We’ve all heard of the impact the Baby Boomers will have on the future of America. To that end, it could be considered surprising that more hospitals haven’t focused on the health care needs of a to-be retiring population. Medicare won’t the highest payer. But they will provide volume. Shoot, the way things are going, health care organizations may become completely dependent upon government payers for sustainability.

As health systems become more competitive, tailoring services to the needs of specific subsets of the population is appropriate. No better population to start with than one that will push 75 million + through the system.

our own system will not open a “Center for the Aging” or classes to learn how to age gracefully or anything else remotely insulting. These years for this cohort will be the first time that an entire population has lived so long. And they aren’t just existing, they’re enjoying, experiencing, and exciting.

Tom Peters has been knocking on this door for a few years now. Here is the latest post in his 100 Ways to Succeed series (#116):

Boomers! Geezers! Now!

Before the week [day?] ends, somehow or other begin a serious conversation about your attitude toward and approach to the Boomer-Geezer market.

(Like race in the world of politics, try to examine your implicit biases—eventually with the help of an outside facilitator.)

If at all applicable, consider Very Radical Alternatives—e.g., re-aligning strategy around Boomers-Geezers.

Big idea/s:

(1) It is a big idea.
(2) Stir the pot. Now.
(3) The opportunities are enormous; the response so far is pitiful.
(4) Don’t be an idiot.

Sticking with the Tom Peters theme, the preceding blog post to that above had this quote from the head of the AARP, Bill Novelli, “People turning 50 today have more than half of their adult life ahead of them.”

Wow.  Mr. Peters continuing on Boomers:

“We are the Aussies & Kiwis & Americans & Canadians. We are the Western Europeans & Japanese. We are the fastest growing, the biggest, the wealthiest, the boldest, the most (yes) ambitious, the most experimental & exploratory, the most different, the most indulgent, the most difficult & demanding, the most service & experience obsessed, the most vigorous, (the least vigorous,) the most health conscious, the most female, the most profoundly important commercial market in the history of the world—and we will be the Center of your universe for the next twenty-five years. We have arrived!”

We.
Have.
Arrived.

(Pause: read the above paragraph, until you understand)

our own system is late.  But we’re ahead of most.  Starting now, we are tailoring services for Boomers.  Period.  How?  Not so sure.  Those decisions will be left for Boomers to make.  We obviously have some work ahead.

And the best part?  It won’t take a considerable investment to get in line.  Steady growth over the next few years will allow us to successfully add and customize services as they are needed.  From the Health Beat Blog:

“In truth, the aging of the population is not a big problem,” Uwe Reinhardt says. We really don’t have to worry about greedy geezers suddenly clamoring for more care than we can afford. For one, they won’t grow old all at once. They’ll grow old just as they were born—over a period of many years.

Principle #17:  The Boomers are coming.  The Boomers are here.  The Boomers are still coming.  Theeir impact on local health care systems will be large.  And in a competitive health care world (to be), we want them at our own system.  The customization of health care services will allow us to tailor the experiences for this huge (read: important) population.

Two recent news events have made apparent the need for better community education. An important value of our own system is community involvement and these events have inspired the creation of a department dedicated to the betterment of the community.

Item 1. We’ve known for a few years that obesity has clearly become a problem. Last week PLoS published an article that found in some rural U.S. counties life expectancy actually decreased. Among the reasons: obesity.

This statement should stop you in your tracks: “Young Americans risk being the first generation whose health status will be worse off than the last.”

If this picture wasn’t the reality, it might be funny.

It’s time for Personal Preventive Medicine. We, as individuals in this country, need to take responsibility for our health decisions. We need to eat better. We need to exercise more. We need regular preventive visits to physicians. It literally means the difference between living and dying.

But we need the tools to do so. And for various reasons many of us haven’t acquired those tools. our own system community education will teach community members the tools of living a healthy life.

Item 2. The way we have conducted “health insurance” as subsidization of health care purchases in this country has reached the point that no one knows what health care costs anymore. And if a person doesn’t know how much health care costs it makes it extremely difficult to purchase health insurance sufficient enough to cover potential costs.

