Did a Pittsburgh Hospital Try to Kill my Mother-in-Law?

On Tuesday, October 25, my mother-in-law entered a prominent Pittsburgh hospital to undergo a routine surgical procedure. She was at the hospital to have cataract surgery performed. Before getting into her situation, the following factual information should be disclosed.

This year, great medical newspapers, like the Pittsburgh Post-Gazette have reported that nearly 2,000,000 U.S. citizens acquire an infection as a consequence of treatment in a U.S. hospital and that 90,000 people die as a consequence. The average hospital infection rate is five percent of all hospital admissions. The death rate is higher than the death rate of breast cancer. A copy of the official report can be found in an online newspaper: www.governing.com.

So, back to my mother-in—law. I must say that each person who treated her and prepared her for surgery was very nice to her. Each staff member was courteous and respectful of this 84 year old mother, grandmother and great-grandmother.

In the interest of time, let me focus on the pre-operative observations. One nurse, to be delicate, was ministering to the needs of her nose with her fingers and hand. She immediately went to a man and administered eye drops to his eyes and then to my mother-in-law to put in her eye drops. All three procedures were ungloved, done in rapid succession; no hand washing was performed. As a matter of fact, not one nurse nor employee in the pre-operative setting wore gloves as they prepared a group of patients for surgery. Another nurse had an interesting pre-surgical technique. She reviewed the medical record of each patient by putting two of her fingers in her mouth every time she turned a page in the medical record and then, without washing her hands, pulled back the eye lids of an elderly gentleman to examine his eye and surrounding tissues. Another nurse had something; ironically, bothering her eyes and rubbed her eyes with two fists and then, without washing her hand or wearing gloves, continued to touch the tissues surrounding the eyes of the patients being prepared for surgery.

Why did I not say something to someone in charge? Here are several lame excuses:

1. I knew my mother-in-law would have been uncomfortable with me complaining about her treatment, just before going to surgery.

2. Even though this is a form of “Russian Roulette”, I knew the odds were in her favor. Nineteen of twenty patients escape the American hospital without an infection.

3. Somewhere in my base fears was the anxiety that someone would retaliate or insult my mother-in-law because of my complaining.

4. Last, and the most honest answer, despite all of my bluster in writing, when the chips were down, I was gutless to say something in my mother-in-law’s defense.

I am truly ashamed. I love my mother-in-law. She has been feeding me for nearly forty years.

So, why are healthcare personnel so sloppy when it comes to the most basic and, perhaps, the most important infection control technique - hand washing.

That answer is deeply rooted in a very simple explanation. Hospital organizations are generally not organized or managed to change the culture with respect to infection control. How can I be so sure? Well, you do not have to go very far in Pittsburgh to dismiss two myths about infection control:

Myth # 1: Infections are an inevitable consequence of interacting with the American Hospital.
Allegheny General Hospital has provided national leadership in demonstrating that the impossible can be attained in eliminating hospital acquired infections through a commitment to patient safety and process improvement. Their achievements are well documented, and the leadership of Allegheny General Hospital does not need me to tell their story. They are among a growing number of hospitals that are fighting back against cultural norms that permit sloppy infection control practices.

Myth # 2: Nurses and physicians are too busy to wash their hands.
In many hospital settings, this is not a myth. Nurses are frequently sent out to do the impossible without appropriate support, tools or training to be effective in their advocacy for the patient. A recent feature article in Newsweek singled out the nursing leadership of UPMC Shadyside Hospital for fundamentally reorganizing nursing to eliminate the sense of chaos so often experienced by practicing nurses. And, the nurses and nursing leadership at UPMC Shadyside Hospital have not stopped in their efforts to continue improving the working conditions for nurses at the hospital. Guess what? The nurses not only have time to wash their hands, they have time to wash their hands properly.

No, the unnamed Pittsburgh hospital was not trying to kill my mother-in-law. The nurses involved in her pre-operative care would be shocked to read this. They were nice people working in a hospital that has established low expectations for them.

My mother-in-law had a favorable surgical outcome as expected and did not acquire an infection. One in twenty mothers-in-law is not so lucky.

Republished with permission from the Hospital News Group

High Technology Leads a Double Life

Who does not own a cell phone? You hear them ringing when you watch a movie. Sitting in a typical restaurant is like a scene from Saturday Night Live; every third person is talking to someone about something that is annoying to the other patrons. As a frequent flyer, my favorite experience is sitting in wait to board my plane. Men and women talk into their cell phones disclosing confidential and sensitive information about their companies and clients that would have them terminated if known to their employers.

No, these descriptions of the ubiquitous cell phones are not what is on my mind today. What I am interested in today is buying a cell phone or getting service for a cell phone. I am not going to mention my "cellular technology service provider" (notice we don't say "company" any longer) because I fear they will call me on my cell phone!

Recently I went to buy a new cell phone. I wanted to move up the food chain of new and improved cellular technology. As I entered the store, I was greeted by a woman with a pleasant countenance who directed me to a sign-in kiosk. I obediently complied. I gave up my name, cell phone number and other information irrelevant to my visit. It turns out that the kiosk was used to determine what place in line I would be assigned.

Then, while standing in a showroom that gave testimony to breathtaking time-saving technology, I waited and waited and waited. Finally, I heard my name called out. I was greeted by a young fellow who was deeply in need of a personality transplant. He seemed remarkably less human than the kiosk. We went to his standing desk and were separated by his desk and a computer. He stared into the computer screen and began asking me a series of questions, most of which I had provided to the kiosk. Okay, the poor fellow has a job to do. Without his ever making eye contact with me, the divine liturgy of buying cellular technology was in full swing. He worked over his keyboard with such determination. Most of the typing was done without asking any questions. It had a life of its own. He could have been writing the great American novel for all I knew.

