Health Care Strategist

I can't predict the impact on Washington politics of President Obama's visit to a Republican retreat and the resulting 82 minute confrontation, er, debate. Regardless of the outcome though, spending time with your critics is an under-appreciated method of growing into a confident leader. Most of us naturally prefer to hang out with people with whom we agree. We like hearing we're smart and that our opinions are uniquely insightful. The ongoing validation - given and gotten - feels, well, validating. But sometimes it's better to spend time with critics - the people who won't tell us what we WANT to hear but instead tell us what we NEED to hear: other interpretations of situations and information. New viewpoints. Fresh ideas. Re-drawn road maps. Pathways to improvement. Maybe even our mistakes (which are really the raw material for performance improvement.) Critics being what they are, sometimes the conversation adjourns with an agreement to disagree. That...

Some great learnings from BlueShield of California's web portal design process, done in 9 months at 10% of the original packaged solution cost.

From MedCity News, transformational opportunities for Apple's new iPad . "The obvious potential for the tablet lies in electronic health records, pieces of software that are often clumsy, poorly designed and inhibit doctors’ worklow. A “killer” EHR app on the tablet could change all that." Obstacle number one appears to be teaching a generation of IT leaders that their kids have something to teach THEM.

Dr. Matthew Katz, M.D. commented on yesterday's post here on Health Care Strategist , positing that cancer registry statistics place the official rate of radiation injury closer to 0.1% - far lower than the Times' 5% estimate. I'm tempted to split the difference. A 5% error rate may be too high, but given the pervasive under-reporting of medical errors, 0.1% is almost certainly too low. Dr. Katz is right about one thing though: the greatest harm of all would occur if frightened patients avoid potentially life-saving care. And therein lies today's headline: it's all about trust. Today The NY Times ' Walt Bogdanich continues his series on radiation safety with an article spotlighting Intensity Modulated Radiation Therapy (I.M.R.T.), an expensive, complicated technology that's lifesaving in the right hands, dangerous in others. Full disclosure on my part: I'm not a Radiation Safety Officer nor do I have those magical initials "M.D." after m...

Image by William Hamon (aka Ewns) via Flickr I found this interesting quote today: "In reality, there’s really no one to root for. Hospitals and doctors provide world-class medical care but make lousy efficiency experts. Payers are experts at, well, paying but could use some pointers on public empathy." Steve, UnitedHealth Group vs. New York hospitals: Are those my only choices? , Jan 2010 Read the whole article.

From the NY Times, that's an estimate from a radiation oncologist and leading authority in the treatment of radiation injuries. 1 in 20. 5 out of every 100. "Most are normal complications from radiation, not mistakes... But in some cases the line between the two is uncertain..." . "My suspicion is that maybe half of the accidents we don't know about..." says another expert. What's the true rate of error-caused injury from radiation therapy? Since radiation has inevitable side effects, maybe it's not as bad as 1 in 20. But injuries are said to be under-reported so maybe it's worse. Let's say the two adjustments cancel each other out and 1 in 20 is close to the real rate. Name another industry that injures or kills five percent of its customers. This being health care, mistakes leading to injury are blamed on everything from balky computer software to staffing shortages to something called a "wide open multileaf collimator." A...

...says Walt Shill, head of North American management consulting practice for Accenture Ltd. The "Managing" column in today's Wall Street Journal describes the economy's impact on corporate strategic planning processes. Maybe the key phrase there is "...as we knew it..." Out: rigid calendars, static three-year plans and quarterly updates. In: flexibility, accelerated decision-making, 'adaptive' strategy, scenario-testing, war rooms and opportunism. Office Depot began updating its budget every month after quarterly reviews left leaders slow to react to changing customer needs. Retailer J.C. Penney put its entire strategy on hold in favor of a "bridge" plan, delaying some efforts and speeding up others. Penney's CEO 'Mike' Ullman III credits the plan with improving margins and helping the company avoid layoffs. Now he's reviewing the 2007 plan's "relevance" and whether it should be revived. Wanna bet? Hist...

From MedCity News , Dr. John D. Halamka, chief information officer and dean for technology at Harvard Medical School, writes the story of health care in 2015, when Stage III of meaningful use is fully implemented. Among his forecasts: "Hospitals will compete based on the results they achieve rather than the grandeur of their buildings. Transparency in the reporting of quality and outcomes will transform the health care marketplace. Patients will have a much better understanding of quality, cost, and outcomes." And this... "Patients will have much more choice as consumers. Access to the electronic records including their genomes will enable personalized medicine – selecting the treatments that best align with their care preferences, risk-taking thresholds , and physiology." Good stuff, and high time for providers to move beyond the 'do we/don't we/how can we?' questions and consider the revolutionary aspects of an EMR-enabled industry.

What happened the last time someone brought you a new idea? Did you respond with a "Yes, but..." or with a "What if...why not?" Once you learned that nobody else had tried it, were you less interested...or more? The answer can't always be "Yes!" Sometimes you must say "No" or "Not right now." But do you make "No" a learning experience so the next great idea isn't stillborn, locked away or, worse, taken down the street to your competitor? Did you make that person an "innovation hero" for trying? Or do you reserve that status for budget target-hitters? In fact, who are your organization's heroes and what do they represent? Feeling a lack of innovation? Maybe it's not 'them' out there. Maybe it's you. And if 'they' are not thinking 'outside the box" (a term I've come to loathe...) maybe you built the box's walls too high.

