Comments

We'll spend a cajillion dollars on GM and other bad business ventures and allow Americans to go without healthcare, even substandard healthcare. Too many hands in too many pockets. There is big money in keeping people alive or suffering. There is also less money in becoming a great doctor...

The road to nowhere, of our healthcare system, leads right to Washington.

Posted by The Joker at July 25, 2009 3:33 PM

Tom - My feeling is that “Putting the patient and the patients family first” requires leadership more than ever. I support Tom’s view that some healthcare providers “do wonders already in terms of quality, safety, minimization of unnecessary tests and procedures” - we have the same situation over here in that some providers achieve more than others in terms of outcomes – and that is WITHIN a universal healthcare system – it has to be about leadership. Until excellence in outcomes becomes the norm rather than the exception there will be ever widening inequalities.

These are the core principles of the UK National Health Service – we need leaders to ensure these principles are met for ALL the population. I repeat we have real challenges meeting these principles even within a universal healthcare system so I do sympathise with my US friends as you don’t have a universal system. Doubly difficult challenge it seems to me when profit becomes a prime motive in healthcare.

• Service based on clinical need not ability to pay
• Provide a comprehensive range of services
• Shape services around needs of patients, families & carers
• Different needs for different populations
• Improve quality of services, minimise errors
• Support & value its staff
• Public funds devoted solely to NHS patients
• Work with others for seamless service
• Keep people healthy & reduce health inequalities
• Respect confidentiality of patients and provide information about services.

Posted by Trevor Gay at July 25, 2009 5:18 PM

Meanwhile here in the UK the deceipt, corruption and perversion of the National "Health" System continues - true anarchy as Labour drives us into bankruptcy.

http://vids.myspace.com/index.cfm?fuseaction=vids.individual&videoid=2800657

Posted by UK Love at July 25, 2009 5:28 PM

I have had the opportunity to do some study and research on hospitals in the State of Arkansas. I am learning that hospitals, like public schools are a communities most critical resource and can be key to the economic growth and development.

Each school and hospital serves a unique community and each has their own unique strengths, challenges, opportunities and threats. Building level leadership is essential to improving performance, productivity and results within their communities. Billions get spent and wasted on education and healthcare reform because far to much of the funding gets spent on needless administrative functions and far to little reaches the local school or hospital where it needs to be spent to improve the deliverable to the customer. Who provides the oversight and makes those in executive leadership positions responsible accountable for the results they produce? No one, and that needs to change.

"We the People" need to get out of our seats and into the streets, neighborhoods, and communities and help get our building level leaders...Hospital Administrators/School Principals and their teams the resources and support they need to excel!

Posted by Dave Wheeler at July 25, 2009 10:23 PM

Dear Tom,

I am delighted you are out and about and I did enjoy your comments from San Francisco. I also admire Mayo and other institutions that you mention.

However, I think the Purpose of the bill discussed in Congress is not to promote Excellence in Healthcare, but rather to control costs. All systems promising a Heroic universal coverage have to focus on costs. In my view, the pursuit of Excellence is incompatible with a low cost strategy. I, therefore, expect frustrations
with the bill to go up. The bill will never satisfy those who are looking for Excellence. The question is whether it will provide a low cost strategy for the average american family.

All the Best,
Nikos Mourkogiannis
Author, "Purpose:The Starting Point Of Great Companies"
Nikos@Nikos.com

Posted by Nikos Mourkogiannis at July 26, 2009 4:24 AM

Tom, thank you for speaking up and out on the issue of health care. It would be pointless and redundant for me to share my rants on the issue here. Yes, I am as disgusted as anyone over the state of affairs in health care. But on this occasion, I just want to let you know that many of us appreciate you helping to lead the charge for the change. Wish I could have been there to hear what you had to say to them. It probably isn't possible, but if it is, I would love it if the presentation was streaming audio or video on the web. Nothing like getting my blood pressure raised now and then. ;-)

Posted by Dan Gunter at July 26, 2009 4:33 PM

Nikos

Great to see you commenting here. We both saw a crystal clear emphasis/case study on the imperative of Cost Cutting at Australia's Medibank Private in 2006.

The clear and present purpose in healthcare delivery today, worldwide, is to slash costs. Slashing costs is your "need" whether you run a healthcare system that is taxpayer funded (UK's NHS) or a seemingly privately funded one that is held together by a patchwork of government subsidies (US's Medicare). In both systems the limit to spending on health care is mandated by the government of the day.

