Nick's Blog

In their Own Words: What patients, staff, and physicians have to tell us about their experience at Windber

Patients, staff, and physicians describe their unique, positive experiences at Windber Medical Center.

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The Wheels on the Bus Go Round and Round (Jacobs Announces Retirement December 31st)

Okay, so the word is out, way way out, that my tenure at WMC/WRI is beginning to wane.  As I look toward the next chapter of my life, there is something that you all need to know.  The board has met with both leadership teams to reiterate their complete support of my position until I am no longer here.  What does that mean?  It's like the old saying, "It ain't over until it's over."  

Interestingly, when one of my senior leaders heard my plans, he turned to me and said, "I can see it now. In about a year after you are gone, there will be weeds growing in the fountains, the trees will all be cut down, and all of the bullies will rise again!"  In fact, the rubber band seems to have started to return to its original shape already.  Last week we had an employee make one of our most important sponsors the offer of an appointment sometime next year. That sponsor selected another physician at another facility.  We then had another employee inappropriately question a guest's intentions. 

Let me tell you that, until they pry my retired fingers from my presidential desk, the weeds will not take over, the bullies will not be tolerated, and anyone who does not demonstrate love and respect for our patients and their families will be offered a transfer to any of our neighboring hospitals.  There is NO ROOM here for tolerance of anything that does NOT produce an optimal healing environment, that is NOT PLANETREE in every way, that does not embrace the vision of prevention, wellness, respect, and love.

I'm sorry if I sound upset, but this is an extremely serious situation. If any of you believe that we can go back to being a "NORMAL" hospital and survive, your head is buried deeply in the sand.  If any of you think we can be unpleasant and continue to capture the imagination of our patients and their families, you are completely delusional.  We are engaged in a struggle that will not easily be put to rest.  There is an urgi-care center, a surgery center, and a medical mall being built less than two miles from our walls. 

This, my last regular WMC blog post, is directed to the 15 or 20 people who are falsely being lured into believing that those of us who have embraced this nearly Utopian philosophy will permit you to run rough shod over our healing environment.  We will not.  The 600 other employees who do get it WILL WIN, and I will not let go unless or until I am no longer in a position to influence our work.  Our search committee has been charged to look for a replacement that also embraces this vision.

Get Your Hips on Route 56

In case you ever hear someone ask, "Windber?," we've complied a short list of attributes that have become part of our landscape over the past decade. Windber's ascendancy to the top tier of national hospitals and research centers this size and scope has been an amazing journey. With nearly 600 employees and a payroll of more than $21 Million, not acknowledging our Healing Hillside has become more and more difficult for even those oblivious narcissists who have ignored us for 100 years.

We are closing in on $3 M of successful fund raising activities being lead by Attorney Timothy Leventry and our Foundation office. These funds will be used for a new Emergency and expanded OB departments, and we are thrilled to report that the two highest operational income producing fiscal years in the hospital's 100+ year history are now "in the bag." These funds have enabled us to begin a massive installation of an entirely new computer system. The research institute also has nearly $20 M in the pipeline for significant research projects over the next two years with $10 M more pending for the third year.

With the announcement of the breast coil on our 3T MRI, WMC continues our bent of embracing innovative hospital care and treatment. As one of the first hospitals in the nation to adapt the patient-centered Planetree philosophy which pays particular attention to the environment in which patients pursue wellness, we now have clinical partners like the Cleveland Clinic along with us on this journey. The decision to promote the Dr. Dean Ornish Program for Heart Disease Reversal started us on our track to integrative medicine which uniquely places us internationally. Reiki, drum circles, labyrinths, pet, aroma, music, and massage therapy, accupuncture and energy medicine are just a few of the modalities offered here at Windber.

The research made possible by the opening of the Joyce Murtha Breast Care Center, one of the most innovative facilities of its kind in the United States, just adds further evidence of Windber’s uniqueness, and leadership there has literally opened the doors to numerous programs for woman's health that will further establish our commitment to this segment of our population.

We have successfully rallied important legislative support for far reaching projects here in cooperation with local, regional, state and national government through co-operation and support from Congressman John Murtha, Governor Ed Rendell and other public leaders. With the infusion of public contributions these include but are not limited to the a state-of-the-art HealthStyles Wellness Center, numerous research initiatives, the breast center and WindberPlace.

