Friday, November 5, 2010

Why I've been away...

To all my loyal friends and followers, I apologize for the time that has elapsed since my last post.  I've been in the process of overhauling my website and the changes are almost complete.  Stay tuned...the new site should be active later this weekend.  See you soon! 

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Tuesday, September 28, 2010

Health Reform Explained in 9 Minutes...



I am constantly being asked my opinion about health reform and I am ususally happy to share it. However, it is probably far more productive for one to become individually knowledgeable about what health reform is trying to accomplish versus merely collecting opinions to support our own individual biases about the subject. With that in mind and given that most people will resist the urge to read the 1,000 pages of legislation devoted to this topic, this clip does a pretty good job of summarizing health reform at a high level in just under nine minutes.  

I'm sure I will comment again about my own thoughts on this subject at some point in the future, but for now enjoy the clip and we can continue the discussion when we are all on the same playing field (minus the political influences of MSNBC, Fox News, the Daily Show, or wherever else we tend to turn to for an explanation of the "news").

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Monday, September 27, 2010

Undercover Boss?

On a few occasions, I have watched the CBS TV show, "Undercover Boss" with intrigue.  For those who haven't seen the show, the basic premise involves the CEO of a large organization going into disquise and working with the front-line employees doing the daily jobs that make their organizations tick.  Through this process they get to see first-hand the good, bad, and ugly about their organizations and the people who work within them.   As the show concludes, the CEO is revealed to the employees they worked along-side and the CEO pledges to make changes to various aspects of the company that they saw needing improvement while recognizing some of the unsung heroes they encountered. 

At first, I was shocked to see how many employees could work side-by-side with their CEO and not have a clue as to who they were - not to mention with camera crew in tote following them around!  But then I realized that these are large national organizations and many of these employees have likely never had the chance to meet, talk, or interact with their company leadership before and so maybe that wasn't so far fetched to expect.   I was also interested to see how some of the employees in different episodes treated their new "trainee" as they described to their boss unknowingly the job and culture of their company.  Through both good and bad examples, it becomes very clear to see how every company is a representation of their people and not just their product. 

All of this has me intrigued to wonder what I would "discover" if I could go undercover in our hospital?   While I humbly believe it would be difficult to go completely "undercover," I am interested in walking-in-the-shoes of some team members to see first hand what they experience and how we can continue to live up to the mission of our hospital.  What would I find that surprised me? What would I find that needed to be improved?  Who would I find going above-and-beyond yet never getting the recognition they deserve?  I'd love to hear your thoughts on these questions and others that you may be wanting to share.

 

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Monday, September 13, 2010

Comments....Lost (and found) in cyberspace!

Just wanted to post a quick apology to those of you have posted or made any comments over the past several weeks. As I logged into my account tonight I encountered 8 posts that I had not seen or acted on in previous logins (most likely user error on my part!).   With that being said, I started this blog to spur conversation and I greatly appreciate the comments and thoughts you have to share.  Please keep them coming and hopefully I won't have another comment time warp!  For those who have not made a comment yet - it's easy - just click on the link at the bottom of each post that says "Make/Read Comments" and let me know what you think - Thanks for reading (and responding)! 


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Tuesday, August 24, 2010

Jewish Hospital to perform double hand transplant - Follow live on twitter!

For all those interested in learning more about pioneering medical care, be sure to follow this post from our Marketing and PR department....

Kleinert Kutz and University of Louisville hand surgeons are preparing to perform a double hand transplant at the Jewish Hospital Hand Care Center.  The procedure will be chronicled live on the social networking site Twitter, providing real time updates of the innovative procedure. 

It is the first time the team at Jewish Hospital, Kleinert Kutz and UofL have performed a double hand transplant and the first time the procedure has ever been tweeted live. We expect to begin tweeting the procedure at approximately 7 p.m. and it is expected to last 18 – 20 hours.  Updates will be posted at www.twitter.com/jewishhospital.  In addition, information can be found at www.handtransplant.com.

