The Flexner Report Centennial Symposium

Tomorrow we are hosting a lecture in honor on the 100th Anniversary of the Flexner Report. For those of you who didn't know the significance behind our address, I thought I would share this summary and information with you as we celebrate the man behind this "game changing" report and his impact on medical education as we know it today.

One hundred years ago, Louisville educator Abraham Flexner revolutionized the medical profession with his exhaustive report entitled “Medical Education in the United States and Canada.” The report, published in 1910, served as a catalyst for the standardization of medical education around North America. To celebrate the centennial anniversary of the Flexner Report, the University of Louisville School of Medicine and Jewish Hospital will be jointly sponsoring a national event to be held on May 4 at the hospital’s Rudd Heart and Lung Conference Center and at the Old Louisville Medical School. The T. Cook Smith Lecture of the Innominate Society for Medical History and Banquet will be held the same evening.

Flexner’s research, originally commissioned by Henry Pritchett, president of the Carnegie Foundation for the Advancement of Teaching, included information gathered from his survey of the 155 medical schools then in existence in the United States and Canada. In matter-of-fact language, Flexner castigated the appalling state of medical education in America, named the names of schools with astounding low standards, and suggested drastic steps to improve the sad state of affairs.

Flexner, then secretary of the Rockefeller Foundation, became the major mover and shaker to ensure that medical education would never be the same. He was instrumental in providing funds to many designated medical schools and ushered in the aptly-named Flexnerian revolution in medical education. The Flexner Report catapulted Flexner, who was not a physician, to celebrity status in the education field where his opinion was sought on various educational matters – particularly on medical education.

“It is our pleasure to be co-hosting this event honoring Abraham Flexner,” says Jewish Hospital CEO Marty Bonick. “Medical schools throughout the United States are far stronger – even now – due to his extraordinary efforts. We appreciate our close association with the University of Louisville’s School of Medicine, and share their excitement in paying tribute to Flexner’s work in a substantive way.”

“Flexner was born in Louisville and lived here until he was 39 years of age,” said Dr. Edward Halperin, dean of the UofL School of Medicine. “Louisville is a fitting location to celebrate the centennial of the Report.”

Transition Director of the Jewish Community of Louisville, Ronald Greenberg, is aware of the Flexner family’s role in the Jewish community. Abraham Flexner’s brother, Jacob, and his nephews, Morris and Samuel, were all physicians associated with the old Jewish Hospital. After the Flexner report’s findings became known, all of the city’s “private medical colleges” closed; only the University of Louisville’s School of Medicine survived. Jewish Hospital memorialized Flexner’s contributions to medical education by naming the street in front of the hospital Abraham Flexner Way.

Drs. Morris Weiss, Adewale Troutman, Gordon Tobin, Charles Smith and E. Ray Knight have agreed to serve on different panels and on the Abstract Review Committee.

[by Phyllis Shaikun]

The Flexner Report Centennial Symposium

More thoughts on email...

Thinking further on my previous post and adding to the discussion, let's assume that on average one-minute is spent processing each email sent or received (a reasonable assumption I would think). That would mean for the 30,000 emails I dealt with last year, that translates into almost 21 solid days of doing nothing but email! No eating, sleeping, daydreaming, nothing - just email. If you focused that on a more manageable 8-hour "work-day" (which never happens in only 8 hours) that would be 62 days of doing nothing but email, two-whole months!

I don't have an answer on how to change any of this at the moment, but its obviously struck a nerve with me. I am interested in hearing your thoughts, what do you think???
IMPORTANT LEGAL NOTICE: This communication, including any
attachment, contains information that may be confidential or
privileged and is intended solely for the entity or individual to
whom it is addressed. If you are not the intended recipient, please
notify the sender at once. You should delete this message and are
hereby notified that any disclosure, copying, or distribution of
this message is strictly prohibited. Nothing in this email,
including any attachment, is intended to be a legally binding
signature.

More thoughts on email...

What did we ever do before email?

On a lighter note tonight, I thought I would share an interesting factoid I was forced to reflect upon recently as my laptop locked up for several minutes while trying to find an email I had in my archives...

