posted by admin at 10:18 pm
Our colleague, Dolly Bellhouse, just had a column published in the For Your Advantage e-newsletter. The newsletter’s publisher, Jerry Pogue, introduced her column by saying “Ms. Bellhouse shares that when an organization is in a crisis mode, remarkable things can be accomplished if everyone pulls together. However, when an organization operates all the time in a crisis mode, the performance gap can widen, and as it widens, managerial anxiety again spikes. A continuous “tough get going” mantra will fuel the performance gap cycle. Management teams need to learn how to break their performance gap cycle with not only new thinking, but new actions and experiences.
Read her column at http://www.foryouradvantage.com and if you read this after October 3, 2011, you can find her article at the same link in the archives, look for the Volume 10, Issue 18 – September 19, 2011 issue.
posted by admin at 7:34 am
Lately, I’ve begun to point out to leadership groups face an important and persistent problem that requires their attention.
The easiest way to say this is planning/initiatives will always outpace the ability of an organization to change.
Here’s a graphical representation of what I mean.
On the one hand, this graph represents a predicament: the gap between expectations and execution causes increased demands on monitoring and “educating” or forcing “buy in.” These become activities that occupy much of leaders’ time. On the other hand, this predicament causes a sense of hopelessness or cynicism on the part of workers. I consistently hear healthcare professionals bemoan the fact that they feel “scattered,” that they feel like they have “a million initiatives.”
I contend that leaders must match their initiatives to the pace of change. Not because it’s morally right, but because leaders have no other option if they wish to succeed.
posted by admin at 4:38 pm
Today, a public call with HHS Secretary Kathleen Sebelius and CMS Administrator, Dr. Donald Berwick, celebrated 4500+ organizations pledging support for the Partnership for Patients. Over 2000 of the participants are hospitals.
Joe McCannon, Senior Advisor to the Administrator, offered a number of characteristics of healthcare organizations leading the way in making patient care safer, more reliable and less costly. I have paraphrased Mr. McCannon’s observations made as he and the Partnership for Patients team have traveled across the country. These leading organizations:
• set aims & goals for patient safety improvements and state them publicly – what, how much & by when
• put patients and families on the Board and committees
• count the number of tests they run every day because they are as interested in learning every day as they are in results
• devolve ownership of improvement to the frontline
• continually recognize success – incremental and period-end results
• share stories & narratives of patient experiences & use language of creation – to create an ideal health system
• are rabid about finding new ideas – doing site visits, reviewing literature to help them break out of traditional patterns of thinking
• have the “patient & family” in the room, in the discussion – always
Learn more about the Partnership for Patients @ (more…)
posted by admin at 5:47 am
Kaiser’s news feed has an interesting article about so-called “Accountable Care Organizations,” (ACOs) which to date remain mysterious.
First, it needs to be said that NO ONE knows what ACOs are or will look like. There has been a pilot, which was quite successful. But CMS was set to clarify regs for ACOs and has missed the deadline. And there’s little indication when the guidelines will emerge.
Second, I’ve heard policy analysts report that the one most important thing for success in ACOs is “culture.” I really didn’t see that coming; yet it makes perfect sense.
Finally, ACOs–to date–are focused on docs and their behavior. The article I link to above argues that patients ought to be included in ACOs. Healthy behaviors can, the authors rightly mention, be part of the ACO calculation.
Nevertheless, I’m not sure how CMS can share gains in this way. It’s an interesting idea. And, in my view, shows promise.
posted by admin at 6:07 am
The Dartmouth Atlas issued a report on end-of-life care in some cancer patients.
The long and short of the paper is–from my limited perspective–that hospice is underutilized. My experience is that among clinicians, there are common misconceptions about what hospice organizations do. (Most people think hospice cuts off other treatment programs and/or as merely palliative care–pain management &c.) Even granting these misunderstandings, hospice care is still not being provided as often as it could (should) be. As the Atlas points out, many patients are dying in hospitals, rather than more nurturing environments.
Much of what hospice organizations do is alleviate caregiver overburden, help family/loved ones to prepare for and deal with the consequences of someone’s passing–everything from support groups to helping people get paperwork in order.
My experience is that hospice organizations are doing some of the most effective and important work in healthcare. Oh, and hospice care is often more cost-effective than other benefits to patients with terminal diagnoses.
posted by admin at 5:44 am
This article from Politico.com mentions the high cost of the 5% sickest patients. They are, in fact, the most costly patients to care for.
But I have a question about regression to the mean (and perhaps exiting the system–aka, death). Isn’t it the case that the sickest 5% of patients are likely not to be the 5% sickest patients next year, simply because of regression to the mean?
posted by admin at 6:32 pm
Ezra Klein of the Washington Post cites a study from Canada that concludes:
Health care services use by itself had little explanatory effect on the income-mortality association (4.3 percent) and no explanatory effect on the education-mortality association.
Put another way, health care may not contribute that much to good health. Of course, it may be different in the US. But I suspect there is something to this.
posted by admin at 9:40 am
Last week when John Kenagy and I were having lunch he emphasized that his recent book–that, by the way was named the Book of the Year by the American College of Healthcare Executives (ACHE)–focuses on the role of senior leadership in transforming healthcare.
John continues to speak to groups of Execs and has been working with some systems to prepare them to begin their Adaptive Design transformation.
It’s worth reading.
posted by admin at 7:12 am
In his very interesting article Doctor Davis Liu–I think, unwittingly–provides a clue to the well known and firmly established problems with health care IT (HIT).
Dr. Liu suggests that the problem with HIT is that the technology is insufficiently mature. And I think he has mis-framed the problem.
Evidence from many industries shows that it’s the business models and operational modes of organizations that must adapt to existing technologies. That is, rather than trying to get a new technology to become good enough for the needs we currently have, we should figure out how to use the strengths of new technologies to find markets that are underserved (or that don’t even exist).
For example, every consumer electronics company licensed the transistor in the late 50s and early 60s. They worked hard at getting the transistor to power big, furniture-like TV sets and table-top radios. They were framing the transistor as a technological problem.
In the meantime, true innovators framed the transistor as an entry into new or underserved markets that exploited the unique characteristics of the transistor.
The first application of the transistor was in germanium hearing aids. While existing consumer electronics firms couldn’t figure out how to make the transistor good enough for existing applications, other products like pocket transistor radios and portable television sets were tremendously successful.
My prediction is that soon, relatively inexpesive things like tablets will serve to connect clinicians to a world of great innovations. In fact, recently my doc looked up my risk for heart disease on his iPhone by Googling a risk-factor calculator. If that isn’t a case of framing our HIT problems as a matter of discovering new or underserved markets nothing is.
posted by admin at 1:27 pm
I was at a conference a couple of weeks ago and heard an attorney who specializes in policy speak about Accountable Care Organizations.
Interestingly, besides saying that we know very little about what ACOs will look like, he continually made the point that the organizations that took place in the pilot felt that a culture of adaptation and openness were the most important success factors.
Culture–to me, anyway–often sounds a bit squishy as a term. But clearly, health care organizations must become adept at adaptation and improvement if they want to meet the challenges to come.