Finally, I told him why I was there. Never looking up, he told me I have seventeen options. What do I know? I inquired what he thought might be best for my circumstance? He replied, “. . . How would I know anything about your circumstance?” I guess that is a fair question, but it was not so friendly. I was on the defensive with all of my ignorance in full view. I sucked down my emotions and continued to participate. I made a selection on a par with selecting cantaloupe in the summer. Sometimes it is hard to know if you have made the right selection. One thing is certain, sniffing cell phones does not help one bit.

The purchase was complete . . . sort of. Then the paperwork started. It was printed out of view beneath the computer in the stand up desk. I signed more paperwork than at the closing on my last home. The receipt was three feet long. Then came another three-foot receipt to mail in with a bar code from the package containing my cell phone so I might receive a $50.00 rebate. I get the impression they do not expect people as busy as me to mail too many of these cut-out bar codes and three-foot long receipts very often, or they would simply reduce the price of the cell phone. This is all very much unappreciated.

This experience lasted one hour and fifteen minutes. Remember, I am standing in a cathedral of advanced technology designed to make life more convenient and save time.

So, high technology lives a double life. The engineers of cellular technology have not spent much time engineering their retail stores. I exited the store with a magnificent PDA cell phone combination. Why did I not feel good about my new found technology? The answer is simple. For one hour and fifteen minutes, I was treated like I was an inanimate object . . . not a human being. This second life of the technology industry should change. In fact, the company that learns how to treat customers like human beings is likely to grow like a weed, even if they do not have the absolute best cell phone. Maybe I am just too sensitive. Maybe I am right.

Jan Jennings

Republished with permission from the Hospital News Group

Customer Service

Why can’t Mr. Goodman’s example help us in healthcare?

My childhood was centered in a working-class bedroom community near Pittsburgh and just outside of McKeesport, Pennsylvania. McKeesport was a typical Western Pennsylvania mill town. U. S. Steel was booming, and the centerpiece was the U. S. Steel National Tube Works.

Saturday was a big day for us. We would go shopping in McKeesport. It was a mysterious and exciting experience, with dozens of foreign languages being spoken on every corner of Fifth Avenue. My parents were both born on peanut farms in Virginia. This was all very strange to them as well.

There were all kinds of stores, and the city was bustling in the 1950’s. There was one store that was first among equals, at least for my family. It was the Goodman’s Jewelry Store. It was a family business, and the senior Mr. Goodman, through my ten-year-old eyes, was probably 200 years old. He had a very serious looking and craggy face. But could he dress. To this day I always think of him as the best dressed man I ever saw. He had two sons in the business, and I suspect there were other family members involved as well. The store was always sparkling clean and lighted to show off the items for sale.

This store was special to our family. Somehow the Goodmans learned and remembered our names, all of our names. They were patient as my mother looked over all of the wonderful items we could never afford. The Goodmans had a kind and gentle spirit and found a way to steer my parents to items they both wanted and could afford. The Goodman men could wait on two or three people at one time and never seemed flustered or inattentive to their customers’ needs. When Mr. Goodman saw one of my parents agonizing over the price of something they really wanted to buy, they almost always would find a way to provide a discount on the item. In doing so, it was always done with grace and never embarrassing to my parents. Occasionally, one of my parents would purchase something for the other that was a little over our heads. Mr. Goodman would escort one of my parents to a corner glass case, and he would fill out a slip and put their purchase on a monthly payment plan. They never asked for a social security number, references, employer information, banking relationships, net worth, prior income tax filings or distinguishable birthmarks. There was no credit card or charge plate like some of the other stores, and they would mail a monthly bill which my parents would pay promptly. My parents respected the owners of the Goodman’s Jewelry Store because they were always treated with kindness and respect any time they visited the store, in good times and in bad. The Goodman Family never treated us like “Southern hicks,” like so many other people did.

It is interesting that sometimes we noticed that the Goodmans did not agree with one another about one thing or another. We have no idea what these little snits were about because they maintained them in the privacy of speaking Yiddish. Their desire and commitment to exclude their customers from their internal disagreements were both fascinating and appreciated. They were always tougher on each other than they were on us . . . their treasured customers.

Although an unusual item for a jewelry store, in 1959, my parents bought me my first electric typewriter at Goodmans. It came with a gray steel typing stand, and I used it faithfully for ten years until I graduated from college. My love for writing down my thoughts originated with that little typewriter. It was Mr. Goodman who recommended it to my parents. He thought I would need it as I prepared for my future.

There were Sunday afternoon drives when we would drive through the better neighborhoods of McKeesport and became familiar with the location of the Goodman home. It was a beautiful place, modest by today’s standards. It is clear to me now that the Goodmans did not get rich serving that community, but they were always first to contribute to the local schools, police and fire departments and countless other local charities. They were Jewish, and we were Christian. It did not matter to them, and it did not matter to us.

