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Posts Tagged ‘management’

Healthcare Economics: Why this stuff doesn’t work the way you think it does — and how to fix it

Posted by capcityspeakers on April 19, 2017

by Joe Flower

albatross-close-up

[This is a letter I sent to Gary Cohn, appointed by President Trump to head the National Economic Council and, among other things, come up with a plan for reforming healthcare. Formerly president of Goldman Sachs, Cohn may be a wizard at finance, but healthcare economics are wildly different and famously opaque.

So I thought I would help him out. As things are going with the Republicans’ health plan on Capitol Hill, Trump may need a Plan B.]

Healthcare economics are weird, opaque, and convoluted. The business of healthcare is unlike any other business. The politicians and pundits arguing about how to fix healthcare in the United States don’t understand what they are trying to fix. Neither do you, probably, because almost no one does.

So let me help with this explainer. Here’s the promise: This will be non-partisan, factual, and some parts at least will be different from anything you have heard before. This is a version of a letter I sent to the White House economists charged with coming up the new, better replacement for the Affordable Care Act.

Subject: Your best eight minutes on healthcare economics.

  • Why healthcare economics are different.
  • What would work

Who I am: An independent healthcare author and analyst since Jimmy Carter’s administration, speaker, consultant across the industry at all levels, including insurers, hospitals, device manufacturers, employers, the Veterans Administration, the pharmaceutical industry, the World Health Organization, the Department of Defense, a real insider.

Core problem: The core problem in fixing healthcare is the actual cost of medical care.

  • Healthcare in the U.S. by any measure costs about twice what it should and is twice more than in most other countries.
  • Medical prices are completely disconnected from the cost of production.
  • Few medical providers even know the true cost of their products, their tests, therapies, and surgeries because they reverse-engineer their prices based on reimbursements
  • By a number of highly respected analyses at least one third of that (well over $1 trillion this year) is waste, paying for things that we don’t need and that don’t help and often hurt.
  • Solving just the federal part of this would completely wipe out the deficit.

Trying to “take care of everybody” will always be impossible politically and economically as long as healthcare costs twice what it should and wastes trillions of dollars.

Solvable: This is a solvable problem. If we manage to stop paying for waste, over $1 trillion per year in unneeded overtreatment will disappear. Prices will drop to something like a true market price. This will not happen overnight, but it could happen over five years with vigorous implementation.

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3 must-do strategies for executive leaders to permanently improve employee engagement

Posted by capcityspeakers on January 17, 2017

by Vicki Hess

Every executive leader in healthcare has a vested interest in improving employee engagement – whether he or she acknowledges it or not.

Unfortunately, many senior leaders think HR should manage engagement or they are looking for a magic formula when it comes to sustained improvement. Of course one doesn’t exist.

First, the problem. Here’s what I typically hear in my conversations with hospitals and health systems across the country. Employee engagement survey results come in and senior leaders talk about how important engagement is with their manager group. They share their desire for front line leaders to create department level action plans to transform engagement.

The action plans are created and quite often recorded in online monitoring systems for “accountability”. Most leaders – at all levels – understand that engagement is a key lever for productivity, creativity, safety and patient satisfaction so these actions make sense. Too often, the actions center around what the organization and leader need to do to impact engagement and they leave off the personal responsibility of the employees – but that’s another article.

For a month or two, there’s a focus on improving engagement. Then a new priority comes along and the front line leader’s attention is drawn to a new concern. The front line leader’s “one-up” manager stops asking about engagement. It moves to the back burner and all of the sudden it’s 9 months later and time for a new survey and whole cycle starts again.

If you want to stop this vicious cycle, try these 3 strategies.

Have an Engagement Champion at the executive level
Ideally, everyone on the senior leadership team would feel completely committed to engagement, but I know that’s not always going to happen. To quote Peter Drucker, “Whenever anything is being accomplished, it is being done, I have learned, by a monomaniac with a mission.” This doesn’t mean that some leaders can let engagement slide off their dashboards; it does mean that you need a champion. Read the rest of this entry »

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Why Did Healthcare Inflation Slow Down? Why Does It Matter?

Posted by capcityspeakers on August 11, 2016

by Joe Flower

The costs of healthcare turned a corner in 2009. You can see it on any graph of National Health Expenditures, whether by dollars or dollars per capita or percentage of the economy. There is a decided downward bend in the trend line between 2008 and 2009. The line then stays nearly flat, close to or below the increase in the general economy.

This Great Flattening is really interesting, but the reasons why it’s happening are even more interesting — because they tell us something about healthcare’s future.

Robert Woods Johnson Foundation just put out the latest report on this. The line blipped up a bit in 2014, the first year of the full implementation of Obamacare. According to the RWJF analysis, though, it then resumed its near-flat trajectory in 2015. The Great Flattening is not over.

Why is this happening?

Healthcare commentators have given three competing reasons for it. At first, most dismissed it as an epicycle of the Great Recession. Later others claimed that its continuation showed that Obamacare was working.

I and some others had a different idea: The Great Flattening, at least in part and increasingly as time went on, has been the first sign that structural changes in how we pay for healthcare are beginning to make a difference in how much we pay for healthcare.

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Bratwurst, Bad Weather, & Bruises

Posted by capcityspeakers on July 8, 2016

by Vicki Hess

Remember those papers you wrote as kid entitled “What I learned on my summer vacation?” I just got back from a cycling vacation and I’d like to share what I learned and how it might help you at work.