WMC has received top awards for excellence from AARP, numerous Planetree and Telly awards, was the first institution to win the coveted Fierce Healthcare Award for Hospital Innovation, and has been recognized by Forbes, The Wall Street Journal, USA Today, and numerous other media leaders.

If that's not enough . . . our HCHAPS scores were in the top 10% of the country, infection rates among the lowest, at 1%, readmission rates are low, lengths of stay are below average, and employee turnover is some of the lowest in the business. People like us because we like people.

Quality of Care

Back in the 70's, competitive marching bands came into vogue in Western Pennsylvania. Let me explain the before and after of this phenomenon: Before there were competitions, bands were made up of  nearly 10 times more students than they typically have today. My bands ranged in size from 120 to 185 students. Once competition came into play, the borderline students were not able to survive.  Consequently, it is not unusual now to have 20 students or less in a band.

What's happening in medicine and in health care overall?  The Government is taking a three-pronged approach to improve quality in health care:

1.  They are pushing quality through public reporting.  (Check a website near you.)

2.  Enforcing quality through the False Claims Act.  (Check a prison near you.)

3.  Incentivizing quality through payment reform. (Check a checkbook near you.)

Senator Chuck Grassley is quoted as saying, "Today, Medicare rewards poor quality care.  That is just plain wrong, and we need to address this problem."

HMO's are currently embracing "pay for performance" plans for physicians and hospitals.  Medicare is introducing value-based purchase plans.  Medicare is proposing the linking of quality outcomes to physician payments.

As I have written before, hospitals will no longer be paid for hospital acquired conditions. That seems like a rather simple fix, but to appropriately determine if the condition was not acquired at the hospital, extensive testing must be added pre-admission at considerable costs to the hospitals. 

James G. Sheehan, Medicaid Inspector General of New York said, "We are reviewing assorted sources of quality information on your facility to see what it says and if it is consistent.  You should be doing the same."  

Except for the financial implications, not unlike my competitive band story, the goal was to work toward perfection. The public reporting of quality of care is intended to:

1.  Correct inappropriate behavior

2.  Identify overpayment's

3. Deny payments

The False Claims Act, on the other hand has different goals. When asked how he viewed the False Claims Act, Kirk Ogrosky, U.S. Deputy Chief for Health Care Fraud said, "You will see more and more physicians going to jail."   I guess the prisoners will be receiving better care.

Where's it all going?  Competitive band.  Will it improve health care delivery?  Probably, for the patients who can find the few docs and hospital that will be left?  I recently had a conversation with a young computer specialist who took care of physician practices.  He said, "Doctors and hospitals haven't figured it out yet, but they are simply becoming data entry centers for 'Big Brother' as the facts and figures are accumulated to be used against them any way the payers decide to move forward."

Looking back at the school year that included gym class twice a week for the entire year, rich courses in music and art, and remembering a time when priorities included those classes intended to make every student well rounded, we have to ask, "Is education today better?" 

Maybe this is all too complicated to get our arms around, but if there are 78 million Baby Boomers, and the Medicare Trust Fund is heading toward bankruptcy, then we probably will see every rule in the book being applied to keep from paying out money, because there is simply not enough money to go around. 

Will health care improve?  Once we understand that technology is not the end all and cure all that creates healing; once we endorse prevention, wellness, optimal healing environments, and systems approaches to health and wellness, health care will improve.  I'll bet you that it will have very little to do with the rules that are unfolding right now and much more to do with the creation and acceptance of a National Health Policy.   

Hospital Bullies take a Toll on Patient Safety

That was the title of an article written by JoNel Aleccia for MSNBC.com.  When I thought about writing this blog, a cold chill went down my spine. The last time I attempted to address this issue, I was attacked, not here, but from other places. My family was hassled, there were letters written to the paper, to my board, to the Medical Society and demands for apologies all around. This article, however, took a much tougher stand than I did, and made its point much better than I did as well. 

JoNel started by writing, "They're the bullies of the operating room, the brow beaters of bedside manner; doctors, nurses and other clinicians who make a habit of behaving badly."  Before you start sending me your hate E-mails and trying to get me fired, censured, and publicly whipped again, let me begin by saying that there are only about 4 to 6% of workers and staff nationwide who typically fall into this category, and, in our case, I can honestly and proudly say that at Windber Medical Center there are less than 1%, but that's not the point.  The point is that this type of behavior is still tolerated ANYWHERE. 