The problem was illustrated in a Wall Street Journal article this week when an oncology patient reported for an appointment and was asked to make a substantial upfront payment before receiving treatment. The problem? Underinsurance.

M.D. Anderson says it provides assistance or free care to poor patients who can’t afford treatment. It says it acted appropriately in Mrs. Kelly’s case because she wasn’t indigent, but underinsured. The hospital says it wouldn’t accept her insurance because the payout, a maximum of $37,000 a year, would be less than 30% of the estimated costs of her care.

This “limited-benefit” health insurance plan, a product of UnitedHealth, is meant to cover a gap in more traditional coverage according to the company.

A quote from the patient, “I just thought I needed some kind of insurance policy because you never know what’s going to happen.”

And how about this:

Fifty-five percent of members from 107 commercial health plans nationally said they do not understand “critical details” of their coverage, including prescription drug benefits, finding the proper physician and appealing coverage denials, according to the 2008 National Health Insurance Plan study.

There are disconnects somewhere.

Update: This seems to be a hot topic.

Principle #16: We often hear that people need more education on a variety of topics. Some of those topics are becoming necessary know-how when it comes to health. our own system is taking the idea of more education and translating it into action: serving the community is what a hospital is all about.

First impressions matter.

our own system’s Department of The Best Start will be responsible for greeting and helping patients, families, and visitors when they walk into the lobby.

We borrow the job description from the blog of Beth Israel Deaconess Medical Center CEO Paul Levy:  employees in the Department will “answer all kinds of questions, give directions, escort people to their appointments, and are otherwise exceptionally pleasant and helpful.”

Simple, right?  Not always.  Smiles and hellos are not always pervasive in a hospital.  But what better to help sooth a patient’s rattled nerves as they enter a hospital than a friendly, smiling face?

The distinction between a run-of-the-mill staffed hospital lobby desk and the Department of The Best Start is a move from a static office desk dedicated to answering questions by those who approach to a constantly mobile group of individuals dedicated to the patient experience by seeking out all who walk through the front door.

Innovative patient experiences is really what the Department of The Best Start is all about.  This group will always be on the lookout for ways to improve the patient/hospital interaction.  At BIDMC, they have interpreters in over 30 languages and have “a rotating box with instructions in several languages to help people who do not speak English get the help they need.”

The Department of The Best Start will be the dedicated Relationship Builders between those entering the hospital and our own system.  If patients start with an enjoyable beginning we know that there is a better chance their entire experience will be positive.  And it all depends on communication.

As Mr. Levy writes on his blog, “Good communication is not just a pleasantry in a hospital: It can be a matter of life and death.”

Principle #15: Beginnings matter.  A lot.  As we move to a competitive hospital world where patient satisfaction actually manifests into return visits/word of mouth marketing, how we build relationships with those who enter our organizations will become vitally important.  We’re just getting a head start.

More information is key. Providing an abundance of information to patients can be challenging. Properly organizing and delivering that information can mean the difference between a satisfied and dissatisfied patient.

If you’ve ever walked into a hospital room you know there is one thing most have in common: the TV is on.

Video on-demand is a concept many are familiar with. our own system will use the technology to create an interactive media channel delivered over an internal network. Johns Hopkins has a patient safety video on-demand service:

Patient education is an important part of your hospital stay and recovery after discharge. It is important for you and your family to understand your condition, treatment and any follow-up care you may need. As part of our television service, the hospital offers a wide range of patient education videos and informational presentations on our free Patient Education On-Demand TV System.

In order for the channel to carry a professional feel, our own system will hire a team to work with providers and employees to create content. That staff will need skills in videography, production, writing, graphic design, among others.

The possibilities are truly endless.

Patients could be welcomed by management with a video. Providers could each have a video describing what they do and who they are. An outline of hospital services and local community information could be displayed and disseminated with ease. Or how about hospital policies, principles, and other information. our own system could explain its commitment to the highest quality care, or information about its Leapfrog designation (and U.S. News ranking), or latest Joint Commission accreditation survey findings, or policies related to medical record privacy.

After a physician provides a diagnosis and answers all of the patient’s questions, that patient may desire more information. It could be provided in video format and may include information about the diagnosis, treatments, and what to expect from that point on.

