Your Clinical Staff’s Attitude May Be Poisoning Your Facility’s Reputation

I won’t lie to you. Training cannot solve all your problems.

But the right training, in the right amount, at the right time, targeted to the right people, can make a huge difference in your organization’s performance.

Case in point: clinical staff training to improve attitudes. If you think you can’t train attitudes, think again. Trainers are taught to teach three things: knowledge, skills and attitudes or K-S-A’s. If you’re worried about patient experience, this is a great place to start.

Are You “Much” or “Not-So-Much”?

Some healthcare facilities exhibit exemplary performance and attitudes from the person who changes the sheets to the head of surgery. Great leadership figures into such places, as does a solid history of doing well for patients and colleagues over a long time.

Some facilities, well, not so much. As a trainer, I get to see more of the facilities that are in the “not so much” category.

You might think your staffing problems are intractable. How can training possibly help a bunch of bad attitudes – staff-to-staff, management-to-staff, staff-to-management and – horrors! – staff-to-patient. Guess what? Just like teaching someone how to start a pic line, your really can teach behaviors. And it doesn’t have to be as hard as it sounds.

Have I seen it all? Nope. Have I seen enough? You betcha.

Let me tell you about my favorite client, and why  they are my favorite client.

When one nursing home chain finds some facilities performing below industry standards, it sends in the trainers. I’ve been to long-term-care homes that saw a spike in patient-on-caregiver abuse. We found talking to each other on shift handoffs, and a few other communication adjustments, made a huge difference in bringing those numbers to zero.

Another LTC facility was told it was “the worst home in the chain.” Gee, something to live down to, huh? No more. When you change the vision of what you are best at, and what’s at stake for you, your coworkers and your patients, you can motivate people to find another way to be the best at something.

This healthcare facility faces its demons head on, stares them down, and sends them packing. And it is the great and caring people from top to bottom that are behind it all. With a little help from training.

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Healthcare Spending and a Negative GDP: Engine of the Economy?

For the past nearly 20 years, I’ve been working in some way in health policy or managed care….writing training, papers, articles. That means for nearly two decades, I’ve been tracking the cost of healthcare and its effect on utilization. After all, if economics is interesting, where else does it play out in a more important or personal way than in the way it affects our individual wellbeing?

Over that same time, payers have continued to complain about the cost of care. Healthcare isn’t cheap.

Here’s what the complaining sounds like: When I started working in this field, payers were upset that healthcare was consuming 12.9 percent of GDP. Think about all the other ways we could be spending that money, complainers said. Meanwhile, I was sitting there thinking, Wow, healthcare is a huge engine of this economy!

After all, what better way to spend our national treasure than in taking care of our people? The problem is making sure we are truly spending it in ways that are most effective, reach the most people, and do it for the least possible cost per person so the goodies get spread around. In a nutshell, that is the cost, quality, access conundrum.

Who are the Payers?

Today, healthcare makes up more than 17% of GDP and projections have it headed toward 20% – a full one-fifth of the national economy – by 2020. The complaining, once mostly confined to academics and healthcare professionals, has become a national obsession. That’s because the pressure on payers has morphed into a problem of patient access.

We’re all payers, and we’re all patients. But the tide is turning regarding who pays what and who controls access.

Payers fall in several buckets: the government, private employers, patients and, by extension, the health plans paid to insure the cost of care against catastrophic loss for those same groups. Each payer has their own unique complaints about cost and, in all cases, the one outstanding common compliant is that the cost of care is a drag on their bottom line.

Bear with me while I explain what that looks like. I’m going somewhere with this:

Government: The feds pay the lion’s share of Medicare, VA, DOD, and Medicaid, not to mention federal, state and local employees, prisons and public clinics, etc. Medicaid is its own peculiar animal which shares costs with individual states that run their own programs, and the important fact here is that the cost of the Medicaid program is usually the highest or second highest state budget item vying with education. Unlike the feds, the states must balance their budgets. You can hear the screaming from state capitols every year.

Private Employers: Back when the economy was booming years ago in the Clinton era, most Americans got their healthcare paid by private  employers. Many still do, but it is shifting more toward the government. The cost of healthcare for workers and their families, and retirees, costs a bundle and contributes to the overall cost of goods and services of American-made products. One medical director from a Big Three automaker (remember those?) was known for his histrionics at meetings where he was once seen pulling his empty pockets from his trousers and yelling at his pharmaceutical company hosts who were introducing a new product to him, “See this? Lint. I got nothin’ left but lint!”

