention for best onsite child care options (children 6 weeks to 5 years, with an additional ACH fitness program).

ACH ranked 76th overall, but child care at the hospital's center costs just $240/month.

Apparently, hospitals across the country are doing a decent job of providing child care options: 6 of the top 10 for Onsite Child Care were hospitals/healthcare systems.

Other winners include:

• Baptist Health South Florida: Overall rank 94; child care $340/month, increased adoption benefit to 10k (8th year on the list)

• King's Daughters Medical Center: Overall rank 63; child care $402/month, 13% job growth rate, 96% employee retention rate

• Lehigh Valley Hospital and Health Network: Overall rank 85; child care $570/month, $500 wellness money for FTEs (2nd year on the list - "To be a great place to care, we need to be a great place to work." - Mary Kay Grim, SVP of HR)

• OhioHealth: Overall rank 18; child care $624/month (2nd year on the list, overall rank 52nd 2007)
  

• Scripps Health: Overall rank 56; child care $680/month, increased tuition reimbursement by 50%
  

Does your hospital have an onsite child care center or affiliated service line center with discounts for employees? If not, might want to look into that...if so, do prospective applicants know about your child/dependent care benefits?

I'll really start cheering when I see hospitals with affiliated day care centers for seniors.

And speaking of care - 21 companies on the top 100 list pay for employee health care (100% of employee premiums).

Of those 21 companies, guess how many are hospitals?

The correct answer would be ONE - Lehigh Valley Hospital and Health Network, ranked 85th.

No surprises in the Work-life Balance category - zero hospitals on that top 10 list.

Would better work-life balance for employees lead to improved outcomes and morale? Of course.

Is it easy to promote work-life balance in a shift system where most of your employees are already overworked on understaffed units? Of course not.

So what are your strategic goals for recognizing the value of Work-life Balance this year?

The unusual perks page is also worth a look. Click here.

On the list overall, hospitals are doing well hiring women...I'll refrain from commenting on gender disparities in medicine and nursing.

Think your hospital should be on the list next year?

Pick up a copy of Fortune on sale tomorrow (1.28.08) if you don't subscribe. Check out the winners; read what makes them unique.

Go to www.greatplacetowork.com to fill out the nomination form.

The deadline for 2009 is a little over 3 months away - you have until March 31st to submit. Your organization must be 7 years old with at least 1,000 employees (sorry newer specialty hospitals).

Here's a bit on the methodology used to find the top 100 - there's more available on Fortune's page.

How we pick the 100 Best

To pick the 100 Best Companies to Work for, Fortune partners with Great Place to Work Institute® to conduct the most extensive employee survey in corporate America. Of some 1,500 firms that were contacted, 406 companies participated in this year's survey. Nearly 100,000 employees at those companies responded to a 57-question survey created by the Great Place to Work Institute®, a global research and consulting firm with offices in 30 countries.

Most of the company's score (two-thirds) is based on the results of the survey, which is sent to a minimum of 400 randomly selected employees from each company. The survey asks questions related to their attitudes about the management's credibility, job satisfaction and camaraderie. The other third of the scoring is based on the company's responses to the Institute's Culture Audit, which includes detailed questions about demographic makeup, and pay and benefit programs, as well as a series of open-ended questions about the company's management philosophy, methods of internal communications, opportunities, compensation practices, and diversity efforts, etc.

After our evaluations are completed, if news about a company comes to light that may significantly damage employees' faith in management, we may exclude that company from the list. Any company that is at least seven years old with more than 1,000 U.S. employees is eligible. The deadline for applying for next year's list is March 31, 2008. For an online nomination form, go to www.greatplacetowork.com.

—Robert Levering and Milton Moskowitz

Hope to see more hospitals on the list next year.

Living Healthy - In Holland & Elsewhere

After my Guitar Hero Healthcare post, a reader named Chloe left a great comment.

Chloe takes me to task about how difficult it will be to constructively channel the self-interest of the 'me' generation into positive changes (rather than destructive demands) that induce physicians to offer specialized services and customized patient interactions.

Meaning, if we want customized interactions - we'll have to pay for them.

The bottom line is this - if we want healthier people we have to build a system that provides incentives to docs and incentives to consumers.

Meaning, we first have to pay PCPs and GPs in a manner that properly recompenses them for the vital services they currently provide, including managing expectations and acting as gatekeepers for the system.

Meaning, if we want additional PCPs to enter the field, we have to provide more incentives. Meaning, we have to provide them with more benefits.

Meaning, if consumers want customized services that take more time and may decrease volume, we have to offer them, and we have to pay docs MORE. Meaning, we have to respect and respond to PCP concerns about quality of life and work arrangements.

Now, docs can hold their breaths until they're blue in the face waiting for someone to do something about the situation and up reimbursements (CMS? HMOs? Govt?).

Or, docs can take a deep breath and decide to offer services that people are willing to pay more to receive.

