“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.

Since the beginning of Western medicine–when a patient had a few swigs from the whiskey bottle before a procedure–the practice of medicine has been reactive. And for good reason: someone has a medical problem so a doctor would address it. Why would someone see a doctor if they’re not even sick?

Well, progress is a strange thing. Today, we don’t think twice (sadly, some don’t think about it at all) about yearly physicals or a mammogram every one to two years. Proactive health care is here (that shouldn’t be much of a surprise). Preventive medicine can help to control disease–even prevent disease in some cases.

This post at the World Health Care Blog addresses the issue by discussing whether or not hospitals are moving from a model dedicated to health instead of the more traditional sickness; it was inspired by a report published by the American Hospital Association with a section titled “Focus on Wellness.”

our own system will focus on wellness. Traditionally, the post says, “efforts often address one or two wellness initiatives, such as flu shots for their own employees and the medically underprivileged, or focus on the poor and frail, as part of their mission, PR and tax-exemption maintenance strategies.” our own system will make a concerted effort to dedicate the system’s complete efforts in order to focus on wellness. More from the blog describing that mission:

This wellness focus included the call for efforts to prevent or at least reduce the incidence and prevalence of illness and injury in the first place, along with measures to manage chronic illness once it has arisen. It addresses the health risk conditions and behaviors that employee and population health management efforts by employers, insurers, and governments have been investing in for some time. This suggests, at least, that hospitals are finally being asked to become part of the solution to the healthcare/cost crisis, rather than the part of the problem they have been up to now.

Of course, sickness care will still need to be a big component of our care for patients.  However, our own system will be the impetus for the paradigm change amongst our stakeholders required to make the shift to wellness.  The shift will take considerable patient education, third-party payer support, and physician buy-in.  As the meeting place for all three of these groups, our own system can be the uniting component of a fundamental shift in thinking and practice.

Principle #7: We will focus on the health portion of the phrase health care.  our own system will bring together key stakeholders in the delivery of care and provide the needed platform to make a complete effort dedicated to comprehensive care for our patients, with an important focus on wellness.

Sharing is the way to do business.

Google (and others) allows developers to download it’s code for applications like Google Maps.  Those developers then create “mash-ups” combining ideas: a map and something else (a pretty cool example: “Time Space Map is an encyclopedic atlas of history and happenings that anyone can edit.”)  Linux is an operating system (similar to what many of you are using currently: Windows).  Only Linux is developed by anyone who wants to–the source code is freely available to anyone–developers collaborate on creation.

Some more examples:

According to Bloomberg, “Harvard University professors may publish more research online, free to readers, after the school’s arts and sciences faculty adopted a new policy.”

The University of California Berkeley has a YouTube site where you can view a number of lectures including “Physics for Future Presidents.”

Stanford utilizes iTunes for much the same purpose.

The Public Library of Science “is a nonprofit organization of scientists and physicians committed to making the world’s scientific and medical literature a freely available public resource.”

Sharing themes abound.

Ideas don’t do any good if you place them under lock and key hang onto them for dear life.  They will probably be irellevant in a year anyway.  The power of ideas comes when they are shared, when they can be thought about, utilized, and implemented everywhere.

Maggie Mahar’s “Money-Driven Medicine” brings us this vignette from Dr. Donald Berwick, co-founder of the Institute for Healthcare Improvement, “Berwick recalls phoning a hospital in Houston to learn about its reportedly successful innovations in pneumonia care, and being told that ‘the gains were enormous but that the methods could not be reported to the public–excellent pneumonia care offered the hospital local competitive advantage.’”

The book continues as Dr. Berwick says, “The enemy is disease.  The competition that matters is against disease, not one another.  The purpose is healing.”

Maybe we all need to re-visit the sharing lesson.

