Nick's Blog

THEY'RE BACK . . .

Just when we think the EVIL SPIRITS have gone away for awhile, they come crashing back. 

What evil spirits, you ask?  Well, over the past few years we have had several individuals and organizations do everything humanly possible to thwart our progress. 

I have no desire to expose these individuals and organizations or their motives in this treatise, at least not while I'm alive . . . but the book could easily end up a best seller. 

 For those of you old enough to remember Michael Douglas as Gordon Gekko in "Wall Street," or Larry Hagman as J.R. Ewing in "Dallas,"  they both played the role of the Easter Bunny in comparison to some of the people with whom we have had to deal in the last five years. 

These people, their motives and interesting views are part of the reason why this area has had so many challenges on its journey back from the flood of '77.  Jealousy, power, greed, blind passion, disbelief in progress, or just the crying out of tortured souls trying to find ways to keep WMC and WRI from growing, prospering, and advancing.

We have had individuals interfere with our state grants. (They actually had them withdrawn during the former administration.)  We have had individuals work tirelessly against us to have taxes imposed upon our not for profit organizations.

We have had individuals block the building of our new research center, work to freeze our federal grants, and come back at us again and again.

We have had problems with contractors, steel companies, window companies, and just a few weeks ago, there was an attempt by a very powerful Washington D.C. bureaucracy to freeze our grants, again. Thankfully, they were not successful.

Now, we are being told that they're coming back for another visit, those negative energy generating nay sayers who would have us languish or fail. 

So, as I make two separate trips to Florida this week to deliver five speeches about the wondrous, phenomenal accomplishments at WMC and WRI, we deal minute by minute, hour by hour, day by day "in the weeds." 

Now is the time to say . . . focus on the positive and good will prevail.  We are moving ahead on all levels, and if one partner doesn't do what they promise, we'll get another, better partner.  If one senior leader doesn't do what needs to be done, we'll get new leaders. 

NOTHING WILL STOP THIS EFFORT.  N-O-T-H-I-N-G.  Because all of our combined POSITIVE energy, commitment, and passion will ensure safe passage to the new frontier, to the new healthcare delivery system, to a better future.

Medication Errors?

Why do national statistics show that thousands of people are injured or die each year in hospitals due to medication errors?  Thankfully, like many other aspects of care at Windber Medical Center, we are obsessed with perfection in this area and very rarely see even a near miss, but this problem persists in hospitals all over America.

If pharmacists are careful, you might ask, how does this possibly happen? 

Well,  besides the pharmacists, there are pharmacy techs and pharmacy aids, poorly written prescription orders, and there are busy  RN’s, and LPN’s.  There are inappropriately registered patients with similar last names.  There are emergency room employees who sometimes miss or misunderstand what the patient is saying about the drugs they take at home. There are patients who don't tell the entire story, or their personal drug lists are inaccurate.  They often do not mention the "recreational "drugs that they take, for whatever reason.

Do the patients sneak in their herbal medicines, laxatives and antacids?  Yes. 

So, do you get the picture?

As human beings we are subject to human error. As hospitals, we continue to work toward putting systems in place that are as sophisticated and complex as those used to keep 747's in the air, and those policies then need to be checked and counter-checked. We will never stop pursuing the perfection needed to protect our patients.

Some Nice Blogging Features

This week two of our friends helped to spread the WMC word/world through blogging activities that have concluded by featuring us on various other Blog sites.

Name: Bob Coffield
Location: Charleston, West Virginia, United States

Bob is a lawyer-blogger practicing health care law at the firm of Flaherty, Sensabaugh & Bonasso, PLLC in Charleston, West Virginia featured us in his blog: http://healthcarebloglaw.blogspot.com

"Nick Jacobs, the CEO at Windber Medical Center and regular blogger at Nick's Blog, guest posts at Hospital Impact. His End-of-Life Care Healthcare will end the life of healthcare indicates why we all need to discuss with each other, our families and our nation end of life care issues and the impact on the health care system. Nick's Blog, the first known hospital CEO blog, is an excellent example of how blogs can be used by a CEO to communicate to staff, employees, customers (or in this case patients) and the community."

Then, our friend Tony Chen of HospitalImpact.org, for whom I have been guest blogging for the past several months queried me about our senior leadership group the other day. Shortly after that he informed me that he had featured us on the Healthcare Financial Management Association's new blog.  Excerpts from Tony's article to HFMA's Blog- HFMA Views.

"Recently I had a conversation with my friend and fellow blogger, Nick Jacobs, who is CEO of Windber Medical Center. Given that his hospital has received dozens of accolades and media mentions (featured on the Today show, Forbes Magazine, and the WSJ), I asked him about the secret of his success. What are the one or two things that they do really well? This is what Nick said:

'My team is excellent at taking pure air, a.k.a., one of my ideas, and operationalizing it in a very brief amount of time. For example, we decide to buy a piece of equipment that is so new that most physicians in the area have no real understanding of its capabilities.