Patients: Healthcare is a necessary expense. If you break your arm, you probably aren’t going to set it yourself. Medical products and services go in the family budget,  and it’s a priority. It is up there with mortgage, food and car expenses, in that it is not optional. In most cases, private patients can expect to pay about 25% of the total cost of care.

Health Plans: Health plans are identified as the payer because the government, private employers and patients most times offload their responsibility for the total cost of care to an insurer and pay them to take on the risk that something catastrophic could happen that would break the bank. Over time, health plans have taken on the job of paying for simple, everyday things like a checkup with the pediatrician, so in turn, they are now in the position of managing all care – since they are paying for everything, not just the big items. Hence, managed care.

Engine of the Economy Breaking Down?

Which leads us to the fact that the White House Council on Economic Advisors this week partially attributed a 2.9% drop in GDP during the first quarter of this year to a decline in healthcare spending. But wait! I thought all these payers, all these years, have been screaming that healthcare costs are killing them and were trying to reduce spending.

Today, in 2014, people are struggling. They are buying fewer cheeseburgers and Chevys, and it appears they are also going to the doctor less frequently. After all, more disposable income is going to gas up the Chevy and pay for the beef.

So, were healthcare costs killing us or were rising medical costs indicative of a thriving economy where people could afford to go to the doctor and pay for medicine, physical therapy and dialysis?

Healthcare might be a drag on the bottom line, or, might we postulate, the sector may be providing jobs and encouraging spending on necessary (broken arms) and optional (checkups, flu shots, Botox injections) medical care that puts money into the economy.

Perhaps it wasn’t the cost of care that helped drive the economy into the ground, but the lack of good-paying jobs in other sectors that means patients, employers and the government can no longer afford to buy healthcare – or cheeseburgers or Chevys. Which might explain those recent hospital closures, layoffs and hiring freezes…

This might be a case of If it ain’t broke, wait around. We can break it.

Note to readers: I recognize this is a very complicated issue, and I am not a health economist. This diatribe does not begin to address a single-payer system, mandates, tax incentives or any other confounding issue. It is not intended to simplify this issue or to make light of very serious problems of cost and access, but rather to get a discussion going about the value of healthcare as a contributing sector of a vibrant economy. I welcome input. Thank you for reading.

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If You Buy a Donut, You May Hear From Your Doctor

Cross-posted on LinkedIn

The Health Information Portability and Accountability Act (HIPAA) has fascinated me since it was first passed in 1996. You know HIPAA. It’s the reason you sign a lot of papers when you go to the doctor that allows them to share your private health information with other providers.

To give you a little background, I was fortunate enough to be involved in some early HIPAA analysis for the pharmaceutical industry and, as a result, the whole issue of privacy of patient records has remained on my radar screen. As HIPAA was hammered out, one of the major concerns of our client was that pharmaceutical companies would not have access to individual patient records so they could use it for drug marketing efforts.

So today, when the news hit (see http://mobile.bloomberg.com/news/2014-06-26/hosptials-soon-see-donuts -to-cigarette-charges-for-health.html) that hospitals, doctors and insurance companies may track your private purchases at, say, Dunkin Donuts and pass that information on to your healthcare providers sort of made me wince. No, actually, I think I wanted to scream, “Are you kidding?”

It is nearly impossible to describe the kind of thought and the hours of debate that went into the nitty gritty details of HIPAA to come up with a workable law that protected patient privacy. I wrote a response to the federal regulations for a major pharmaceutical company so I read that law, line-by-line. Don’t ask me now about the details, but in an overarching way I remember that the point was to protect the privacy of individual data in the interest of having access to aggregated, de-identified data to study populations.

For the purposes of research and to derive clinical protocols, this makes a whole bunch of sense. We don’t need to know who you are, individually, but it makes sense for healthcare researchers to have access to everyone’s healthcare data so we know what costs money and what works. Under this scheme, your individual right to consume Boston crème donuts is protected…theoretically. Your private healthcare information collected at the point of care is used to care for you, period.