In 1968 I asked a woman to marry me, and, to my surprise, she said yes. Like a homing pigeon, I and my prospective fiancé and bride-to-be headed for the Goodman’s Jewelry Store. It was no longer near where I lived or would live, and it had been years since I had been there. Everyone in the Goodman family seemed older, and, sadly, the patriarch of the family had passed. To my delight, one of the Goodman brothers remembered me and spent hours with us selecting a diamond and a setting. He took us into a special room he had built that was totally free from any outside light. He showed us examples of cloudy diamonds, flawed stones and provided more information about diamonds than I knew existed. In the end, we bought an engagement ring. When it was time to pay, Mr. Goodman pulled me aside and told me he would extend the same credit arrangements that he had always extended to my father and mother.

Healthcare leaders could learn a lot from the Goodman family. Here are several ideas:

• Remember that it is important to know your patients and families, physicians, board members, auxilians, volunteers and other internal stakeholders. There is no substitute for sincere, honest and face-to-face communication.

• The demonstration of civility and good manners is like throwing a “note in a bottle” into the ocean. It always comes back to enrich the life of someone.

• The internal problems of the hospital or health system should be maintained in private. I am not suggesting a crash course in Yiddish. I am suggesting that it makes stakeholders uncomfortable to see the leadership team of the hospital or health system throwing sand on each other.

• Knowing your programs and services is important. Mr. Goodman’s commanding knowledge about diamonds was an important lesson. I have been with hospital CEO’s who cannot take an outside guest on a tour because they do not know where anything is . . . honest!

• Pricing programs and services and review of the charge master should be used as a strategic and tactical tool, not an assignment of drudgery. Mr. Goodwin used discounts artfully. With his varied pricing strategies he built interest in his business, expanded his market share and bonded loyal customers.

• Seize new programs and services on an opportunistic basis. Mr. Goodman foresaw that the “baby boomers” would be better educated than their parents. His early jump into electric typewriters was a masterstroke. In our consulting practice, we frequently see opportunities for the hospital to meet unfulfilled needs in the community; e.g., diabetic teaching programs and hypertension screening, among others. While these are wonderful opportunities for the hospital, the impact is far greater on the citizens of the community being served.

• The appearance of any organization and its people matters. If you need a hospital and use a rest room that is dirty, the floors look terrible and the hospital personnel are attired like a “rag tag army,” it does not inspire confidence in a place that will control whether you live or die.

• Community service is important. I do not know the inner recesses of Mr. Goodman’s heart, but his sense of duty and service to McKeesport brought him respect that reflected well on him and his business.

• Integrity matters. Mr. Goodman’s name and reputation was his most valuable asset. He nurtured and protected that asset by his predictable business practices. Many hospitals are equally vigilant regarding transparency and corporate compliance; some could learn from Mr. Goodman.

• Consistent fulfillment of commitments will lead to brand name equity and repeat business.

These ten lessons should not be lost on healthcare executives. I wish Mr. Goodman were alive today to read this. I would rather he be alive so I could visit with him and get to know him better. His example meant a lot to me, and I hope it is helpful to you.

Jan Jennings

Republished with permission from the Hospital News Group

The truth, the whole truth and nothing but the truth

Often said . . . rarely practiced

We do not know the author of the oath or expression, “The truth, the whole truth and nothing but the truth.” There is a consensus that it developed in English law courts sometime between 1189 and before the end of the thirteenth century. What is clear is how rarely it is applied to our everyday lives.

In over forty years of gainful employment and thirty-five years of healthcare administration, I can only remember a handful of occasions when someone obviously lied to me. Most people utter the truth and fear not telling the truth.

On the other hand, the whole truth is not a treasured component of our culture. In organizational life, people use filters when sharing information both up and down the chain of command. Ironically, it is probably the CEO and the housekeeper most insulated from a complete view of the state of affairs of the hospital they serve; i.e., the specific hospital’s strengths, weaknesses, opportunities and threats. As I look back over my career I am now aware of numerous examples of truth that oozed out of the organization and to my attention in the most stumblebum manner. Sometimes the truth hurts and people are hesitant to be candid (another component of truth) when dealing with a reporting official. Recently, there has been a growing concern about the accuracy of reporting medical errors and hospital-acquired infections. The impulse to turn away from the truth in these circumstances is understandable on some level.

Similarly, a maxim of human resources management is to disclose to all employees as much organizational information as possible to avoid distrust within the organization and short circuit malicious rumor mongering. Notwithstanding, it is difficult to determine when and how much information to disseminate. I can remember the emergence of the Balanced Budget Act and the management debate of what to share with the employees and how to share it so that it could be effectively understood. Do you insult healthcare staff when the information is too watered down, or do you use provisions from the Federal Register that would make a Philadelphia lawyer dizzy with detail? This can be a daunting challenge.

In our consulting practice, we see hospital management teams that tell the truth to each other but fail to tell each other the whole truth. These are normally good people trying to be polite and, unwittingly, prevent the organization from achieving maximum effectiveness. I know it is easy to pontificate from Mount Olympus. On the other hand, it is so delightful to see the effects of hospital organizations where “the truth, the whole truth and nothing but the truth” is exchanged freely and at the same time strike a balance with civility and good manners.

This may all seem like a lot of nuance or nonsense. It is not. Today’s American hospital is like driving a hospital through a driving rainstorm. Truth can be seen through the windshield of the organization, the “whole truth” is represented by the windshield wipers at full speed. It makes a difference. Find a way to turn on the organizational windshield wipers at all levels, and the roadway to success will be clearer.

Jan Jennings

Republished with permission from the Hospital News Group

When you have hurt feelings, “clear the air”

Recently, I participated in a staff meeting as two people resolved a personal conflict. The emotions were running high. My role was to moderate the discussion and, I guess, make sure no one was injured.

