While at HIMSS I presented at a session that discussed the relationship between costs and patient satisfaction, a collaborative research project done with ARAMARK Healthcare and Deirdre McCauhgey, Ph.D., Assistant Professor form Penn State.  Dr. McCaughey and I are pictured at left at our session.   The session looked at outline an approach for analyzing the  relationship between costs and patient satisfaction, described the creation of a value equation linking expenses to outcome metrics, and explain how to apply this approach to hospitals.

On another note, as I spoke to people (many of whom symbiotically connected to their IPads) I began to get a feel for the way that clinical technology is moving closer and closer to information technology. The complexity of medical equipment has increased so significantly that the relationship between clinical engineering and IT has become very intertwined.

For example, I was talking to one hospital CIO who was telling me how he needed to perform a software upgrade on 600 medical devices. His quandary was who should do this … the clinical engineering team or the IT department?

The solution turned out to be both, led by a clinical engineering team that is integrated with the IT department as a partner.  What is happening is that more and more clinical engineering teams are reporting to the CIO. This is a trend that will surely gain momentum as equipment continues to become more sophisticated and highly networked.

What does this mean? From my perspective it means that clinical engineers and biomed technicians will need more and more of the right kind of training and nurturing as they perform service under this strengthening partnership with IT.

No question that technology has both advanced and complicated the healthcare industry, even in the service sectors, but unlike the Matrix movies  I believe it is ultimately good for human kind, even if we are getting closer to science fiction.

A leader sets the pace for the organization.  If the top person is optimistic and upbeat, and believes in a positive future, then the organization moves that way.   What the top person is thinking about influences the direction of an organization.   In healthcare, much has focused on government and politics.  ARAMARK Healthcare’s Group President, John Babiarz, once said to me, “Anthony all of that politics matters, but not that much.  It’s what the hospitals are doing that is key to keep our eyes on.”  Just like Job’s brick analogy, our nation’s CEOs are getting hit in the head not just with one brick, but a whole dump truck full of them.  Where they focus is key.

Since 2002, the American College of Healthcare Executives (ACHE)  has conducted a survey of hospital CEOs.  This survey provides a sense of where our nation’s hospitals are headed.    ACHE  recently released the results of this year’s version of the annual survey where 514 hospital CEOs responded.

Key takeaways:

1)     Financial Challenges remained the highest concern, with 75% of CEOs listing them as one of the top 3.  No statistically significant difference was seen in the scores for the past 4 years

• Chief among the sub-issues under financial challenges are Medicare reimbursement (89%), Government funding cuts (88%), Medicare cuts (78%), and Bad Debt (71%).  Note that CEOs can check as many of these “sub-issues” as desired.

2)     Healthcare reform implementation dropped 10 percentage points, but still ranks as the second highest score.  Government mandates (many of which are a result of reform) increased to the third highest item, with a score of 39%.  This is the highest score ever for Government Mandates.

• Included among the leading issues with government mandates are RAC audits (79%), implementation of ICD-10 (74%), and CMS regulations (66%).

3)     “Care for the Uninsured” and “Patient Safety and Quality” tied for fourth with 33%.

4)     “Physician Relations” is next with 30%, unchanged from 2010, and lower than the 2006 high of 40%.

5)     “Patient Satisfaction” trends at a three year high, but is below the 2008 score of 22% when HCAHPS was being implemented.

6)     “Capacity” was not asked.  It had historic low scores in 2009 and 2010.

7)     “Technology” remains statistically unchanged at historic low scores since 2005.

8)     CEOs were asked about their implementation of an ACO.  Only 6% rated that as one of the top 3 items on their list.

Here’s a link to ACHE’s summary of the results and a chart that I’ve compiled annually to compare results year over year. Top CEO Issues ACHE_2011

Steve Jobs said, “You’ve got to find what you love. The only way to be truly satisfied is to do great work.  And the only way to do great work is to do what you love.”  This posting is dedicated to those hospital CEOs who are making a difference in health care because they love what they do, and realize that importance of doing what they love for all of us.