A partnership of physicians and researchers at Jewish Hospital Hand Care Center, Kleinert Kutz and the University of Louisville developed the pioneering procedure.  Warren C. Breidenbach, III, M.D., with Kleinert Kutz and assistant clinical professor of surgery at the University of Louisville will lead the team of hand surgeons, hand fellows and anesthesiology team. 

Michael Marvin, M.D., director, Jewish Hospital Transplant Center and Rosemary Ouesph, M.D., Professor of Medicine, Director of Kidney Transplantation, Kidney Disease Program at the University of Louisville manage the immunosuppressive therapy for all six hand transplant patients performed at Jewish Hospital to date.

Kentuckiana Organ Donor Affiliates (KODA) is coordinating the hand donation with the family and hospital. Without the help of KODA and the family, this procedure could not have taken place.

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Sunday, August 8, 2010

The White Coat Ceremony - A time of celebration and reflection

This afternoon I had the distinct pleasure to participate in the University of Louisville School of Medicine's White Coat ceremony.  For those not familiar, the White Coat ceremony is a celebration recognizing the first day of the incoming class of medical students and concludes with the students being presented their first "white coat" in recognition of their officially being accepted into the medical profession as a doctor in training.


Today we celebrated the incoming class of 2014 as 160 new students were adorned with their first white coat.  I have been able to participate in a number of these ceremonies over the years and they always cause me to reflect back on the true meaning of our roles in the medical profession. We heard from a number of speakers that spoke to these future doctors about their roles and responsibilities as they embark upon becoming a physician.  The Provost praised the incoming students for their achievement and accomplishments, yet reminded them that while they will become great scientists in medicine, that they also must be humanists in order to truly heal and treat the patients they will encounter.  The Dean of the medical school reflected on several lessons to learn including the responsibility and humility of becoming a physician, and the pride and knowledge that coincides with becoming part of an academic teaching institution.  And perhaps most touching, we heard from a second year medical student who shared his experience of when he first realized that he wasn't just a student, but a doctor in training as he recounted a very personal experience of losing a lifelong friend to a very rare and debilitating cancer at the young age of 24.


Throughout the ceremony, I couldn't help but look out into the audience at these 160 future doctors and imagine the thoughts that they must be going through their minds.  The sense of pride and accomplishment of being accepted into medical school after years of hard work and schooling, the hopes and dreams of what their lives will become as they complete their training, and the sense of anxiety and fear of the work and responsibility that lies ahead for each and every one of them.  I also thought back to the early days when I started my medical career as an Emergency Medical Technician.  Back then I wasn't concerned about politics, budgets, staffing levels and morale, insurance, health reform or any of the number of things that typically occupy my time and thoughts these days.  It was about helping people in their time of need, plain and simple.


Much has changed in my life since those early days, just as much will change for these future doctors.  Yet despite all of the political and financial realities within which we must operate, my hope is that they will never stray too far from the thoughts and reasons that brought them to this point in their careers, and that they help all of us continue to remember why we were first called into this profession of healing.


The White Coat ceremony finished with the students reciting and taking the pledge of the Declaration of Geneva.   For all of my fellow colleagues in the medical profession, I encourage you to also reflect  on its significance, especially in light of the challenges we all face today...


Declaration of Geneva


At the time of being admitted as a member of the medical profession, I solemnly pledge myself to consecrate my life to the service of humanity.


I will give to my teachers the respect and gratitude which is their due;


I will practice my profession with conscience and dignity;


The health of my patient will be my first consideration;


I will respect the secrets which are confided in me;


I will maintain by all the means in my power the honor and the noble traditions of the medical profession;


My colleagues will be my brothers and sisters;


I will not permit considerations of religion, nationality, race, gender, politics, socioeconomic standing, or sexual orientation to intervene between my duty and my patient;


I will maintain the utmost respect for human life; even under threat, I will not use my medical knowledge contrary to the laws of humanity.


I make those promises solemnly, freely and upon my honor.