Ms. Aleccia goes on to say, "They yell, they cuss, they throw things. Or they engage in more subversive behaviors; ignoring questions, acting impatient, insulting colleagues or speaking to them in condescending tones."  Any of us in this industry who have not observed this behavior should please stand and be recognized.  Interestingly, the Joint Commission has recently taken a stand against bullying behavior with a first-ever alert, and the reason for their alert is patient safety.

Dr. Mark Chassin, President of the Joint Commission, says, "It's a problem that goes underreported, threatens patient safety and has become so ingrained in healthcare that it's rarely talked about."  (So, send your evil E-mails to Mark, and let me alone.)

Dianne Felblinger, an associate professor of nursing at the University of Cincinnati who studies medical intimidation goes on to state that "About 70% of nurses studied believe there's a link between disruptive behavior and adverse outcomes, and nearly 25 percent said there was a direct tie between the bad acts and patient mortality."

The great news is that Windber Medical Center's Administration, Medical Executive and Credentials Committees and Human Resources Department deal with these behaviors immediately. They do not and will not tolerate bullying.  Oh, and before we end this blog post, remember, this behavior is NOT limited to care givers; clearly, administrators, department heads, and others can be just as guilty.   

The advice given in the article is the same advice that we adhere to here at WMC as well.  When someone is disruptive we should simply say, "You know what...? That doesn't work here...And we're going to have to do this together as a team because that's what it's all about."

Amen!

The Hospital of the FUTURE . . .

Healthleaders magazine had a cover story entitled "The Hospital of the Future" written by Molly Rowe.   The line below the title read: "Sure, your organization offers sophisticated, compassionate care.  But the patient of tomorrow will want much more than that.  Here's how some hospitals are creating facilities for a new vision of healthcare." 

Rather than re-write the entire story, I'd like to list eleven of the bullet points that were identified as qualifiers for future care in these new hospitals.  Then I'd like to ask those of you who have known, followed, or otherwise used us for your healthcare needs to identify which of those eleven are currently missing from this hospital environment, and, for that matter, which have not been a part of our experience here for the past decade?

1. Rather than report to a central admitting desk, patients and visitors are welcomed by greeters who escort them to appropriate locations.
   
   
2. Decor is focused on nature with earthy colors; indoor gardens, trees and fountains; and ample natural light.
   
   
3. It's much quieter thanks to sound-absorbing tiles, wireless communication, and limited overhead paging.
   
   
4. The lobby is consumer-centric with coffee shops, sitting areas, and kiosks for requesting information and scheduling appointments.
   
   
5. More attention is paid to way finding and signage, and hospital departments are given names that are less medical in nature.
   
   
6. Preventing disease and encouraging wellness are as important as diagnosing symptoms and treating illness.
   
   
7. Patient rooms are private, standardized, and bigger to allow overnight space for family members.
   
   
8. Patient rooms include built-in safety features like bathrooms located near patient beds to reduce falls and prominently placed sinks to encourage hand-washing.
   
   
9. For patient education and family entertainment, patient rooms and waiting ares are equipped with flat-screen TV's and Internet access.
   
   
10. Electronic records are standard practice.
    
    
11. In-home monitoring and diagnostic tools make it possible for patients to be diagnosed, treated, and monitored in their own homes.

Maybe the better question to ask is: are there any ideas listed here that have not been put forth as challenges for implementation to our vice presidents, directors, or physician leaders?  Okay, we're not completely there yet, but we surely are close, and for Windber Medical Center the future has been NOW for quite some time.  The things not on this list that we do include:

• Comprehensive Integrative Medicine including: acupuncture, Reiki, massage, energy medicine, flower essence, music, spiritual healing programs, physical manipulation, stress management/yoga, humor, pet, and aroma therapy.
• Community based work-out facility.
• Genomic and proteomic affiliated research lab for translational medicine.
• Walking trails, meditation and healing gardens, outdoor fountains and labrynths.
• Cardiac disease reversal program
• On-campus Greenhouse
• Trans-fat-free menu
• Meals served to patients, families, and staff on each floor.
• Lots and lots of polite, nurturing tender loving care.