'The team puts together a business plan, adapts the building, begins an educational blitz of all of the physicians in a four-county area, establishes billing/coding solutions, prints appropriate forms for every aspect of registration and billing, identifies key physicians for interpretation of the diagnostics, puts together a marketing plan, hires the expert staff and launches the new modality within a period of three months after the decision was made to move forward.'

'During the past year, the above description has effectively occurred with the launching of a 16 slice PET/CT; 3T-MRI; 4D ultrasound; a new minimally invasive surgery practice; sleep lab; respiratory center and a new OB/GYN practice with three new physicians.'

'Because we're under 100 beds, my team is small, but they also are very bright, highly skilled, and extremely agile. "Hire five, work like ten, and pay like eight."'

In other words, a great team (and great leadership). And, by the way, his team has also implemented Planetree, hired a hotel manager for their patient access area, and brought in a baker to bake fresh bread on the premises twice a day."

Oh my . . .

When you depend on any single source of business for your existence, you often times play out a scenario in your head where someone comes into your office and tells you that the party is over.  It's  like an advertising agency with only one client or a sports agent with one athlete. 

WRI has plenty of grants, but the bulk of them are from one major source, the Department of Defense.  Well, we are doing everything possible to diversify and have been for the past four years, but it takes time when you're the new kid on the international block, and we are really close, but not there yet. 

So, take a walk with me down tension lane as we explore what happens when the Executive Branch of our government decides that it's time for a little hardball?

On Tuesday at about 3:00 PM, one of our senior leaders came into my office at the Research Institute and said, "The office of the Secretary of Defense has decided to put a hold on all of the 2006 Department of Defense earmark grants." There it was.  That ominous pronouncement.  Nearly $20 million research dollars went into limbo.  Cancer vaccines, heart interventions, diabetes monitoring, obesity studies... everything went into the black hole.

What did it mean to have our grants held?  Well, we knew all too well what that meant because two years ago we had it happen to us when Tommy Thompson, then Secretary of Health and Human Services, held our grants during our building project.  We literally ran on air for nearly six months.  Now, here we were once again faced with this possible reality. 

We learned that 4,000 other organizations were placed in this very precarious situation along with us. Not all of the organizations did research.  Some manufactured specialty equipment for the war in Iraq.  Could we survive?  Sure, but it wouldn't be pretty for either the Research Institute or the Medical Center.

Without exposing anyone's identity, I grabbed my Palm Pilot and sent a message to a former student, one of my former fifth grade trumpet players, and expressed my concern over this situation.  He called me back and said that he and his boss, a very powerful U.S. Senator, would check into it. 

The following day, during an extremely serious meeting of the Research Institute Board, I discussed this potentially ominous situation and the steps that we were prepared to take to survive this funding interruption.  As I began to discuss the survival plan, my hand held Treo began to vibrate. I looked down and read the following message from my trumpet player buddy, "It looks like the situation that you contacted me about yesterday has been rectified."  Nice timing, my friend.

Then our Principal Investigator sent this text, "The requirement that was in place to hold our grants up has now been withdrawn."

Okay, as Msgr. Paul always says, "And the bottom line?"   Well, the bottom line is, be good to your students... So, thank you, Richard. Nice job, my friend.

The Netherlands R Us

Erasmus MC strengthens Translational Medicine Cooperation with Windber Research Institute

Pushing Genomics based Medicine ahead to improve patient care for wide range of diseases by integrating data

Rotterdam, Neth. and Windber, PA USA., Febr., 2006 – The private, non-profit Windber Research Institute (WRI) will work closely with Erasmus University Medical Center Rotterdam in a strategic partnership to jointly develop a translational medicine data warehousing solution for clinical, molecular (genomic and proteomic) and imaging data.

Erasmus and WRI expressed a joint vision towards developing standardized approaches to data warehousing and analytics in support of translational medicine based clinical decision making, each relying heavily upon Oracle and InforSense technology respectively. The WRI Biomedical informatics team, headed by Dr. Hai Hu, will work closely with the Erasmus MC department of Bioinformatics headed by Prof. Dr. Peter van der Spek on storage, data analysis and interpretation of translational medicine data.

Windber Research Institute is involved in clinical studies and clinical trials through an existing relationship with the Walter Reed Army Medical Center in the Clinical Breast Care Program and the Integrative Cardiac and Metabolic Health Program. Currently, more than 19,000 highly annotated and qualified breast disease samples, with more than 500 data fields collected on each patient, are integrated with molecular and imaging data into an Oracle datawarehouse.

Erasmus MC extensively uses Affymetrix microarrays in virtually every disease research area throughout the institution, from pediatric to geriatric studies, to infectious disease and cancer through its strategic Translational Medicine program with Affymetrix Inc. (Nasdaq: AFFX)

With the rapid expansion of expression and genotyping data in both institutes, data warehousing solutions are required in parallel with data mining tools for translational medicine based projects.