Now, one of the reasons I reacted strongly to this story today is that – just yesterday – I was exposed to an unintended consequence of HIPAA that has negatively impacted healthcare workers. I spent the day training healthcare providers in a long-term-care facility about how to respond to patient aggression. In the nursing home population of mostly infirm elderly often with dementia, aggression is a fairly common and serious problem. At least 8 workers in this particular facility had incurred injuries this year from bites, scratches, kicks, and so on from agitated patients.

One of the issues is that, due to HIPAA regulations which require the privacy of patient information, patients who are prone to aggression can no longer be identified publicly. That means that the staff can no longer place a little symbol on their door (even something as innocuous as the picture of a small, furry animal or some other clue) to identify that the patient inside may be prone to violence. So, caregivers who are new or occasional cannot immediately identify which patients require special handling or backup.

Which leads me back to the Boston crème  donuts.

HIPAA laws were intended to protect the privacy of patient data especially as electronic patient records were anticipated. It was believed, in the late ’90s, that one of the biggest hurdles to the uptake and full use of electronic patient data was concern for the privacy of patients’ medical information. Once a patient’s private health information was out there in the ether, might someone use it against them? Would it make is harder to get insured? Would their insurance rates rise? Could their health status be used to discriminate against them by their employer? What about a legal case, like a divorce?

It seems that the latest news that our personally identifiable private consumer purchases can be put in the hands of our healthcare providers violates the spirit, if not the letter, of the intent of the HIPAA privacy laws. Should private consumer purchases be subject to HIPAA if they occur outside the protected health records environment but are then entered into the health record? What if those same purchases are inferred – correctly or not – to impact our health? Hmmmm…

At the same time, as evidenced by the injured caregivers at the nursing home yesterday, important information that caregivers need at the point of care is being withheld due to patient privacy concerns.

I wonder if the law of unintended consequences has devolved to its illogical conclusion. What about patient safety? Caregiver safety? Having access to the information  that you need at the point of care?

With the caveat that I am not a lawyer and not current on the latest gyrations in the HIPAA law, I would invite comment from people who are closer to this issue to offer insight. Maybe I’m mixing apples and oranges, but it seems the core issue here (pun intended) is the privacy of our personal information, who legitimately needs access to it and under what circumstances.

Until then, my spidey sense tells me that some things aren’t working out quite the way the framers of the HIPAA law had intended.

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First Day of Summer Blog: Another Pleasant Valley Sunday in HealthcareLand

I love to write these blogs. I love to write and I love what I do.

“What is it that you do?” people ask. Um, well, I am interested in how healthcare gets paid. It has to do with an interest in economics, you know, the dismal science.

Oh, but never mind all that. Today is the first day of summer and it is gorgeous. Blue sky, wispy clouds, low humidity and warm temps. These are the kinds of days made for anything but work, and it is Saturday.  But I was out there mowing the lawn, putting up the umbrella on the sundeck and pouring a glass of iced tea when I realized I haven’t blogged in a few weeks. It’s time.

Since it is gorgeous, and the weekend, before we dig into the dismal science, please cut and paste this link into your browser. Let’s have a little fun even though Mike Nesmith looks like he’d rather be anywhere but here in this video:

http://www.bing.com/videos/search?q=pleasant+valley+sunday+monkees&FORM=VIRE2#view=detail&mid=C7180BF67E798BB63814C7180BF67E798BB63814

Well, now that we got that out of the way…

Figuring It All Out

I’ve been blogging on the healthcare system for five years; it is fun because I am opinionated. For this reason, the blogs tend to fall into four distinct categories:

1. Cheerleading – something is done well and it is worth promoting

2. Prescriptive – something seems wrong and there is room for ideas to make it better

3. Scorning – something is done poorly and it is worth pointing out

4. Analytical – something needs to be figured out

A lot of definitive work is being done by the government, in academia, in provider organizations, in think tanks and within supplier organizations to improve the healthcare system that we use. Up until recently, a lot of ideas were floated but the path was unclear. That is changing as people are starting to figure it all out.

The Affordable Care Act, no matter where you stand on it, has goosed along a lot of changes that have been in various stages of development for decades. In addition, bundled payments, population health, patient-centered medical homes, patient satisfaction, diagnostic technology and wearable technology, just to name a few, are redefining what we think of as the healthcare system.