For backup purposes and reasons that are not worth going into here, I essentially have to maintain a duplicate mail folder that archives every single email that is sent from me or to me over time. This process has been in place for just about a year now, and up until the other night I had never tried to go into that archive folder. However, while searching for an email I did have to go into this archive at which point my laptop froze as it tried to restore and process the twenty-two THOUSAND (22,000) emails I have received in just the past year. Assuming the majority of those were received on business days that averages 88 emails per day! That doesn't include my other personal and blog email accounts or facebook messages that are also received each day. I have often been asked how many emails I get everyday, but never really knew with certainty until I stumbled upon this. (By comparison I only sent 8,000 emails last year which can draw all sorts of other inferences).

I certainly don't think this bit of trivia is particularly newsworthy, but it did make me reflect back on what life was like before email or even worse the blackberry... I'm quite certain I didn't process that much incoming mail and memos and I'm guessing there was a lot more personal interaction taking place. So the question is, are we any more productive today than before and even if we are, are we any better for it? Just food for thought...

What did we ever do before email?

Healthcare Excellence? Yeah, there's an app for that!

As I have written about previously, social media is the new mode of communicating in today's world. As such, in trying to keep with the times and always trying to be the healthcare innovator in Louisville, today we launched our newest healthcare advance in the social media frontier - our own "app" for Jewish Hospital & St. Mary's Healthcare!

After spending months on design and development, our first version of the JHSMH app will allow you to:

• Find a physician near you and request an appointment
• Register for JHSMH events
• Keep track of the latest JHSMH news
• Receive interesting health news and tips
• Monitor your food intake with a calorie tracker and food diary
• Determine if you are in a healthy weight range with a BMI calculator

Developments like this don't just happen of course, and I'd like to congratulate and thank Leslie Dorris for having the vision and drive to see this all the way through its successful launch! Download it here and let us know what you think!

Healthcare Excellence? Yeah, there's an app for that!

Oh Canada...Healthcare Debate Looming?

Given all of the discussion about health reform in America, I thought I would pass along a link forwarded to me by a member of our marketing and communications team that he discovered while vacationing in Canada. It is an opinion written by Jeffrey Simpson in "The Globe and Mail" news from Quebec City entitled "In Quebec, health care is no longer a free ride."

The discussion focuses on the ever inflating costs that "free" healthcare in Quebec are consuming and changes that are being proposed to slow the increase of government spending on healthcare. Ideas being discussed are a citizen "contribution" to increase healthcare revenues (note the attempt to not say "tax") and the notion of physician co-pays to which the opinion notes “ ...to this is added the extra fear that change will lead inexorably to U.S.-style medicine.”

So maybe we are not alone in our attempts to reform healthcare and control escalating costs? However, the person sending this to me noted..."You can’t escape the high rate of taxes around here and the massive government subsidies. I can tell you that there is a 10-15% tax on meals; makes our 6% sales tax seem puny. However, people don’t seem any less “free” than we do."

Interesting times indeed, your thoughts?

Oh Canada...Healthcare Debate Looming?

Tough Discussions

Last week I held several Team Member forums to discuss the sate of our economy and its ongoing effects on our hospital and market. As many of you are aware, since the beginning of this year, hospital volumes have been trending down nationwide and we are having to make a number of tough decisions in order to react to our ever changing industry. I always consider these forums to be time well spent as I am able to interact with our team, hear what is on their minds, listen to their ideas, and share information on what is happening inside our organization. Particularly given the topic of conversation, I greatly appreciate the interest, candor, and professionalism that has been shown by all of our Team Members as we are implementing decisions to proactively protect our mission to the community. For the past two years that I have been with the hospital, many changes and improvements have been made to better our operating performance and quality metrics and that could not be done without the dedication and talent of our collective team. Despite the challenges that the healthcare industry is facing and has yet to face, I am greatful to work with a team that has a "can do" attitude that never seems to give up! Below is the internal "Progress Note" that I sent out to the team last week to further discuss this issue.


Over the last couple weeks you’ve heard about the tough decisions being made not only at Jewish Hospital and Frazier Rehab Institute but across the Jewish Hospital & St. Mary’s HealthCare system. The decision to eliminate 500 positions throughout our system did not come lightly and is always a last resort as our team members are our organization.