For the purposes of this posting, the subject matter of the office conflict is not relevant. Ironically, I learned something about myself in this session that I did not know. The instant circumstance we were discussing had many factors, but one was a tendency for one of the two parties to harbor a perceived insult, hang on to it and magnify the hurt. As a consequence of not “clearing the air” at the time of the adverse personal incident, the internalized perception of the incident became malignant and toxic to the morale of the individual with hurt feelings. This only worsened the situation and made it more difficult to come to an amicable resolution of the problem.

As this discussion was taking place, I had one of those “ah hah” moments. A light bulb went on that I, too, am inclined to take in an insult, hold it tight, re-live it, nurture the pain and magnify the hurt feelings until it cannot be held in any longer. It makes me feel silly. Recently, I wrote a letter to a person I hold dear and discharged all of the poison I have been harboring for six years of hurt feelings. In retrospect, I should have resolved the problem six years ago, or at least I should have attempted to resolve the problem sooner. I have done this several times before. These missives are filled with noxious gases and venom. So, in the future, it is my furtive prayer to resolve issues sooner. I also have another alternative . . . act like an adult. We all have our feelings hurt from time to time, and learning to deal with them in a mature manner is well advised.

In 1964 when I was in business school, an old professor of business administration suggested that we never "burn bridges behind us." Apparently I am a slow learner. Holding it in and not working it out in short order is not a good idea. Clear the air as soon as possible and avoid writing letters you will live to regret. Clear air is not just for breathing.

Jan Jennings

Republished with permission from the Hospital News Group

Clamoring for Success

In all the years I have served healthcare organizations, I have always been perplexed by hospitals that thrive against all odds and others that wither with clinical and financial resources that would suggest otherwise.

Recently, I met two relatively young brothers who have been extremely successful in business. They own or are partnered with businesses I can barely understand. Now they have turned their attention to healthcare. I am reluctant to share their names, because one of their many well-established business principles and practices is to maintain a very low profile in general, and with the media in particular. Every time I have met with them or discussed a proposal on the telephone I have come away with a deeper respect for their maturity and mastery of a business philosophy that is breathtaking in its clarity. They are bereft of arrogance or hubris. To the contrary, they are sensitive to the people they work with and honor peoples’ lives with respect and dignity.

From all that I have observed and learned from these two individuals, there is one lesson that stands out as first among equals -- clamor for success. What does that mean? The dictionary describes clamoring as vigorously advocating for a better set of conditions. Clamoring is characterized by fanatical commitment and purpose. As applied to business, it is that energy that drives consistent improvement and fends off the status quo. It is the drive to exceed the expectations of customers, employees and business partners. It is the commitment to never pay more for a unit of production than is necessary. We hear these expressions in hospitals all the time, so why is there a difference? These gentlemen mean it. They live it. They are determined to clamor for success, and they are intense.

As I sit at their feet and learn, I can see the answer to my opening question. Many hospital leaders clamor for success, but some do not. Seeking to exceed customer expectations is either a cliché or a fury of thoughtful energy and action. It is one or the other. It cannot be both.
It is with a little bit of "kidding on the level" that I often describe the plight of many hospital CEOs. They get up at 5:30 a.m. and make their way to the 7:00 a.m. Medical Staff Executive Committee (MSEC) meeting. Sometimes the physicians at the meeting, facing their own practice challenges and often unwittingly, spend two or more hours taking out their frustrations on the CEO. Staggering out of the MSEC, the CEO goes to his or her office to meet with Mrs. Schmedlapp (former patient) who has persistently worked to get on the CEO’s calendar. In very earnest terms she explains some moral outrage that occurred when she was a patient in the hospital. Nurse Sprocket spoke to her in a harsh manner, and it made her feel bad. The CEO takes copious notes and promises to look into the matter. At 10:30 a.m. the CFO arrives with more bad news. Somehow the Medicare labor adjustment for the hospital was misstated in the budget, and the hospital will have to make up $600,000 in this year’s budget . . . somehow . . . some way.

The CEO is very assured that they will find a way to do this. At 11:45 a.m. the CEO leaves the building to make a noon presentation to the local Rotary Club. The CEO is not interested in the presentation, and, as it turns out, the Rotarians are not very interested either. At 2:00 p.m. the CEO returns to the hospital to meet with an eager member of his/her staff. This staff member enthusiastically delivers more problems to the CEO’s desk and gives the CEO every opportunity to do the staff member’s job. From 3:00 to 5:30 p.m. the management team assembles for the weekly staff meeting. Most of the meeting is characterized by not making essential decisions, throwing sand on each other and finding a way to avoid controversy. At 6:00 p.m. the CEO arrives at the local country club to have a dinner meeting with a group of physicians to focus on growing discontent about some ill-defined problem. The essence of the meeting is that the physicians just "don’t feel the love like they once did." At 10:00 p.m. the CEO arrives home. He/she is emotionally and physically exhausted. The entire day can be described as a "bucket full of busy."

The CEO who clamors for success finds an alternate approach. He or she finds a way to make the calendar work for the benefit of all stakeholders. Everyone in the organization is encouraged, even coached, to clamor for success. A new and different kind of energy is infused into the organization. People no longer seek to achieve goals. They clamor to exceed the goals. Teamwork replaces politics. Each person in the organization is given a clear understanding of what it means to be a success. To achieve "clamoring for success" requires a change in the culture. To effect this change requires intelligent effort, patience and time. It cannot happen without the CEO going first. Then the senior management teams needs to go through a process of looking at previous efforts in a fresh and imaginative way. Next the department heads need to be enlisted to clamor for the success of the hospital. In truth, it is the department heads that truly run the hospital and control the culture. It is here that the most intense efforts to modify the culture must take place. It can be done if there is the will, determination, consistency of purpose and dedication of appropriate resources.