So, while I could be cheerleading, I’m still not sure all of it is going to be worth promoting. I could be prescriptive, but I’m not so sure I have any ideas that aren’t already underway. I could take this opportunity to scorn the changes, but until we see how some of the changes are implemented, it isn’t clear that anything is really worthy of scorn.

Taking the Analytical Route

We are on the cusp of a new world in healthcare. Technological advances and new payment systems will drive the way the healthcare system of the future is put together, play roles in who it serves well,  and determine who may be left wanting.

A lot of people are working hard to move the system to a place where it serves as many patients as possible, as well as possible, for the least possible cost. That’s because this is a time of possibility.

And for the first day of summer, it is a good time to allow these things to just settle into our minds and practice a little watchful, hopeful waiting, which is sometimes the best course of action for a patient whose outcome is uncertain.

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Transformational Lean Leadership in Action

Oncology is a field that is changing at the speed of medical progress, which is stunning. Just a decade ago, a diagnosis of stage 4 melanoma skin cancer was a wake-up call to get your affairs in order. Today, it is a managed, chronic disease thanks to breakthroughs that are shifting treatment from an emphasis on chemotherapy to one of immunotherapy. The advances don’t just offer empty hope; patients are living years toward a cure.

Medical leaps such  as this occur because brilliant researchers are dedicated to solving the mysteries of the interplay of disease and health. One of those researchers who has dedicated his life and career to cancer research is Dr. Suresh Nair of Lehigh Valley Hospital in Allentown, PA.

You might think that the Lehigh Valley Health Network in Allentown is a backwater medical facility. You’d be wrong. LVHN is cutting edge in the way it thinks about healthcare. It has embraced a Lean philosophy that means it is focused on it value to patients. LVHN is recognized as a leader in Lean healthcare. Its leaders embrace Lean principles, which provide an environment in which Dr. Nair is able to be on the cutting edge of cancer research.

Walking the Talk

Last week, Lehigh Valley Health Network sponsored a Melanoma Celebration Day that featured – its patients. The Melanoma Celebration Day started as a modest idea to provide a place for melanoma patients to meet each other and grew into a full-fledged festivity as the staff saw the potential for honoring its patients in a meaningful way.

For the celebration, a conference room was packed with patients, their families, doctors, nurses, staff and executives. The event was conducted in a way that showed LVHN does, indeed, “get” Lean even though Lean never once was mentioned. Looking at LVHN through its culture, however, these few hours presented a microcosm of what LVHN does right.

1. Engage executive management.

Every successful Lean transformation must occur for the top down. A panel discussion included patients, Dr. Nair, surgical oncologist Dr. Rohit Sharma, and the hospital President and CEO, Dr. Ronald Swinfard. Dr. Swinfard clearly provided the top down leadership support required for Dr. Nair and his clinical trial team to do their jobs. Dr. Swinfard was effusive about the efforts of the clinical trial team. He wasn’t just present, he was engaged.

2. Emphasize patient engagement.

The event focused on the patients. Hospitals talk about patient engagement; LVHN showed how it’s done. A stage 4 melanoma patient who had been told elsewhere that he had little time was referred to LVHN to participate in a clinical trial. He said he was rushed into testing to make sure he was appropriate for a trial, then staff removed all barriers to treatment with urgent haste. He spoke from the dais:

“I was so scared. I didn’t want to leave my wife and grandkids. I knew what I was facing. How do you say thank you for somebody saving your life and giving you more time? I am so grateful. Thank you.”

3. Celebrate success.

The trial team presented Dr. Nair with an engraved award to recognize his efforts. The event was catered with a lovely breakfast. People cheered, clapped and cried, especially the trial team who has seen many successes – and some losses – along the way. The patients, past and present, were honored. The local media captured the event to publicize the success.

4. Practice humility.

In the spirit of Lean, the leaders are truly humble. President and CEO Dr. Swinfard used his time at the microphone to honor his colleagues, and Dr. Nair used his moment in the sun to deflect the light onto his patients, clinical trial team and the researchers who preceded him.

“These patients are taking the risk that helps all the other patients,” Dr. Nair said.

The event featured the accomplishments of all the team players. The nurse team that worked on a high-dose interferon study displayed a poster they presented at a meeting of oncology nurses in Anaheim, California the previous week.

