On "Medical Homes" & Healthcare as a Business

The most constructive critiques are usually a double-edged sword, and this one's no different.

Today the latest issue of the Journal of Healthcare Management, published by the Foundation of the American College of Healthcare Executives ("for leaders who care (R)," and of which I am a member), arrived via my friendly Dutch postal carrier.

Here's the sweet spot...

It is the FIRST issue of JHM that I've been unable to put down (in just over a year of devoted, cover-to-cover reading).

In fact, it is the first issue I found directly relevant to current healthcare management issues. Usually (sorry ACHE) I reserved JHM for bathroom reading.

Editor Kyle Grazier sets the right tone with her editorial. This issue, finally, is "A call to arms."

Articles included succeed in raising "awareness, attention, and action." Hope this quality coverage continues.

JHM has also chosen to run 2 new columns, the most interesting being Sandy Lutz's ongoing discussion of "current trends and future implications of consumer-driven healthcare."

Each issue of JHM starts with a 'famous person' interview, highlighting someone in the field of healthcare management (usually FACHE certified, naturally).

This issue interviews Lucian Leape MD, an adjunct professor of health policy at Harvard.

Dr. Leape has heaps of experience in the field, more letters after his name than I can ever hope to obtain, and makes a hobby out of testifying for Congress about healthcare safety and quality issues.

I agree with many of his views (including the fact that we'll have a national effort in the US to enforce patient safety goals in the near future).

However, one sentence on page 75 made me check while filling out my mutual admiration society card. And here's the sword...

Dr. Leape says: "Part of the reason for this is that the American healthcare system puts so much emphasis on the business of medicine."

It's here, Dr. Leape, that I beg to differ.

In fact, it drives me nuts when I hear this line.

This is NOT the problem. We don't place too much emphasis on the 'business of medicine.'

The problem is that we're trying to morph a cottage, craft-based industry composed of loosely organized individual practitioners into a working, centered, corporate-efficient business model nearly overnight.

But we're failing at it.

If we weren't, we'd recognize the value of getting and retaining human capital (staff).

If we weren't, we'd recognize the value of getting and retaining customers (patients).

Integrating a 'business of medicine' approach and creating a care environment that puts safety at the forefront are not mutually exclusive strategies.

Creating a safe, productive, empowering, efficient, empathic environment of care (for both populations) is THE primary tenet necessary to achieve both goals.

A well-run business would recognize this and realize ROI in both profits and people, dollars and dreams realized, loyalty and less lawsuits.

It's not that we have too much 'business' in healthcare Dr. Leape - it's that we have too little.

The latest 'care' based healthcare initiative slaps a new customer-friendly tag on an old search.

Pundits and analysts (many of whom I respect and whose views I admire) are looking to solidify the amorphous concept of consumer-centric care around a universal 'medical home.'

To all those looking, forget it. We're grasping at straws.

This is the healthcare industry equivalent of Arthurian legend.

No single heroic stratagem will pull the sword from the stone and save the kingdom.

Stop searching for a larger-than-life solution - a much more self-effacing hero already exists.

The 'medical home' we're all looking for is embodied (literally) in each patient we see, each consumer we 'touch' with a Health 2.0 communication.

Stop thinking of 'safety' initiatives as universal measures that can be implemented mirror-image in each clinical setting.

New checklists and protocols to prevent medical errors most appropriately begin centered around the experiences, prognoses, and wellness goals of each patient, taking into account clinical pathways and docs orders, of course.

That's not just safe, empathic medicine Dr. Leape, it's good, efficient business practice.

Live: ACHE Congress 2008 - Chicago

I'll be blogging from ACHE this week.

After attending Health 2.0 in sunny San Diego, the annual congress of the American College of Healthcare Executives, titled "Redefining the Healthcare Landscape," provides a stark contrast.

Health 2.0 is charging ahead and changing the way the healthcare establishment connects with consumers. ACHE IS the establishment.

The good thing is both parties, the staid, slow-moving current establishment as well as the shock-me-with-high-tech Health 2.0, realize that the landscape is changing.

This convention is 'old school' healthcare.

I'm the only one I've seen blogging live from any session. Q&As after speakers are more an opportunity for high-ups to emerge as 'thought leaders' rather than ask tough questions.

Poster sessions present the necessary and basic building blocks plethora of quality and performance improvement initiatives hospitals must take to reduce, say catheter site infection rates.

Hallway conversation centers on hotel quality, generic descriptions of the woe that is physician relations (according to administrators), and, from the students, tales of last night's adventures on the town.

After the entrepreneurial fervor of excitement at H2.0, ACHE is a bit of a let down.

It's much more difficult to meet a CEO you admire in this type of cattle-car environment.

It makes me question why I believe a career in the heirarchical, troubled world of hospital administration is the right thing for me.

I'm sure other graduate students, especially those to whom shaking hands in suits still seems new and nerve-wracking, may find themselves asking the same question.

What is our motivation for joining this industry?

The day to day work of hospital management isn't sexy stuff - but it's absolutely necessary for improving the service of hospital-based healthcare.

And there is no challenge like healing a hospital system and integrating all care provider and patient activities to achieve optimal wellness.

I'm off to a session on the Globalization of Healthcare...and I love a challenge.

Hi Tech Tomorrow, Lo Tech Today: What Percentage of Your Patients Have Advance Directives?

In the next few weeks we'll hear all kinds of buzz about the plethora of high tech health IT firms presenting at this week's fantastic Health 2.0 Spring Fling.

In the midst of this swirling idea cloud, let's remember there's significant low-hanging fruit we can encourage consumers to pick and co-direct treatment along their personal care continuum.

Here's a low tech approach we should encourage -the creation, safe storage, and appropriate distribution of an advance directive.

If you really want to empower patients and engage them as consumers, try this aggressive goal; by April 16th, 100% of patients over 18 should have an advance directive on file.

Why April 16th? Why not?

A partnership between the American College of Healthcare Executives and state/community organizations have designated it National Healthcare Decisions Day, and it's coming right up.


A website gives recipes for activities: http://www.nationalhealthcaredecisionsday.org/.


And speaking of consumer directed healthcare, how many of you, dear readers, have advance directives?

Does your designated healthcare advocate have a copy? Your local ED? Each of your treating physicians including your PCP?

End of life and long-term care decisions always seem to be needed when we least expect them. In other words, now is the best time to clarify your thoughts and codify them in a legal document outlining your wishes.


Practice what we preach - there's both personal and professional work to do here...