I rest my case...

    

Knowing Enough About Systems to be Dangerous

From the age of about eight until 20 years ago, my entire life was immersed in music, education, the arts and, in a very pure way, people in general.  It was a complex world that required a deep, intuitive understanding of the human condition on multiple levels.  In a very general way, that life, (pre-health care management) was all about systems.  

Obviously, it was never just about one or two individuals, and it was not about life and death, but it was magnificently complex in its own way. It involved working with  people to do something that was extremely challenging, that required incredible hand/eye co-ordination, and an ensemble mindset of co-operativeness that was paramount to success.  Most importantly, it required them to listen intently to each other so as to find the perfect balance, blend and intonation. 

The nuances of taking a systemic approach to the creation of music through the efforts of an ensemble in many ways have escaped our world of healing, at least until now. 

At a recent visit to my dentist, he and his hygienist were talking about the fact that the doc had just taken a continuing medical education course.  When he was asked if anything new had evolved from his class, he smiled and said, "Well, for the first time in 28 years of practice, they admitted that the mouth is connected to the body."  He went on to elaborate about the fact that each and every day he sees the destruction caused by inflammatory disease of the gums, and then told me about his attempts to communicate that information to a physician friend several years ago.  "It just didn't register," he said. 

What little we know about inflammatory disease has us dutifully brushing our dog's teeth to prevent a heart condition, yet we still do not have direct lines of communication between our primary or cardiac physicians and the the dentists who see these problems as they manifest themselves in our body.  

Someone once told me that Descartes' Treatise of Man played a major role in the imposed medical and emotional separation of the brain from the body, as it clearly took the stand that "Hospitals and physicians should take care of the body while the church takes care of the mind and the soul."

One of our scientific collaborators, Dr. Lee Hood, is famous for his work in Systems Biology.  Another collaborator, Georgetown University, is involved in the creation of a medical school program revolving around Systems Medicine, and finally, our Optimal Healing Environment collaborator, the Samueli Institute, is focused on Systems Wellness.  In spite of these wonderful leaps into what would have to be considered common sense approaches to health and life, we still sometimes miss the ensemble approach.

My recommendation? 

Maybe it would help our healers to take their place on the podium, look at every one of the 30 plus lines of music on the score, raise the baton and begin to direct their way through every nuance, inflection, and harmonious signature present in a score of music with the appropriate rhythm, intonation and accents just to remind themselves that; we human beings are basically all made up of systems as well, and those systems will not function smoothly if one is completely out of sync with the other." 

This is something that we all know intuitively.  Maybe immersing ourselves in that world for a while will help bring that concept totally back into focus.  It's all about harmony, balance and nature's perfection, and a disjointed approach to health is as potentially harmful as a disjointed approach to life.   

Transparency

Transparency is a hot subject in health care these days.  The front page of last Sunday's New York Times carried a story about a physician who told his patient immediately after surgery that he had made a mistake, and basically apologized and asked for forgiveness.   Even with about 1,000,000 active attorneys in the United States working to make a living, the concept of telling the truth before it evolves into a lawsuit is more and more in the forefront of our literature. 

This week, I received a three page E-mail that was transparent, but it was not from us, it was about us.  It was so transparent that it should rock our collective souls.  As a patient-centered hospital that has reached some degree of recognition nationally, this letter represented not an A in patient centered care, but very close to a C, or worse. 

The person who took the time to record their stay at Windber Medical Center was painfully thorough.  Their hospitalization was over a 74 hour period when the house was full.  We were extremely busy, and somewhat short on some staff members, and a few key physicians were away.  This patient recorded every aspect of their experience.  They let us know when water was or wasn't delivered to the room, when the rooms were cleaned, where the nurses were and how often they delivered meds, checked their IV's, provided them with medicine, and met the patient's medical and/or personal needs. 

If it were not possible to determine who this patient was from the content of the letter, in the spirit of full disclosure, I would have reprinted it here for everyone to read. Instead, I will simply delineate the lowlights of its content.

The hardest thing about this letter for me was that we have been working for eleven years to bring improvement to the entire process, to improve health care delivery, and to provide an optimal healing environment. But, when things get rough, we seem to revert back to business-as-usual, circa 1997, and from the transparent report that this former patient provided, we did not always act appropriately. 