If you're a PCP, the fundamental economic question is this: At what level can I substitute the value of individual services for the volume I must currently maintain to make a living wage? And will operating at this level bring some joy and job satisfaction back to practicing the art and science of primary care services?

Do the CBA for yourself.

If you decide to offer customized services, you'll need to ask the following basic brainstorming questions:

• What services should I offer?
• What do I need to charge per patient per service?
• How does my scheduling change as a result of offering personalized medical services?
• How does my billing/accounting/budgeting change?
• Why am I interested in offering personalized medicine?
  
• What benefits do I expect to gain from modifying the fundamental structure and vision of my practice?
  

Docs are an intelligent, highly-trained bunch offering expert services. I don't see many of them hanging around waiting for someone to up reimbursements - I see them leaving the field instead.

We're not paying them enough to stay in the game. They're not thinking about creative ways to make enough to stay in the game - they're too busy trying to heal people in 4-8 minute windows.

The new healthcare marketplace is a hybrid of services - a mix of wants and needs. Services you tell us we need and services we tell you we want.

Docs can design payment plans and combo menus of services that mimic formats consumers are familiar with using.

Let's take emailing your PCP as an example.

• Docs could require we pay up front for 10 emails/month a la the Blockbuster plan, or pay per email a la the ITunes a la carte menu.
  
• Please note I'm talking about paying MORE for access to the doc's knowledge here, not asking for a massage while I wait to be weighed in.

So yes, Chloe, in response to your excellent comment, I do believe enough of us will pay to have docs spend primary time on our individual care, advising us at a personal level what we can do to improve our health. I believe we don't have much other choice.

• I believe our insurance companies and our government are already playing with switching the burden of payment to us, via FSAs and HSAs, via requirements that we have health insurance coverage, etc.

• I believe our employers are already playing with switching the burden of healthcare costs to us - with enforced wellness programs (see blogger Toby Dayton's take on Scott's no-smoking policy) and reduced paid coverage.

• I believe that even if we end up with a government-funded federal healthcare system, a subterranean 'black market' for individually paid personal services will thrive.

Why? We won't wait 6 months for a knee-replacement. Remember, the global healthcare market is a hybrid of wants (services provided in a timeline we want) and needs (services docs tell us we need and arrange to provide).

I believe we pay for services we need (electricity, water) and we pay for services we want (cell phone service, high-speed internet).

I believe the healthcare market is waiting for all of us (providers, payers, docs, hospitals, insurers, policymakers) to catch up to the idea that in the hospital/healthcare/wellness management basket of goods there are both services we need (emergency care, L&D, trauma) and services we want (discretionary plastics, fertility treatments, dermatology, concierge care/telemedicine).

And yes, I'd pay more to be able to email my doc (although not at 3am - during office hours is fine). I wouldn't mind paying a fee per email, in fact. I wouldn't mind waiting 72 hours for a response. I wouldn't mind paying double the rate for a response within 24 hours.

I'd pay much more to be able to visit in the evening for my annual physical (or on a Saturday morning).

I'd pay out of pocket to have 20 uninterrupted minutes to sit down with my PCP and go over my SHMP (self health management program) and hear her recommendations.

Maybe a doc-blogger can figure out according to CMS/UnitedHealthcare rates how much that 20 mins would cost me? (And add another 1o to type/print out an Rx of recommendations).

And speaking of an SHMP, rather than try to outline what works for an entire generation of new healthcare consumers and providers, I'll share what works for me.

Below are two of my not-so-secret weapons for self-health management.

I don't yet have a GP here in The Netherlands, but when I do, I will share these activities and ask for recommendations on how to improve my health.

This being Holland, the land common sense has not forgot, the doc will most likely look at me like I'm completely gonzo.

Will these two factors ensure I stay healthy? Of course not. They don't completely negate genetic predispositions (such as high cholesterol) or offset my tendency to drink too much java.

But they're two daily choices I consciously make to maintain a fit and active lifestyle.

• First, my fiets.

I'm now the proud owner of a well-broken in Gazelle (you don't want to buy a new bike unless you keep it indoors as there's a thriving stolen bike trade) - yesterday I took off for my inaugural ride.

This will be my commuting vehicle.

Rides to and from work should take between 40-60 mins depending on the 'traffic' in bike lanes and the weather, as well as my tolerance for weaving in and out of mopeds and other cyclists on the way to work/school.

• Second, my daily dose of Knorr Vie.

I drink at least two of these little blended fruit shots a day - they're strangely addictive and contain a full serving of fruit. I can't believe Knorr (Unilever) hasn't made them available in the States yet.

The company does limited edition seasonal fruit/veggie mixes - I'm currently loving the winter fruit (apple, pear, pumpkin). A four-pack goes for about 1.99E, and some grocery stores sell 12 packs.

Sometimes I mix them with an orange-flavored tablet of Vitamin C (1,000mg) and sparkling water, and sometimes I take the hit plain.

