I riffed on presenting well here.

Here’s some cool data presentation help via The New York Times via TP Wire Service.

New hero: Phillip Newbold, CEO of Memorial Hospital in South Bend, IN, and the self-described “champion of innovation” at the hospital.  The hospital’s website is Quality of Life dot org, tremendous!

See previous posts on innovation centers here and here and here and here.

The Wall Street Journal brings news of the coolest innovation center yet:

The Innovation Café is an unusual teaching laboratory created by Philip A. Newbold, the veteran chief executive of this midsize community hospital and health system. He converted a failed delicatessen into a venue where staffers and outsiders can learn to craft new ideas.

[snip]

It was a tour of an innovation training center for Whirlpool staffers that sparked the establishment of his teaching lab. He persuaded his employer to become the first U.S. community hospital with an innovation research-and-development budget. The board committed up to 1% of annual revenue for innovation activities. That equals about $4 million a year. The hospital ended up spending just $195,000 in 2005, $622,000 in 2006 and $711,000 in 2007 on innovation efforts such as venture start-up costs and staff training. But the increase in related operating profit was as much as three times the annual expenditure.

Other cool stuff from Mr. Newbold: visits other innovative businesses, rewards staff for “good tries,” developed private label health drink through strategic partnership, worked with IDEO, developed a cryo tank, and shares his innovation ideas with others in the health care field.

Be thankful that Maggie Mahar blogs: The crux of our problem.  Fix primary care to fix health care.

A month ago, a fellow MHA friend told me about a conversation he had on the golf course with a current MBA student.  Though not friends, it turns out the two had something in common: they were both interested in jobs in the health care field.  The MHA friend then asked the MBAer, “Why health care?”

The MBAer’s response?  “For the money.”

Insert appropriate jaw drop here.

The above conversation transpired around the same time of a couple of synchronistic news stories.

Ohio execs sentenced for $1.9B fraud

Memorial Regional Hospital Administrator Resigns

3 Southern California hospitals accused of using homeless for fraud

The shady dealings of some health care leaders prompted a few blogosphere conversations (as well it should) on the poor decision making skills of accused (see above) leaders.  Not everyone puts the needs of patients first, occasionaly money gets in the way.

Much of the debate surrounded a licensure process for hospital CEOs.  While that type of credential is unlikely to keep out fraudulent individuals, it would provide a base level of knowledge for health care executives.  And isn’t that what a license is all about anyway, knowledge?  If that’s the case, then we already have a process in place: Fellow of the American College of Healthcare Executives.  If it is a “board certified” CEO that a hospital seeks, requiring that individual to be a Fellow of ACHE seems to be a solution.

But that doesn’t solve the general problem of improving decision making as a leader.  A lack of knowledge  is a factor in poor decision making.  We know that the complexities of both medicine and health care are tremendous—it seems nearly impossible to expect any one person to be well versed in both.  While I have no statistics to back this up, my assumption is that the physicians who do decide to take on executive roles often end up dedicating the majority of their time to the business role over the clinical role.

This is how a hospital should work: physicians have knowledge of the business side and the business people have knowledge of the medical side.

One of the solutions proposed in the Health Beat post is this:

In an article titled “Physician as Hospital Chief Executive” published in Vascular and Endovascular Surgery earlier this year, Robert E. Falcone, MD Bhagwan Satiani, MD, MBA, go a step further, suggesting that, perhaps, the management of medical care is so important that it should be left to doctors.

I don’t think that is necessary.  But it is imperative that health care leaders (the ones without medical degrees, me) be able to completely understand both the business and medical ramifications of a decision.  But how?

Listen.

A former summer job (laborer) taught me an important lesson on the power of a can of soda on a hot day.  It does two things: 1) breaks down barriers and 2) provides an insightful look at the front line.  The lesson: given the opportunity and due respect, people are more than willing to explain what is important.  But you have to listen.

Instead of perching in a top-floor office find the information necessary to make an intelligent decision that balances the needs of all stakeholders.  The “power-of-one” observation is a principle of former Medtronic CEO Bill George.  The system often gets in the way of successful communication.  The importance of some decisions is such that the only information that matters is straight from the source.