Principle 6: It’s not mine, it’s not yours, it’s ours.  We’re in this together (this meaning fixing our health care system).  Revolutionary ideas need to be diffused…quickly…incessantly.  our own system will share all we have to offer, from research, to innovative ways to care for patients, to the ways we do business.  It’s time we rid ourselves of selfishness and come together and share to achieve a common good.

Somewhere (probably many places) someone has found the components of the perfect workplace. And while no company has reached perfection, many are working hard to get as close as they can.

But what makes a company great to work for? Google has its ideas (they seem to be working, BTW). Specifically, what makes a hospital great to work for? Fortune released its annual list not (too) long ago and ten hospitals made the list (and provided the data for the examples below). Hospital Impact has the complete rundown and some observations on the list.

The problem with this question is that the answer is going to be different for everyone. There are many things that go into making a place great to work. Becoming a workplace of choice is a culmination of hard work from all departments in the organization, not just human resources. So let’s borrow some ideas, add some of our own, and try to come up with the outline of a workplace of choice.

Benefits and wages are important. Obviously the availability of health insurance as a benefit is decreasing, so providing that service is of high importance. Fair and decent pay is an obvious need as well. Griffin Hospital in Derby, CT., received “6,691 applications for 180 open positions in 2007″ because of the organization’s benefits and customer service supremacy. Although benefits and wages matter, their importance is often forgotten on a daily basis–and so less relevant in the discussion on great places to work.

Care for people. I’ve written before on Methodist Hospital System’s “No One Dies Alone” program. As a hospital, we need to care for our patients–that is job number one. Most hospitals do that. But what separates a middle-of-the-pack hospital and a hospital that employees want to work for is how the organization cares for its employees. Are voices heard? Is communication encouraged? Are concerns acted upon? The Golden Rule applies. Every day.

Facilities can be an important aspect of a great place to work as well. Clean floors. Well-cared-for grounds. Investment in physical facilities. Innovative purchases of information technology (remember the training, lots of it!). These kinds of things can help to make employees proud of the organization they work for.

Rewards for high performance and involvement, like how OhioHealth rewards their employees for “customer service, community service, stars of the month, and perfect attendance,” amongst others. The company also rewards long-time employees with shopping trips at a local mall. It is important to reward for the right reasons, however. Reward systems have the potential to become competitive and could ultimately send employee satisfaction in the wrong direction.

A good measure of how employees feel about their workplace is the referral rate for open positions. With the current state of health care worker shortages a reality and predictor of what is likely to come, referrals may be the all-important factor that keeps our FTE openings limited and separates our own system from the competition. Children’s Healthcare of Atlanta has a referral rate for open positions that approaches 50% and many of its employees count ten or more years of service for the organization. Keeping current employees employed (satisfied!) is a great way to keep openings minimal. The Mayo Clinic has a goal to hire for life,”17% of its workforce has been there for 20 years.”

Training, constant training, for employees. Promoting within and educating the workforce to enable them to acquire the skills necessary for advancement within the organization is a very good thing. We will all become experts in customer service. Southern Ohio Medical Center “engages all employees in caregiving: Even housekeepers are urged to ask patients how they can be of help.”

Obviously there are some great hospitals listed here. There are likely even more great hospitals to work for that are not on the list. The components of a great workplace are nearly limitless. And while all the above components are important, when they come together in an organization, they create culture. Culture is the most important component of a workplace of choice.

It’s not always explainable, rarely definable, but definitely consequential.

Tony Chen at Hospital Impact writes, “Hospital culture isn’t some warm fuzzy thing that only consultants talk about - it is the unwritten norms of behavior and the frank conversations. Of course, this means that the people trust the leader enough to share!”

Principle #5: Being a workplace of choice is not an easy task to accomplish. Heck, it’s even difficult to talk about because we all have different opinions and ideas on what “great” is. But if we encourage the discussion, actively listen, and work incessantly to improve, our goal of being the best hospital to work for is achievable.

Dr. Michael Wilkes writes a great editorial.

“What is the role of a doctor?”

Starting right now, what do you want from your doctor?