This is a very different way to run a hospital. Many hospitals do this now. Many do not. If you are in the "do not" column, take this as encouragement to reconsider the organizational priorities and the manner in which business is conducted. Clamoring for success is organizationally infectious if presented and coached properly. Catch the fever.

Jan Jennings

Republished with permission from the Hospital News Group

American Pharmaceutical Industry: Evil at any Price

Over this weekend we got good news and bad news from the FDA. Two similar regimens to treat HIV and AIDS were tentatively approved.

For the United States, a single pill per day drug was approved. This will replace the drug cocktail that HIV positive and AIDS patients have been forced to take in recent years. Here is the bad news, it will be so expensive the American public, Medicare and Medicaid will pay through the nose for this so-called breakthrough. The Medicare Drug program has a very interesting provision that prohibits the Medicare Program from competitive bidding drug purchases. It is enough to make your head spin. When I was a Purchasing Officer for the United States Air Force Medical Service Corps during the Vietnam War, we competitively bid “garden hoses.”

Here we are in 2006 as the only industrialized country on earth that does not competitively bid its publicly purchased medications. The argument is that the United States has a “big heart” and its citizens have to pay for the research and development for new drugs. What is odd about this argument is that so many of the new U.S. marketed pharmaceuticals were, indeed, developed abroad. Most drug companies are now multi-national corporations. Notwithstanding, they have a stranglehold on the United States Congress and the Executive Branch, regardless of political affiliation.

Further, what is the big deal about the science of this new single-dose drug administration? The true breakthrough was getting Bristol-Myers Squibb Company and Gilead Sciences, Inc., to cooperate in compounding existing medications manufactured by their respective firms -- specifically, Squibb’s Sustiva (efavirenz) and Gilead’s Truvada (emtricitabine tenofovir disoproxil fumarate).

What will this cost the American people, the Medicare and Medicaid program? We will find out soon. At the moment, only God knows how the American public will be fleeced to pay for existing drugs compounded and marketed only inside the United States.

Almost comically, this same weekend, the Voice of America reported that a similar approach to drug compounding has tentative approval from the FDA, but it will require two pills per day. The impact of arresting HIV and slowing down the progress of AIDS is the same. The active ingredients in this “two pills per day” regimen are remarkably similar. The drugs are sold under the trade name of Epivir, Retrovir and Viramune. The drugs are lamivudine, zidovudine and nevirapine.

This compounding will be manufactured by a company that may not “ring a bell” for you. The drug company is Aurobindo Pharma in Hyderabad, India. Following is a direct quote from the Voice of America Press Release, “This is the first time the Food and Drug Administration has approved a product like this under the plan. The decision is a tentative approval. That means the product meets all quality and safety requirements for marketing in the United States. Full approval would mean that the product could be sold in the United States. But that is not possible because of patent protections and marketing agreements.”

Wait a minute. I thought we were in support of a global economy. Why are we being denied these Indian medications? When I need to call and ask a technical question about one of my computers, the Indian engineers and technicians are good enough for me and the rest of the American people. Why can we not have the benefit of their pharmaceutical manufacturing expertise?

How about that, “. . . Cannot be sold in the United States . . . because of patent protections and marketing agreements.” In other words, the fifteen countries desperate for these drugs will receive them at reasonable prices because of the moral outrage that these drugs have largely been withheld from them to date.

Stay tuned for the following. You are going to hear a lot about what a wonderful thing this is that American people suffering from HIV or AIDS will only have to take one pill. The public relations campaign will not have much to say about how expensive the pill will cost.

You can also expect to hear how compassionate we are to make similar drugs available to the third world and reduce suffering among those poor people suffering from HIV or AIDS. You will hear less about the fact that this drug regimen will be quite inexpensive.

P.T. Barnum said, “A sucker is born every minute.” When it comes to the American people and the drug industry, you have a financial circus that would give P.T. Barnum a giggle. Do not expect any moral outrage from Washington. The United States Congress is for sale to the highest bidder. I should be clear. This is my opinion. What is your opinion?

Jan Jennings

Republished with permission with from the Hospital News Group

When do two people love one another?

Love has so many meanings it is challenging to talk about love between two people. Some folks love their dogs, a sunset or certain clothes. I love baseball . . . really, I do. I mingle with people who love to go to church or bowling. My friend loves to garden. One of my colleagues loves to see someone sing . . . I think his name is Dave Mathews. There are those of us who love good food. The use of the word “love” has very wide boundaries.

So, what does it mean when two people love one another? I have a working definition based on loving someone for nearly forty years. For me, love is mutual faithfulness, commitment to each others interests, values and sacrifice even to your partner’s whimsy. My belief in God is deeply rooted in the love I have found in the woman I met on a college campus on March 26, 1967. The joy I have found in this relationship has to be related to a power greater than anything on this earth. She has supported me in good times and in bad. She has made sacrifices for me that no man deserves. I pray each morning and each evening that I can be half the man she deserves. We have found love. We are one. We disagree. We are different people. On some level, however, our lives are so intertwined it is hard to know where her life and my life are different. Trust me. This is not like loving baseball.