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Wednesday, June 30, 2010

Thoughts on communication and planning for our future...partnership discussions with University Medical Center and Catholic Health Initiatives

One of my sayings has always been, "in the absence of communication lies rumor" and this topic could serve as the poster example for that saying. Over the past few few months, it has been a rare occasion for me to make it through the hospital without being stopped and asked about rumored talks between our health system and the University of Louisville's hospital (University Medical Center). For the first time, I am now able to publicly acknowledge these rumors and confirm that our leadership has indeed been in conversations with the University of Louisville and Catholic Health Initiatives as more fully described in the statement posted below and on our website today.

The bigger question you may have is why we have not been able to comment up until this point? As you could probably imagine, discussions of this nature are very strategic in nature which makes it difficult to talk about them in an open forum as plans are being developed. Also as expected, when large numbers of people become involved in a planning process, it is also very difficult to keep any discussions confidential for any length of time, especially in a town as connected as Louisville! Together this combination has lead to the rumors that so many of you may have found yourselves confronted with.

With the announcement copied below, I fully expect that people will be speculating and reading into what this might mean for our system and the rationale behind our discussions. In attempts to bring closure to these rumors, I wanted to take this opportunity to make it perfectly clear that no recommendations or decisions have been made as of yet in these partnership discussions. If and when a decision is reached there will certainly be more information to come. What we are trying to accomplish now is to begin sharing information and laying out the rationale for the discussions taking place.

I hope this joint statement announced today can help bring some color to the discussions that have been taking place with our leadership. As always, I welcome and would appreciate your thoughts and input as we continue to navigate along in this journey.


A Statement Regarding Partnership Discussions

Catholic Health Initiatives, Jewish Hospital & St. Mary's HealthCare
and the University Medical Center

In order to promote our shared commitment to patient care, biomedical research, and the education of the next generation of health care providers, the leadership of the University of Louisville/University Medical Center, Jewish Hospital & St. Mary’s HealthCare (JHSMH) and Catholic Health Initiatives (CHI) are holding discussions to explore how they could work together in a more formal partnership to better serve Kentuckians.

These conversations are driven by the fundamental changes that are occurring in clinical medicine, demographics, and the needs of Kentuckians.

Over the next five years, the Healthcare Reform Act will dramatically alter the environment for disease prevention and in which care is delivered. Changes brought by legislative reform will place demands on all healthcare providers that must be addressed proactively to ensure future viability. Practicing physicians, medical educators, scientists, and hospitals will need to work together to find solutions and make substantive and innovative changes in the way care is delivered, students are educated, and new knowledge is generated.

In Kentucky, we must find new and better ways to attack the serious health issues facing our population. We have the undesirable distinction of leading the nation in the incidence of lung cancer – our rate is 50% higher than the national average. We are fourth in the nation in overall cancer incidence. Our ranking in the Top 10 doesn’t end there. We are seventh in the nation in obesity and the number of deaths from cardiovascular disease. We are also ninth in the number of deaths from heart disease as well as from stroke.

In 2005, Jewish Hospital HealthCare Services (JHHS) and CARITAS Health Services, a part of CHI, merged to form JHSMH. This followed more than 19 months of discussions and negotiations. JHHS and CHI are the parent organizations of JHSMH, and appoint a joint board to oversee the combined company.

The University of Louisville/University Medical Center (UMC) and JHSMH have a historical partnership in cardiothoracic surgery, cardiology, community and family medicine, ophthalmology, and solid organ transplantation. Additionally, the organizations work together closely to provide critical services to patients seeking care for neurological disorders such as Parkinson’s disease and cerebral palsy, as well as rehabilitation medicine following a stroke or a traumatic neurological accident such as a spinal cord injury. Together, these organizations have pioneered new medical procedures in cardiac surgery, adult cardiac stem cell research, and organ and tissue transplantation. The two organizations have an extensive partnership in providing a location for medical student, internship, and residency education. The University of Louisville and JHSMH have also been at the forefront of developing new organizations such as the Cardiovascular Innovation Institute.