Dr. Wilkes provides a few suggestions from an audience he recently spoke to:

• Knows me and my family.
• Is a good listener.
• I can reach when I get sick – even on weekends.
• Is working for me – not an insurance company or a hospital.
• Cares.
• Treats me with dignity and respect.
• Won’t go home because their shift is over with my problem still unresolved.
• Explains things so I can understand them.

Dr. Wilkes was struck by something that wasn’t on the list, “No one – not a single person – said they wanted the smartest doctor or a doctor who was an expert at medicine.”

Anyway his point: asking (and answering!) this question delivers two things: 1) insight on how to retool medical education and 2) information we can use to measure performance.

Two extremely relevant and important things. But I don’t think we should stop there. What do nurses expect from physicians? How about hospitals? Other relevant stakeholders?

And once that process has started we need to start asking questions about our hospital. What do patients want from the hospital? What does the community want from the hospital? What do providers expect from the hospital?

And we won’t stop there. Questions will be asked about, and of, all providers. Processes will be questioned. Governing bodies will be questioned. The analyses will continue until all have been analyzed and the questions have been answered.

These discussions, though time consuming (this is the greatness of being a virtual system), will lay out expectations from the start. These discussions will allow us to deliver the best care possible. Our expectations of each other will be on the table allowing us to focus on what matters most: patient care.

Principle #4: Asking questions not only promotes learning, it encourages discussion. We will ask questions from the beginning. And not stop. Incessant questions = incessant improvement!

Consumer-driven health care hasn’t (yet?) delivered on its promise, but one deliverable it has brought to us is transparency.

Still in a stage of infancy, the secret of what transparency can provide is out. Empowering patients to make decisions with useful and relevant information is a good (great!) thing. Making health care organizations accountable is of greater importance.

But like all change, a great many organizations are lagging behind on the movement. In order for transparency to truly work, everyone must share information–it must be the same information and measured the same way in order to be useful.

If you have studied Everett Rogers’ Diffusion of Innovations you know that individuals (and in turn organizations) adopt innovations at varying stages. The first stage is that of the early adopters. Beth Israel Deaconess Medical Center, headed by Paul Levy, has been an early adopter in the world of transparency. The first page on BIDMC’s website prominently displays a link to a page where the medical center details their innovative transparency efforts.

Mr. Levy has long advocated for transparency on his blog. The issue with this innovation is that in order for it to truly work, everyone must adopt it. And to this point, the great majority have not taken the steps that BIDMC has. Mr Levy writes in a BusinessWeek Special Report:

Several months ago, I started to post infection rates and other clinical information about Beth Israel Deaconess Medical Center (BIDMC) on my blog. I suggested, too, that it would be great if other hospitals in Boston would do the same thing. Not for competitive purposes, but to show the public that we were all willing to be held accountable and to demonstrate our commitments to quality improvement.

The response was either underwhelming or hostile. I received arguments against the idea because “the data wouldn’t be comparable from one hospital to the next,” and “the public won’t understand it.”

The Center for Medicaid and Medicare Services has started reporting data through a tool called Hospital Compare where consumers can compare a number of quality measures between hospitals. It’s a great tool. But I’m unsure how many consumers are privy to the knowledge that giving aspirin upon arrival can improve the care for AMI (heart attack).

I don’t think we should resort to combining all quality measures to come up with one less-meaningful all-encompassing measure to rank all hospitals. But we need to make information easier to understand for the average patient. And this is what BIDMC gets exactly right.

Making our organizations completely transparent is seen by some to be a huge risk. That makes one wonder what those organizations could be hiding. Increasing transparency not only helps consumers, it will make us better. And that should be the goal of being transparent: making ourselves accountable to ourselves.

Some more resources here and here, courtesy of Mr. Levy’s blog.

Principle #3: Quality! Make it transparent. Report incessantly. Help (and encourage!) patients to understand it. Look ourselves in the mirror!

