Health Care Fine Art comments on a new look hospital in London.  There’s also a link to a post from last summer asking the question “Why No Cool Looking Hospitals?“  Read the post and the comments—there are some interesting thoughts.

One thought on why the newest of hospitals continue to utilize traditional architectural themes is the opportunity for expansion.  The boxy buildings make it easier to add floors or corridors without upsetting the design.  Medicine changes often and sometime those changes require new construction.

Anyway, hospital design is getting better.  The biggest challenge will come as we continue to update the Hill-Burton hospitals to allow, among other things (including functionality), natural light into buildings.

After years of giving advice to “deny and defend,” some hospitals are instructing providers to admit to and apologize for mistakes (medical errors).  Not surprisingly (or maybe surprisingly), this humanistic approach to medicine has reduced lawsuits.  It seems patients appreciate not being lied to…

(Real, True, Actual) Communication works. The New York Times reports:

But with providers choking on malpractice costs and consumers demanding action against medical errors, a handful of prominent academic medical centers, like Johns Hopkins and Stanford, are trying a disarming approach.

By promptly disclosing medical errors and offering earnest apologies and fair compensation, they hope to restore integrity to dealings with patients, make it easier to learn from mistakes and dilute anger that often fuels lawsuits.

Malpractice lawyers say that what often transforms a reasonable patient into an indignant plaintiff is less an error than its concealment, and the victim’s concern that it will happen again.

Despite some projections that disclosure would prompt a flood of lawsuits, hospitals are reporting decreases in their caseloads and savings in legal costs. Malpractice premiums have declined in some instances, though market forces may be partly responsible.

Thirty-four states have passed laws making provider apologies inadmissible in court to alleviate any concerns.  Applause for forward thinking.

In an effort to continuously bring new perspective to my health care thinking, I braved up and attended Likemind in Columbus on Friday.

Not only did I receive a free book (Buying In) and sip free coffee, I greatly enjoyed the conversation I had with the folks in attendance.

At the beginning of my MHA program it was fun to hear people describe why they decided to pursue a career in health care. Most had some twist on the save-the-world mantra (you know, fix our health care problems). And then the first day of school starts and we begin to hear that the problems we are going to try to solve are (more or less) the same problems we’ve had all along. To say there has been no progress would be disrespectful and naive. To say that the problems have become more problematic is truth. Two steps forward, one step back. But I do get the feeling that many in health care often try to shut out the rest of the world with the thinking that only “we” in the inner circle know what is best for health care. Shoot, many would like to argue that administrators have only exasperated the problem.

Well, no matter what side of the fence you fall on, this is clear: the fact that we have been in this “health care crisis” for 40+ years makes me wonder if we are approaching the issues from misplaced perspective.

And that is why I appreciate Health 2.0 so much. That is why I’m encouraged by Jay Parkinson. That is why retail clinics interest me. That is why I am intrigued by the paradigm shift from sick care to preventive care.

I love this attributed Einstein quote and used it on day one to introduce this blog: “The significant problems we have cannot be solved at the same level of thinking with which we created them.”

So whether it is Likemind, or books and magazines and blogs that have nothing to do with health care, or talking to people with no health care experience, please make the attempt to expand your perspective. It very well could be the only way we improve what we’ve got.

Health care stuff to read.

The World Health Care Blog looks ahead to the coming privacy issues as health care (finally) goes internet:

So how do we manage ‘consent’ when it comes to private health information in this social media environment? This is one hell of a key question that needs to be addressed, and one that many are afraid to ask less it result in some draconian measures applied to all social media.

Do we have to accept a diminished private space to gain the benefits of social media? Will confidential health information become the entertainment for the ‘monitorial citizen’, part of the banal collective din of spectators who are fast becoming the new surveillance force in contemporary society? The values that are “animating our concern for privacy” are changing according to Zittrain, noting the age gap between those who use social media and those who shun it.