I wanted to take a moment and outline to you our rationale and reason for making the position eliminations. As you all know, over the past year, we have been undergoing a process called the ACE Plan, where we have focused on operations, finance and strategy. This process, designed to make sustainable improvements to achieve and ensure long-term success, has identified now over $70 million in improvements across our organization. Twenty-five million dollars of these improvements have already been implemented. These changes, across Human Resources, Labor, Non-Labor, Quality and Revenue Cycle are many times not easy but they are ones that need to be made to ensure that this organization is stable not only today but in the years to come.

We are weathering a perfect storm in health care. As 2009 ended and 2010 began, we saw an immediate and drastic decline in inpatient and outpatient volumes at our facilities—approximately 3—7%. The good news in this is that this is not just at Jewish Hospital and Frazier Rehab—rather it is an issue being faced all over Louisville and the nation as a whole. This means that while we are facing dropping volumes, we are not losing market share — there is simply less of a market to go around.

There are many speculations as to why the health care market changed. We believe it is a combination of:

• COBRA insurance coverage running out for those first laid off in the beginning of the recession

• High deductible health insurance plans causing consumers to think twice about whether they need a certain test

• Delaying of procedures/office visits due to the economy

All this is coupled with increasing bad debt. In 2009, JHSMH provided $68 million in uncompensated charity care. Compare that number to 2008’s figure of $52 million — a $16 million difference. These figures, while not our fault or of our doing, still have to be accounted for and mean we must change the way we do business.

I’ve had many people ask me what success will look like at the end of the ACE Plan. By making these changes we will:

• Be operationally and financially stable

• Have made strategic decisions for long-term stability and growth

• Be a quality focused organization

• Focus on results vs. activity

• Cross-collaborate vs. staying in silos

• Encourage empowerment over obedience

I appreciate the perseverance that each of you has shown over the last several months. In many ways, we are climbing a mountain. If you have ever gone on a climb, you know there are stretches where you just wonder if you can go on and think maybe you should just bail and turn around and go home. But if you keep pushing through and make it to the top, it’s all worth it in that moment because the view is breathtaking and the sense of accomplishment is empowering.

We’re on a climb. And I ask you to keep pushing ahead with me. The changes and decisions we are making may not be easy but we are heading in the right direction for long-term success—and when we get there very soon, the view from the top will have made it all worthwhile.

Tough Discussions

Celebrating Doctor's Day!

On Friday, we celebrated Doctor's Day with our medical staff in the Rudd Heart & Lung Conference Center. It is always a great occasion to be able to recognize our physicians for their dedication to their patients and support of our hospital's mission. Each year at this time I am reminded of the important role that our medical staff plays in helping to lead and grow our organization to continued new heights.

Over the past year we have taken on a number of new initiatives that have helped us to improve the quality, service, and efficiency of the care we deliver to our patients. Specifically, with the help of our medical staff leaders who took on the challenge of chairing our new service line committees that kicked off in 2009, we achieved significant improvement in each of our core measure "perfect-care" bundles*. This year, on Doctor's Day, we chose to recognize those physicians who achieved the highest level of achievement in quality and service.

This year's winners for Highest Patient Satisfaction at Jewish Hospital were :

• Outstanding Patient Satisfaction at the 99^th Percentile: Dr. Raymond Shea
• Outstanding Patient Satisfaction at the 99^th Percentile: Dr. Kelly McCants
• Outstanding Patient Satisfaction at the 92^nd Percentile: Dr. Brian Ganzel

And for Frazier Rehab:

• Outstanding Patient Satisfaction at the 99^th Percentile: Dr. Kenneth Mook
• Outstanding Patient Satisfaction at the 94^th Percentile: Dr. Douglas Stevens
• Outstanding Patient Satisfaction at the 92^nd Percentile: Dr. Louie Williams

Those physicians recognized for highest achievement of CMS Core Measures are:

• Perfect Care Bundle Results at the 96^th Percentile: Dr. Chandhiran Rangaswamy
• Perfect Care Bundle Results at the 95^th Percentile: Dr. Ibrahim Fahsah
• Perfect Care Bundle Results at the 94^th Percentile: Dr. Naresh Solankhi
• Perfect Care Bundle Results at the 94^th Percentile: Dr. Larry Leslie

I wish to congratulate all of these physicians for their outstanding outcomes in delivering the highest quality patient care and I thank our entire medical staff for their continued efforts at making Jewish Hospital and Frazier Rehab the best hospital in America!