How does a visitor get to the cafeteria from the hospital room? Or to a coffee stand? They could watch a video tour outlining the way to the cafeteria before setting out on the journey in order to gain familiarity with the surroundings.

Another opportunity include healing video options like NewYork-Presbyterian:

Patients at NewYork-Presbyterian Hospital are tuning in to a unique television channel specially designed to promote healing. Putting aside pundits, police dramas and other anxiety-laden programming, they can now relax and reflect to uninterrupted video imagery of beautiful and inspiring natural vistas—a meadow of wildflowers, ducks swimming in a mountain lake, etc.—set to soothing instrumental music.

The video on-demand service could also provide answers to questions that may be tough to ask. If the patient is dissatisfied with an aspect of their care, it may be difficult to ask a nurse how to make a complaint. A video could explain who to call and how we will respond.

Most importantly, the videos would cover safety issues in the hospital. They could explain proper safety procedures, how the hospital deals with safety and infection control issues, and what kinds of questions to ask providers related to safety.

Principle #14: Some patients want as much information as they can get, others could care less. Instead of trying to find the balance between giving too much paper and not enough, healthTV at our own system would allow patients to choose what they receive. This type of media allows the hospital to individualize care and improve patient satisfaction. We have nothing to hide. Being completely open with patients is the right thing to do. As connectedness continues to evolve, our own system will use the latest technologies to improve the patient experience.

Have you heard of the Geek Squad? From their website: “Geek Squad Agents, Advisors and Installers teach people to embrace technology fearlessly and practice the art of human interaction.”

In order to offer patients more care options (and a throwback to the days of old), our own system will deploy the Doc Squad (still deciding whether to outfit them with Beetles or not) to respond to individuals who need attention at home. These providers will be able to provide basic general practitioner duties in the patient’s home.

Jay Parkinson and a few others are practicing virtual medicine…but why couldn’t this innovative solution be employed in the hospital? Well it can. And we will.

The Health Care Blog has a good piece on Dr. Parkinson. The best quote:

“The healthcare industry is so stuck in 1994,” he says, “The only way they’ve used the Internet is to provide information. I look at the Internet as something that provides communication.”

Principle #14: 1994 or not, it’s time that we (hospitals) start deploying new business models. The Doc Squad is our own system’s version of a previous era doctor’s house call. Every decision we make should make the process easier for the patient. Period. And if you’re not innovating for the patient (or the patient’s well being) you shouldn’t be innovating. Period.

Medicine is steeped in tradition. Tradition can be good. Other times, not.

The reason providers wear white coats is of some debate. At most academic medical centers the white coat signifies status in the physician hierarchy (i.e., attendings wear long coats, interns wear short coats).

our own system will ban the white coat. All providers involved in patient care, no matter their role, will wear scrubs. We’re not opposed to tradition, we’re just in favor of practicality. However small the risk, if the white coat is worn every day and goes unwashed it can spread infectious disease.

Superbugs have been on the march (technically, since the beginning of time). Stories of MRSA were rampantly covered by the media a few months ago. VRE and LRE are around. Bugs have always been in the hospital. With new patients arriving daily (more like hourly), bugs will always be in the hospital.

It is our job to minimize the patient’s risk and exposure. Don then dump. Don the scrubs when you walk in, dump them in the laundry cart when you leave.

Principle #12: Scrubs for all. No more white coats. Or any other clothing from home for that matter to be worn while seeing patients. The small stuff matters—we must do all we can to ensure patient safety.

Evidence-based medicine.  Evidence-based management.  Evidence-based design.

The thinking makes a lot of sense: do today with what you (and others!) learned yesterday.

The Center for Health Design is the ultimate source on this subject and they provide a much more comprehensive definition:

Evidence-based healthcare designs are used to create environments that are therapeutic, supportive of family involvement, efficient for staff performance, and restorative for workers under stress.

An evidence-based designer, together with an informed client, makes decisions based on the best information available from research and project evaluations. Critical thinking is required to develop an appropriate solution to the design problem; the pool of information will rarely offer a precise fit with a client’s unique situation.

In the last analysis, though, an evidence-based healthcare design should result in demonstrated improvements in the organization’s clinical outcomes, economic performance, productivity, customer satisfaction, and cultural measures.