The health care debate we have most often concerns the issues we have in this country. I think it is important to remember that health is an international priority. Health in other countries increasingly has an effect on health in this country. And health care in this country apparently has an effect on health care in other countries. Health Populi reports:

Across the OECD countries, only 3% of health costs go to prevention. Yet we are well aware that once a person develops a chronic condition, it is much more expensive and difficult to reverse. It appears that the developed world is exporting sick-care medical systems to the developing world. This is a prescription for global health financing implosion — in addition to the extraordinarily negative impacts on business on a global basis.

The Health Blog writes a post that makes me really start to wonder how prevalent (and realistic) such doctor thoughts are:

Certainly, any doc (or anyone else, for that matter) who is not getting paid by the hour is likely to do some uncompensated work. But the issue does seem pretty compelling in the case of primary care docs, who work in a payment system that tends to favor procedure-oriented specialties.

“Just in the last three weeks, I have actually noticed three medication errors from specialists who prescribed medications for my patients because they did not have the full history,” (Ryan) Mire said. “I received those consultation notes, saw what the specialist prescribed, and said, ‘Absolutely not, do not take that medicine.’”

Yul Ejnes, a Rhode Island internist also on the panel added a couple other typical primary care tasks that aren’t reimbursable: “talking with family members,” and “just sitting down and thinking” about a case.

“Sometimes I wonder whether I want to keep doing this,” Ejnes said.

The culture of a hospital can be strikingly different during the evening hours. But the Health Blog explains that more than just the culture can be different:

After sundown the doctors get scarcer, the nurses fewer and the waits for just about everything get longer. There aren’t many bosses or seasoned pros around when things get sticky.

The result is a “stark discrepancy in quality between daytime and nighttime inpatient services,” David Shulkin, president and CEO of Beth Israel Medical Center in New York, writes in the current issue of the New England Journal of Medicine.

The lighter staffing in off-hours contributes to higher mortality rates, more complications from surgery and more frequent errors compared with the day side. Shulkin says we shouldn’t accept that. For starters, he writes, we need to scrap the notion that hospitals should run differently at night compared with the daytime. “We should be establishing equal standards for staffing and service and striving for acceptable outcomes for every hour of the week,” he argues.

We are in an era of elaborate medical technology, complicated medical procedures, sophisticated medications, detailed medical regulations, etc. That is reality. It makes this next point quite striking: simplicity is saving lives.

We first came across the utility of checklists in January. By February the powers-that-be declared them to be useful.

Here are some more examples.

Look-alike, sound-alike medications are a problem. Think Heparin. What’s the solution? Make the adult and child containers look as different as possible so providers never mistake the difference. Makes sense. But Paul Levy on Running a Hospital provides an example of an idea that makes Simple Sense:

Our head of pharmacy, Frank Mitrano, likes to say that he wishes that all drugs were packaged in exactly the same sized containers, with covers and lids of the same color, and with simple black lettering on a white background in the same font. Why? Because it is human nature to assume that a vial of medicine with a green cap and green lettering is, in fact, the medicine you were looking for, even if it is something quite different. And, also, the more layers of safety protection information systems and other technology that you have in place, the more likely you are to assume that you have the correct drug and the less likely you are to read — in detail — what the label actually says before administering the drug to a patient. On the other hand, if every vial were to look exactly the same, a human being would actually have to carefully read what is in it before administering a drug.

The Health Blog shares the story of New York City public hospitals and their ability to reduce ICU infections. “But if you find yourself in intensive care in one of New York City’s public hospitals, your chance of catching some nasty infections is way down. And you can thank some pretty simple measures for the improvement.” Simple Sense. Here’s the explanation:

“It’s not rocket science,” Alan Aviles, the hospital system’s CEO, told Health Blog. “It is really four or five or six relatively simple practices that need to be followed every time.”

One kind of hospital-acquired infection — ventilator-associated pneumonia — plummeted by 78% between 2005 and 2007 at the New York City Health and Hospitals Corp., the organization said. Another, central-line infections, fell 55%. Surgical-site infections fell as well, but not as dramatically.

