The Point (think Malcolm Gladwell’s “The Tipping Point“) “helps groups of people, large or small, coordinate action and solve the problems they share.”

With any activity that involves a group of people, we want to know that enough others are participating for our contribution to make a difference. Once participation crosses that “tipping point,” people are more than happy to take action. So, on The Point, each user-generated campaign is only “activated” when the tipping point is reached.

The possible uses of The Point are limitless. Form an ultimatum against an unsatisfactory company. Raise money for a group purchase or charity. Broker an agreement between a group of people. Plan an event with your friends. Those are a few we’ve thought of, and you will think of many more. The Point facilitates any situation where people want to know that enough others are committed before they are willing to commit. Now you can know if your contribution will make a difference before you lift a finger or spend a dime.

From Springwise:

To do this, The Point takes the notion of the tipping point—that point at which group action will produce a clear result and inevitable change—and applies it to organizing group efforts. Those who join a campaign pledge to take specific action—to boycott a company, for example, or donate funds toward a cause—but no one actually acts until the campaign reaches its preset tipping point, or number of pledged participants. When that point is reached, however, the action is triggered and participants make their donations, attend the event or boycott the organization. The Point can also be used to organize anonymously until a campaign builds to a level that provides safety in numbers and allows people to reveal their identities comfortably.

It’s a wonderfully cool idea. But you could end up on the wrong side of coolness. Hospitals could be affected in a number of ways: community benefit concerns, organizing providers, unhappy employees, disgusted patients…

What would happen if hospitals competed on quality?

Competition is rare in health care. Really. Health care is full of rivalry. There’s a difference.

From the trusty Merriam-Webster OnLine: competitor: “one selling or buying goods or services in the same market as another;” rival: “one of two or more striving to reach or obtain something that only one can possess.”

I would suppose that rivalry is similar to what Porter calls zero-sum competition.

Competition is healthy and it should force prices down while improving the product delivered. Here’s the problem: prices are not decreasing. And quality is improving—because it is the right thing to do—not because of the forces of competition.

It may be possible to compete on price at some point in the future. But until health insurance is reformed so that patients know how much health care really costs, I just don’t see it happening. If we’re really interested in competition, and competition sooner rather than later, it is going to have to be quality of care that leads the way.

This isn’t a new idea, but I like it, and I think it could go somewhere.  The prevailing question has been “will competition improve quality?” But why not just compete on quality since we’re having such a difficult time competing on price?

CMS is working toward a quality comparison solution.  But its development is slow and functionality minimal.  Quality measures are difficult to agree upon for comparison purposes.  Difficult is the key word here, it is not impossible.  It is another opportunity to be proactive about positive change.  Hospitals are already late: Health 2.0 companies are pushing the comparison tools forward.  Thankfully.

Here’s the question: is your organization hiding behind a rock or leading the way in quality reporting?  Competition on quality could very well be the future.  And if so, the transition will be swift (it won’t be phased in by CMS, it will be forced in by outside forces).  Will you be ready?

A friend was describing her hospital workplace culture recently.  Problem: people rarely smile.

The power of a smile.

The winter months do get long.  Gray is gray is gray.  But I think there is a much larger problem here.  How can we make people truly happy when they come to work in the hospital?  How do we get people to care about the vibe an organization conveys?

(sidebar: check out Gretchen Rubin’s The Happiness Project)

We have to make people care.  (For a relevant metaphorical blog post, read this one by Ben Casnocha)

I believe it goes further than great wages and good benefits.  Those are important, no doubt.  Crafting an enjoyable work environment is vitally important.  Responding to employee needs.  Asking for employee input (secret to success: acting on employee input).  Truly valuing employees is key.  Saying we value employees isn’t it.  Employees that feel valued…is…it.

Not having been in management, I’m unaware of the difficulty in building an employees-are-valued environment. But having worked in a plethora of organizations my list of things not to do is long.  Let’s just say there is plenty of room for improvement.  The thing is, many organizations are not trying to improve.  And that could be a fatal mistake.

