The Healthcare Experience

Daily perspectives of a healthcare executive in pursuit of patient safety, the premier healthcare experience, an engaged & healthy workforce and life balance.

Got Value?

Do you know the cost of delivering the key value in your organization:

- Customer or patient experience

- A safe environment

- A high quality outcome

In healthcare, we know we are getting paid more each day on value and quality. That should not be a shock to anyone.  The challenge we face is really understanding what we are paying for and the value we get from this towards our organization's goals. 

What if I told you to invest $200k so you could save only $50k, would you do it? What if someone said he/she could improve the customer experience in your organization, would you let them have a blank check to provide this?  What's that worth to your organization?

What if I told you, I could could help reduce the incidence of diabetes and obesity in your community...would you pay for that? What if it meant each member in your community had a Nutritionalist assigned to them during every waking hour so they could guide and watch over them.  Would that cost (and intrusiveness) be worth it?

The answer is probably no in every example.  As we move into the back half of 2012, it is time to really dig into the value we get and challenge everything we are doing in our organization.

Some examples include:

Length of stay: We do need an appropriate length of stay (LOS) for patients. They do not necessarily want to stay any longer than they need to nor do they want to leave early only to get re-admitted later on that week.  When organizations claim to save millions by reducing LOS, I would challenge them to look at the real costs of a half day - typically meals and meds. Certainly there is the opportunity cost to bring in an additional patient (assuming you would not have received this patient any other way than by gettning this bed) and staffing to the new LOS. 

Staffing to the expected patient experience (satisfaction): Have you taken the time to look at how you need to staff up to improve this experience and what the true impact would be if you decreased staff.  Many organizations have the conversation more is better.  Are your organizations showing the plan regarding what results would look like based on different staff plans and better yet, improved processes.

My challenge to you:

What value will you make better in your organization and what is the expected and measurable quality, safety, satisfaction and financial impact for your organization?

I look forward to hearing from you.

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Be and Lead The Change - Guest Blogger: Dr. Scott Nygaard

 

As I have journeyed through health care over the years, so often I hear why we can’t do something, why it will fail and why it is a bad idea, etc. and then I listen carefully for the "obvious" solution that everyone has missed. It is not common to have clear solution but rather a clear complaint. I think this has dampened the enthusiasm and confidence in our profession that we actually can provide the required leadership and be a part of the solution. Honestly, I believe that it is time for us to rise up and provide the required leadership and to manage the necessary change to improve the outputs of our health care system to create value for the communities, businesses and employees and patients we serve. To that end there have been many trying to lead the charge, but the ability to change a nation’s, state, county, city’s health care system has moved forward at a very slow pace despite mounting evidence that we have no way to sustain the current system, evidence that it is not providing the highest quality, greatest experience or best outputs across all venues of delivery. Think of the gamble you would take getting on an airplane, driving a car with the amount of variation in performance we have tolerated in health care for years. I have been reminded many times through the comments of a real visionary and leader, Peter Drucker about the importance of being a change leader. I share the following excerpt from Management Challenges for the 21st Century, Managing in the Next Society.

 

"One cannot manage change. One can only be ahead of it. In a period of upheavals, such as the one we are living in, change is the norm. To be sure, it is painful and risky, and above all requires a great deal of very

 

hard work. But unless it is seen as the task of the organization to lead change, it will not survive. In a period of rapid structural change, the only ones who survive are the change leaders. A change leader sees change as an opportunity. A change leader looks for change, know how to find the right change, and know how to make them effective both outside the organization and inside it. To make the future is highly risky. It is less risky, however, than not to try to make it. A goodly proportion of those attempting to will surely not succeed. But predictably, no one else will."

 

So I urge you as leaders, nurses, physicians, clinicians, care givers to "be and lead the change".

 

The most effective way to manage change successfully is to CREATE IT!

 

 

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Logo Reflects Balance & Pursuit of Full Potential

I've recently updated the site logo to more accurately reflect the balance of daily life, work, health and wellness. It also reflects the ongoing pursuit of our full potential. I'm always interested in hearing about people's interests and passions.  So many times, we forget this, even in our own careers.  The desire to be excellent...the desire not to just be mediocre.  To me, it does not matter if people are not "the best" at something.  I'm more interested in the pusuit of their full potential.  This could mean the experience they create if someone visits their home or their workplace.  It could mean their efforts as a parent, friend, partner or spouse.  This pursuit has it's ups and downs, of course.  However, if this pursuit is consistent, it will include recovery breaks.  It will also show an upward trend in performance as opposed to a hotizontal wave similar to a radio frequency!