Interesting to see President Obama go to the Cleveland Clinic to check it out. As you know that is where Google Health is running its trials on web-based patient's records, etc. As you also know, the CEO of Google, Eric Schmidt, is an Advisor to the President/White House thus he is a key figure in how this will all play out.

At the end of this Obama term it will be interesting to see how much of what Google is doing now and is preparing to do in the health care space will be adopted by Obama in his push to slash costs.

As you also know, the big cost reductions will come from hospitals. Shorter stays. Less intervention. Cutting cost in hospitals is not easy given the lack information technology and thus the continued reliance on paper records and people-based systems.

Finally, returning to the big picture issue. Negotiations between the White House and the hard core ideologues of the Democrats in Congress will be interesting. Let us all hope that the White House (yeah you Rahm Emanuel) win this fight and bring cost cutting reforms into positive effect within the US health care provisioning.

I am not sure Obama can win this one though with all the other things he has on his plate right now. Thus I expect to see much less excellence in US health care provisioning over the next decade.

Good to see you are still presenting "purpose" as the key to building a great company, community, and health care system.

Best of luck to you Nikos.

Richard.

Posted by Richard Lipscombe at July 26, 2009 7:53 PM

However, I think the Purpose of the bill discussed in Congress is not to promote Excellence in Healthcare, but rather to control costs. All systems promising a Heroic universal coverage have to focus on costs. In my view, the pursuit of Excellence is incompatible with a low cost strategy. I, therefore, expect frustrations
with the bill to go up. The bill will never satisfy those who are looking for Excellence. The question is whether it will provide a low cost strategy for the average american family.

Thanks for the topic.

Real Estate

Posted by DavidDock at July 26, 2009 9:38 PM

Dear Richard,

It is such a pleasure to reconnect with you thanks to Tom`s on line hospitality.

I am in violant agreement with all the points you are making. The big enemy of Health Care is paper.

I am writing a thoughtpiece on Health Care. I would like your feedback before I publish it. How can I reach you directly?

Pls email me your email adress at Nikos@Nikos.com

Nikos,

Author, " Purpose: The Starting Point Of Great Companies".

Posted by Nikos Mourkogiannis at July 27, 2009 9:26 AM

The purpose is to cut costs? I thought it was to provide universal coverage and universal access. Oh, and to remain budget neutral. And which of the 4 plans in committee will come to the front?

Kaiser, Mayo, Cleveland Clinic can do great things because they have the physicians in one location and they are employees. Most healthcare is what someone called a cottage industry. Physicians in practice alone or small groups and they don't talk to each other. Even an electronic medical record won't solve that. Everything is fragmented so you are herding cats.

And finally, since most of our healthcare is spent on chronic conditions; diabetes, various things heart related, and the snack food fueled obesity, until there is an incentive to live more healthy lifestyles the cost to insurers and revenues to providers will stay up.

Posted by MikeC at July 27, 2009 11:27 AM

Great points, MikeC, not to mention that it is profitable to keep Americans unhealthy for some industries. It is perhaps not by accident that most healthy foods cost so much. I love Whole Foods, but the average American cannot afford to shop there. These are those who probably need it the most, who don't have insurance and the rest of us pay for during their visits to emergency hospitals throughout the country.

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We should probably also take a good hard look at who’s producing our food and who's receiving subsidies.

Growing up, we did not have a lot of money; we hate baked chicken many times a weeks that became chicken soup with various kinds of hearty vegetables thrown in grown from my uncles farm in the summer. We had a salad with just about every dinner that included colorful fresh vegetables of every kind. We did not have a lot of money to buy junk food and we rarely ate out. Our declining health is largely associated with our increased wealth.

Thanks, TP, for the post. I too love San Francisco and lived there just above the Haight/Asbury district in the most wonderful Victorian shared with three others; each bedroom had a fireplace that was fired up in summer. I have great memories and love it when I visit. What a city! After a while, though, it got a bit too small and I moved to New York City, another great city!

Posted by Judith Ellis at July 27, 2009 12:26 PM

Fragmentation of healthcare perpetuates and widens the gap between the healthy and the unwell which also means the wealthy and the poor. Mike is right that the emphasis on health rather than illness is the correct mindset. The problem is that prevention of ill health and promotion of health is not a sexy vote catcher for politicians. On the other hand threats to close an acute hospital (the ‘treatment’ end of healthcare) results in politicians milking the vote catching opportunity.