It does start at the top.  Step 1: smile when you’re in the building (not every event in a hospital calls for a smile, but make it your default facial expression).  Step 2: ask employees how they are doing and if they need anything to help them do their job better.  Step 3: ask patients if you can do anything to make their visit more comfortable. Step 4: repeat! repeat! repeat!

I do know the first step in making a hospital a warm and inviting place for patients: the workers inside the hospital need to be warm and inviting.  Not groundbreaking.  But I’ve yet to find a place that is perfect.  And if your organization isn’t perfect, why aren’t you working on being so?

Hospitals have most likely responded (let’s hope) to CMS’s decision to not pay for a number of medical problems arising from hospital mistakes.

Good news. CMS has come out with a proposal to not pay for nine more preventable conditions.

Is quality getting the attention it deserves at your hospital?

My guess is (and probably dependent upon your role in the organization) that the answer is “not really.” We all know it is important. BUT! Some hospitals take quality very seriously. Most are just trying to figure out how to prevent the conditions CMS won’t reimburse for. And some hospitals probably shouldn’t be in business. It’s the bell curve. We need to shift that curve to the right.

Hospitals have been entangled in an epic struggle to stay clean since the days of Semmelweis (maybe a few years later). We’ve all seen the posters, maybe participated in a class, possibly evaluated the data. It’s been going on for years.

We know what hand washing (or alcohol sanitizing) can do. Here’s quick refresher if you have forgotten. Yet compliance rates are still poor. What is the problem? My take: accountability.

It’s time to stop paying lip service to quality. High quality is not adding a sentence to a mission statement. It’s not reporting required data to CMS. It’s not telling employees that quality is our top priority.

It is action. As an extreme, think of how good hand washing compliance would be if the person in charge said, “You will wash your hands at every appropriate moment or you will not have a job tomorrow.”

I’m a big fan of a blame-free environment. Report, report, report! But there needs to be balance. From the the New England Journal of Medicine, “But if we really are serious about making care safer, I would argue that we need to find the right balance between blaming mistakes on systems and holding individual providers accountable for their everyday practices.”

We must find the resources to make quality our top priority. Period. In an era when patients will demand to know everything quality-related about our services, we must be ready and willing to comply. CMS has provided the “business case” by ending reimbursements for hospital mistakes (and are working to reinforce the issue by extending the list). The question is, do you want to lead the way (and by proxy, define what high quality is) or slowly follow? The right side of the curve will be filled with leaders. Organizational success will follow.

UPDATE: Coincidentally, two quality related stories today: Cigna is following the CMS lead and the GAO says the feds haven’t done enough to establish quality and infection control guidelines in hospitals

From the Akron Beacon Journal, “Alliance Community Hospital wants to pay you $100 or more to find out how much your health insurer paid for care you received at rival hospitals.”

Hospital’s stated motivation:

Alliance Community Hospital Chief Executive Stan Jonas said the offer is part of the hospital’s attempt to provide consumers with more information about the true cost of medical services.

The hospital plans to share the information eventually on a new Web site.

”We feel that consumers should be able to compare prices before they buy health-care services,” Jonas said. ”We are doing this because we want to prove our value in the marketplace and to provide meaningful comparisons with our own pricing, as well. So in order to help inform consumers, we are seeking information about procedures performed at other hospitals.”

Typical insurer response:

”To the best of my knowledge, this appears to be a new type of initiative,” said Richard Waldron, director of provider networks for Medical Mutual of Ohio. ”While we support the concept of transparency, this initiative seems problematic. Looking through EOBs from unrelated facilities poses issues of data collection, interpretation and validity. Moreover, there may be numerous legal issues inherent in such an effort.”