The colors are intentional as well:

 - GREEN supports balance, harmony, love, communication, social, nature and acceptance.

 - BLUE-INDIGO increases calmness, peace, love, honesty, kindness, truth, innner peace, emotional depth and devotion,

 - YELLOW increases fun, humor, lightness, persistent power, intellect, logic and creativity,

 - ORANGE stimulates creativity, productivity, pleasure, optimism, enthusiasm and emotional expression.

 - RED increases physicial energy, vitality, stamina, grounding, spontaneity, stability and passion.

 - VIOLET stimulates intuition, imagination, universal flow, meditation and artistic qualities.

I used to think all this talk was just "pie in the sky" thinking - just way out there.  The reality is we are all striving to hit certain outcomes in our personal and worklives.  Most surround quality, safety, satisfaction and fianncial stability.  Our actions show the intentinal nature or our choice to achieve these outcomes. It's easy to point the finger towards others however we all know we need others.  Our attitute and actions start with looking ourselves in the mirror.  This is nothing new.  What seems to be new or newer are the increasing pressures we all experience. If we can't handle or don't know how to handle these pressures, it leads to stress.  This can lead to poor quality, safety, satisfaction and fianncial stability.

So, it seems, it is time to be more intentional on pursuing our full potential and understanding the balance we all need to achieve this.

 

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Tapping into Passions

It seems no matter what industry you hear about, people are stressed. It's most likely caused by more than just work. Certainly influences out of work contribute as well. In my workplace, we are trying to make a more intentional effort to find those "healing" spaces to just catch our breath and decompress, even if just for 5-10 minutes.  I'm excited to start exploring additional spaces or activities we can share with our physicians, volunteer, employees and community members. The majority of our ideas are coming from these same groups who are showing a passion for certain activities.

I remember finding out how we could utilize the unique passions and interest of our team and incorporate it into our workplace. It was almost 15 years ago when Staara (yes, her legal name as she shared with me regularly - isn't that right, Staara?), one of our Managers shared her passion for creating art.  We were in luck...he had multiple outpatient campuses and limited funding (sound familar!) for additional artwork, additional equipment, etc.  In the end, Staara utilized our outpatient centers as a "canvas" for her works of art.  Her art not only created a more healing environment for our patients and staff....it led to some of her future exhibits.  I must say, I'm excited to say I knew her when!  Now, we are pursuing our full potential by more intentionally tapping into the passions of our employees, volunteers, physicians and community members to create an ongoing Optimal Healing Environment (based on Samueli Institute framework).

What are you you doing in pursuit of your full potential?

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Guest Blogger - Gen Y

Thanks to Jessica Lindsey...

You know what they say, "if you like "X" ....Y's are like X on steroids, you're going to love them!!!"


It is so important to delve into this "new norm."


You might think, "well generations as a topic has always been sort of fun and timely," but never has it been more important to understand than now!


This is because for the first time ever there are four generations in the workplace, previously there had only ever been three (with volunteers in house we increase the edges of both sides making five generations in our organization).


With each added generation there is great potential for life experiences to draw us further apart leading to strained communication, think of the oldest and the youngest of us in a room.

However if we understand and embrace each generation and that which makes us different then by the same measure we can bring individuals closer together.

Largely the goal for the X's and Y's... the interpreters who bring everyone to the goal.

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Newest Folkswagon Driver

It's official...I'm the newest CCH trained Folkswagon Driver. A few weeks ago, I asked members of our leadership team to share their favorite role (next in line to their current position). Mine was to be a Folkswagaon Driver.  Under the trained eye pf veteran Volunteer, Bill Polk, I passed thje training. These drivers are the first and last people to intereat with our patients, families, staff, employees and other volunteers. They can make the first impression, set the lasting impression and serve as a liaison to help us improve our healthcare experience.

It was very enjoyable. I learned our ususal driving routes and also how to charge the golf carts at the end of the shift.

I  found out the right dress code which is not a tie, long sleeve shirt and suit pants!  Although, I was "dressed to impress" short sleeves and collared golf shirt was the way to go.

Thanks Bill. 

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Reaching Potential-Do you know the feeling?