As written in “How the Wise Decide:”

What George and other leaders who diligently practice the principle of Going to the Source understand is that firsthand information is the best information. It is unfiltered by others, it provides subtle details and nuances that are lost in Power Point presentations and, most important of all, it shows us reality in all its messy details and emotion. Without face-to-face encounters with the people who are driving the future of your business, you will miss out on the power of emotional input.

How did he make it happen?

Bill George knew the tremendous value that derives from making power-of-one observations. In any given year he spent an astounding two thirds of his time in the field gathering first-hand information. Not many CEOs can find a way to do that, but George set up a senior management team that took care of other matters to allow him to get out of the office.

Read about Mr. George’s “power-of-one” observation here, here, and here.

Find the source.  Listen.  Intently.  So we can avoid future iterations of this.

From FierceHealthcare on Aug 22:

Despite the subprime mortgage-fueled financial markets meltdown, ongoing problems in the U.S. economy and ongoing pressure on margins, things weren’t too bad for not-for-profit hospitals in 2007 according to financial industry ratings firm Moody’s Investors Service. After reviewing audited fiscal 2007 financial statements for 410 non-profits, the firm concluded that operating performance and liquidity remained stable for non-profits last year.

From Kaiser Network on Aug 26:

Downgrades in the credit ratings of U.S. not-for-profit health care systems and hospitals exceeded upgrades by a 2-to-1 ratio this year for the first time since 2003, according to a report released on Monday by Standard & Poor’s Ratings Services, the Arkansas Democrat-Gazette reports.  The report examined trends at the 138 not-for-profit health care systems and 470 stand-alone hospitals that S&P rates.

Excerpts they are, but it seems like two different conclusions, no?

I’ve called it mandatory at the organizational level.  But what about at the regulatory level?

Typical health care: creating a mandate to do the right thing (tip of the hat: The Health Care Blog).

Sad, but true: one of the most visited posts on this blog is Billy Mays’ foray into hawking health insurance.

Jessica Hagy’s Indexed provides wit related to the above (and a much better attempt at humorizing it).  More often than not, my thoughts on her wonderful work manifest into some variation of “Huh, so true.”

Have you ever walked through the halls of a medical center and noticed the busied nature of all the people inside?  Their rushed existence to get from point a to point b?

As the great John Lennon espoused, “Life is what happens to you while you’re busy making other plans.”

Health care happens while we plan for the future.

In a health care system with many big, challenging issues, it’s easy to forget the problems that plague us on a daily basis.  The forgotten hand wash.  The misguided patient.  The uneasy interaction of a stressed doctor and a busy nurse.  The elements of health care that affect direct delivery to the patient.  They’re overlooked for the hundreds of thousand square foot tower expansion, the hiring of the latest super specialist, and the acquisition of the greatest MRI machine.

Health care takes place between the big decisions.  And sometimes those who lead health care forget that.  There are a lot of small improvements organizations can make on a daily basis that will improve the health care we deliver, it will improve the satisfaction that patients have with our organizations, and it will help us improve our financial situations.

But how do we do that?  How do we find the areas that we need improvement?  We notice, or rather, super notice.

Steve Portigal and Dan Soltzberg published a dialog in Gain (via kottke) “about the importance of being aware and the advantages of tapping into your ’super-noticing power’ in practicing design and specifically in user research.”

Mr Soltzberg:

It is ironic: people don’t notice that noticing is important! Or that they’re already doing it. It’s kind of like breathing—we’re not usually that aware of it. It’s much easier to recognize more “outbound” activities like brainstorming, testing, designing, refining. But noticing is just as important—it’s really where everything begins. There’s a funny Zen saying about that: “Don’t just do something, sit there.” It’s a reminder to let yourself take things in as well as output them.

In the hustle bustled, go-go-go environment that is health care today, it’s easy to stop noticing the issues that plague us on a daily basis.  But those daily issues are how we can improve health care today.  The issues that we don’t have to wait for anyone else to fix.

