Wednesday, May 24, 2006

It All Matters

My good friend Tony over at Hospital Impact is crossing over to the hospital side and yesterday, he asked for some advice about working in hospitals. Of all my experience in the hospital, I think one thing sticks out to me about being a leader in a hospital. It is that every decision matters. Some decisions will impact caregivers and make their job harder or easier. Some decisions will impact patients and make their visit more or less enjoyable. Other decisions will change the level or types of services that are available to a community, which could have significant, if not life-and-death impact on people's lives.

That may sound dramatic, but it is certainly true in a sense. Healthcare administrators (the MHA type) are not clinically trained and yet their management decisions affect patient care. Some may think that this is inappropriate or a good reason for nurses and physicians to occupy leadership positions. There is certainly nothing wrong with that idea, but I believe there is a place for the non-clinical mind in this clinical world. If I learned anything else in the hospital it is that good management and leadership are required for the organization to thrive. The necessity of meeting immediate patient need drives decisions on the floors, but the organization needs people to look beyond the patient in the bed, to scan the horizon and to manage the resources. It doesn't take clinical training to perform these tasks. It just takes a profound respect for the impact that these tasks have on the patient.

So remember that, Tony, as you move into the hospital setting. It won't make your decisions any easier, but at least you know that they will matter.

Wednesday, May 17, 2006

Update on CAHPS

As promised yesterday on Hospital Impact, here is an update on the CAHPS survey, the standardized patient experience survey that will be collected by CMS and the results posted on the internet.

I started following the development of the CAHPS survey a few years ago. At first it was the major patient satisfaction survey vendors that were jockeying for particular questions and modes of survey delivery. In the end, there appeared to be a compromise on survey delivery (there will be 4 different modes of delivery), but it seemed that NRC Picker won the ideological battle over the questions. The 27 question survey asks about the patient's experience during their stay rather than assess the patient's satisfaction with particular aspects of care. Following the initial design, CMS conducted a 3 state pilot. The results can be found here.

Since I haven't checked in on the CAHPS survey for a while, I had assumed I missed the first phases of the survey implementation. It turns out that we are at the cusp of the implementation. The deadline for signing up for the "dry run" is May 22nd. The dry run will allow hospitals and vendors to collect data for a few months without the data being published. Once that is finished a nine-month data collection period will follow and scores will be publicly released on in late 2007.

Alright hospitals, are your ready for the survey?

Tuesday, May 09, 2006

A Strategy for Mental Health

I haven’t written about mental health and substance abuse yet, which is odd to me, because my major was psychology and I learned something about that branch of healthcare before I knew anything about the rest. What I learned was that mental healthcare in this country is seriously broken. The unfortunate history and development of mental healthcare is that these individuals were hidden away from “normal” society and very few resources were subsequently invested into a comprehensive mental health and substance abuse healthcare system. The sad reality is that even though many, many Americans will suffer as a result of having a mental health condition or substance abuse problem (or know someone that does), we have not decided, as a society, to discuss the issues of the mental health system in the public forum or sufficiently pay for that type of care.

I bring up mental health and substance abuse, because, as it seems to be the case lately, I have found a report that I think should and will have a significant impact on the direction of mental health and substance abuse care. The report is entitled, “From Study to Action: A Strategic Plan for Transformation of Mental Health Care”. The report is the second in a series of publications that brings together previous national studies on mental healthcare, including the IOM’s Crossing the Quality Chasm, and creates a “crosswalk” between them. In other words, this report finds the common ground between significant policy papers and forges strategies for action. I think that publications like this are significant because they give us a framework through which to focus our transformation efforts. When some of the stakeholders in healthcare, and in this case, mental healthcare, can agree on documents like this as a starting point for discussion, they can get to the work of real, constructive change.

Wednesday, May 03, 2006


I have been thinking again about healthcare leadership. My belief is that leadership is displayed in the things you say and do. The things you choose to say and the things you don’t say can encourage people to act or stifle them. My thoughts lately have been about how we do leadership, especially outside of our organizations, how we participate in the transformation of healthcare as an industry. This may sound like a pitch from your friendly professional organization, but it is authentic. I do believe that leaders should participate in local, regional, and/or national healthcare activities. Not only do these organizations and initiatives need volunteers, but your presence shows your commitment to healthcare and your organization’s commitment to being part of the solution.

I could say more, but then I would start to sound preachy.

Here is a really exciting opportunity to volunteer. The Certification Commission for Healthcare Information Technology (CCHIT) lists volunteer opportunities on a page aptly named “How to Participate”. If you are experienced in healthcare IT, then you can volunteer on work groups that evaluate IT solutions for certification. This is a great way to participate and demonstrate leadership.