*A note on the quality awards: The core measure bundle used for the physician quality award includes core measures within the AMI, Heart Failure and community-acquired Pneumonia core measure sets. The AMI-HF-PN bundle score is the percentage of patients meeting all core measure requirements relative to the specific measures for which they qualify within these sets. The denominator is the total number of patients that qualify for one or more measures within the AMI, HF and PN measure sets. The numerator is the number of core measure patients for which all core measure requirements were met. So, “perfect care” is defined relative to having followed the core measure evidence based practice protocols completely within each sub-set.

Celebrating Doctor's Day!

Health "Reform?" Not sure, but a step in the right direction

In the past week it has been hard not to notice all of the talk about the health "reform" legislation passed into law. As much as I prefer not to talk politics, many have asked me my thoughts on this reform legislation and its impact on healthcare as we know it. While I am by no means an expert on the 2,400 plus page bill and its 153 pages of changes, to sum it up simply, I would have to say its a step in the right direction.

Our current healthcare system is not sustainable for the long-term. There are over 47 million American's who are uninsured and with rising costs of labor, technology, pharmaceuticals, supplies and insurance premiums, healthcare will bankrupt our country if we don't do something about it. The New York Times reported that if we did nothing to change healthcare, by 2020 a family health insurance premium would be $24,000 or roughly a quarter of what the average American family is expected to earn at that time. Clearly, this is not something that can be sustained, but it is also not an easy issue to fix.

Everything in healthcare is very intertwined which makes any effort at true reform very elusive. While it was tried, you cannot separate the insurance companies, hospitals, physicians, lawyers, technology and device manufacturers, pharmaceutical companies and expect to come up with a comprehensive solution that will address the out-of-control spending that exists within our current system. Nor can you ignore the entitlement mentality that we have as a nation and neglect to address issues related to beginning and end of life care, preventive care and wellness, rampant obesity and nutrition issues, and smoking and hope that healthcare utilization will decrease. Couple all of this with the fact that our government does not partake in strategic planning, but rather short term partisan politics that are tied to a four-year election cycle and it becomes very easy to understand why "reforming" healthcare is such a daunting effort. So while the legislation that was passed may not be "reform" in the truest sense it will likely spur the discussions that need to begin happening in order for real reform to ultimately take place.

While certainly a deeply contested issue between the parties, I believe that this legislation has done a number of positive things that will begin moving the conversation of health reform in the right direction. Conversations about topics including:

• By covering an additional 32 million people we are beginning to put in place a system to match the entitlement mentality that our nation has around healthcare being a fundamental right of all citizens.
  
• By increasing taxes and requiring all citizens to purchase insurance we are promoting the concept of personal responsibility and the realization that all entitlements do come with a cost that must be ultimately be paid for by someone.
  
• By creating a healthcare exchange and eliminating the ability to disqualify based upon pre-existing conditions and removing lifetime caps we are allowing insurance companies to prove they are a real partner in healthcare and not merely a profiteer from it.
• By reducing payments to hospitals we will find new ways to partner with physicians, suppliers and insurers in efforts to better coordinate the care we deliver in a more efficient and cost-conscious manner.
  

There are many other topics that will undoubtedly come from this passage of legislation that will have some perceived positives and negatives for all involved. For the people of America, I think we have done something that will positively benefit the welfare of our nation. For healthcare, I think that our time has come to show our innovation and adaptability to ensure that we continue to provide a high quality product at a more affordable price. This will require us all to work together in ways that have previously eluded us. As they say, nothing worth doing is easy, but we needed to get something done. I for one look forward to the challenge!

Health "Reform?" Not sure, but a step in the right direction

Mr. Smith Goes to Washington

For the past year that I have been writing, I have somehow managed to keep politics out of my conversations here, but as they say, all good things must eventually come to an end! Last week I had the opportunity to take a quick trip to Washington, D.C. to meet with members of our Kentucky delegation to discuss issues affecting our system and healthcare in general. While my trip may not have exactly been like the movie, it was certainly an interesting and thought provoking experience. After reflecting on the trip I was both fascinated and frustrated by my time at the Capitol.