If you've met with me recently you've probably heard me ask the following: Describe a time or momentum in your life when you felt you reached your fullest potential. It doesn't mean you won't reach higher levels. It just gets you to think about that momentum or time, what it felt like and what led to this. It could be a great grade, getting that new account, meeting your first grandchild. When did you feel you reached your full potential? How did it feel? A few of you asked what music keeps things peaceful for me outside of work- Solitudes Celtic serenity and Yoga journal pure relaxation. Try it...you'll feel like you're at a spa all day long...without the spa cost! Posted from my iPhone using Joomla Admin Mobile!
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Creating a Well Balanced On-Line Community

So I'm thinking about starting an online community with a focus on reaching our true potential in health, wellness and healthcare. No doubt it could apply to every industry. However, I watch companies and people across our world discuss health, wellness and our respective healthcare delivery models. Our results in all three of these areas are no doubt a reflection of the design. If we were more intentional in reaching our fullest potential, what would we do differently to be healthier? Would we create new markets in our community? We had a local farmer open an organic store in our community. His food is fresh and prices very fair - he's getting our community's strong support. What intentional wellness initiatives would we build and support in our communities (eg., diabetes management, stress management, etc.)? What if you had to take 60 seconds every hour to just stop, close your eyes and take deep breaths? During a 10 hour shift, that would mean only 10 minutes. Could that help reduce our stress and overall risk factors? How would our healthcare system look? What services do we really value and who do we expect to pay for these services? If you went to a restaurant and 30% of people paid for the other 70%, how long should we expect the restaurant to last? So, when I explore the online community, it seems worth a fair shot at a more active and balanced discussion than just a blog, a tweet, a Facebook post. LinkedIn is providing some stronger dialogue. I'm interested in stronger feedback on intentionally reaching our fullest potential in health, wellness and healthcare delivery. What's your perspective on the value of an online community for health, wellness and healthcare delivery? I look forward to hearing from you via response to this post or direct email: This email address is being protected from spambots. You need JavaScript enabled to view it..

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Practice and Preparation

So the other day I found my world completely upside down and did not see it coming.  I should have...there were videos showing what would happen, people all around me discussing it and I was just oblivious to the future just 3 minutes ahead of me.  Can you figure out where I was that crazy day when my world was turned upside down and I saw my legs pulled towards the sky? You guessed it, I was chaperone for my son's school trip at Busch gardens and we were on the "Cheetah Hunt" ride where a big drop leads to a corkscrew which spins you upside down.  Perhaps I should have paid better attention! Where am I going with this you ask: Practice and Preparation

For the past few months, I've been running with my daughter on Saturdays.  It gives me a chance to talk about life lessons...ok, now I sound like an old man! Anyway, one of the lessons was on practice and preparation. The more you practice, the more you will be prepared for most situations that arise.  When running, it could mean, preparting for the "what if" situations:

 - What if I get injured?

 - What if my heart is racing too fast...or too slow?

 - What if I come across a hill (well, not in SW Flroida), rain, ice (well not in Florida). humidity, etc.?

Are you practicing and preparing for potential situations and how will you react to them when the situations of the future arise? Will you panic, take your time and think through the situation, rush into the situation?

Not necessarily a right or wrong answer but one that shows how you handle the unknowns in the future.  So what are the true unknowns of the future? What are we really concerned about? Really what is it? Is it our patients, our community, our family, our health, our money, our job security? If we really discussed our true concerns and the "what if" situations, we would find most of them to be manageable and most may only have shorter term struggles if you prepare.

If you know a major hill or obstacle is coming your way in 10 minutes, what would you do? Get in your car and drive over it? Put on your running/walking shoes/rollerblades and go at it on feet? Would you take to your bike? Would you just stop?

In souhwest Florida, we get trained every year (this will be my second summer) that hurricanes may be coming and we have a few days to practice and prepare for it.

Our future will be bright if we practice and prepare for it.  So, I ask you...what are the "what if" situations, worst case scenarios and best case scenarios?  How will you Be The Change?

I look forward to hearing from you. 

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Have You Seen Yourself in the Mirror?

This morning I met with a few of our management team members.  We have a Monday stand-up meeting (yes, we do stand-up as it keeps the meeting focused and short)!  One of our Directors spoke to the challenge of balancing quality, service and financial performance.  No doubt, this weighs on many of our minds on a regular basis.  We have to work well together to achieve these shared goals.  It certainly is not easy and it starts with us.  

Last week, I spoke about the need to reflect and look ourselves in the mirror and I appreciated one of the responses.  Especially the need to "hold up the mirror" for others (of course you have to allow colleagues to hold up the mirror to you...without getting defensive)!

