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.   

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...

    

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.