People often imagine that healthcare information technology works a bit like “The Wizard of Oz,” where a genius behind the curtain does marvelous, mysterious things. But the real benefit of healthcare IT is that it produces very down-to-earth results: better patient care, greater physician satisfaction, higher reimbursement and improved quality and compliance.
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How does an organization with a heavily unionized workforce, spread over hundreds of locations in nine states, not only provide high-quality, affordable healthcare, but also continuously improve care delivery?We do it by working together—25,000 managers, 15,000 physicians and 92,000 workers in 29 local unions—through Kaiser Permanente's Labor Management Partnership, called “the largest, most complex, ambitious and broad-based labor management partnership in U.S. history,” by Thomas Kochan, a management professor at MIT.
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Disaster plans. All hospitals have them, but few of us, thankfully, are forced to implement them. At Los Alamos (N.M.) Medical Center, the immeasurable value of a good disaster plan was demonstrated recently as fires threatened to consume our hospital and community.It began on June 26, a Sunday, when a tree fell on a power line, sparking the first flames of what is known as the Las Conchas fire, the largest in New Mexico history. During the next 36 days, the fire would char nearly 160,000 acres surrounding Los Alamos.
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Everyone counts on high-reliability organizations to ensure our personal safety when we fly on commercial airliners or travel near a nuclear power plant. Air traffic control, nuclear submarines, nuclear aircraft carriers and naval aviation all have well deserved reputations for high-reliability operation.
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Having served as a hospital executive, trustee and board chairman of not-for-profit and for-profit hospitals and health systems in the Midwest and West, my experience suggests that other than having major friction with the medical staff, nothing can undermine the CEO faster than disillusioned or frustrated board members.
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By all external standards, 445-bed Mercy St. Vincent Medical Center in Toledo, Ohio, was a high-performing hospital. We recently won a top 100 hospital designation, earned a J.D. Power & Associates top performer award and rated equally well on other standards of performance, including patient satisfaction scores, regulatory compliance and core measure outcomes. Like many other high-achievement hospitals, we had already initiated a Lean and Six Sigma department. Yet, patient throughput problems persisted, which negatively affected organizational performance.
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I'll never forget that day. I was early in my career as a labor and delivery nurse when a tragedy occurred that is still fresh in my memory. In the mid-1980s, fetal heart rate monitors were big, bulky machines and were difficult to transport. A mother was in labor with her second child and delivery was imminent. The doctor requested we move her to the delivery room. We decided there was no need to bring the monitor for the three-minute move; the mother could be reattached to the monitor in the delivery room.
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The healthcare labor shortage has not been solved. Remember George Clooney in The Perfect Storm? Distracted by business pressures, he mistook for everyday turbulence what turned out to be a devastating tempest. Hospitals are in a similarly hazardous position these days.
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Can electronic health records and other health information technology applications improve our healthcare system and deliver significant improvements in patient care?According to a recent study, published by PLoS Medicine, the answer is no. Based on Intermountain Healthcare's experience more than 40 years, however, the answer is clearly yes. And, as Intermountain's chief information officer, I have the evidence to back it up.
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How do you care for childless adults caught up in the chaos of poverty who don't qualify for Medicaid? In Minnesota, prior to June 1, 2010, you signed them up for General Assistance Medical Care. This program covered patients who in many states are uninsured.
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A year ago, I took part in a Scripps Health medical mission to Haiti to aid victims of the devastating earthquake. When we arrived in the middle of the night, we were driven to our accommodations in the hills overlooking Port-au-Prince. The next morning, as I looked to the valley below, the view was like a postcard from a tropical paradise. It wasn't until we drove into the valley later that day that we saw all the destruction.
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No patient should have to endure what Karen Morrow has endured. In a Las Vegas ambulatory surgical center for a routine colonoscopy, Morrow contracted hepatitis C because the staff committed a cardinal medical sin. They reused syringes and single-dose vials of anesthetic. As a result, Morrow suffered through a year of painful and expensive treatment. She lost her hair, her job and the ability to manage her life independently. She even needed help with grocery shopping and caring for her dogs.
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In the dynamic world of healthcare, it takes more than passively sitting behind a desk and reviewing census numbers and statistics to ensure your hospital is going to survive. Having a successful and profitable hospital requires aggressiveness and a willingness to embrace innovation.
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The Joint Commission's Disease-Specific Care (DSC) Certification Program, launched in 2002, is a voluntary, structured evaluation of a clinical program that delivers care to a defined patient population across their continuum of care. The goal is to improve performance and maintain improved outcomes over time.
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Heated discussions rage over rising costs and the lack of access to affordable care. Medical professionals argue about whether we should pay for prevention or just procedures. Accusations fly about how changes to the way medical care is delivered could lead to socialism.
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The Patient Protection and Affordable Care Act will expand and enhance coverage, but the most sustainable solutions will come from local efforts to transform care and lower costs.
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