Lean Healthcare’s Mission

Lean efforts in healthcare are just beginning to really take hold in the industry. Many hospitals are still struggling with the change that is required to transform a culture. And some places, like Lehigh Valley Health Network, are further along in the journey. The Melanoma Celebration Day certainly demonstrated LVHN’s commitment to its cultural transformation and its emphasis on patient experience which is, after all, all about life.

In the spirit of full disclosure, Lehigh Valley Health Network is my local hospital and I have some personal relationships with people on staff. However, I had learned of LVHN’s Lean leadership during my training work outside this community, so I can, with a clear conscience, say that LVHN is nationally recognized for its efforts in developing a Lean cultural transformation. LVHN has been named on of U.S. News and World Report’s Best Hospitals for 18 consecutive years.

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Is Resistance Futile in Health IT? KSAs in Health IT Education

KSAs? For my readers who are healthcare people, you may ask, “What are KSAs?”

For readers who are training people, you know that KSAs are Knowledge, Skills and Atttitude. You can teach KSAs.

Here are some examples of teaching KSAs in Health IT:

  • Knowledge training includes compliance training. Health IT learners need to know the laws that govern the use of electronic health information such as HIPAA regulations regarding the use of personal health information. Some trainers I’ve worked with call this “head knowledge”.
  • Skills training includes the actual, hands-on software training. Learners experience how to sign on to an application, which fields must be filled in, and how to access, save and send information. Providers learn how to use a laptop or tablet in patient interactions so the device does not interfere with the relationship.
  • Attitude training includes what are known as “soft skills” in the parlance of human resources. Soft skills include things like leadership, empathy, management of self/others/projects. In health IT, attitude training includes change management techniques such as finding champions of an IT implementation and sending them out on the floor to make sure people are on board with the implementation. Soft skills health IT training includes managing the people, timelines and workflow, making sure there is a smooth transition.

You can lead an HCP to health IT, but can you make them think? Think what? This is where attitude training enters:

  • Think about the value of gathering the correct patient information for high-quality care
  • Think about the overall efficiency of gathering information to be disseminated to other caregivers who might be outside your immediate care team – say the dentist and the ophthalmologist
  • Think about the value of patient data to researchers in the fields of cardiology, oncology and neurology (just as examples) based on the accurate information you have entered about the patient in front of you
  • Think about the correct clinical protocol returned to you when you enter patient information into the system

Question: Are you employees trained in essential soft skills related to health IT? Would it help?

The Borg in Start Trek said, “Resistance is futile.” In health IT, resistance is probably futile in the long run. But in the short and medium run, resistance has probably slowed progress.

I would appreciate your feedback on whether you are doing soft skills training for your health IT implementation.

Please leave a comment or email me at peggysalvatore@healthsystemed.com. I am very interested to hear your thoughts on this issue.

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What I Learned About Training from Etiquette Rule #7

I usually blog about healthcare and frequently its relationship to training and performance. Today, however, the subject is pure training. For healthcare afficianados, be assured it was inspired by a blog about table etiquette for doctors that was featured on Kevin MD, one of my favorite healthcare blog aggregators.

See www.kevinmd.com to sign up.

Table Etiquette Rule #7

Table etiquette rule #7 is “Put napkin on lap to unfold. When leaving the table temporarily, place the napkin on the chair. At the end of the meal, place napkin to the left of the plate.”

I know this. I had learned virtually every one of the 30 rules, and most of them ingrained to he point that if I violate one, my conscience nudges me. Well, that is until lately.

I have been placing my napkin on my chair when I temporarily leave the table almost all my life; it’s one of those instinctual things. Not everyone does it; many people who demonstrate good table manners put their napkin on the table when they excuse themselves momentarily. Over time, somewhere deep down inside, I started to wonder if I “remembered it wrong.” After all, maybe the rule had changed.

The table etiquette article affirmed my instincts and, since I tend to see things through the eyes of a trainer, reminded me about a few things regarding training as well.

1. Reinforcement. Even if we learn something well, we can get sloppy over time, cut corners, or begin to question ourselves when people around us don’t apply the learned behavior. Occasionally, we may need a refresher or a job aid placed at our work station to reinforce the learning.