I know this description is deficient. The reason is I only have words to describe this love. No one could ever reduce to writing the depth of feeling I feel when I look deep into her eyes and her soul touches mine.

Jan Jennings

Republished with permission from the Hospital News Group

Why do Physicians and Nurses make Mistakes?

When will Paul O’Neill receive the recognition he deserves?

Many years ago I left my office to meet the Vice President of Medical Affairs down the hall and in his office. As my door swung open, I noticed the Risk Manager talking with one of our more prominent orthopedic surgeons. I had no idea what they were talking about, but whatever it was, they both seemed very concerned.

Later that day I found out. The Risk Manager requested that he see me on an urgent basis. He informed me that the orthopedic surgeon had reported to him that he had operated on a patient’s knee . . . the wrong knee. How could this possibly have happened? The orthopedic surgeon in relating the mistake told the Risk Manager that, “He just could not understand how it happened; he could not remember what he was thinking about?”

Somewhere in his confusion is the answer. He should have been thinking about one thing . . . operating on the correct knee.

We live in a world that celebrates “multi-tasking.” We can drive a car, talk on the phone, listen to music, comb our hair and play a harmonica all at the same time. Physicians and nurses are human beings, with busy lives and lots of things to think about. They care about their patients and are mortified when they make a mistake. When you accidentally spill a cup of coffee on your host’s carpeting, an apology is usually good enough. When a patient accidentally dies due to a medical error, an apology is normally not enough to satisfy the grieving family. A national consensus within healthcare has developed that we can do a better job . . . a lot better. To see the American Hospital Association touting a program to save 100,000 lives would surprise many people in the general public.

At the root of the extraordinary increase in medical errors is the reality that the number of things we can do to patients has expanded much more rapidly than our safety systems. When one considers the history of aviation, there was a time when airplanes would get thrown together by “barnstormers,” and they would race in a primitive form of “Nascar in the sky.” Accidents were routine. A friend of mine who is a private pilot has opined that if automobiles were regulated as closely as airplanes there would never be an automobile accident due to mechanical error. The Federal Aviation Agency keeps a file on every airplane ever licensed and a record on every part that fails. If a pattern of failure is observed, a plan of correction is developed and mandatorily deployed in the aviation community. Still, we have airplane accidents. They are almost always attributed to “pilot error.”

Medical mistakes are almost always “pilot error.” The consequences in aviation are almost always fatal to the pilot. The consequences of medical errors on physicians and nurses will haunt them for the rest of their lives. Insult to injury is the grief that loved ones feel in the aftermath of a medical error discharged against a member of their family and the associated injury or death.

I am not unfamiliar with commercial aviation. Today is July 1. Since January 1, I have flown 67 commercial flights. I know the routine well. What if it were modified in the following manner? When approaching the gate agent, you are taken aside and asked to sign a multi-paged “consent form” moments before boarding the aircraft. You ask the gate agent what this is about; and he says, “Well, everyone signs these consent forms. By flying on our airplane there is a chance you will be killed or injured. If you are killed or injured, this consent form will absolve the airline from any liability, and you will waive all of your rights and the rights of your family to seek any legal redress. Everyone signs these, and you cannot fly until you sign this form.” You think about this for a moment and then ask, “How risky is this flight?” The gate agent says, “Well, since 1999, there is a consensus in the airline industry that we kill 98,000 passengers annually. We have no idea how many we injure.” You think for a moment and ask, “How many passengers did you kill or injure last year?” He says, “Well, that data is hard to get, and by the time we get the data, it will be about eighteen months old. But, I have some good news! The Association that represents all airline carriers has a campaign to reduce the number of accidental deaths by 90,000 this year. See, I’m wearing one of the buttons as a part of the campaign.” This scenario is so absurd it is hard to take seriously. It is an accurate reflection of where the hospital industry finds itself today.

There are two sides of this issue. One is not so nice. The fact is that the American hospital and the healthcare delivery system, in general, are danger zones. Trying to sugar coat this reality is misguided and unwise. Just as exquisitely engineered multi-million dollar airplanes fall out of the sky as a consequence of "pilot error,” hapless citizens will enter the healthcare delivery system and will be injured or die. The problem as described by knowledgeable observers of the healthcare industry is that it happens too often. We don’t have to save 100,000 people annually from flying in airplanes. Far more people fly each year than are admitted to U.S. hospitals, but we are trying to save 100,000 patient lives from the consequences of interacting with U.S. hospitals.

The second reality, and a lot more optimistic, is we can do a better job and there is a lot we can learn from the aviation community. To avert “pilot error” there are many checks and balances before an airplane leaves the ground. There are checklists that go over hundreds of mundane issues seeking to assure that all aircraft systems are operating properly. None of these tasks are intellectually challenging, but each one must be checked each time an aircraft flies. In contrast, there are fewer such systems in the American hospital. They exist, but it is often considered unnecessary, an insult to healthcare professionals and frequently ignored. One only has to remember the girl who died at Duke University Medical Center because someone failed to follow the “checklist” with respect to checking if her blood type was the same as the donated heart offered for transplant. As a consequence, a sequence of adverse events went into a tail spin, and the young girl died several weeks later. This was an accident that could have been averted.

Like pilots, physicians and nurses have busy lives that involve a lot more than flying airplanes or taking care of patients. The whole system has to be slowed down to make sure that the mundane details are checked and double-checked. It is annoying and time consuming. It has to be done, and it can be done. The work of Paul O’Neill and the Pittsburgh Regional Healthcare Initiative has demonstrated that when physicians and nurses accept this reality they can make an enormous difference.