Other healthcare bloggers are writing about what they do to maintain desired levels of health and wellness.

Happy Hospitalist writes here about his top-secret healthy juice.

Life as a Healthcare CIO John Halamka writes here about his vegan Thanksgiving.

Normally I don't tag, but I'd love to see what some more writers keep in their secret wellness weapons arsenals.

I hereby tag 3 other healthcare bloggers to share two of their personal solutions to self-health management.

Emergency Em, The Physician Executive, and WhiteCoat...consider yourselves tagged!

Hospital Accreditation: Get in on the Act - JCAHO 2009 Proposed NPSGs Up for Review

Until Feb. 27th, you can comment on The Joint Commission's proposed 2009 National Patient Safety Goals.

Click here to access the JCAHO page detailing changes (complete with links to PDFs).

You can also read/comment on the Standards Improvement Initiative.

For facilities outside the USA interested in accreditation, click here to visit The Joint Commission International website. At the bottom of the page is a link to a PowerPoint detailing how to get started with the JCI process.

You Can Buy Anything on Craigslist...

There's been a lot of chatter lately about incentivizing the organ trade or changing policy to provide a larger supply.

Britain, led by Prime Minister Gordon Brown, is looking at a program of "presumed consent," which is a policy change from the existing opt-in policy.

Here I am, chewing over some way to blog about the same old sad story - too much need, too few donors. Luckily, Craigslist has added an, ah, interesting angle to the story.

Now, I've used CL to buy great and sell furniture. I used the site to sell my Baltimore rowhome and apartment search in DC.

I'm a pretty big devotee, and I'd seriously consider buying just about anything (legal) on Craigslist.org, except, of course, for anatomical goods.

Looking for used bikes for sale in Amsterdam, I came across this posting.

I'll reprint the listing here, as it's most likely a gag or will be flagged and removed shortly.

"body parts"

---

Reply to: sale-547507854@craigslist.org
Date: 2008-01-22, 3:09PM CET


I am adult healty male, B- blood type, have two kidneys, if you need one let me know.

• Location: usa
• it's NOT ok to contact this poster with services or other commercial interests

PostingID: 547507854

Open Letter to Health 2.0 Companies

Look, I get that there is a lot of money to be made from our health data.

But when I sign up to be the latest member of the hottest new online H2.0 community, I have a few expectations you, as an H2.0 startup executive, should know about.

1. Be honest with me.
You expect transparency from hospitals - in fact, we're beginning to demand it (and impose regulatory strictures to that effect). If you're going to monetize my data in order to avoid the whimsy of venture capitalists and angel investors, that's fine. Just let me know you'll be selling off my registration info.

2. Let me know WHY you're doing what you're doing.
Ok, so you want to grow the most robust online health community in the world. You want to be the MySpace of the medical webosphere. That's fine. Just let me know you'll be selling certain 'blind' numbers to marketers interested in my interest in diabetes, such as Big Pharma.

3. Tell me I can opt out.
Don't make me give you my info and preferences to register. I'm still feeling you out at this early stage in our (hopefully long) relationship. I'm sharing my health information with other users because I realize the global community of individuals may bring the wisdom of crowds to bear on conditions with which I'm struggling. I have something to give them and vice versa. Don't make this all about you!

When I sign up for your site and register with an interest in melanoma, guess what - it means my husband has had 3 primary family members diagnosed with the disease. One uncle died. This is no joke. This is not material for your latest D2C commercial.

I want to know how often other families are getting tested, whether they're participating in the NIH study, etc. I DON'T want drug companies or consumer goods firms hawking the latest SPF super + 5000 to contact me.

4. Learn from Facebook's Beacon - a bad decision.

Give me the chance to opt IN to advertiser messages, rather than requiring that I opt OUT to stop receiving the spam that drives your salary base straight out of the middle class stratosphere.

You know, if I'm trusting a Health 2.0 community enough register and provide my 'interests' in a certain diagnosis (thinly veiled DRG or Dx/Rx area), I'd hope the company is as forthcoming.

Ideally, I'd love to see language like that of my idealized disclaimer:

"Dear H2.0 Registrant -

We realize you are trusting us with a hell of a lot of data, including your email and a specified area of medical/health/wellness interest.

With this plus your logon ISP, it's possible to extrapolate a huge amount of data about you.

We can probably search you down, in fact, and sell your firstborn to our advertising partners, without much effort.

Thank you for your trust in us. Let me tell you why we're partnering with outside advertisers.

First - we need to make money in order to become the number one health/wellness site in the world and provide you with more of the services you find valuable.

You want to talk to more people who have experience with melanoma diagnoses - we want to give you that without charging you a monthly fee, which would surely cause you to run for the proverbial hills and delete your account with us.

Second - we don't want to sell out to Google, et. al. or whomever is leading the next round of Web 2.0 acquisitions.