It would be terrific if transparency is the true motivation. But a hospital isn’t going to shell out that kind of money just so patients can compare prices between hospitals. I have a feeling a competitive market is at least a factor in the decision…

This gem also from the article, “In recent years, ”transparency” has become a buzzword in the medical industry as patients are being forced to foot a higher percentage of the bill.”

Ahh, shouldn’t high quality care be reason number one for transparency?

UPDATE: InsureBlog covers the story and adds a tidbit I was too careless to find: the hospital’s CEO has a blog.

Last week, Marketplace had a story about a medical-legal partnership that is helping to reduce the cost of health care in the U.S.

The innovative partnerships—which are popping up around the country—are hiring “attorneys to help fight illness and disease among the poor.”

Poor families, with no alternative, bring their sick children to the emergency room. Not only is this about the most expensive way to get healthcare, the conditions that bring impoverished kids back to the ER again and again are often preventable. Ellen Lawton is executive director of the Medical-Legal Partnership for Children at Boston Medical Center.

Marketplace describes how the partnership can help, “Say a disadvantaged child lives in an apartment with a leaky pipe. The landlord refuses to fix it, even though the leak is causing mold, and mold can trigger respiratory problems.”  The partnership then makes the situation officially legal and forces the landlord to act.

Dr. Barry Zuckerman of the Boston Medical Center explains the value of the partnership to the hospital:

So our lawyers, by helping out the patients, actually also accrues value in dollars to the hospital, because in many cases they can find that such-and-such a condition was covered, and the hospital should be paid for the services that was provided to the patient.

The partnerships are quickly expanding (now number over 80) and are targeting the problems of patients at a variety of ages with a variety of conditions.  The medical-legal partnership may have created strange bedfellows but it’s proving positive outcomes.  Are there other partnerships that could help us attack health care’s issues?  Local government?  Other non-profit agencies?  Business?  We can, and should, all work together to solve our many issues.

So the effect of Free on health care is not a question of if or when, but more like how much?

And we may be starting to see some real impact.   Are more informed patients going to pay the same for health care services?  We want patients to be involved in their care, will there be price differences for those decide to be more involved? Patients as co-producers of health (!) are going to change the way we deliver health care.

PatientsLikeMe is “a community of patients, doctors, and organizations that inspires, informs, and empowers individuals. We’re committed to providing patients with access to the tools, information, and experiences that they need to take control of their disease.”  They are committed to helping those suffering from disease share information about their treatments, and the community members share a lot of information (way more than HIPAA would allow, which is largely the point).

Thomas Goetz wrote a terrific article titled “Practicing Patients,” it is worth the few minutes it takes to read.  Lots of good stuff.  Mr. Goetz does a great job outlining the difficulties the web presents to health care.

When patients take the reins of their own treatment, what role do doctors play? What’s to keep patients from misinterpreting the streams of data and finding false hope — and what’s stopping them from embarking on unproven and even risky treatments or dosages? And what happens if the real-world information at PatientsLikeMe contradicts the clinically proved protocols of medical science?

The article says PatientsLikeMe allows community members to compare treatment plans and patients are changing their drug regimen, for example, sometimes without the advice of a doctor.

In fact, some PatientsLikeMe members have already started doing pretty much what Ensrud warns against. Last November, the A.L.S. community was abuzz with word that researchers in Italy had found that taking lithium seemed to slow the progression of A.L.S. significantly. The Italian study hadn’t actually been published yet, but that didn’t stop 34 members with A.L.S. from soliciting lithium prescriptions from their doctors and coalescing into an ad-hoc clinical trial. There are now 109 members using lithium and tracking their progress with the data tools on the site. The company has rolled out new features to monitor the group with the hope that they will be able to lend a little credence — or cast a little doubt — on the Italian study in a matter of months.