At a board, physician, and senior leadership meeting last week, I found out that one of our patient-centered practices had simply been discontinued without notification. This practice provided appropriately for patients, families and staff.  When it was discontinued, only the patients were being taken care of, and they were being cared for in an inferior manner compared to the original practice.  We have met with the appropriate staff members, and we are now back in the business of nurturing all of our stakeholders.

 
It seems to me that our reaction to stress and hard work might be like that of a rubber band.  As soon as the tension reaches its peak, that rubber band attempts to go all the way back to its original shape.  We are a Planetree Hospital.  We DO NOT do brain surgery, heart surgery, trauma or neonatal care.  We DO NOT have hundreds of specialists surrounding our campus like most academic medical centers.  Rather, we are a primary acute care hospital and our differentiation is patient and family centered care.  We are philosophically dedicated to treating our patients and their loved ones with dignity.  We are known for providing the highest touch care in the region.  After reading this patient's letter, it seems to me that they could have been in any hospital USA. 

If we believe that our mission is to provide the most wonderful, nurturing care, then we need to do that consistently.  A few weeks ago, a patient who was leaving the hospital said to one of our vice presidents, "Do you ever empty bedpans here?"  The question struck her as unusual . . . until she read the letter. 

We are all in this together.  We can only be as good as our weakest employee, and our future depends totally upon working not only as a team, but as a humane, caring, nurturing, loving team. 

Between our nurses, Integrative Health Team, our volunteers, pastoral care, our aids, housekeepers, dietary department and couriers, we should be in and out of rooms dozens of times a day.  No one should have to  wait for an overdue medication or just a cold glass of water. 

In closing, this is not a blog that is intended to demean, take unfair shots, or berate our staff, it is meant to say that transparency is exactly that: transparent.  Between the State Inspections, the Joint Commission and our own secret shoppers, transparency is here to stay, and we won't continue to grow without the total commitment from each and every one of us to work above and beyond the call of duty on all shifts.

In closing, the letter said, "You had one Golden Girl who was amazing in every way throughout my entire stay.  Her name is Debbie, and she is the pinnacle of everything you stand for as a Planetree hospital."

So, special thanks from us to you, Debbie.  You and people like you are our future. 

What it is all about . . .

Recently, my opinions have created some serious buzz in both our hospital and around our area.  My philosophical stand on patient-centered care is well known.  It has been the driving passion behind my entire life's work.  As a teacher and as a hospital administrator, it has been my commitment to do whatever was necessary to protect first, the kids, and now, our patients; to make them the center of our universe.

It is essential that we are reminded that each of us is a part of a much larger community, mankind. Obviously, some of us internalize these musings as coming from a leader who is not getting his hands dirty in the trenches, and the observation is absolutely accurate.  Unlike Braveheart, I am not out there in the middle of the battle.  I am not dealing with the nuts and bolts of the day to day challenges of patient care, but my role as a leader is to provide clear direction and to enable Windber Medical Center to have a bright, successful future.  The only way that this can occur is through differentiation.  How can we be different from other care centers?

It is important, however, that we detach from the intensity of our emotions now and allow ourselves to cultivate a more global perspective.  How would you want your mother or child to be treated?  How would you, as a patient, want to be cared for here?  If the answer is that you would like to be the center of that care, you are being honest and forthright.  That is all that this is about.  It is about putting the patient first.

But we are reminded of our limitations.  We are, after all, only human, and the daily challenges are real; our ability to deal with every element of our lives is real, and the pressures of life and death challenges are not easy to overlook.  So, we must focus on the fact that "we are not the enemy."  We must be the shining spot where patients know they will be protected, loved and compassionately embraced.

A Short Clarification

Let me begin with a very sincere apology. I am truly sorry if I did not make clear the substance of my article in last Monday's Business Review of the Trib. It was about Love, Compassion, Nurturing, and most importantly, making the patient, not the professional, the center of care.  It doesn't matter if a physician, like the amazing doctors here at Windber Medical Center, makes rounds at midnight, 2:00 AM or 9:00 PM if the patient and their family is the center of their care. Our physicians and staff, carefully ensure that their patients do receive this type of care.  This is was what it should all be about, making the patient, not the professionals, the center of our healthcare world.  This is what makes Windber Medical Center the wonderful place that it is.