We simply want to be the biggest, best repository for personal health experiences on the Net, and this means we need some moohlah.

Third - we don't want to sell out to 'angel' investors or venture capitalists who may try to impose their own priorities on our operations/strategy.

We want to keep adding users, growing our base, and providing you with the means to harness your own healthcare knowledge. Period."


If any H2.0 company actually explained to me the motivation behind selling my data, I'd sign up.

That's right H2.0 firms: how many of you will take me up on this?

Provide me with a win-win. It's not that hard, given the flat world we live in...let me chat with others who show interest in the same conditions. Who's struggling with the same issues? Who's come up with innovative solutions?

These are things I'm considering as I register with H2.0 companies. If you're thinking of how much money you can make from selling my registration data, think again - you're corrupting the core of H2.0 - consumer directed care.

I direct you to listen. I direct you to listen, or I will NOT use your firm.

After all, I have a lot more to lose than you do.

Best of luck in the brave new world of H2.0-
Jen MG

Why Consumer - Directed Medicine, Health 2.0 Will Flourish

Forget catering to the 'feelings' of consumers.

MTV sold more songs via digital download for its games Guitar Hero and Rock Band in 2 months than Sprint sold in 4 (2.5M for Rock Band in 2 mos, 5M for Guitar Hero III versus 1M for Sprint).

Shoot for good feelings and you'll miss the boat.

Consumers want to be integrally involved. This is proof from yet another industry.

We want to be playing with the band, making the music.

We want to be in control of the score.

This is why consumer-based medicine will succeed.

It's only a matter of time before the Guitar Hero generation is the Getting Healthcare generation.

And when they begin seeking medical care and services as primary decision-makers - look out hospital markets.

The future of the American healthcare landscape is hidden behind a clouded horizon. No one knows exactly what future delivery and payment structures will look like.

Declining primary care and the rise of superego conditions related to a more sedentary, me-oriented consumer all play a factor.

The marketplace is cluttered with provider organizations offering partial solutions based on previous industry success - we still aren't HEARING customers.

As individually focused consumers grow up and find a lack of nurturing support in the medical community, we'll reach out to alternative models like generalists on retainer and telemedicine.

Get ready for questions like these:

• What's a 'family doctor?'
  
• Why won't my PCP spend more than 3.456 minutes talking to me about this?
  
• I haven't seen anyone since my pediatrician - can I give you my PHR on this thumb drive?
  
• How do I access your client approval ratings online?
  
• I haven't seen anyone since the NP at the campus health center - what do you mean my insurance won't cover this and so you won't do the xray?

You think the market is tough now?

Get ready for mindsets like these:

• No wireless net for my laptop?
  
• No concierge service?
  
• No low-carb/vegetarian menu options?
  
• No quality/safety data online for my appendectomy?
• No email access to my physician?
  
• Ok, none of my business is coming your way.

Work on mentoring the 'me' generations - the next wave of healthcare delivery will depend on carefully mentoring 'me' thinkers to manage personal responsibility and maintain individual health. Wellness maintenance programs are just one part of the solution.

Look, we don't have all the answers and we don't want to take over the system - we just want to be partners in our own care.

You provide the composers (docs in this musical malady), we just want to be part of the band (and sometimes the lead singer).

Give us a solo - we've been taught for most of our lives to tell people what we want. You've been taught for most of your lives to tell people what we need to be well. Your answers about how to work with us in the new system are waiting.

Weekend Reader's Choice: Wild Ideas to Consider Implementing This Monday

Each week I come across ideas and concepts I'd love to push into the healthcare marketplace in one large, lovely, gushing bolus.

Unfortunately, actual implementation will take longer for many innovative concepts - although I'd love to be able to flush everything into the system at once, releasing new ideas in one cluster would wreak havoc.

While I enjoy creative tension in the workplace (both causing it and helping to alleviate it), I also realize that you have to build up people's capacity for change with successes.

For your weekend reading pleasure, here are a few ideas to think about implementing come Monday.

One can be implemented immediately (Chris Resto's Harvard Business Review piece on managing expectations for young talent should be applied to ALL talent - posthaste), and one will take longer (Linda A. Hill's mention of co-leadership and letting go of our common perceptions about how leadership 'presents' to discover tomorrow's leaders).

Read Tata Motors' idea for harnessing the creative power of entrepreneurs in India - it's like the moto version of Ikea (build what you want from a box of parts), or an auto-franchising Fordization for the next century. Bravo Tata.

Watch Harvard Business Review's interview with Professor Linda A. Hill. Hill tells us how to find the leaders of tomorrow. Where are your next generation of leaders? Are you looking deep in the bench at every employee (techs, physical plant staff, food services, etc.)?

Read one of the best concise discussions on leading/managing talent I've ever seen here - Harvard Business' Conversation Starter by Chris Resto is titled "How to Set Expectations with Young Talent," but includes a conversation every manager should have with EVERY employee, not just promising young millenials.