ARAMARK Healthcare Fellow, Deborah Daniel, a Canadian, leads discussion with Irish healthcare CEOs at the Guinness Storehouse facility in Dublin.

We started the ARAMARK Healthcare Fellowship in 2009 and boy have we seen some great success to date!  Our fellows come from some of the finest CAHME-accredited graduate programs in North America.  Upon completion of the program, nearly all of our fellows have been placed in top-notch healthcare facilities.  It’s great to see and know that the core facets of the program which include traditional hospital project work, academic based translational research, and experiential learning really provide the foundation for a rewarding career in the healthcare industry. Earlier this month our current class of ARAMARK Healthcare Fellows took a trip to Ireland to encounter firsthand what their health care system.  From what I hear, we may be offering the fellowship in the Emerald Isle in 2013.

I’ve asked our fellows to be guest bloggers, to give you their impressions.  Today’s posting is by Deborah Daniel, an MHA graduate from the University of Toronto, who is serving as the ARAMARK Healthcare fellow at Vancouver Coastal Health, British Columbia, Canada.Health Care in Ireland

By Guest Blogger:  Deb Daniel, ARAMARK Healthcare Fellow

As a Canadian in Health Care Administration, post-Master Fellowships are not common. I am very lucky to have been given the opportunity to do a Fellowship with ARAMARK in a Canadian System. Part of my experience included a trip to Ireland to experience not only a different health care system but also to see how ARAMARK helps create positive experiences for their clients in different lines of business such as food services at universities and tourist destinations including the Guinness Brewery. Part of our trip included visiting different health care facilities and hospitals as well as learning the structure and function of the system and how ARAMARK exists within this context.

Ireland has a socialized health care system where all citizens have access to specific medical services – such as hospital visits. There are both private and public run hospitals within Ireland – all citizens have access to the public hospitals, but each person or family has to pay out-of-pocket for access private hospitals either through purchased private insurance or personal expense.  What I found interesting was the initial “fee” that had to be paid whether you sought care at a public or private facility – in contrast to Canada were accessing public hospitals is at a zero cost.

The private hospitals we visited were beautiful – most were very new and extremely clean. I unfortunately had to visit a hospital due to a personal medical issue and chose a private facility as I was told I would get care quicker because I had private insurance. And right they were! I was seen quite quickly at a cost of $110 Euros. In contrast, if I attended a public facility, I would have had to pay $100 Euros and my wait times would have been much longer. However, at the public facility my other tests and services would be covered at no charge, but on the other hand I would have had to pay at the private hospital.

I can see why people would prefer the private hospital, and found it interesting to speak to locals who say that for major trauma and illness they would rather attend the public facility. From the people we spoke to, they said the care in either type of delivery is excellent; however, private facilities are good for more minor incidents such as the one I was having.

Being able to experience the health care system first hand and not just hear about it from locals and affiliates was interesting – I saw, and I believed.

As I was watching the pregame show, studio analyst Tony Dungy gave his overview of the game.  Dungy is a retired NFL head coach who won the Super Bowl in 2007 with the Indianapolis Colts.  All told, he spent 12 years as a head coach in the NFL, making the playoffs a record ten times in a row.  He’s known best for his quiet demeanor and a coaching philosophy that encourages teaching and supporting his players, rather than screaming at or belittling them.  He is known as a “good guy,” but it was his part of this past Sunday’s mortality play that the casual fan didn’t appreciate.

You see, he had a leading role in the rehabilitation of Michael Vick when he was released from prison.   Watching him reminded me of what he was credited with saying to Vick:  “Integrity is what you do when no one is watching; it’s doing the right thing all the time.”

Now some could never forgive Vick, and I’m not going to get into that now.   But I think that there is a lesson in Tony Dungy’s approach to life.  The real person you are is revealed in the moments when no one is watching and you’re not attempting to impress anyone.  Your true nature comes out when you’re just being yourself and doing the right thing.  I’ve stressed to my kids that in moments when no one is watching is how you conduct yourself with integrity.