Jamie insists that PatientsLikeMe isn’t encouraging A.L.S. members to start taking lithium. But he is unmistakably excited by the endeavor. As he sees it, the experiment perfectly illustrates how PatientsLikeMe might complement large-scale and long-term clinical research by conducting observational research “on the fly.” Drawing on the notion of personalized medicine, Jamie calls this “personalized research.” And it has a certain logic: for those who already have A.L.S., traditional science works at far too plodding a pace. “The system is broken for terminally ill patients,” says Hanns Riederer, a music producer in Los Angeles who has joined the group of A.L.S. members taking lithium. “It makes us wait five to seven years for results, when we don’t even have that time. Even if it’s half-true, it’s still groundbreaking. I don’t want to wait for something else. I don’t have time to wait.”

The demands that patients are placing on medicine today are high.  The co-producing patient is placing pressures (time and otherwise) on providers that is extending already overextended professionals.  This press release from Science Daily,  “Doctor Who? Are Patients Making Clinical Decisions?” reports a study that indicates, “Doctors are adjusting their bedside manner as better informed patients make ever-increasing demands and expect to be listened to, and fully involved, in clinical decisions that directly affect their care.”

Today’s patients do not simply have a medical complaint, they desire a particular operation and sometimes even a particular implant. The doctor is no longer the sole source of medical information. Patients have enough snippets of information to stimulate a dialogue and clearly express their expectations for a particular outcome and technique to achieve that outcome. They are also demanding quicker recovery, return to higher-level sport activity and earlier discharge from the hospital.

Finally, Dr. Jim Yong Kim, a Harvard Medical School professor, has a made a call for the creation of a “new science of healthcare delivery that would systematically evaluate which techniques worked and which didn’t.”  We need it.  The changes above are just a few of the new pressures on our health care system and finding the best ways to deliver care is a must.  “While treatments have multiplied, the operations and processes for delivering those medicines haven’t kept pace, slowing health improvement in developing and developed countries.”

(h/t: TP Wire Service)

The New York Times has an article today (in the Fashion and Style section no less) on the competition that medical students encounter for high-paying specialties—specifically dermatology and plastic surgery.

We all know the issue, but just in case:

“It is an unfortunate circumstance that you can spend an hour with a patient treating them for diabetes and hypertension and make $100, or you can do Botox and make $2,000 in the same time,” said Dr. Eric C. Parlette, 35, a dermatologist in Chestnut Hill, Mass., who chose his field because he wanted to perform procedures, like skin-cancer surgery and cosmetic treatments, while keeping regular hours and earning a rewarding salary.

Medical school professors and administrators say such discrepancies are dissuading some top students at American medical schools from entering fields, like family medicine, that manage the most prevalent serious illnesses. They are being replaced in part by graduates of foreign medical schools, some of whom return to their home countries to practice.

Although out of context, this quote is quite scary: “Last year, the school (Emory University) enlarged its incoming class, hoping more students would specialize in the major diseases and preventative care.”

With medical students leaving school with debt loads in the hundreds of thousands of dollars, “hoping” will do nothing.  Changing incentives (reimbursements, loan forgiveness, etc.) will.

Free (paying nothing, receiving something) is definitely here. Well, it’s been “here” for a long time. It’s just acknowledged now. The web is built on free and its implications are widespread, blanketing every industry…and that includes health care. We have reached the point that any new business is seemingly building itself upon the Free model. As for health care and “old business,” the Free concept must not be ignored.

My discovery of Free insight transpired over the course of a few weeks and it started with Chris Anderson’s FREE! article in Wired, which is also the title of his upcoming book. Then I came across “Free Love” at Trend Watching. And then Free spread with many weighing in across the intraweb. PSFK has some highlights of Free. Blogspotting mentions our (humans) infatuation with Free and asks how to make a living on Free. As Seth Godin writes, the interaction completely changes when something is Free, “There is no commitment, one way or the other, for free.”