Just chew them over for a bit. Could any of these concepts work at your hospital? Are your synapses firing with new ideas just reading?

One of the biggest roadblocks to innovation is burnout, so enjoy your weekend. There's plenty of time to innovate next week.

CQI - Eliminate the Buzzwords and Get Back to Work

I spent the last two days pleasantly tucked away at Rotterdam's Novotel Brainpark with some of my new Dutch coworkers, modeling implementation of a targeted CQI theory in the healthcare setting.

Six Sigma, Toyota Lean manufacturing, and pulling CQI processes and initiatives from other industries are items I've addressed here before - in US healthcare we've cobbled together a convoluted cocktail of improvement programs to address larger systemic issues.

At hospitals, we tend to jump somewhat blindly on the latest bandwagon approach. Disney "Be Our Guest" initiatives have scarcely gone out of fashion before we're looking at airline best practices (and anyone who has traveled more than once in the past year doubts the validity of pulling system design from luggage handling).

You can take your pick from a multitude of currently popular manufacturing adaptations, creating hospital focused factories of care where patients and providers are inputs to whom we must deliver service lines (products) as quickly and efficiently as possible (not to say that there's anything inherently wrong in this approach...).

Hospitals end up with a patchwork quilt of initiatives, each piece requiring different staff training courses and management action teams to knit the new process into existing organizational fabric.

Those of you looking for more examples of sensible, 'global' approaches to improving your environment of care (or replacing your current patchwork system), check out the following resources:

1. The IHI's International Forum 2008: Ahhh, Paris. There's nothing better than munching a chocolate croissant strolling the streets of the City of Lights in the spring, unless you're on your way to the IHI Intl. Forum to hear top-notch speakers and bring home results-oriented research.

Two of this year's featured themes are leadership and whole system transformation. Presentations are offered in English; some are available with French translations.

Presenters include IHI President/CEO Donald Berwick, Joint Commission President Emeritis Dennis O'Leary (who gave a great keynote at JCAHO's Hospital of the Future conference last spring in Florida), Current Joint Commission International President/CEO Karen Timmons, VP and Chief Strategy Officer - Blue Cross Blue Shield of Massachusetts Vinod Sahney, AGIS Health Insurance (Dutch firm) Consultant Piet Stam, Director of the Dutch Institute for Healthcare Improvement CBO and researchers, practitioners, and staff from hospitals and healthcare systems all over the world.

Read the brochure here. Register your team by Feb. 29th for an early bird discount - for fee/registration info click here.


2. For those seeking information on process improvement (liberally distributed among commentary on many other issues), check out Clarke Ching's blog, a Bigger Glass please. Clarke also hosts a Yahoo! Group discussing Goldratt's Theory of Constraints in healthcare.


3. Finally your hospital is looking good - but does your daily presentation speak for itself? For wardrobe CQI and engineering your own look, nobody says it better than Life as a Healthcare CIO John Halamka. John, I'm tempted to toss my entire wardrobe and start over.


As hospital management teams, we've begun to trumpet our quality initiatives to press, patients, and providers (sometimes unfortunately in that order).

Quality goals are often ambitious, bold, and seemingly unreachable articulations of our desire to make safe, effective patient care the norm.

Let's be honest with ourselves though, and our patients - going 'where no hospital has gone before' with quality initiatives presents us with a win-win. Patients and hospitals become partners in quality and partners in care.

More patients can be treated with lower variance levels/adverse events, but we can also treat more patients, and deliver care that distances our performance from that of our peer facilities.

Optimizing quality allows hospitals to achieve high marks for both service and safety. Optimizing quality allows hospitals to become the kinds of places we'd recommend to family and friends.

Aggressive quality goals are win-wins for patients, providers, payers, and professionals. But how to get started?

Step 1: Define what quality means for your facility - use simple, brief language that details exactly what you'll achieve (no charge for 28 never events? Joint Commission International accreditation? Top 10% of hospitals domestically? Internationally?).

Step 2: Share your plans with internal constituencies - get feedback. Publish them. This is a time for total transparency. No one picks out the holes in your theory quicker than those who have to put it into daily practice.

Step 3: Get going. We can plan elaborate campaigns and spend half our time around the conference table, or we can quickly articulate an aggressive plan and then authorize employees to 'just do it.' Quality initiatives will evolve when released into the work environment - let your babies go!

After all, quality is what you succeed in doing, not what you succeed in saying is important.

When we look at developing really audacious quality initiatives, what's holding us back? The fear that we won't succeed, or the fear of what problem we'll tackle after the biggest constraint is gone?

Anger Management & Medical Blogging?

What say ye crowd? Are we an angry bunch?

According to today's issue of HITS (Health IT Strategist e-newsletter - sign up here), as a group we demonstrate a predilection for negativity (direct from 1.15.08 edition):

Anger issues? A look inside medical blogging

A plethora of healthcare-related blogs have been created, but with the exception of one called the Happy Hospitalist, most medical bloggers seem to have anger issues.

