Technological

Cultural

"There's no question that the healthcare field is undergoing

a period of fundamental transformation in which the

very model of healthcare delivery is being changed in order to improve quality and

lower costs"

- Sharis Pozen, a partner at Skadden, Arps, Slate, Meagher & Flom, during testimony on behalf of the American Hospital Association for the House Subcommittee on Regulatory Reform and Commercial and Antitrust Law.

The United States' burgeoning primary care crisis amid the

rollout of health reform is akin to "handing out bus tickets when

the bus is already full"

-Perry Pugno, vice president for medical education at the

American Academy of Family Physicians

Republican senators led by Utah's Orrin Hatch have

said they will work to repeal the 2.3 percent medical

device tax that went into effect January as part of the

2010 Affordable Care Act.

The tax--intended to help pay for costs associated

with the healthcare reform law--is a point of

contention for many legislators, as well as device

makers, innovators and providers. Hatch, ranting

about the tax on Tuesday, referred to it as "one of the

stupidest aspects" of the ACA.

A March 2012 report published by AdvaMed concluded

that the tax could result in the loss of close to

39,000 jobs and $8 billion in economic output.

The medical device tax

would generate $30

billion over a decade to

support the tenets of the

Affordable Care Act - President Barack Obama

In fiscal year (FY) 2014, the Hospital

Readmissions Reductions Program will

withhold up to 2% of regular reimbursements for

hospitals that have too many patient

readmissions within 30 days of discharge

because of three medical conditions: heart

attack, heart failure and pneumonia.

Under the ACA, the maximum penalty will top

out at 3% by 2015 and be expanded to include

readmissions for other medical conditions,

including chronic lung disease and elective hip

and knee replacements.

The nonprofit organization--known as the Center for

Medical Interoperability--will be financially backed by the

Gary and Mary West Foundation, according to an

announcement. Founding Board Chairman Michael Johns

called medical device interoperability key to "unlocking

healthcare communications" in hospitals.

"By bringing hospital systems together, we can align all

stakeholder interests in a neutral forum to include

technology vendors, standards organizations, certification

bodies, government agencies and healthcare associations

under a common goal to improve healthcare," Johns said

in a statement.

Healthcare Business

Intelligence: A Guide to

Empowering Successful

Data Reporting and

Analytics"

by Laura B. Madsen, M.S., founder of the Hsummit.

Four things you absolutely should not, under

any circumstances do," which includes:

• Never make a consultant the leader of your

business intelligence program.

• Don't ignore or forget about you own staff.

• Don't believe the vendors who promise you

can install and plug in your data and be up

and running in a few days. If it sounds too

good to be true, it is.

• Never de-emphasize the importance of a

good data model.

Genome Sequencing Prosthetic Development

Stem cell research

Organ growth

Artificial

Hearts

Nanotechnology

The patient-centered medical home

(PCMH) continues to help healthcare

organizations achieve lower costs and

better care, as well as improve physician

and staff morale.

With such potential benefits, FiercePracticeManagement reached

out to Montefiore Medical Group in the Bronx, N.Y., to hear how

it has established a PCMH model and received

National Committee for Quality Assurance (NCQA) recognition.

“Value-based healthcare as a

"breakthrough that will change

the face of medicine." He said

the pay-for-performance model

will lower healthcare

costs, improve quality and

outcomes and eventually affect

every patient across the United

States.”

- Toby Cosgrove, M.D., in a blog post for the Harvard Business Review

Medical errors leading to patient

death are much higher than

previously thought, and may be

as high as 400,000 deaths a

year, according to a new study in

the Journal of Patient Safety.

I sure hope

they

remember

to wash

their hands!

There are about 250,000 C. difficile

infections a year in the United States

that either require hospitalization or

involve already hospitalized patients.

The bacteria kills 14,000 Americans a

year, the CDC says.

Focus on Ecological Sustainability

Healthcare Environmental Efforts

• H2E (Hospitals for a Healthy Environment) -“Making Medicine

Mercury Free” program.

• Recycling tons per year - shredded paper, beverage containers,

mixed paper, old linens and scrubs, batteries, and cardboard.

• The E-Waste (electronic waste) recycling program.

• Printer cartridges returned for reuse.

• Setting copiers to use two-sided printing defaults.

• Medical charity foundations and organizations receive medical

supplies and equipment.

• Implement a standardized temperature control policy.

Healthcare Environmental Efforts

• Movable shutters that promote passive solar heat reduction.

• Use digital radiology scans, reducing the use of water as well as

hazardous waste associated with traditional X-ray processing.

• Reprocessing is a key component in environmental sustainability

programs and is a proven means of not only decreasing the

quantity of waste going into incinerators and landfills, but in

decreasing the cost of providing safe, effective devices.

• Create food gardens on campus dedicated to general education

about seasonal grains, fruits and vegetables. Can be located on

building roofs and provide a source of fresh healthy foods for

patients and staff.

• Low flow fixtures to reduce water consumption. Using solar

power and dual-flush toilets.

Advanced Environmental Efforts

• Assuring facility finishes are free of polyvinyl chlorides (PVCs), have low-VOC

(volatile organic compounds) emissions and be sound attenuating to reduce

noise.

• Focus on passive strategies, such as utilizing narrow floor plates to maximize

exposures, creating an efficient thermal envelope and designing efficient

lighting.

• Address active strategies, such as the use of occupancy and daylight sensors,

fuel cells, renewable energy and water conservation.

• Environmentally preferable purchasing, integrated pest management and green

housekeeping.

• Sewage treated in an on-site membrane bioreactor.

• Building systems also include an integrated day-lighting system, naturally

ventilated stair towers, radiant heating and eco-roofs.

• Rainwater and wastewater are harvested for landscape irrigation.

Severe thunderstorms, such as this one

observed in Oklahoma in 2009, that could

create tornadoes will become more

common with global warming.

Build a bench of informal leaders

In early 2011, Maryann (the new CEO at the time) made it her personal mission to task a refreshed set of leaders with turning around the organization. Instead of looking outside the organization, she collaborated with trusted and loyal colleagues to understand the issues plaguing the organization and build a list of potential leaders.

The goal was to build a culture of transparency – difficult conversations, which previously happened behind closed doors, were held out in the open to build trust and acknowledge the organization’s shortcomings.

Weed out underperformers

Having identified a strong platform of potential leaders, the organization conducted “up or out” conversations with under performing leaders, recognizing that the long-term gains of having the right people steer the ship outweighed the short-term pains associated with turnover.

Quality, turnover, and manager effectiveness data from the engagement survey were used to identify these individuals, and they were confronted with one question – are you either unwilling or unable to lead effectively? Those leaders who were unable to manage their colleagues effectively were offered coaching, and those who were unwilling were asked to leave.

Strategically sequence improvement efforts

Perhaps most importantly, St. Elizabeth’s resisted the urge to tackle all of its performance improvement concerns at once. While many organizations stumble by spreading their focus too thin, St. Elizabeth’s began by shoring up quality metrics to ensure that employees felt they were working at an organization they were proud of.

After encouraging progress across 2011, St. Elizabeth focused primarily on engagement in 2012 and on patient satisfaction in 2013, sustaining previous years’ efforts and building an improvement-driven culture.

St. Elizabeth’s turnaround was driven by their CEO, Maryann Reese, and included three critical elements-Sarah Strumwasser.