This same idea is ingrained in a lot of our people at ARAMARK.  I’m always impressed by the stories I hear about the great things ARAMARK employees are doing every day – often when no one is looking.  Sometimes it’s just a small gesture on a random day that only affects one person – but makes a huge difference.

At the San Martin campus of St. Rose Dominican Hospital in Henderson, NV, Environmental Services (EVS) Director Robert Stewart took it upon himself to help a patient who most people might not give a second thought.  As a result, Robert was honored as the hospital’s Star Performer for August, which is a monthly employee recognition that is voted on by San Martin’s case managers.  Even more impressive, according Hospital President Rod Davis, this behavior is pretty typical from Robert. 

Joni Kurata, a Licensed Social Worker at San Martin, told us about a homeless patient who came in with chest pain.  Obviously, he wasn’t in the best condition, and his clothes – the only clothes he owned – were extremely dirty.  Robert overheard several individuals discussing the patient during the daily bed placement meeting. 

Just to provide some background, ARAMARK’s EVS directors handle a number of tasks, including managing the cleaning and housekeeping services, maintenance, and waste disposal, all while using environmentally conscious processes and equipment.  While the work our EVS group handles does affect patient safety, comfort, and confidence, they aren’t directly responsible for patient well-being.

Well, except in this case.

While the patient was receiving tests, Robert went and personally found the patient’s clothing, pretreated the stains, and ran them through the washing machine and dryer, having them back to the patient within a couple hours.  The patient was extremely grateful and the entire staff appreciated his unsolicited effort.  “I could tell he (Robert) was really busy that day, but he still went out of his way to help,” said Joni.  “I am so impressed by ARAMARK’s staff and their willingness to help, no matter what the circumstance.”

“What can I say other than Robert does a fantastic job?” mused GM Lee Timothy.  “He always takes ownership, steps in, takes initiative, and makes things happen.”

He makes things happen.  Even going so far as to tackle what clearly wasn’t an enjoyable task, when no one was watching.  Robert went out of his way to ensure that this patient’s stay would be as pleasant and comfortable as possible.  Employees like Robert Stewart are our unsung heroes, and they are who make us successful.

So with all of the cost constraints on hospitals, some may question about why we should care about what a hospital looks like? 

Well, I think it reflects on the management of the hospital.  When an organization cares to make itself look good, then there is an underlying statement that they are good.  I’m reminded of the story about the rock legend Van Halen, who demanded that promoters provide a bowl of M&Ms with the brown ones removed.   You see, Van Halen was one of the first rock bands to bring truly massive concerts to mid-size cities like Macon, Georgia.  The arena staff in these smallish cities was used to bands coming to town with, at most, three tractor-trailers full of equipment.  Van Halen’s equipment took up nine tractor-trailers.  It was a lot of stuff, and the staff at these venues was frequently overwhelmed.  And when people are overwhelmed, they make mistakes.  At a rock concert, “making a mistake” during setup has a large number of possible outcomes.  Some mistakes don’t have any effect at all.  Other mistakes can make the band sound awful, which only hurts the band’s image.  But more serious mistakes can kill people… which is exactly what the band was afraid of.

The band said that was a trick to make sure promoters read the contract carefully.  If they showed up and found brown M&Ms, they would know the promoter might have been sloppy about more important things like sound and lighting… and safety.

For patients going to a hospital… seeing a beautiful facility that is clean and organized, and well-dressed staff, reflects on the degree of pride that people have in the organization.  There is a comfort in knowing that if the hospital got the “little things right” – like clean floors – then it may get the big things right – like surgery. 

Gale Yochum, a five-year Soliant operating room travel nurse said, “There is a special feel to hospitals with inviting public spaces and soothing private rooms.  Patients who feel satisfied with the facility may recover faster and have shorter stays, which is good for both hospital and patient.”  I’ve got to reinforce that the patient’s perception becomes a reality.

So what makes a hospital beautiful?  Any number of things… the building design, the location, patient rooms and amenities, or outdoor spaces.  Some of the hospitals on the list feature modern architecture, public atriums, entertainment systems, leather furniture, wraparound windows, individual fireplaces, ornate landscaping, outdoor sculptures, and lobbies that look more like they belong in five-star hotels.  Some are located near water, mountains, lakes, or parks, which provide a more tranquil environment for the patients.