CHI is interested in broadening its relationships in Kentucky, where it has made significant investments in healthcare. CHI leaders see many opportunities to make a positive difference in the state by transforming how healthcare is delivered, expanding access to care, contributing to the mission of academic medicine, and building healthier communities. CHI shares the deeply held commitment of the faculty and staff of the University of Louisville and JHSMH to serving historically underserved and marginalized populations.

With an eye toward the fundamental changes that are ahead for health care providers, the boards of JHSMH and UMC are discussing the benefits of forming an integrated partnership that will position the organizations for the future.

Board representatives have evaluated a possible network that has relationships across the Commonwealth, the role of academic medicine in the delivery of healthcare services, the needs of Kentucky for medical education, and how a formal partnership could help prepare for the significant number of Kentuckians who will be added to the rolls of health insurers.

There are still many issues to discuss and resolve over the coming months as the organizations work toward a possible letter of intent. Board representatives must address a number of major items, including equity/ownership, governance structure, the management of medical education, and the integration of the academic mission throughout the proposed organization.

No final recommendations or decisions have been made. Additional information will be shared over the next several months as part of an ever-expanding dialogue between organizational leadership, the community, public officials, the staff of the institutions, and the faculty of the School of Medicine and community physicians.

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Sunday, June 13, 2010

Zappos CEO Tony Hsieh on Culture, Service, and "Delivering Happiness"


One of the many benefits of writing this blog has been some of the great people I have had the chance to meet as a result along the way. .
Frank Eliason, Senior Director of National Customer Service for Comcast Cable is one of those individuals who I've gotten to know and co-present with at a couple of conferences. Frank has made a legend of himself in the corporate customer service world and has been written about in Business Week, the New York Times, and the Wall Street Journal to name a few. So when it comes to customer service, I tend to take his opinions to heart. The last time we were together in Chicago, he was telling me the story about Zappos, (the online shoe retailer that was recently sold to Amazon for the equivalent of $1.2 billion in stock) and about how their CEO, Tony Hsieh turned this internet start up into one of the most successful internet businesses of all time principally by being obsessed with creating an outstanding culture of service. So when I was recently contacted to see if I wanted an advanced copy of Hsieh's new book, Delivering Happiness: A Path to Profits, Passion, and Purpose, I was more than a little intrigued and agreed.

In reviewing the book, there is background on Hsieh's upbringing, early career start-ups, and ultimately how he got involved with creating Zappos. From there it reads quite differently from many business books I have read with many personal stories and anecdotes from Hsieh and his staff, however the message is not entirely new or inconsistent with I have always believed in...create a winning culture and your brand will be successful.

Zappos' goal is simple: have the best customer service in the world. For Zappos, customer service is not a department but rather a core purpose that transcends every aspect of the business. To accomplish this goal, everyone has to be on board. As the company was struggling in their early existence to survive, the staff created a set of 10 core principles for which everyone is now screened before hiring and evaluated against to remain employed by Zappos.

As taken from an excerpt on the Zappos website and the book, the core values are listed below...

As we grow as a company, it has become more and more important to explicitly define the core values from which we develop our culture, our brand, and our business strategies. These are the ten core values that we live by:

  1. Deliver WOW Through Service
  2. Embrace and Drive Change
  3. Create Fun and A Little Weirdness
  4. Be Adventurous, Creative, and Open-Minded
  5. Pursue Growth and Learning
  6. Build Open and Honest Relationships With Communication
  7. Build a Positive Team and Family Spirit
  8. Do More With Less
  9. Be Passionate and Determined
  10. Be Humble

These principles are not merely words talked about at orientation or hanging on a framed picture in the hall, but are truly the core values for which the Zappos brand and company exists. Hsieh points out to "Hire slowly and fire quickly" is one of their secrets of success. With these values firmly committed to, Hsieh has challenged each of his staff to make at least one improvement each week to make Zappos better reflect its core principles.