Another way to look at it: The country’s biggest public hospital chain — with 11 facilities and 30% of its patients uninsured — has averaged 5.2 months without a central-line infection, and 5.8 months without a case of ventilator-associated pneumonia.

Mr. Aviles says the hospitals focused on specific “bundles” of precautionary measures to tackle each kind of infection: elevating the heads of ventilator patients and giving them periodic respites from sedatives that can worsen infection risks.

Or, to prevent central-line infections — blood infections acquired when doctors insert a catheter deep in the body — the hospital emphasizes hand-washing, deciding each day whether a patient really still needs a central line, and using drapes and other barriers to isolate the catheter’s entry point from other areas of the body that may be colonized by bacteria.

Birth can become a complicated medical procedure quite quickly.  Fierce Healthcare summarizes a USA Today story in which Premier research says that three of every 1000 infants are injured at birth—and that 80% of those injuries could be prevented.  They are using Simple Sense:

The project, backed by healthcare alliance Premier Inc., is designed to address the major sources of birth injury identified by the Alliance, including failing to recognize when a baby is in distress, failing to perform a timely C-section, failing to properly resuscitate a baby, inducing labor inappropriately with drugs, and using vacuums or forceps inappropriately.

Hospitals participating in this project have committed to following a set of guidelines proven to reduce harm to infants and mothers in each of these situations. Not only that, hospitals are drilling their staff on how to respond, with Harris Methodist Fort Worth Hospital, or example, offering staff the chance to practice with computerized simulators named “Mama Noelle” and “Baby Hal.”

Teams are also taking the time to develop clear plans ahead of time for how to deal with dangerous situations. For example, doctors and nurses are creating agreements on how many attempts to make before using a vacuum device to deliver a baby. While developing such strategies is time consuming, hospital leaders and Premier officials believe that the time spent will pay for itself in reduced expenses and fewer lawsuits.

Principle #18: Simple Sense makes sense.  We are on a mission of constant innovation and reducing complicated processes to their simplest, most effective possible iterations is an ongoing necessity.  Simplicity saves lives.  We need more of it.  our own system is committed to Simple Sense.

OK, so we know hospital and physician rating sites are going to be big sooner than later.  The fact that the rating information is so diffuse at this point allows us to breathe a sigh of relief.  But not for long.  This opportunity to “get the house in order” is a gift.  Act accordingly.

Dr. Michael Millenson writes in H&HN’s Most Wired Magazine on ratings.  Selected excerpts (link via THCB):

The “electronic medical grapevine,” to coin a term, is growing in importance. In 2001, the American Medical Association issued a press release suggesting that patients make a New Year’s resolution to “trust your physician, not a chat room.” As with much other New Year’s advice, this proffered piece of wisdom went unheeded. Today, online doctor ratings have become an integral part of an effort to intensify the interactivity of health care sites and thereby make them more attractive to users.

…

If you think this is only the doctor’s problem, think again. Although a hospital’s reputation is woven from many threads, it all unravels without good physicians. Scattered positive or negative comments won’t have much impact, but a pattern of “best doctors” ratings or, conversely, ratings showing the “worst attitude toward patients” can be much more important in a competitive marketplace. To protect themselves, hospitals at the very least should check up on big admitters and prominent leaders of the medical staff. Like it or not, the first thing many “singles” do before a first date is search the Web for information on that potential partner. In that same spirit, keeping track of your physician partners is just common sense.

…

We all know that in the real world, the importance of regulatory authorities isn’t going away. But in the virtual world, the electronic medical grapevine is growing in importance in a way that may someday rival the stamp of approval of regulators. These days, it pays to pay attention to the impact of both.

Soon market leaders will emerge in this health care rating business giving the industry needed credibility.  When that happens, it is only natural for the form of those ratings to progress.  And the natural progression will include specificity.