And most importantly, I believe that in all cases, the beauty of facility goes far beyond the bricks and mortar to the people who work inside the walls. 

I’m especially proud of the ARAMARK Healthcare services provided at Sumner Regional Health System (Gallatin, TN), Thomas Memorial Hospital (South Charleston, WV), Union Hospital (Terre Haute, IN), and  Bon Secours St. Francis (Midlothia, VA).   I know our team helps make a difference in those places.

North Region DM Rick Bremer agrees:  “ARAMARK has been serving at Union Hospital since 1969… that just goes to show that how much the client values and demonstrates commitment.  And that commitment extends to their partners, employees, AND patients.  ARAMARK is very proud to serve such a fine partner that has been recognized with this great mark of distinction.”

An environment that benefits both patients and the individuals who work there?  That’s a win-win for everyone!  

Congratulations to all the hospitals selected.  For more information, click here for the complete list and photos.

I wanted to share with you Dr. Poplin’s perspective on the subject through excerpts from the work by researchers at Memorial Sloan-Kettering Cancer Center.

The development of advanced imaging technology and techniques will usher in an era of personalized cancer care, which will be critical to combat the 45 to 50 percent increase in cancer incidence expected during the next 20 years, said Hedvig Hricak, M.D., Ph.D., chair of radiology at Memorial Sloan-Kettering Cancer Center in New York City.

“Imaging has continuously advanced cancer care and paved the road to personalized medicine,” said Dr. Hricak, who is president of the Radiological Society of North America (RSNA), in an address to open the RSNA’s annual meeting.  Particularly important to cancer care is the development of molecular imaging, Dr. Hricak said.

Dr. Poplin noted that the ability of molecular imaging to facilitate personalized cancer care was recently documented in a series of studies published in the September Journal of Nuclear Medicine, according to a report in Science Daily. In the studies, researchers showed that molecular imaging allowed physicians to identify the severity and extent of disease and determine the effectiveness of treatments early enough in the process to make modifications.

“Through molecular imaging, the paradigm is changing toward more tailored and customized management of treatment. As a result, we can see how far a disease has spread and spare the patient from additional examination, time and radiation exposure,” said Ravinder Grewal, M.D., a report author and an assistant attending physician in nuclear medicine at Memorial Sloan-Kettering Cancer Center.

Pictured are Bakery Chef, Amanda Garcia (right) and her two daughters Jennifer and Lisa with their finished product at ARAMARK Healthcare’s Gingerbread House event at Baylor University Medical Center in Dallas.

One of my childhood memories is the sweet smell of Christmas cookies.  Maybe more than the actual taste, it was helping my mom with the pizzelle iron. For those who are unfamiliar, pizzelle are thin waffle-like Italian cookies.    Making pizelles was more than just a tasty treat; it was part of being a family.

One hospital found a way to use the spirit of the season to enhance collaboration with nurses and support service teams.  ARAMARK Healthcare hosts an annual Gingerbread House Decorating at Baylor University Medical Center at Dallas (BUMC) that has turned into a way for the support service team to connect with nurse managers outside of working hours.  The result is a stronger workplace relationship. 

Shannon Heard, Resident District Manager for Food Services at Baylor Health Care System, was a part of the initial conception of the event. “In the past, ARAMARK chefs built gingerbread houses to decorate the lobbies of the hospital,” said Heard. “In the spirit of collaboration, we thought it would be a great idea to use this project as an opportunity for BUMC nurse managers and their families to join our ARAMARK managers and their families to decorate the houses and establish a closer network.”

The literature indicates that nurses who are happier with their jobs deliver better patient care.  Since nursing and support services work closely together, stronger collaboration among these groups can also lead to better patient outcomes for the hospital.

Patricia Ault, Nurse Manager at BUMC has enjoyed bringing her grandchildren and other family members to the event for the past 3 years.