Our Crirical Care Educator, Jennifer Ochs, RN,provided the following feedback:

I found your message last week very thought provoking.  It has taken me a few days to decide how I wanted to convey my thoughts to you. In my years in healthcare, I have found that having introspective thoughts and questioning how I am doing as a staff member and as a leader has been very helpful to my personal and professional growth. I have read books and attended conferences and lit the flame of others to burn with passion.  The one thing that I have found to be most beneficial to me personally and professionally though is having someone else hold up the mirror. It is hard to see ourselves as others see us. When another colleague or a leader holds up a miirror and says, "Take a good look, this is what I see and this is what I want you to work on.' is very powerful because it can be fifficult to swallow at first, but then you realize that this person cares enough to make you a better co-worker and person. I think the greatest part of Cape Coral Hospital is the people. We need to care for the people working here so they can care for the people that come here. If we can give them ways to grow and develop and care enough to have those difficult conversations to make them better, then we will certainly be on the road to excellence. I hope you have a great weekend.

Thank you Jennifer. Let's thank those who have cared enough to raise that mirror to our face!

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How Does this Reform Differ from All Other Healthcare Reforms?

After attending the ACHE conference, I thought a little more about the impact of healthcare reform. I met up with Fred Brown, the former and first President and CEO of BJC Health System in St. Louis. BJC came together through the merger of several large hospitals under his leadership. Certainly no easy task however talks of healthcare reform continued to brew in 1993, when I first met Fred (actually Mr. Brown to me). Mr. Brown and his organization did not wait to see what would be done to their organization. They took a proactive stance, reforming the delivery of healthcare with quality, satisfaction and cost a central focus. Sound familiar-why wait? How are you reforming your delivery system? Is it daily, yearly or are you waiting to see what happens. Care can be delivered the same as it is today...we will just be paid much less! Will this message really change? Seems similar to 1993 - just larger financial impacts and a more pressing sense of urgency. Does this describe healthcare reform as we know it today?: Health care reform could dramatically alter the health care landscape. While there is substantial disagreement over the changes that should be implemented, there appears to be a consensus within the Federal Government that insurance markets need reform. To forecast the likely effects of reform, it is necessary to construct models of consumer behavior. This was taken from an excerpt of "A Case Study of the Health Security Act of 1993" by Dana Goldman, Paul Gertler and James Smith. How do you think this round of reform will differ from 1993? Keep reforming your healthcare system on a daily basis. It will prepare you for the financial reform we are really discussing.
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Show You Care

The first couple of days this week, I'm attending the annual congress with the American College of Healthcare Executives. It's certainly good to see former colleagues and make new connections as we all explore ways to improve our organization's performance. Many of the courses seem like refreshers however I always pick up something that helps. This morning I attended the session, The Patient Comes Second: Focusing on Employees. After all, our employees, volunteers and physicians are providing the support and direct care to our patients. Therefore, in management, the focus really needs to be on our employees, volunteers ad physicians. Too many times, I think we (in management) are not open with our shared vision-what are the key things we need to accomplish in our organization. When we share that, it is much easier to focus on our employees and helping support them so they can help the organization realize our goals. Once I had a manager who said to me, "I know what you are going to tell me Scott...I'm too abrasive and need to change my style-I won't mention your name but will owe you unch with a simple note...you know who you are :) What I shared was to look at his/her approach and reflect if he/she was influential in his/her role. Did employees, volunteers and physicians rally around his departmental vision? How did he show his team they were appreciated and supported in helping the organization? How do you show employees, volunteers and physicians come first in your healthcare organization? Do they know the vision? Let them share how they can help and what support they need. It's much easier to perform better with several thousand people helping. Don't forget...first focus on your employees, volunteers and physicians. Show you care.
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Edison Bridge

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Silence Signals Disagreement

How often do you attend meetings where people talk too much? And yes, sometimes I'm one of those people. As our environments become more complex, we need do hear different perspectives. I do appreciate attending meetings where the rule is, "silence signals support." However, sometimes it really does not and the conversation stopped based on the loudest voice in the room taking over...then the rest of the opinions are shared after the meeting. Have you tried stating, "silence signals disagreement," encouraging the balanced views? How does that change the conversation or possibly even the direction of a critical decision for an organization? I look forward to hearing from you. Enjoy your day.
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Taking Time to Relax