1. Bratwurst
I’m a pretty healthy eater and wouldn’t typically eat anything close to a bratwurst – especially when it’s prepared by a street vendor and I don’t know the contents or origins of the sausage. But, I learned that sometimes the “locals” really do know what’s best and that bratwurst is really good!
Lesson Learned… Maybe the folks in other departments that are serving you their “bratwurst” really do know something you don’t know. Maybe the local knowledge gives them different insights and perspectives that you don’t have. What if you trusted their judgement and tried something new?

2. Bad WeatherGermany Rainbow
I cycled 168 miles in 6 days throughout Germany, Austria and Switzerland. What a glorious way to see the countryside and observe local customs. One challenge was that It rained 5 of the 6 days. UGH! My husband and I could have ridden in the van and hung out in museums but that wasn’t the trip we had in mind so we got up every day and put on our right rain gear and started peddling. Of course it became a joke with our fellow cyclists. We are all better riders now and we still had lots of laughs.
So it was fitting that right after our good bye dinner in Konstanz, Germany we stepped outside to survey the skies. Lo and behold, we saw the most beautiful double rainbow over the city. What a fabulous reward for all the rain!

Lesson Learned… Work can be challenging. Unexpected obstacles arise and you just have to keep “peddling” to move forward. It’s not what you planned, it’s not what you would have chosen – it’s what’s in front of you right now. The bad weather brings the team closer and helps you learn – if you let it. Now you can go look for that rainbow.

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The Patients Just Don’t Get It (Or Maybe It’s You That Doesn’t Get It)

Posted by capcityspeakers on June 30, 2016

by Kristin Baird

Just the other day, I heard a story from a nursing unit manager that really annoyed me. The manager was asked to follow up on a patient complaint where the patient stated he was disappointed that the entire time he was in the hospital, he never had a bath. Having been an inpatient for four days following a total hip replacement, it seemed like a reasonable expectation to have a bath (or four for that matter), so his complaint seemed justifiable.  The problem was, the manager shifted the blame onto the patient. The first words out of her mouth were, “These patients just don’t get it. We give them a bath-in-a-bag every day.”

There is so much about this single comment that bugs me, but let’s just start with, “They just don’t get it.” The tone implies the patient is wrong and you, the care provider, are right. This type of thinking places you and the patient, in two separate camps; the right and the wrong. One or the other. Secondly, it implies that the patient should know better; again, a condescending posture for the sender.

Whenever I hear the phrase, “They just don’t get it,” I can’t help but think that it’s the sender that doesn’t get it. The comment comes from a posture of superiority and arrogance rather than one of collaboration. What if the nurse manager received the complaint in a spirit of ownership and collaboration? Her response would have been something like, “It sounds like we didn’t do a good job of explaining the bath-in-a-bag. I’ll work on this with my team.”

The other part of this comment that bugs me is the idea that the patient should “get it.” When a patient enters a hospital, it is a foreign land with a foreign language, strange sounds, sights, and smells. This is YOUR world, not theirs. Don’t expect them to just “get it.” It’s up to the caregivers to welcome patients into this strange world, and explain things. The word “bath” in the common vernacular implies a tub filled with water. A bed bath implies a basin of water and a wash cloth. It’s only in today’s healthcare world that a plastic packet filled with moistened paper towels constitutes a bath. So when the patient doesn’t “get it,” simply reposition the lens with which you see the world. Look through the patient’s eyes, then help him understand.

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8 extraordinary things that healthcare presidents do: As reported by others in the organization

Posted by capcityspeakers on March 24, 2016

by Vicki Hess

It all started on a phone call with nursing leader, Anita Walden. Anita is the Chief Nursing Officer at Decatur Morgan Hospital in Decatur, AL. We were talking about best practices related to employee engagement and she shared a story with me about the president of the hospital, Nat Richardson. I was amazed!

When anyone enters the hospital he or she receives a postcard with the president’s picture and cell phone number. As Anita was telling me about this card, I automatically assumed that they had an assistant answering the phone and triaging the messages. I figured the president would then pass along the information to other senior leaders and make sure they were taken care of.

I was wrong (you’ll read more about this extraordinary president in #7 below). This prompted me to reach out to my followers on social media and my newsletter subscribers to ask for stories of extraordinary things that healthcare presidents/CEOs do. I asked one simple question and promptly received 10 responses. I’m sharing some of them verbatim and for the last few I’ll include the highlights. Of course, you don’t have to be the president to try out these ieas. Any leader – in fact anyone – can try them on for size.

Let’s define extraordinary

One thing I found particularly noteworthy is what folks describe as “extraordinary”. According to Merriam Webster, extraordinary means “going beyond what is usual, regular, or customary.”

What I also find interesting is that the folks who took the time to respond my question have defined extraordinary according to their own beliefs and mindsets. What I quickly learned is that one person’s “ordinary” often becomes another’s “extraordinary.” As you read the following eight ideas, you can judge for yourself.

1. Jars of jam. “Carole Holmes, CEO of inSite Senior Care, shared her love with us this past Christmas by using jam! She personally made a variety of little jars of jam from local fruit and sent them to all the residents and staff of each of inSite’s seven facilities. Everyone enjoyed her gift and the thought behind it.”
Shared by Angela Senneker, LPN, MA, Community Manager, Chateau Three Hills

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