Food, exercise and heart disease prevention is a great example to look at in terms of fragmentation. The convenience food culture means that the only exercise I need to take (if it were my wish) is to reach out of my car window to collect my take away food from the food drive in. This is the market at work. We can’t have it both ways. If we don’t want government interference but at the same time we want a universal healthcare system then the market will dictate. That way the rich get healthier – the poor get sicker. This is not new news – this is just human nature and pragmatism in action.

Universal healthcare will work best when there is no fragmentation of all aspects of our ‘well being.’ As long as health is seen as a separate issue, isolated in some strange place and ‘away’ from issues like employment, poverty, education then we will continue to see health inequalities gaps widen in all populations. I don't believe it's not about cutting costs or about electronic records (although those 2 things are important) - it is about more emphasis on quality and that means LEADERSHIP.

Posted by Trevor Gay at July 27, 2009 1:26 PM

Sorry - meant to say; canadian generic viagra healthcare

I don't believe it's about cutting costs or about electronic records (although those 2 things are important) - it is about more emphasis on quality and that means LEADERSHIP.

Posted by Trevor Gay at July 27, 2009 3:19 PM

Much of the money spent in healthcare is spent on chronic conditions.
This is because there is no cure for these conditions. This is a bit of a no brainer.
Once you have diabetes, you maintain the condition and so are always being treated.
Why don't we have more research on thinks like
antibiotics which are cure desease? Maybe because curing a patient means you lose business.

Posted by zorro at July 27, 2009 3:30 PM

About 10 years ago I met a very brilliant man who designed the keypad, the initial device used for hotel room entries. My sister-in-law had/has a very successful medical billing practice. One day sitting in her office, looking at all the reams of paper, I had an idea. I approached this gentleman about my idea to work with the government (Medicaid and Medicare), hospitals and private practices to reduce the waste and simplify the medical billing process. I began doing research and was appalled at the waste of paper and the abuse from double billing and errors in codes. Frankly, a lot of it looked like fraud and abuse.

My partner and I began a company, got a few doctors to use our system, which was quite successful, and approached the government. We met with government officials. They talked a good game, but in the end it was strictly show. They wanted to look good but they didn't really want to do anything different; it's sort of like what Senator Dodd is doing right now: putting out ads about bad lobbyists and taking their big money at the same time. Many others, Republicans and Democrats, are doing the same thing.

But it does appear (oh, God, appearances can be so deceiving) that we are getting more serious about waste, fraud and abuse that will definitely assist in bringing down healthcare costs. The procedures and codes are many. The work that the government is doing with Google seems like a winner. But I must also say that I am concerned about the lost of a paper trail with the push of a key or the decoding of a system; I am concerned about privacy issues. Regarding the rules designed to detect fraud and abuse, however, are almost as egregious as those that enable it. There are too many procedures and codes. No one could follow that many accurately.

Posted by Judith Ellis at July 27, 2009 3:39 PM

Clearly a worthwhile venue for speaking leadership. I was heartened to read that there were 42 healthcare applications out of 70 total applications for the Malcolm Baldrige National Quality Award this year. The process requires commitment from the top of the organization and it is great to see hospital/healthcare leaders pursuing excellence in this manner.

Posted by David Porter at July 27, 2009 4:58 PM

David - thank you - it is indeed encouraging to see those numbers. Effective leadership is the biggest single challenge in healthcare in my opinion. Technology advancements in medicine are brilliant; electronic records are a fantastic development which sees the patient rightfully given more control over their own destiny; cost control is crucial as Richard and Nikos point out; but NONE OF THESE THINGS will be effectively implemented unless the leadership is prepared to grasp the many nettles.

Posted by Trevor Gay at July 27, 2009 5:42 PM

David/Trevor...I am a member of the Board of Examiners for my state's quality award that is aligned with the Malcom Baldrige Quality Award. We too have seen high percentage of our applicants coming from the health care sector. Involved and engaged leadership is indeed a performance and productivity multiplier.

Posted by Dave Wheeler at July 27, 2009 7:15 PM

Meanwhile - some have learned the zen of "healthcare" & their codes & circular logic - now when I show up as a patient - they pay ME - if I say I am a specialist patient they pay me MORE.

Can it can happen for you one of these days or one of these nights?

http://www.youtube.com/watch?v=94bL91pazq4

Posted by UK Love at July 27, 2009 8:11 PM

Zen + Health care... interesting combination.

Stick out your tongue and say "Ohhhhmmmmmm..."

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