A related, but equally important, reality is that the American hospital does not enjoy two realities we find in the aviation community; i.e., training and well engineered systems.
As I crisscross the country flying from client to client, I often overhear pilots talking about the need to get their mandatory re-training completed. It is a cost of doing business that is embedded in the aviation business, if you will. The re-education and training of physicians is woefully underfunded and poorly regulated. Hospitals, under cost pressures, have gutted education and in-service education programs to their nurses, other caregivers and employees, in general.

Is it any wonder that patients are frequently the “grist on the mill” of hospitals in which shortcuts are taken, physicians do not receive appropriate continuing education, nurses and others do not receive ongoing education and training and the hospital systems are thrown together by dilettantes?

While it is true that “bad things happen to good people,” it is equally true that “good people do bad things to good people” in the American healthcare delivery system.

Our firm does not have the expertise to make a difference in this area. We do not try. We are not qualified. We refer such business to others. One of the leading firms in this area frequently turns us away because they are simply too busy to take on another hospital client. They have another reason for turning business away. Believe it or not, they still find many hospitals leaders who “just don’t get it.” Not shared from a religious or spiritual point of view, Jesus said at the Sermon on the Mount, “. . . cast not your pearls before swine.” The unnamed consulting firm would rather “gargle with ground glass” than spend their time working with hospital leaders, physicians and other caregivers who are still in denial about the opportunities for patient safety. Worse, some healthcare leaders do "get it" but are not prepared to invest the will, energy, drive and "stick out their neck qualities" necessary to get their organizations on a new and improved pathway to success.

In time, ignorance will be exposed to light, and we will remember this as the “transition era in patient safety.” One hundred years ago, Dr. Abraham Flexner exposed the healthcare education industry to the “light” that medical education could be performed better . . . much better. At the time he was despised for stirring the pot. One hundred years from now, Paul O’Neill will be remembered for speaking “truth to power” and exposing the healthcare industry for performing well below its capabilities. We can only hope his dream for an error-free healthcare delivery system will occur during his lifetime.

Jan Jennings

Republished with permission from the Hospital News Group

Faith Based Healthcare and Persons of Faith in Healthcare

Why are we so skeptical?

People of faith and organizations proclaiming faith always end up categorized by one of the religious congregations or societies. For those of us who have served in faith-based organizations or worked for people who wear their faith on their shirtsleeves, there is often disappointment and skepticism. Why? In Christian circles, is it not good enough that Catholic, Baptist, Methodist, Presbyterian, Lutheran and Episcopal organizations that operate hospitals and other healthcare institutions are living out the story of the Good Samaritan? After all, how good was the Good Samaritan? We only know one story of the way he conducted his life. At home, he may have been abusive to his wife. Who knows? We do know this. If he was a real human being, he had his own set of strengths and weaknesses.

For people of faith serving in the healthcare industry, there can be a personal sense of ministry in exercising medical, nursing, or even executive skill in serving God. When they choose to openly talk about their faith or religious life, we tend to hold them to a higher standard. This is probably not a good idea. Many are jaded by personal experience. The truth is we expect something more of religious organizations and people. Why? Well, we just do.

I work with an individual who claims to be an atheist. His life is bereft of any pretense that there is a higher power. The way he lives his life is consistent with his belief system. He is ruthless, self-absorbed and a moral reprobate. Most people really like him. There is no pretense . . . and he can be very charming while he drops that knife between someone’s shoulder blades. One thing is clear at all times, you know that his philosophy of life and faith (or lack thereof) is consistent with the way he lives his life.

I have been guilty of talking too much about my religious affiliation (Eastern Orthodoxy). I have noticed that it puts me in a position in which people expect more from me than others. The truth is that I am a flawed creature like everyone else. I carry a bag of personal and professional strengths to work everyday. Most days, I carry a heavier bag of personal and professional weaknesses.

I have become close friends with an Eastern Orthodox priest. I serve on the Board of Directors of a ministry he started forty years ago devoted to housing and healing. He refers to himself as the “country priest.” When I have discussed these concerns with him, he quips, “We all have a story and pretend that we don't .” It is an honest representation that these religious organizations and religious people have their strengths and weaknesses just like everyone else. Somewhere in our childhood development, most of us were encouraged to show deference, if not reverence, to people of faith. When we find out they are flawed in some way we are frequently surprised and disappointed.

Once I served a religiously sponsored hospital and was shocked to observe that there was behavior at work that was frequently petty, ruthless, ethically challenged and frequently wrong. Where was God when we needed Him or Her?

There was a time when I reported to an individual who wore his religious affiliation from head to toe. Every morning, even at work, he would read from a religious book, meditating on the Word of God. He was generous to a fault and was devoted to his religious organization as much as he was involved in his healthcare organization.

At a point during our relationship, I developed a cardiac illness with potentially life altering consequences. I did not hear from him for eight weeks. The hurt feelings were amplified by the visual recollection of him reading aloud from his meditation manual. His concern was that I would potentially become a financial liability to the organization. There was no concern demonstrated for me or my family. When his name comes up in healthcare circles, the typical reflection on him is this, “. . . that fellow can really hold a good grudge.” It is too bad. In many ways, this is the most generous person I know and was good to me in so many ways.

The essence of how we evaluate people is the way they conduct themselves in their personal and professional dealings. We really do not care very much about what their religious affiliation is or is purported to be. The cultural expectation that religious organizations and people of faith are going to be better than expected is unfortunate and unfair. Remember what the good “country priest” said, “We all have a story and pretend that we don’t.”