Take a look at SeatGuru, which gives travelers information about the best and worst seats on hundreds of airplanes around the world.  Or the newly launched TripKick which does the same for hotel rooms.  From Springwise:

While TripAdvisor (which acquired SeatGuru in 2007) gives travellers access to detailed hotel reviews by other travellers, who occasionally include info on which rooms to book, there’s definitely an opportunity in getting specific about individual rooms.

TripKick—”your hotel sidekick”—launched with about 250 hotels in 10 US cities, with more to follow. Coverage of each hotel includes detailed information on which rooms to request: which rooms are oversized (rooms ending in 03 and 04, for example), which have great bathrooms or are quieter than others. TripKick, which spent a year gathering all of this information, also points out which floors are better, and which to avoid. Guests are encouraged to add their own reviews and upload photos of rooms they’ve stayed in.

The impact of health care rating sites will be truly felt when the information gets specific.  Specific about departments, about visits, about procedures, about experiences.  Pictures included.  Are you making the necessary preparations?

Health 2.0 is growing quickly. Expect it to continue. A quick comparison from Health Populi:

How much time Americans spend researching:

• Medical procedure or surgeon: 1 hour
• Planning a vacation: 4 hours
• Picking out new appliances: 5 hours
• Deciding to buy/lease new car: 8 hours
• Thinking about a job change: 10 hours…

What is old is new again. I’ve been calling it the wrong name all along. Alas, we call it Direct Practice. Crossover Health compares the old and new physician practice models:

Current Hamster Wheel Model (Dr. running in between patients in 7-12 min increments)

• 2,500 patient population
• 12-15 minute increments
• Tons of paperwork, administrative burden, frustrations, lack of care coordination, ? quality
• Even when patients satisfied with the physician, they hate the experience (long waits, no personalization, unintelligible interactions with health care system)
• Avg Salary = ~$150,000

Direct Practice Model (Direct relationship with patients)

• 500 patient population
• $1,500 access/retainer fee
• Paced, minimal practice overhead, positive interactions, care coordination, increased quality
• Love the physician, love the experience (no headaches, no paperwork, transparent pricing)
• 24/7 access, same day appointments, multiple other amenities
• Avg Take Home = ~$500,000+ (this is conservative)

The Tom Peters blog had the top ten quotes from Mr. Peters at a recent event in London. One particularly caught my attention:

Brand inside is more important than brand outside for sustained success.

What you do inside your organization when the patient is present is much more important than the advertising you use to get those patients in the door. So true.

I have been fortunate (really!) to see the inside of many hospitals. In the great ones I could feel the culture when walking through the front door. Building that culture can be complicated. Signal vs. Noise provides some simple advice:

You don’t create a culture. Culture happens. It’s the by-product of consistent behavior. If you encourage people to share, and you give them the freedom to share, then sharing will be built into your culture. If you reward trust then trust will be built into your culture.

Artificial cultures are instant. They’re big bangs made of mission statements, declarations, and rules. They are obvious, ugly, and plastic. Artificial culture is paint.

Real cultures are built over time. They’re the result of action, reaction, and truth. They are nuanced, beautiful, and authentic. Real culture is patina.

Don’t think about how to create a culture, just do the right things for you, your customers, and your team and it’ll happen.

Instead of building culture, maybe it is Happening Culture.  If you’re trying to build a great culture, you are already on the wrong path.  Let it happen by doing the right thing.  Always.  For employees and patients and providers.

Continuing the brand conversation.

Noah Brier has created a simple-looking application that is allowing users to express their feelings about particular brands.  The collected tags are then displayed allowing companies (or whoever) the opportunity to see what words users associate with a particular brand.  It’s called Brand Tags.  And it seems to be a pretty big hit.

Chances are slim that your health care organization will appear on the site.  Seth Godin provides some advice for our localized organizations: “Superbrands have a mystical connection with people. Odds are, you can’t own one, but there’s no reason you can’t build a micro one, a local one, a brand that’s magical for a smaller group of people.”