The first one that comes to mind is the The Angry Nurse! In turn, links from that site are positively—or perhaps negatively—splenetic. One is the British blog Angry Medic, which in turn links to Angry Doctor, sponsored by a Singapore physician. Keep tapping and you'll eventually find the Angry Pharmacist, who provides "rants from the most trusted profession."

Not every medical blogger has such obvious anger issues. A hospitalist with a blog called Fat Doctor reflects on life at work and home with only "occasional whining."

The intentions and emotions of one particular obstetrician blogger are unclear. The blog bears the name Midwife with a Knife, and it warns that "any resemblence (sic) of anything in this blog to actual patients is entirely coincidental."

If awards were given out for the cleverest name in healthcare blogging, a clear favorite would have to be OB/GYN Kenobi, written by a physician who also warns readers not to take her posts as complete works of nonfiction: "All names are changed to protect my licensure. I reserve the right to relate in hyperbolic terms for dramatic effect." -- by Andis Robeznieks / HITS staff writer

Author Robeznieks obviously skimmed the names and disclaimers of some of our brethren medical bloggers, but does Andis come to the correct conclusion?

Are we an angry bunch? Do "most medical bloggers seem to have anger issues?"

Several years ago I attended the inaugural "Writing the Medical Experience" conference and workshop at the Squaw Valley Writers' Community in California (BIDMC's own poet-physician Rafael Campo was a featured author).

Robeznieks' observations remind me of debates the writers had about our tendency to use gallows humor when talking about work, and how we need to make light of death, doom and destruction we see on the job in order to REMAIN on the job.

As a result of those conversations, and many others with medical providers, I think releasing negativity in a blog (as in poetry, fiction, and other creative communications) can be a cathartic, positive force.

I may be biased, however - my senior thesis at SMCM was titled "Poetry Readings: Catharsis for Author and Audience."

We can't assault the frequent flyers (first do no harm), however, in the semi-protected world of bloggers' anonymity (sorry Dr. Flea), we may be able to release vituperative bile that otherwise would affect patient care.

Unfortunately, I can't completely refute Robeznieks' perception as I'm not a 'medical' blogger per say (I didn't blog while working as a Patient Advocate in an ED) - and it would be foolish to discount that there is a drastic difference between protecting your job by blogging as an unnamed doc, nurse, EMT, pharmacist, etc. and writing as a transparent, self-branded healthcare corporate blogger.

Both types of bloggers are actually under tremendous pressures; one group NOT to share anything that might compromise confidentiality and result in a lawsuit or losing a job - the other to relate positive, sunshine-and-puppy-dog-tail "lessons learned" experiences in the field (after all, if we spouted off like Uncle Panda we might not have jobs come next Monday).

That said, is there any positive ROI for blogging in the medical/healthcare/hospital fields?

Really, most of us who believe we are safe behind the wall of relative blogger anonymity and write our op-eds unnamed could be tracked. *Blogger's note: I'm not counting the tech elite among us who cover tracks carefully to prevent being revealed.

Of course there are benefits to medical blogging.

The way we interact in the blogosphere reminds me of a brick and mortar model community - the Young Presidents' Organization (YPO).

At YPO, execs have a forum to converse at a personal level about professional experiences, and hash over challenges in a more casual atmosphere, where they benefit from peer advice.

The wisdom of crowds is harnessed there, as it is here.

Because medbloggers blog, I can experience second-hand some of the procedures and difficulties docs and nurses deal with on a daily basis.

Because medbloggers blog, I have a better idea of what's going on in American healthcare - and what I want to do about it.

Even if not one other person read my blog, or I changed the settings to make my entries private, the online journaling benefit can't be discounted.

Blogging gives me a chance to hash out my personal position on emergent issues such as the great checklist debate.

I find tremendous positive ROI in sharing experiences, news, anecdotes, and other lessons about living and working in the healthcare field. I find it well worth the time spent to generate content.

I hope for all of our sakes, the medbloggers above do as well - the blogosphere provides a place where emotive experiences, frustrations and triumphs, death, grief, pity, and yes, anger, all have a rightful place in the continuing evolution of our American continuum of care.

Does blogging make me a better healthcare worker? I'm not sure, but I do know reading the blogs of others, angry rants included, most definitely does.

Cool Healthcare Jobs of the Week

Number 1, hands down.

Courtesy of Barbara Duck at The Medical Quack, a medblogger who turns up some of the most interesting stories anywhere on the web and oh-so-nicely puts them into an easy to digest daily briefing.

Number 2, my new one.

In the classic style of "healthcare bloggers who have big news but initially keep it selfishly to themselves," I'm going to spill only a bit.

More to come as details are finalized, but for now I'll just share that it's with a team I'm thrilled to call colleagues - and that they've got heads, hearts, and all hands on deck moving in the right direction.