2. Learn it well the first time, apply it often. The original learned behavior “stuck” because it was repeated many times with correction for failure. The ingrained behavior is automatic and deviation causes a little subconscious nudge.

3. Teach everyone the same rules and processes for consistency. We don’t like to be different than our peers. If someone does it differently, long enough, we may start to emulate them to fit in. Make sure all, or at least the majority, of your employees know the correct way to do something and it will spread to others who may not have learned it as well, or at all.

The Stickiness of Training

The Learning, Education and Training group on LinkedIn has a hot trending topic this week on “In 10 Words or Less…Why do you think learners forget what they’ve learned so quickly?” This topic has garnered over 1,000 comments, akin to going viral. Just about everyone agrees stickiness is all about having the learning be relevant to your job, using it soon and frequently.

We all know this. But after we write and implement training, how often do we go back to reinforce what we’ve delivered? Sure, maybe we don’t have the time or resources. Or the managers back on the job don’t know the new learned behavior or don’t reinforce it. Or something.

If we’re going to stop wasting training dollars, we need to put in the time and effort to follow-up to make sure what we’ve taught is reinforced in the workplace and relevant to the job at hand. Then our employees will always place their napkins on the chair when they temporarily dismiss themselves from the table, just the way they learned it the first time.

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Healthcare Futurist Meets Present Reality

Frequently, when I go to work, I get in my car and drive to New York City, Philadelphia, New Jersey or to the airport. That’s the life of a home-based writer. Last week was a little different. I got in my car and drove 5 minutes to a speech by healthcare futurist Joe Flower sponsored by the local Blue Cross affiliate. So, I mention this because proximity brought me there, and I am very glad this happened in my backyard.

Joe Flower is a good speaker in the tradition of a performer. He is engaging and his slides are entertaining. His dry subject comes to life with humor and some good graphic design. So, let’s get beyond style to substance.

I’ve spent part of my career writing managed care training, including the history of managed care. Some of Joe Flower’s history of the US healthcare system was strained through a pro-ACA sieve. The bottom line of his storyline is that presidents of both stripes have been trying to get universal coverage and mandate through the reluctant Congress and recalcitrant American people since 1900, and this president finally made it happen. Hallelujah! We’re finally all covered. Well, in some corners, the jury may still be behind closed doors on that.

However, the upshot of his speech was the future of healthcare.  It is here that I was wholly in agreement with Mr. Flower. He discussed the promise of technology making healthcare inexpensive and accessible to everyone, everywhere, as long as they have a wireless connection. That sounds about right to me, too. If the past is chequered, the present holds great promise. Right?

His audience found the “yes, but”. When he took a few questions from attendees, the first speaker was a small businessman who saw his insurance rates for himself and his employees rise 42% in the last year and his doctors leaving practice. He asked how he was expected to sustain this.

Another attendee looked unimpressed, as well. “It is very difficult to make the thoughts actionable,” she said to me flatly when I asked her opinion about the speech in the elevator.

We can retell history in any number of ways, choosing to interpret or reinterpret the meaning of cost and price trajectories or the actions of presidents and Congress over the last century. We can look forward with rose-colored glasses to what is possible given the current, incredible technology.

But for those payers and patients on the ground everyday, trying to pay their bills and get care, it’s just a good speech.

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New Leadership at HHS and ONC: A Change in Direction or Doubling Down?

The greatest indicators of a sea change at Health and Human Services are the selections for the two top jobs in that department: the new Health and Human Services Secretary and the new National Coordinator for Health Information Technology. Both women bring substantive and substantial resumes to the job, which begs the question if their appointments signal a change in direction or a doubling down on the tasks at hand.

At first blush, with only a few weeks of actions to make that judgment call, I’m inclined to think the answer is “both”.

Roll-Your-Sleeves-Up-and-Get-Her-Done Kinda Women

Their resumes indicate that they have a history of getting things done…right…with both hands on the wheel.

That would indicate a change in direction I style for both directions where leadership has been more about tone. It would also indicate a doubling down on the current direction in substance because both women have a history of success in similar roles with a demonstrated ability to overcome obstacles and move things along.