As we plan and build our virtual hospital, our own system is committed to constructing a healing environment through evidence-based design.  The Center even provides a toolkit that will help us:

• Understand what patients want from the built environment
• Enhance the design process through consumer involvement
• Build patient-centered environments
• Improve design quality and consumer satisfaction

Ulrich and Zimring published a comprehensive literature review/report on hospital evidence-based design in 2004.  The Robert Wood Johnson Foundation has a nice overview/summary of the research.  We can take explicit recommendations from this research and turn them into action:

The Single Room that does it all. “This change alone will help improve patient safety by reducing patient transfers, cut the risk of nosocomial infections, enhance patient privacy, lower stress for patients and their families, and improve staff communication with patients.”

Ventilation Systems and Air Filters. “Several studies have demonstrated that identifying and fixing air-quality problems, in combination with single rooms and scrupulous hand-washing, can substantially lower infection rates at hospitals.”

Noise Reduction. Elements like carpeting and sound-reducing ceiling tiles can lower noise levels.  “Research shows that noise is a major source of stress at hospitals. At hospitals that took steps to cut noise levels, patients were more satisfied with their care, slept better, had lower blood pressure, and were less likely to be re-hospitalized.”

Natural Light. “Looking out at bright light can improve health outcomes, including depression, agitation, sleep, and circadian rest-activity rhythms.”

The “Little Stuff.” “Small changes to room layouts, color scheme, furniture choice and arrangement, floor coverings, and curtains, as well as providing informational material and displays, can improve people’s moods and physiological states.”

Easy Navigation. “It’s easy to get lost or confused trying to find one’s way in a hospital. Not only is this confusion stressful for visitors, but it also incurs a cost to hospitals.”

Work Environments that help staff do their work. “Nursing stations are hectic and stressful places where too many errors occur while updating charts, filling medication orders, and communicating between shifts.”

One more thing: the Pebble Project.  “The purpose of the work (Pebble Project) is to create a ripple effect in the healthcare community by providing researched and documented examples of healthcare facilities whose design has made a difference in the quality of care and financial performance of the institution.”  Just take a look at some of the benefits of great design: staff turnover reduced, occupancy rates increased, patient satisfaction up, etc.  And if you have an extra minute or two, enjoy the great images of proven evidence-based design.

Principle #11: Evidence-based design is beyond important, it’s item number one on the things to do list at our own system. The Center for Health Design will help us get there.

In the kind of prognostication you can only find in a bar like Cheers, serendipity ran me into a know-it-all-end-of-the-bar type several months ago that put our future environmental status in stark perspective: Mother Nature will be just fine. If we, as in humans, don’t change the way we interact with the Earth, it will be us who is disposed of; Mother Nature will have done her job: react to imbalance to ensure stability. Weird and uncomfortable as the situation was, the message resonated.

Making our own system green is a small step we can take “to do our part.” But, for a moment, let us move beyond the environmental benefits of going green and focus on our patients. An article at Building Design and Construction puts it well:

Think about this: If you were asked to identify the one building type that needed the highest-quality indoor air, the lowest levels of toxic off-gassing, the greatest access to daylighting and outdoor views for occupants, the most efficient energy and water usage—in other words, the greenest building—what would you think of first?

Hospitals, right? Sure you would. Hospitals should be leading the way in providing patients, their families, doctors, nurses, technicians, and office staff the ultimate sustainable experience. Sick people should have the greenest buildings of all.

But it’s not the case.  Hospitals have been slow to jump on the green revolution. The U.S. Green Building Council reports that only 74 hospital construction projects have been LEED certified, about 2% of all LEED-registered projects. But, as construction booms, and as we continue to build our virtual hospital, the opportunity to build green facilities is upon us.

National Geographic published an article in 2006 ranking the top 10 green hospitals in the U.S. that also discussed the challenges of building green hospitals, “Infection control requires strict cleaning procedures and frequent air changes, which increase the already-high energy costs of the 24/7 operations and sophisticated medical equipment that make hospitals among the greatest energy consumers of any institution.”

A solution.