The Erasmus MC projects are planned to consistently and systematically use large patient populations.  The large number of well-annotated clinical samples, standardized protocols, and ground-breaking bioinformatics infrastructure will allow Erasmus MC researchers to produce statistically relevant, well-documented results which can quickly be translated into diagnostics for patients. Additionally, such analyses are anticipated to lead to the discovery of new drug targets.

“This strategic collaboration is designed to quickly integrate genomic research data with patient clinical data to bring solutions from the laboratory to the bedside as rapidly as possible”, said Dr. Michael N. Liebman, Executive Director, Windber Research Institute.  “Our joint goal is to take translational medicine from theory to practice. We are dedicated to optimize the use of existing knowledge, while employing new technologies and developing biomedical systems for the future and help reduce healthcare costs.”

About Windber Research Institute, Windber Pennsylvania, USA

The Windber Research Institute is a translational medicine research center that focuses on bringing the problems in the clinic back to the research laboratory for analysis at the genomic, proteomic, image and informatic levels.  It is focused in its research areas on women’s health, including obstetrics and gynecologic diseases including breast, ovarian, endometrial and cervical cancers, cardiovascular disease, obesity and diabetes, and processes of normal aging including menopause.  It has worked closely with its partners at GE Healthcare and InforSense to develop an integrated research environment that is being extended to support physician decision making in collaboration with the patient.  Major efforts in tissue banking, patient data acquisition and genomic research (sequencing, genotyping, gene expression, whole genome analysis) and proteomics (protein separation and identification) comprise the experimental focus.  The biomedical informatics efforts include data modelling and warehousing, data mining and research into the development of disease models for risk assessment, prevention and early detection, including environmental and lifestyle factors.

Windber Research Institute collaborates closely with the Walter Reed Army Medical Center  and with the Joyce Murtha Breast Care Center, the University of Pittsburgh Medical Center and Cancer Institute, Georgetown University, and the University of California-San Francisco in the areas of women’s health, cardiovascular disease and obesity.  It is a private, non-profit research institute that is located approximately 1.5 hours from Pittsburgh, Pennsylvania, in the Laurel Highlands Mountains, and is affiliated with the Windber Medical Center, part of the Conemaugh Healthcare System which services central Pennsylvania.  Additional information can be obtained at www.wriwindber.org.

About Erasmus University Medical Center Rotterdam:

The Faculty of Medicine and Health Sciences of Erasmus University Rotterdam and the University Hospital Rotterdam joined forces to form the Erasmus MC, the largest centre of it’s kind in the Netherlands. Advanced medical care is provided in three clinical branches: the General Hospital, Erasmus MC - Sophia Children’s Hospital, and Erasmus MC - Daniel den Hoed Oncology Center. Located in the heart of Rotterdam, Erasmus MC provides advanced medical care to 3 million people living in the south-western part of the Netherlands. The Erasmus MC has achieved excellence in many areas including cardiovascular diseases, oncology, pediatrics, clinical genetics, human reproduction, endocrinology, virology, immunology, hepatology and microsurgery. The research activities at Erasmus MC range from fundamental biomedical research, patient-related research and epidemiology to health care policy and management. Additional information on Erasmus MC can be found at www.erasmusmc.nl.

State of the George Bush Union

I'm in New York City for the weekend . . . seeing shows, eating, touristing, you know . . . it's New York. But while I've been here, my e-mail has been flying.  Seems like that will ALWAYS be the way it is in the 21st Century.  What have I received this week-end that has been EXTREMELY distracting?  Well, two messages rocked my days:  the first was from the words of George W. Bush and the second was from the interpretation of his words. 

First, immediately after the State of the Union speech, Mr. Bush announced that he needed billions more for the Iraq war, but, to pay for it, he has begun to make serious and significant cuts in many social services programs to include Medicare.  Wherever Medicare goes, Medicaid will shortly follow, and that's bad news, because about 60+ percent of our local healthcare dollars come from those sources. 

Second, many of you may not know what the first Balanced Budget Amendment Act did or almost did to numerous hospitals in this country, but the cuts were serious enough to nearly close many of us down.  Our reimbursements were cut so significantly and so quickly that it took us four years to figure out how to counter them. MRI, HealthStyles, PET/CT, and minimally invasive surgery were all new initiatives that worked for Windber, but not for Lee and hundreds of other hospitals that called it quits.  The ideas that worked for us were difficult, risky and painful.

So, hold onto your hats for BBA 2 . . .

Second, Mr. Bush announced that he was going after "earmarks."  Now, again, for those of you who don't know what earmarks are, they are individual projects initiated by local Congressmen and Senators to assist their districts with federally funded projects, in other words: WRI, CTC, NDIC, etc.

So, as I look at the immediate future, I say, enjoy the day, because, except for terrorist attacks, avian flu, and locusts, the worst may be yet to come. 

Just remember that obstacles and challenges create opportunities, and that's what we'll be looking for during the new few Bush years.  Only the CREATIVE will survive.  Thank God I studied music for so long.