On the one hand, to see the variety, pace, and sheer volume of issues that must be dealt with on any given day in any given legislators office is mind-boggling to say the least. Constantly shifting gears from issues ranging from education to labor to healthcare to energy to transportation to (you get the point) requires a level of study and preparation that no one person can possibly master in any significant way. Yet through the coordination of legislative aides, assistants, and directors our public officials manage to do a pretty good job of being knowledgeable not only about the issues, but also the pros/cons and political consequences of any decision that they must make or support. Specifically, I was impressed to see the level of understanding that our elected officials have about the activities taking place in our hospital ranging from our research efforts in spinal cord injury and composite tissue allotransplantation (hand transplants) to our local issues affecting patient volumes, insurance, and reimbursements just to name a few. We should be comforted by the fact that our legislators are very aware (in a positive way) of the excellent care we provide to the community and the reputation that we hold as we carry out our mission.

On the other hand, after spending some time in the Capitol and seeing the level of competing priorities, agendas, and partisan politics, you can't help but get a bit dismayed at how difficult it really is to get anything accomplished. I just happened to be in D.C. as Senator Jim Bunning was in the news for blocking legislation to increase federal spending by $10 billion. Nevermind the fact that the Senator was really not opposed to spending the money per se, all he was asking was that we be accountable and have a way to pay for the proposed new expenditures (just as we must be accountable in our business). The result is an avalanche of chaos and commotion as lobbyists, constituents, and the media all flood the office, phone lines and email boxes as they scramble to position their personal agendas and biases in order to put pressure in overturning the last vote needed to sway in their direction. After seeing that display, you can't help but wonder where our issues on healthcare stand and to what degree they evaluated on their merits versus simply how objectionable or valuable they might be to any single legislators portfolio that they must manage as they attempt to barter with their votes to make progress.

However, as one legislator said to us, it really isn't the people in Washington that are the problem, but rather the process and I think he was correct in his assessment. When you look at a problem as complex and controversial as healthcare, to expect meaningful reform to occur in a single session is highly unlikely if not impossible. The number of variables that must be addressed to achieve true transformation is simply to large to be accomplished at one time. In my opinion we need a deliberate process to address not only hospitals and insurance companies, but also physicians, pharmaceuticals and supply companies, technology, tort reform, education, and even our entitlement philosophy as a nation. Unfortunately though, our government does not partake in a true strategic planning process, but instead resorts to politics and reconciliation to try and make good on a worthy, yet overambitious campaign promise regardless of the fact that the "reform" now being discussed will no longer provide a solution to the real problems we face. There ought to be (and is) a smarter and more thoughtful approach to tackle something as important as the health and well being of our nation. Hopefully we will figure this out before our current healthcare system collapses and bankrupts the country.

(But in the words of Dennis Miller, one of my favorite comedians)...Of course that's just my opinion, I could be wrong.

Mr. Smith Goes to Washington

Mono-Blog-ue or Dia-Blog-ue?

After a rather interesting month of travel for both personal and professional reasons, I have realized that an entire month has gotten away from my blogging. While I am always encountering situations that I think would be good topics to blog-about, I'm apparently still lacking the discipline to commit the time to actually sit down and write. To my loyal readers, I apologize and promise to do better about getting back on schedule!

When I do get to write, one of the questions that I am always asking myself is whether or not I am discussing topics that are interesting to you. In other words, am I hitting the mark or not? Are the posts relevant, meaningful, and engaging or are they so-so, watered down, or not all that worthwhile? I realize that is putting myself out there for a wide array of comments, but personally, I would prefer to know than to keep on guessing. To help with this, I have added a new "reaction" feature to the blog comments (special thanks to Jonathan at Press-Ganey for helping me figure this out!). At the bottom of each post there are now check-boxes that can be clicked like on Facebook to let me know if you "Like it!" find it "Interesting" or politely want to tell me that you didn't find it all that worthwhile by checking "No thanks." Of course you can also leave me a longer comment by clicking on the "Make/Read" comments link. While I do allow anonymous comments, I do have to preview them before they are posted to ensure there is nothing completely off-color or that would violate any of our privacy rules at the hospital.

When talking at the hospital in team forums, meetings or just the hall-way, I have always said I prefer to have a dialogue vs a monologue and to keep this meaningful, I'd prefer the same online. So now is your chance...let me know what topics you'd like me to cover and write about and please let me know what you think when I do. Thanks again for making this a worthwhile experiment!

Mono-Blog-ue or Dia-Blog-ue?