Jan Jennings

Republished with permission from the Hospital News Group

What is worse, “poor” management or “under-management?”

Our firm normally gets called two or three years after the client hospital or health system needs help. These hospitals are normally “in the financial ditch” and require admission into our consulting intensive care unit. Explicit poor management is not difficult to detect. These hospitals have been losing money month after month and/or the leadership of the hospital has no vision for the future of the institution and/or the administration, board of directors, medical staff or some combination of these relationships are throwing sand on each other. Worse, we see patient and employee safety problems that would make you lose your appetite. It is this kind of client that does not even challenge our skills and abilities. It is often so patently obvious what needs to be done . . . we frequently discount our fees because it is not heavy lifting.

The potential clients we hate to work with have the following kind of attitudes and opinions. “We are breaking even, everybody seems pretty happy and we are not sure we need any help.” Pleeeeease deliver me from this cup and cross! These are the hospitals and health systems that are under-managed. They do not know what they do not know. They rarely monitor productivity against reliable benchmarks, the agenda for the board meeting is thrown together at the last possible moment, the input of the medical staff is studiously avoided and no one seems to really care about whether the employees work in a safe environment and if the patients are treated safely.

Our friends and partner consulting firms that work in the industrial sector rarely run into this kind of client. Let me use an example or two. The publicly traded company has no confusion about who they serve. It is the shareholder. Management has incentives to improve revenue and drive out poor quality, sub-standard service and squeeze out every nickel of unnecessary cost. A friend of mine is a project manager by training and experience. The management to whom he is accountable held him in high regard, gave him the highest ratings for his services and praised him in every reasonable way. Last week he lost his job. Management was able to find similar talent on the Pacific Rim willing to provide the same services at 45 percent of the cost. He is now out of work. The unnecessary costs were not tolerated.

We see hospital management and boards of directors willing to accept unnecessary costs within their hospitals . . . well, because we are breaking even. The fact that breaking even will never be sufficient to refresh the physical plant or field new and improved technology is lost on these executives and the board of directors. This kind of thinking is Neanderthal, at best. It is the kind of thinking that thoughtful board members observe and shake their head when they get put in their place when trying to provoke reform and alternative thinking.

Let’s look at the customer service at a major industrial giant WalMart. If you buy something that you get home and you suffer “buyer’s regret” or it does not perform as you had hoped, you simply take it back for a refund. No questions asked . . . they want you back for future purchases.

How about when a patient receives poor care or lousy service? Do they get a refund, or is the health insurer informed that they should not pay the hospital or physician for slipshod service or outcomes? A friend of mine recently had a cataract removed, and his vision worsened. When he questioned the eye surgeon, the surgeon was only too willing to admit that his hand slipped and he accidentally cut the eye in a manner that was not appropriate. The physician bills arrived right on time just as if the surgery had been performed perfectly. From a conceptual point of view it is almost too hard to take in. If you have your auto dealer replace a defective new fender on your car and it falls off on the way out of the dealership parking lot . . . should you have to pay for the fender repair? Of course not! In hospital and medical care you get the bill regardless of the outcome. Why?

The answer normally comes back as follow, “. . . that’s the way we have always done it; I think everyone does it that way; why fix what is not broken.” Organizational reality is this: you are moving forward or you are moving backward. There is no such thing as standing still.

If your institution is under-managed it is only a matter of time before you end up out of work and your former hospital is admitted to intensive care for a retrofit. If you feel a little queasy after reading this . . . the best thing you can do is re-examine how things are done and get some help. It is not necessary to call our firm, but call someone before your board chairman starts calling around for you after you are gone.

Jan Jennings

Republished with permission from the Hospital News Group

"Baby Boomer" makes a life altering change . . .

Born in 1946, and without any input into the decision to join planet earth, and without my knowledge, I joined the ranks of the first year of baby boomers. Not to bore you with my biography, I have spent most of my working years as a CEO of U.S. hospitals . . . four to be exact.

In 2003 I simply had enough of that routine. The typical Hospital CEO gets up between 5-6 AM and gets his brains and emotions scrambled for 12 to 14 hours per day. Much of this work is very gratifying, and a lot is a "bucket full of busy." So, without a business plan, I plunged into a crowded pool of healthcare consulting firms. What a swim it has been. I have learned more in the past three years than the previous thirteen. There is a lot of flying, long days away from home and the associated concerns of starting something (new business) you know precious little about.

On the other hand, the joy of waking up in the morning and being responsible only to your family and employees is a real kick. There is no medical staff and there is no board of directors. I have advisors, and they speak frankly about what they like and don't like. But, in the final analysis, I make the key decisions on behalf of the firm American Healthcare Solutions and live with the consequences. I have my list of mistakes. But the successes are sweet and satisfying. Helping a little hospital get back on its feet and find its way in the market place is fun enough. The psychic rewards of a Board of Directors, Medical Staff and employees saying "thank you" is almost too hard to believe. This is the happiest and most liberated time in my life.

My friends and partners in the firm have been enormously patient and supportive. There have been good times and not so good times. However, if I want to know who is responsible, it does not take long to find a mirror.

So my fellow "baby boomers" on a road of despair I would only suggest that there are options. Take one. Life is short. There is little time to waste. Do not suffer fools. Nurture the young. Honor the elderly. Share your love everyday. Appreciate the little things in life. And first among equals, be honest with yourself.

Jan Jennings

Republished with permission from the Hospital News Group