The end of the book and "the end game", as Hsieh calls it, is all about Happiness. He's passionate when he talks about customer happiness, employee happiness, and [leadership] happiness - "the goals of happiness aren't mutually exclusive." From there he challenge his readers to think about happiness and what it means to them. A few example questions he poses:
  • What is success?
  • What is happiness?
  • What am I working towards? (Make sure that the answer to this question supports the answers you gave for the first two.)
  • Make a list of the happiest periods of your life, and find the connecting threads.
  • Where's the opportunity for you to live your happiness?
  • What is your company's core values and higher purpose?
  • How do you relate to them?
So if you have read this far, you may be asking why have I written about this book and this topic? The answer lies in the following question....if an online shoe store could turn themselves into a billion dollar enterprise with wildly loyal customers by focusing on culture and service, what do we need to do accomplish the same goal? I look forward to hearing your suggestions and continuing the discussion!



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Monday, May 24, 2010

A culture of safety? Your thoughts please!

I have written about our efforts around improving patient safety a number of times in the past (here and here as examples) and will continue to do so in future posts. However, from time-to-time it is also important to stop and ask, how safe are we we and are our efforts making a positive difference in the care we provide to our patients?

As leaders, we need to listen (as well as direct) and this is one of those times. A couple of weeks ago we launched a survey for our team members to tell us how they feel about our culture and just how safe of an environment we have created. It's actually something we do every other year to gauge our progress and identify opportunities of where we can continue to improve.

Our last survey in
2008 survey identified opportunities in the following areas:
- Hospital hand-offs and transitions
- Non-punitive response to error
- Teamwork across hospital units
- Staffing based on acuity

Since then we have made concerted efforts to improve upon these items as well as other safety initiatives that have surfaced. I look forward to seeing the results of this years survey and to see how far we have come along and what new areas we can work to improve upon.

If you are a JHSMH team member and haven't completed your survey, please do so by the end of the month so your voice can be heard! Details are on the intranet: under “Company News and Announcements” you will find “AHRQ Patient Safety Survey.” Click the link and tell us what you think! Thank you!



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Saturday, May 22, 2010

Celebrating our care givers...the true meaning of patient care

I was in a meting with the Dean of our Medical School yesterday and he noted that I must be really busy lately because I haven't added any new blog posts recently. Astute as always, he also has a way of helping me to reflect and refocus on our mission and why it is we are ultimately here.

With great timing, right after our meeting, I received this note from one of our managers and thought it was fitting to share as just one example of many that define and distinguish our care givers at
Jewish Hospital. Granted, this is a little late for nurses day, but then again we don't have to wait for just one day a year to share and celebrate the caring and compassionate care givers we have exhibiting excellence in action. Please read the note below and if you see one of our care givers today, please tell them "Thank You" and encourage them for the outstanding jobs that they do each and every day!

"I wanted to share an example of why after three plus decades I am still a nurse and still in management. Yesterday we lost a patient. Working in ICU this is not an uncommon event but this time it hurt more than it normally does. I was so proud of our team of nurses, nursing assistants, unit secretaries, respiratory therapists, chaplains, social workers and physicians; everyone treated her with love and respect. Her mother hugged me yesterday prior to her death, and asked me if I knew what a great team that we had, and I told her "absolutely". Our patient died surrounded by the love of her family but also surrounded by the compassion and love of the ICU Tower's team, the RT's and everyone else mentioned. It was a true interdisciplinary effort. During this last hospitalization she received manicures, shampoos, her legs were shaved and of course lots of friendship. In the scheme of things this may not seem important but these were tasks that normalized a far from normal existence while in a hospital. These were tasks done by a team that is used to a high tech environment but who knew these tasks perhaps made this high tech environment more "normal" and truthfully it made "us" feel helpful in a situation where we felt helpless. At the management meetings we are always asked what "wins" we have had. Although it was not a win as such for the team since we lost our patient and this has been a horribly sad event, I am immensely proud of our team. They were high tech when they needed to be, they were humanistic when they needed to be. They just were everything they should have been and I am proud."

--From a Jewish Hospital Nurse Manager (edited to protect the identity of our patient)

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