On the ground in Haiti, the health care situation grows more dire every day. International Medical Corp has response teams in Haiti treating crush injuries, trauma, substantial wound care, shock and other critical cases with the few available supplies. Here's how you can help:

'Yes' says HealthLeaders magazine , and offers 5 strategies that prove the point; Fill the gaps in continuity of care. Example: Using a hub-and-spoke model, Kettering Health Network in Dayton, OH is developing ambulatory care centers for independent and system-employed physicians, including a hand-surgery center and a neuro-rehab and balance center. Extract value from clinical benchmarking. Example: expecting a shift toward performance-based compensation systems, Wisconsin's Dean Health System quantified clinical utilization measures and used Lean-like processes to discover $9 million in savings in 2009. Transform payer-provider relations. Example: in an Ohio-based pilot program , several insurers and provider organizations created a one-stop Web portal for electronic transactions intended to reduce paperwork and administrative overhead. Ninety-one percent of privately-insured Ohio residents are part of the project. Base design and layout decisions on quality and...

Asks Dave deBronkart, co-chairman of the Society for Participatory Medicine in a recent post on e-Patients.net. deBronkart is, of course, referring to the fraternity hazing-like processes patients frequently endure to get copies of their medical records, copies to which they are entitled by law, ethics and common courtesy. Oh wait. Maybe I answered my own question right there with that last one. CNN has more, here , along with the sub-head "You have to be a jerk." What industry doesn't love hearing its customers advised to act out to get what's rightfully theirs? And isn't it time for health care to stop hiding behind HIPAA whenever tough questions are asked? For once, try finding an excuse that doesn't assume everybody listening to you is a raving nitwit.

Washington continues its dot-connecting on the financial crisis. Yesterday, the aptly-named Financial Crisis Inquiry Commission summoned four financial services titans to a hearing on what went wrong and how to fix it. One titan opined that he knew his bank was selling mortgage-backed securities loosely (but succinctly) described as "crap" WHILE SELLING SHORT the very same securities, a strategy he justified by saying "Hey, our buyers are sophisticated enough to know what they're buying and it's THEIR problem if we sell them crap and bet against them!" (That's not a direct quote, just a pretty accurate paraphrase.) The financial services industry remains in deep denial over the level of populist rage, the loathing and distrust, directed at "them" in general and high-earning "bonus babies" in particular. This time, I doubt the tried-and-true "hunker down and wait it out" approach will save them. Business as usual? Not in t...

CNBC just featured an interview with Sam Zell, noted real estate investor. Zell is also noteworthy (maybe "notorious" is a better word) for acquiring the Chicago Tribune's parent organization, leveraging it up and then taking it into bankruptcy when "big" media failed to support "big" debt. Hmmm. Who could've foreseen that? I guess the lesson here is that losing a few paltry millions only gets you fired. Losing BILLIONS and demolishing an iconic American newspaper grants you "tycoon" status and an interview with Maria "genuine media personality" Bartiromo. Can you spell "Donald Trump?" YOU'RE FIRED! GO BIG OR GO HOME!

The Innovation Age Bias At Sequoia Capital Is there an age bias to innovation? Douglas Leone, partner at Sequoia Capital seems to think so. My response? It's his money to invest wherever and with whomever he chooses. But truly innovative people know that great ideas are wherever you find them. Limiting your search to people with X characteristics is just stupid.

According to The American Customer Satisfaction Index, hospitals' customer satisfaction ranks no better than middle of the pack, slightly ahead of energy utilities and the U.S. Postal Service, and well behind major appliances and pet food manufacturers. So what does a hospital saying "We're in the 99th percentile...!" really mean? Usually, it means "We scored pretty well within some peer group." Ah, a peer group. There's the rub. Hospitals are great at benchmarking themselves against other hospitals. It's like 14th century astronomy, where the entire universe consisted of the few thousand objects in the night sky visible to the naked eye. It was easy to believe that nothing else existed, certainly nothing that mattered. But if our "peers" are other hospitals in our health care universe maybe we should set our sights a little higher, adjusting for the fact that, across all industries and the full range of consumer experiences, none of...

As I execute against one of my New Year's resolutions (namely, to rid my "to read" shelf of all books I haven't read but know I should...) I'm again reminded of why I read few "business" books from cover to cover. Most offer but a single idea that can be grasped in a chapter or two or, better yet, a short magazine article. More perniciously, many are so poorly written as to corrode the reader's ability to appreciate anything resembling better literature. My value proposition here at Health Care Strategist is to always offer scribblings and ideas worth more than you're paying. I think I've kept my end of the bargain though, if it'll make you feel better, you're welcome to donate $29.95 once in a while. And by the way, "impact" is NOT a verb. Think about it.

From today's New York Times: "With a brain already full of well-connected pathways, adult learners should “jiggle their synapses a bit” by confronting thoughts that are contrary to their own..." So scramble a few cognitive eggs once in a while to keep your brain building new pathways and making new connections. Here's an idea to get you started, from Cornell University Professor Emeritus Thomas Gold, who for 20 years directed the Cornell Center for Radiophysics and Space Research. Dr. Gold proposes the striking and controversial theory that "a full functioning ecosystem feeding on hydrocarbons, exists deep within the earth, and that a primordial source of hydrocarbons lies even deeper." In other words, oil and natural gas are not decomposed, prehistoric plants but the natural result of ongoing biological activity deep in the earth's crust. (Thanks to http://coyoteprime-runningcauseicantfly.blogspot.com/ for the heads-up.) What if...he's right? S...

With prophets of decline on both the left and the right, sometimes it's nice to see the "on the other hand..." argument.