But noticing is a concerted effort.  It’s a process of pattern finding as Mr. Portigal comments:

This process of noticing once and then noticing again is how you start finding patterns and uncovering themes.

To embrace the power of super-noticing we must release ourselves from our ideas and thoughts and preconceptions of what’s going on.  We must notice, super notice, bias free.  See what is happening.  Experience what is happening.  Do something about it.

Mr. Soltzberg:

Which really supports what we were talking about earlier, that it all begins with noticing. There’s another classic Zen concept that everything you need to know and experience is already happening and present, but you need to get your old ways of thinking out of the way so you can experience it. Doing contextual research is like using “super-noticing power” to peel back those layers of preconception, culture and habit. When you do that you get to something fundamental and then you’ve got a really solid platform for developing new concepts.

Principle #32: Spend time super noticing.  Do it every day.  our own system will make a commitment to finding the everyday problems that prevent us from becoming a superior health care delivery organization.  We’ll also do something about them.  Planning for the future is important, too.  However, we must not forget the now.  Health care happens in the trenches, we need to focus on solutions that improve those conditions.

Wal-Mart is opening its first Marketside store (yes, that Wal-Mart).  The concept is a 15,000 square foot (much, much smaller than the Super Wal-Mart) neighborhood market.  It’s meant to compete with Tesco’s Fresh & Easy entrance into the United States.

The Financial Times reports the new concept “marks a dramatic break with the branding of the rest of Wal-Mart’s more than 3,400 low-cost US stores.”

What does this have to do with health care?

The trend.  It’s smaller, manageable, intimate, community-like.  If a Super Wal-Mart is 1000+ bed quaternary hospital, then a Marketside neighborhood market is a … to be determined.

Some may think it’s a retail clinic, but the analogy doesn’t hold here.  The retail clinic depends on the foot traffic generated by the big box retailer or pharmacy.  It’s not a specialty hospital either, not enough product offerings.  Most likely it’s a health delivery concept that hasn’t reached the masses yet, like the medical home or micro practice.

Regardless of what it actually is, the concept of neighborhood health care delivery is much more desireable than the mass production of a primary care clinic attached to a super hospital.

Jen McCabe Gorman passed along a link to a video via Twitter Tuesday.  It’s a Modern Healthcare highlight reel of the Rocky Mountain Roundtable 2008.  The theme of the short footage is generally about bettering wellness prevention and chronic disease management.

Reed Tuckson, executive vice president and chief of medical affairs at UnitedHealth Group, emphasized community solutions, especially community-based health centers for all patients.

Dr. Tuckson’s talk focused on a four-step approach to improving prevention efforts and disease management:

1. Better leadership

2. Better strategic planning

3. Support research

4. Integrate prevention into clinical care through IT

All good points.  However, his quote about step two is bothersome.  Dr. Tuckson said, “We gotta get better strategic planning, we play around with prevention. ‘I heard a good idea the other day, let’s try that.’  That’s foolishness.  We need data, information that’s locally specific that says ‘here are the problems in our zip code and here are things we need to get at.’”

If trying new ideas is foolishness, fools are what we should aspire to be.

Granted, planning around prevention would improve through locally gathered data.  It would tell us a community’s greatest needs and then we would apply proven methods to address them.  That’s fantastic.  And some day it may work like that.

But varying needs will require solutions of many different feathers.  How do we find such solutions?  When researchers, doctors, public health officials, citizens, patients, etc. say, “I heard a good idea the other day, let’s try that.”

Tom Peters:

If Randomness Rules then your only defense is the so-called “law of large numbers”—that is, success follows from tryin’ enough stuff so that the odds of doin’ something right tilt your way; in my speeches I declare that the only thing I’ve truly learned “for sure” in the last 40 years is “Try more stuff than the other guy”—there is no poetic license here, I mean it.

You have to try stuff to find winners.

It’s wonderful to hear an executive from a private insurer pushing these ideas.  But throwing out the engine (good ideas) that will create innovative solutions to solve our oppressing health care issues is unwise.