What do you do to relax, decompress and just catch your breath? We probably don't do this nearly as much as we should. Even if for 5 minutes some days! Do you have that time or space to do it? Over the coming months, I'll be working with Joany Odorizzi, Kent Ley and Sandra Raak on finding that space in and outside the hospital campus. With all the daily pressures of life, this "healing" space is for our team and community members. It will allow everyone to take a few moments and get re-energized so we can better serve others. After all, we need to take care of ourselves to do the same, long term, for others. Once we have a rendering, we will share with employees, physicians, volunteers, auxilians and community members. We will have an opportunity for everyone to contribute and build onto our "Center for Community Health (CCH)" as Joany calls it. And yes, today, I found that time to relax and spend my anniversary with Jenny...it helped having our in laws in town to watch our kids! How would you describe the perfect healing space to "catch your breath" each day?
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Post Interview First Impression

The other day, I noticed some new employees coming out of orientation. Most dressed professionally. One stood out, wearing a sloppy shirt and baseball cap turned backwards. Orientation time is really your first "post interview" impression. Personally, I think it sets the wrong tone. Question for you...would this bother you as a co-worker, patient or family member?
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Protecting Your Brand

Recently, I've given a lot of thought about my organization's "brand". What do we stand for and certainly what are non-negotiable actions or behaviors. One of my colleagues, Dr. Scott Nygaard, often speaks to "protecting our brand". Protecting and promoting our brand becomes part of every interaction. We show what we represent...in healthcare this should mean safety, caring, healing, friendly people, clean environment, compassion, respect and value for your time, care coordination, etc. Do we say hello, heal, share time expectations, coordinate your care, role model expected behaviors and healthy living? These are ways to protect and promote our brand. Then, of course, there are those who destruct and destroy brands. I walked into a store the other day trying to get around a person smoking at the front door...with his work shirt on...he was on a break smoking at his company's front door...it was a health food store! Protecting and promoting vs. destructing and destroying our organization's "brand" takes place in every interaction and ultimately pays a toll on each of us if our businesses fails to stay afloat. So, the next time you say hello...or don't, keep in mind the destiny you expect for your organization. Share your stories. Posted from my iPhone using Joomla Admin Mobile!
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Living on Little...And Making it Work Well

My healthcare organization has a major challenge ahead with a potential $43M reimbursement cut next year on a $29M margin or 2.6% (if you do the math, $29M minus $43M is, um, not good!). It's similar to putting $260 in your savings account for every $10,000 you bring home.  So, if you made $30,000, you'd save $780 every year...spread that over 45 years of work and you will save up $35,100 - excluding interest).  If the average person did this, how much would you need for retirement, additional allowance for kids, capital improvements (e.g, new refrigerator) or just "in case" the rainy day comes? Would this savings be adequate? Obviously not.

That challenge is upon all of us. Instead of just asking what process needs to change or how can you staff or resource with less, I've put out a challnge to several departments today:

How would you operate with just 5% less in your expense budget next year and still improve engagement of our staff, volunteers, physicians and patients?   You can staff with the ratios you recommend, celebrate with your team, change the processes you want.  Essentially, create the department you want in alignment with the organization's vision and strategic plan.  The challenge before our leaders and staff will be engaging as a team in this review.  If we all remember what inspired us to get into this field, I know we will have great success reinspiring and engaging each other through these challenges and changes. 

Let me know some of the ways you've engaged (or re-engaged) your team in advancing the goals of your organization. 

 

 

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Lesson on Humility

Humbled...there is truly something rewarding when you are "humbled" to keep you humble. Let me clarify - last week, I was in the Naples 1/2 marathon running well (for me). I was off to finish with a PR when the negotiations began (in my head). "If I just passed these next few people, I'll take it easy and finish well." What happened after passing them...2 people passed me. Clearly they were in negotiations as well! I tried my best to chase them down but they only picked up speed. I thanked them after the race. Although "humbled" they made me a stronger runner that day. Well, wouldn't you know, it happened again this evening. I had a wonderful time meeting people before my presentation at the Pine Island Annual Chamber event. Right before the presentation, I was told "you weren't our first choice...but we are glad you could be here." It made me smile and once again, another great lesson on humility. And the food and views (a dolphin was swimming nearby) at Sandy Hook restaurant was really outstanding. Stay humble or be humbled.
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Clean Handhelds Save Lives

The Centers for Disease Control set guidelines for Handwashing: clean hands save lives. Well, the other day, I'm attending an event and I see a well dressed person (e.g., sportcoat/pants) enter into the bathroom on the phone.  Ok, I know this is getting to be more information than you want.  So, I notice that he does not stop texting the entire time.  How, you ask...the phone was almost dropped onto my shoulder! 

Isn't there a commercial where a guy is doing this and the person next to him says..."Really? Really?"

So, perhaps our next campaign needs to be: Handheld devises...clean handelds...keep hands clean...clean hands save lives.

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