Yes, we’ll allow visitors. But it’s the hours we’re getting rid of. If a patient wants visitors for a game of cribbage at 8:00 p.m., good. If a patient wants visitors at 7:30 a.m. for breakfast and 4:00 p.m. for Oprah, better. If a patient wants visitors 24 hours/ 7 days a week, best.

Unrestricted visitation hours. It’s not a new concept, but it’s definitely something we will incorporate into our own system.

Aside from the relevant research claiming improved patient outcomes that come along with unrestricted visitation, it’s (again!) the right thing to do. Tara Parker-Pope writing (way back in 2004) in the Wall Street Journal says:

While visits from family and friends may not seem like a pressing health-care concern, doctors and nurses say there’s growing awareness that family members are a key part of a patient’s recovery, whether it’s to provide information, to alert health-care providers to changes and symptoms or simply to offer emotional support to the patient.

In a (increasingly) competitive market, unrestricted visitation hours can be a distinguishing factor for patients. Parker-Pope continues “Health-care experts say that while the quality of medical care is obviously the biggest priority, visiting policies and other patient-centered services also make a difference in a patient’s recovery, and should be priorities when choosing a hospital.”

Principle #2: unrestricted visitation hours for families. Always! And Forever! No debate! Exceptionless.

WSJ Article reprint status courtesy of the Institute for Healthcare Improvement

Influence: Planetree

A theme last week across the internet was patient-centered care.

Paul Levy started with this post. (BTW - If you happen to be a health care amateur, you should be reading Mr. Levy’s blog. He is the CEO of Beth Israel Deaconess Medical Center and one of only two CEOs that I know of who blogs, and writes on topics that most hospital CEOs wouldn’t.)

Nick Jacobs posted this (he is the other CEO that blogs, he works at Windber Medical Center, a Planetree hospital that seems to have actually made the patient its “first” priority). Mr. Jacobs’ post is in response to CNN news personality Glenn Beck’s personal encounter with the health care industry. The Health Care Blog also picked-up Mr. Beck’s patient-care problem.

As it happens, Mr. Jacobs happens to be at Hospital Impact discussing a recent article in the New York Times that discusses recent research suggesting poor physician/patient communication (really? but, it is a two-way street). Advanced cancer patients don’t seem to be displaying much emotion in the presence of physicians.

Quite a few instances of empathic issues in a relatively short period of time. People often have a strong distaste for hospitals based mostly upon how they are feeling physically when they arrive at the door. We can’t change that. We must recognize that we have an opportunity to change perceptions when a patient seeks care (and if you explore any of the blogs I have linked to in this post you will find multiple examples of providers who deliver exceptional care). What we can change is this: how each and every one of us relates empathetically to patients (including administrators, direct patient care personnel, housekeeping, etc…).

In his book A Whole New Mind, Daniel Pink tells us that the Information Age is over and in its stead is the Conceptual Age (I am a futurist so I really enjoyed the book, but no matter your thoughts on change, read his book, I promise you will enjoy it). Short (doesn’t really do it justice) summary: Traditional left-brain thinking (Pink calls it L-Directed) will give way to right-brain thinking (R-Directed) for several reasons. To deal with this transition we must develop six senses. One of the senses is empathy: “Empathy is the ability to imagine yourself in someone else’s position and to intuit what that person is feeling.” And lovely for us, Pink talks about how empathy directly impacts health care: physicians need to empathize with patients to provide the proper level of care to today’s patients. Medical schools are building communication and empathy skills into their curricula.

This is just a start. As a system we must not depend on our employees entering our facilities with the necessary level of empathic education, we must develop programs to build and foster empathy in every employee that works for us.

And even if empathy doesn’t improve patient care directly (I for one feel that it will, and Pink gives a poignant example in his book), it is the right thing to do as humans.

Principle #1: every employee in our own system works to serve patients. Patient care will be the reason for every decision we make.

UPDATE! Some more on Mr. Beck.