Salvation at Hand - PCPs as Gatekeepers

St. Peter ain't got nothing on these guys.

In Holland in 2004 (Cardol et al., 2004), 95% of complaints brought to GPs were handled by the GPs themselves.

GPs in Holland are exemplary gatekeepers.

Some studies even suggest that the real referral rate to specialists has dropped in the last 15 years (van Weel, 2005) following the 2004 introduction of "incentives against unlimited care utilization" (2006 RiVM Dutch Healthcare Performance Report).

In Holland (and I'm sure you'll all get tired of hearing me use that intro), GPs select the hospital where they'd like to refer patients based on several factors:

1. location;
2. physician they know (connections); and
3. reputation.

Admits are often based on the patient's GP having personal knowledge of a doc at the hospital where they recommend care.

That said, the patient in The Netherlands can still choose any hospital they wish, but many will decide based a combination of:

1. the GPs recommendation;
2. location/convenience/proximity;
3. community reputation; and
4. personal recommendations.

Hospitals in Holland face an interesting challenge as a result of eroding doc-to-doc relationships...GPs are now older Boomers, and the average age of specialists is younger (some boomers, Gen X and Y as well). How to work with the age differential?

How do hospitals, who have established relationships with specialists (it's rare for a specialist to be affiliated with more than one hospital), nurture relationships between GPs and their docs?

Good question. Some hospitals offer educational courses and research opportunities. Others emphasize partnerships and other benefits of being affiliated with internationally-known centers of excellence.

This model may well work in the US - if we take the nature of the problem seriously.

If the US can reinvigorate primary care (Who am I kidding with that phraseology - who's going to call the code? We need to completely re-animate primary care...), we may be able to solve problems that start at the consumer level.

Without trusted, quick, affordable primary care, customers bypass initial medical evaluation and carry issues through to hospital care (now PCP = triage nurse on duty), due to lack of interaction with a 'general' medical partner (i.e. the now severely endangered personal physician) who acts as a gatekeeper.

Example: If my throat really REALLY hurts and has an icky coating on the sides and I'm tired and feel horrid and have a bump on the back of my head (swollen gland/lymph node) and I don't trust my PCP, or worse yet, don't have one, what do I do?

I point my mono-stricken self to the nearest ER, where it takes 4.5678 hours to get tested and get results (+ for EB).

However, if I have a very active, engaged PCP that I consider a partner in my health and wellbeing, I call (or email) and make an appointment.

Because I trust her, and she knows me and my health as well as I do, I'm willing to wait for that appointment (unless of course my condition becomes a true life/limb threatening emergency, not just an emergent PITB).

Happy Hospitalist thinks this is the solution.

John Sharp at E-Health has a good post on primary care here.

Here's another good question: why has the hospitalist specialty grown so fast?

One factor: they're one component of a cadre of new services replacing primary care (Exhibit B = rise of the retail clinics).

Hospitalists do what PCPs used to do...provide comprehensive, personalized medical care across the complete spectrum of your entry, exit, and re-entry into the healthcare system (which in the US has almost become synonymous with hospitals).

So Mission Impossible for the next 10 years? Reinvent primary care.

Luckily, some docs aren't waiting for bureaucracies to generate change - concierge care and personalized medicine a la Jay Parkinson have seen market opportunities and seized them.

How would hospitals do the same?
Build on the hospitalist model.

At AMCs, make PC (personal care) a specialty. Recruit physicians who have shown an interest in both the business (MBAs) and the empathic (PsyDs, etc.) sides of medicine.

Build new partnerships with your cadre of promising PCSs.

Give these docs the opportunity for unique affiliations with your hospital.

House them in the medical mall near your main building, provide them with hospital privileges, outfit their offices with compatible/copycat EMR and HIT systems so when a patient of theirs is admitted, they receive real-time updates at the office. They should be able to access results between visits.

In short, treat them like specialists - because that's exactly what they are.

Give them access to unique benefits including outsourced accounting used by the hospital, etc.

Value them for what they are (gatekeepers and primary partners in care) and for what they could become - acting in concert with consumers, co-saviors of the American healthcare system.

I Get By With a Little Help From My Friends - Compassion in Healthcare & Holland

Over at the Hospital Impact forum, Tony Chen has kickstarted a conversation about culture. (If you haven't signed up for the HI community yet, it's worth a look).

Nick Jacobs discusses culture and the responsibility for treating others with compassion (and accountability) eloquently on his blog, and points the proverbial finger of responsibility straight towards the managerial/executive branch.

So much of what's going on in American healthcare involves not just the supply-demand side need for greater economic incentives and market-based consumption, but also the ongoing debate about how hospitals can be businesses that put patients first - in other words, how can we make money, provide good jobs AND good care, and be compassionate in our actions, reactions, and treatments - all at the same time?

This is an old axe, but forgive me for dragging it out to grind.