HHS Secretary Sylvia Mathews Burwell

President Obama’s first HHS Secretary, Kathleen Sebelius, as a former governor was a very accomplished politician and leader. In other times, those would be stellar qualifications for the job. In these difficult times, the job calls for a different skill set. Sylvia Mathews Burwell brings that “something more” to the table. She has a distinguished background in healthcare, including a stint as COO for the Gates Foundation, an organization which is probably doing more than any other on the planet to advance global health. Burwell knows healthcare delivery in the most difficult environments, and we need that at the top right now.

I have done a little work in global health, and vaccines in particular, including some work with the Gates Foundation’s pediatric dengue fever International Vaccine Institute during its inception. The issues are highly complex with regional variations in both availability and quality of healthcare infrastructure confounded by a panoply of political and social sensitivities in each country. If she can run that, she can run anything.

ONC Chief Dr. Karen DeSalvo

When former ONC chief Dr. Farzad Mostashari stepped down last fall, it appeared to be a step backwards for national health IT leadership. He was charismatic and passionate, a great voice for the promotion of health IT. Health IT needed a cheerleader, and he was it.

Now that the promotional phase is over, it is time to dig into the details. In addition to her M.D., Dr. DeSalvo has a Master’s in Public Health and her accomplishments center around working with the impoverished in New Orleans as an internist at Tulane University in the aftermath of Katrina. She understands healthcare problems from the ground, but she also has solved them at a systemic level during her time in The Big Easy. She is credited with leading the effort to transform public health from an outmoded system to a modern one, and has experience instituting successful information technology as part of a total system transformation.

I only needed to read an article this morning from a HealthData Management report to see that her experience is already transforming the national health IT effort from the top by coordinating the policy and standards groups. In part, the article said:

Earlier this month, Karen DeSalvo, M.D., National Coordinator for Health IT, announced changes to the Health IT Policy Committee “somewhat siloed” workgroup structure. In an April 8 meeting of the HIT Policy Committee, she called for revisions to the names and scope of the workgroups so that they are more “strategic and forward-thinking” with the restructuring slated to begin in May for a couple of the workgroups and the rest of the transition continuing this summer…In Thursday’s Health IT Standards Committee meeting, DeSalvo announced that outgoing committee chair Jonathan Perlin, M.D., president-elect of the American Hospital Association, will be replaced by Jacob Reider, M.D., ONC’s deputy national coordinator. She said that under Reider’s leadership the HIT Standards Committee will “mirror” the structure of the HIT Policy Committee where ONC is chair but the vice chair, John Halamka, M.D., CIO at Beth Israel Deaconess Medical Center in Boston, will retain his role running meetings.

“That will, I hope, keep the Standards Committee very tethered to the work of Policy [Committee] and ONC,” De Salvo said.

Leadership and Management

In periods of relative calm, leadership can be largely titular. These are not those times. While Burwell’s and DeSalvo’s predecessors were both stellar leaders in their own right, these times call for operational excellence. That requires hands-on leadership with proven management skills.

With only several weeks’ experience to judge them, it appears the country is getting what it needs right now: a change in direction of the kind of leadership that will double down on moving along all the initiatives to coordinate the implementation of health IT within the larger implementation of the Affordable Care Act.

Wouldn’t you love to be a fly on the wall when these two powerhouses go to lunch to talk about it?

Next Week: Looking at ECRI’s research on the Top 10 Health Information Hazards

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Lean Implementation is a Priority on Hospitals’ 2014 To-Do Lists

HealthLeader’s  Media Intelligence released its annual hospital survey that showed fully 50% of hospitals are now taking a very serious look at “continuous improvement techniques such as Lean”.

Just what is it about Lean that attracts hospitals? Their interest is driven largely by the #1 response to the survey, “patient experience improvements”.

Hospitals that are on the Lean path have discovered that well-designed processes lead to improved performance because the patient remains at the center of care. How? It’s a virtuous cycle.

1. Lean implementations drive process improvements by involving people as close to the work as possible in making changes in the workplace.

2. Lean value stream mapping helps employees find the shortest distance between two points to identify excess movement, materials and people that are better utilized elsewhere.

3. Squeezing the waste out of a process using Lean tools and techniques leads to greater efficiency and lower cost.

4. Greater efficiency and lower cost results in greater patient experiences.

You’ll see it in improved patient satisfaction scores. Guaranteed.

Next week: New leadership at HHS and ONC: What does it mean for the future?

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