The Green Guide to Health Care provides a 400+ page document (go to their site and register for a free download of the document) that is “the healthcare sector’s first quantifiable sustainable design toolkit integrating enhanced environmental and health principles and practices into the planning, design, construction, operations and maintenance of their facilities. This Guide provides the healthcare sector with a voluntary, self-certifying metric toolkit of best practices that designers, owners, and operators can use to guide and evaluate their progress towards high performance healing environments.”

The GGHC combines several resources to come up with their assessment principles including the Green Healthcare Construction Guidance Statement (pdf) by the American Society for Healthcare Engineering, LEED, the U.S. Environmental Protection Agency’s Labs 21 Environmental Performance Criteria, the Green Building Council of Australia’s Green Star Green Building Rating System, among others.

The aforementioned Building Design and Construction article offers 14 steps to greener hospitals and an analysis of GGHC, “This well-conceived set of guidelines goes far beyond LEED in rating hospital projects. GGHC requires integrated design, something LEED only hints at. It covers both construction and operations, and it offers specific health policy reasons for each of its credits. Unlike LEED, however, it is self-compliant: Building Teams rate their own performance, which to some is a shortcoming. Currently, 79 projects are participating in the GGHC pilot program.”

Principle #10: Building green facilities is a must. The best part: aside from being good for the environment, the elements of a green hospital are great for patients.

We’re on the verge of an extreme infusion of information technology into hospitals across the country. Electronic medical records (EMR) are the future of inpatient and outpatient record keeping. I see three fears holding back many: 1) cost of implementation, 2) technophobia, and 3) concern about purchasing the “right system.”

While information technology is not the solution to all of our problems, when implemented and used correctly it can help reduce costs and allow for continuity of care amongst providers, ultimately benefiting the patient.

The announcement of the partnership between Google and the Cleveland Clinic moves us one step further (no matter how long it took us to take that step!) toward converting our system of paper to one that is electronic.

However, our own system will go a step beyond the EMR and will be a “paperless hospital.” Being paperless means, well, no paper. Beyond the EMR, going paperless has an impact on all aspects of the hospital. Some organizations have implemented paperless systems already allowing us to learn from what they have done. Newly constructed Dublin Methodist Hospital’s paperless system is highlighted here. Read (it’s in the first paragraph) about the paperless Baptist Medical Center South.

Vanderbilt Children’s even has a demo to show us how easy it can be:

Principle 9: Paperless from the start! It is best for our patients. It is best for our organization. It is best for our health system. Removing waste and reducing errors are top priorities. We can do both by going paperless.

“Art washes away from the soul the dust of everyday life.” –Pablo Picasso

I’ve heard that art has healing power. Whether that is true for everyone, it matters not. As one Planetree (”promotes the development and implementation of innovative models of healthcare”) component says, “Artwork in patient rooms, treatment areas and on art carts add to the ambiance (of the hospital). Volunteers work with patients who would like to create their own art, while involvement from artists, musicians, poets and story tellers from the local community help to expand the boundaries of the health care facility.”

Art’s importance in the hospital setting is a design component that can help patients and families (and staff!) feel more comfortable. Anything that helps to reverse the notion that a hospital is cold and gray is a good thing. Art adds color and warmth.

But we must be careful: I’m sure we’ve all seen those tired, old pieces that have been on display in the hospital’s waiting room for too long. our own system has a solution. Seth wrote a few months ago (I’ve remembered it this long, so it must have been good) about a truly intriguing idea: an artist in residence. We will hire an artist (or a few, even, depending on our size) that comes to work everyday to create art that will be displayed throughout the hospital. If anyone wants to buy a piece of art, they can. That piece will be taken off display and replaced with another work. Rotating art will keep the atmosphere fresh, it may even turn into something of an exhibition that we normally see at museums.

The notion of good art in the hospital is growing. There’s even a conference on The Value and Importance of Art in Health Care (be careful, it’s a PDF). And you can even get a daily fix on health care and art by reading this blog, it has some good stuff. If going all the way and hiring an artist in residence is too much for your organization here are some tips on starting an art program.

Principle #8: our own system, on its journey to try innovative ideas, will hire an artist in residence (maybe even a team!) to keep the hospital full of great art. This art will help to create an atmosphere attractive to patients, staff, and the community.