As a Patient Advocate in a small community hospital working through my last year of college, I saw how integrally important compassion is to the success of care modalities. I spent, ironically, much less time talking to patients than I did mediating communications between the medical staff and families.

Here's the kicker - compassion isn't just de riguer for your patients.

As the industry places increasing focus on compassionate care at the SYSTEM level, so too must our leadership emphasize and embody compassionate communication at the INDIVIDUAL level.

If you have great patient safety and quality of care initiatives, have a wonderful research staff, turn out great docs at your AMC, but treat your employees in physical plant like crap, you're operating in a situation of cultural hypocrisy.

Managing people and processes in a healthcare setting is no piece of cake, that's for sure. And it shouldn't be...these are people's lives we're dealing with - their wellbeing.

At MCRZ here in Holland, compassionate community-based care is driving a turnaround. Following a challenging merger 4 years ago, the proof is now in the pudding: they've instituted performance evals for docs as well as managers (360 degree feedback). *Blogger's Note: I hope to have more news to come re: MCRZ.

And guess what? When someone doesn't measure up to the level of expected compassion, when a staff member (regardless of department) doesn't perform with attention to care and quality, that person is held accountable, and may actually face termination (not just empty threats).

This afternoon (it's 3pm Saturday here now) I found that compassion in Holland doesn't just flourish in the healthcare system.

A neighbor just rung my bell and delivered a package (our cable modem thank goodness- here we come Skype/Vonage!).

She and I chatted for a few minutes; it's common here for the postal service to deliver packages to another house on the block, depending upon who's home at the time.

Then the postal service leaves you a note telling you where your package is, and when you're neighbor gets home, they bring you the package (you can alternately ring them, but it's considered polite to deliver the package in person door-to-door with thanks).

Isn't this a great example of compassion? My neighbor didn't have to deliver our package, she could certainly have waited for me to buzz her and ask for my box.

I'm almost tempted to pretend I'm not home next time I see the postal delivery person (and order a bunch of stuff online), just so I have an excuse to meet all my neighbors.

There's a better way to do that though - excuse me while I go knock on some doors and introduce myself.

It's the compassionate thing to do, after all.

Palmetto Health Richland Implements Suggestions from MBA Students at USC’s Moore School of Business.

My only question is - why on earth did it take so long for hospital administrators to figure this out?

It's All About the Drugs...

Ok, I couldn't stay away. There's just too much going on in American healthcare this week.

It's definitely been a Big week for Big Pharma.

First, the Los Angeles Times broke this story, in which two former Amgen (click here for company website) sales reps allege the firm used an invasive program to access dermatologists' patient files and contact patients directly to market psoriasis treatment Rx Enbrel.

In addition to having sales reps write letters to patients on physician letterhead suggesting Enbrel (and having them signed by the docs), the firm may also have provided incentives to physicians who cooperated, in the form of payments for dinner-dance type lectures.

Definitely worth the time spent for a 2 page read. Click here for the HealthLeaders Media link.

In other news, the DC Council again passed Bill 17-364, otherwise known as the SafeRx act (in a narrow vote of 7-6).

And for your analytical pleasure, you can read the act itself here.

If you're really, really Type A (or interested in how the vote broke down for lobbying purposes), you can click here to see how each Council member voted (select session 17 and the Council member's name; for most it will be located on page 13 of the results).

Turns out not one changed his or her mind; the members voting for and against were unchanged from the initial vote to yesterday's final vote.

For a quick recap on SafeRx, here's my original breaking news blog entry. Here's my followup after the initial vote.

For coverage on the final vote (Tuesday 1.8.07) - here's a Washington Business Journal piece.

And then of course, if you haven't seen it already, there's Glenn Beck's tale of medication-related woe following a recent, ahem, surgery of a rather personal nature.

As a patient who, 5 days out of an MVA with lower limb trauma and reconstructive surgeries, experienced all kinds of interesting side effects due to a narcotic pain cocktail (too many meds for lil ol' me) and started voluntarily refusing morphine and my PCA (to the consternation of my pain management team and the panicked disbelief of my dad "she CAN'T do that can she? I mean, she CAN'T just REFUSE her medications?!"), I can empathize with some of his obvious fear and frustration.

Blogger's Note: I have other opinions on Glenn's story content, his YouTube video-which may be a potentially pain-killer assisted broadcast, and the way Beck relates his experiences, but that's a post for another type of blog, or the Rants and Raves board of Craigslist.org. He has some points to be considered. Click here to see the ABC News followup.

If all the drug-related scuttlebutt wasn't enough to ring in the New Year in American healthcare in a big way, there's The Commonwealth Fund study that places the USA in dead last place for healthcare performance among developed countries.

Click here to read a TCF synopsis. Guess who's first? C'est la vie.

On the other hand, from across the pond there's this good news. Slainte! Talk about it being time for big changes. Ain't it a grand era to be in healthcare?!