Health care analysis started with Health Populi and the free implications on health care information technology, especially web based Health 2.0 applications. This is a good place to start the Free health care discussion—it’s the first aspect of health care delivery to move digital—because as Chris Anderson says, “Every industry that becomes digital, eventually becomes free.”

The broader implications of Free health care are sure to send any old economy organization/service provider running. Look at some of the services that have gone digital, services that people once shelled out significant money for: university classes (download an entire MIT class or view lectures at UC Berkeley), scientific knowledge (a new(er) group of journals at PLoS allows the viewing of articles for free), communication (think of the email, instant messaging, or Skype calls one can do on free wireless networks), the list could go on for a quite a while.

Fred Fortin at the World Health Care Blog goes further in analysis, “The real and most interesting question has to do with the impact of free healthcare on those aspects of healthcare for which we pay dearly.” As we know, a provider’s response to payer reimbursement cuts is simple: increase volume. When actual health care services delivery is wholly affected by Free, volume increases will do nothing to supplement an entire decrease in reimbursement. It’s happening already, primary care physicians exchange email and phone calls with patients, in essence providing care, but unfortunately are not being paid for it. The real bad news for physicians, as is demonstrated by the music industry, is that once you start providing a service for Free, there is no way to return to the model of compensation, no matter the amount of litigation.

As we increasingly push health care digital (read: the web), how can we create value in a world dominated by Free? The important debate: not how can we prevent health care from becoming Free but how to add value in order to make money.

Kevin Kelly at The Technium offers, what else but, some free advice: It starts with examination from the user’s perspective, “why would we ever pay for anything that we could get for free?” Mr. Kelly goes on to describe eight generatives to combat free. “A generative value is a quality or attribute that must be generated, grown, cultivated, nurtured. A generative thing can not be copied, cloned, faked, replicated, counterfeited, or reproduced. It is generated uniquely, in place, over time.” Read about them here. Four generatives that I think will have the largest impact on health care: immediacy, personalization, interpretation, and findability. Feel free to comment on your thoughts.

But here’s the good news, the World Health Care Blog asks, “Healthcare is a late bloomer when it comes to the information technology revolution, but it will, as they say, suffer from 100 percent of the effects of that technology. Are we prepared and being mindful of the changes all around us? That remains to be seen.” As recently reported in The New York Times, late adopters are important in the technology adoption cycle.

The health care industry, being the late bloomer that it is (that’s putting it nicely), allows itself to learn from the trials and tribulations of the rest of the industrialized world. The feet dragging in health care gives us a window (although quickly closing it is) to research, test, and implement models that will work. Some have already started, don’t be left behind.

60 Minutes had an interview with Dennis and Kimberly Quaid Sunday evening, see video here.

The Quaid’s, if you will remember, went through a scary ordeal several months ago as their newborn twins were administered Heparin 1000 times that of which was prescribed. The gist of the story is that it was a preventable medical error—and was eerily similar to the 2006 events that transpired to sextuplets in Indiana, killing three.

Cedars Sinai is prominently displayed in the 60 Minutes piece and has received an abundance of negative press over the error. The thing about it, and the public is beginning to find this out, is that preventable medical errors happen quite often. In fact, the Institute of Medicine says 1.5 million people a year are injured as a result of medical errors. The Quaid’s have filed a lawsuit against Baxter, the maker of Heparin; to this point they have decided against filing a lawsuit against Cedars Sinai. The family is also starting a foundation to reduce medical errors.

I see a series of outcomes from this scenario: the call for higher quality in hospitals is only going to intensify. As Americans become more aware of the issues inside hospitals, the pressure for hospitals to rectify those issues will only increase. But here’s the problem: many hospitals will turn and run from transparency (yes, efforts to improve quality are happening everywhere, just not reported all the time), becoming even more secretive about avoidable mistakes to prevent the negative media onslaught that could occur.

That’s completely the wrong thing to do. The right thing to do is to start reporting everything publicly. More transparency is what is required here, not less. As I’ve written before, “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.”