“This year I brought 14 people,” Ault said. “It gets us in the mood for Christmas and we look forward to attending every year.” “This event is a great way to have a different look at employees outside of the day to day operation.”

Throughout the month of December, the gingerbread houses are displayed in “villages” throughout the two hospitals, along with a sign that informs onlookers about the program. The displays assist with increasing the holiday spirit in the hospitals for patients, visitors, and staff year after year.

Reminds me…when my kids come home from school, I’ll break out the pizzelle iron!  Happy holidays!

The quote from contemporary French author Frédéric Beigbeder: “Le plaisir présente un avantage: contrairement au bonheur il a le mérite d’exister!” In English: “The advantage of pleasure: unlike happiness it deserves to exist!”

“Non s’efforcer vers le plaisir mais trouver son plaisir dans l’effort mem s’est le secret de mon bonheur”, from the famous French author, André Paul Guillaume Gide. Translated: “Not in making an effort to find pleasure, but in finding pleasure in the effort, that’s the secret to my happiness.”  

When I began my career in healthcare, I took a Medical Terminology class to try to get my arms around the complex world of medicine. Patients don’t go through such classes, although we frequently communicate with them in our professional vernacular. I was at a hospital in Texas, which had a similar approach to the Hotel Chateau Laurier, to try to explain to its patients the types of tests that they are having.

Using photos and a description of what the tests provide, the hospital artistically displayed on the halls leading to many of its outpatient testing areas what is being performed. The photo below shows ARAMARK Healthcare fellow Chenita Lawrence next to one of the terms, Chemistry, in the outpatient laboratory. It’s a comforting way to bring to patients an understanding of what tests they are having done. Not surprisingly, this hospital’s commitment to its patients resonates with them … it is in the 90th percentile of outpatient patient satisfaction!

A September 21, 2010 article based on an interview with Trent Haywood, MD, JD, chief medical officer, VHA, Inc., Irving, Texas, and former deputy chief medical offer at the Centers for Medicare & Medicaid Services in Healthcare Financial Management (HFMA)  talked about how less-than-stellar patient satisfaction results are dragging down hospitals’ value-based purchasing (VBP) scores—a tally that CMS intends to use in calculating Medicare reimbursements beginning October 1, 2012.

 There are many things that hospitals need to do to improve patient satisfaction scores.  Haywood states, “With HCAHPS, there is a much wider distribution (in scores). While many hospitals are starting to focus on patient satisfaction, many still have room for improvement.” 

It is hard to improve scores…patients don’t really want to be in a hospital….it’s a somewhat strange environment for most … and patients lose a lot of control over their environment.  Some hospitals are trying to give patients back some control, over something that they are very familiar with…food. 

I saw this video featuring Leonard Votion, Director of Food & Nutrition Services at Trinity Mother Frances Hospital, a 395 bed acute care hospital in Tyler, Texas.  Votion is interviewed on KETK NBC 56 about the room service program that they started to offer in August 2010.  Said Votion: “Food is healing.   It is a real satisfier.”  Votion added that TMF provides ” What they eat, to when they  eat, at no additional cost for the patient.”  Room service staff  works with patients and their medical team to help ensure that patient dietary wants work in harmony with the dietary needs necessary to properly aid in a quick recovery.  I love the quote at the end from the host —food can make a difference.  

Food is not part of the HCAHPS survey, but I feel that it has a halo effect.  Sure it does NOT make up for poor care…but it does provide an additional level of comfort and control for patients who are being well cared for clinically as well.  As patient satisfaction scores become a part of CMS’ Value Based Purchasing program, hospitals that gain an edge by finding cost-effective ways to create satisfied patients —and strong clinical outcomes —will succeed.

Based on an annual sample of 65,000 people, the overall Customer Satisfaction Index created by ACSI was unchanged at 75.9 (out of 100) from the previous quarter, but results improved for all industries except health care and energy utilities. A sharp 5% drop in satisfaction for the hospital industry dragged on the overall index. The health care sector also fell 1.9% year-over-year. 

As lately as last November, Press Ganey showed continued increases in patient satisfaction.  These new results from the “American Customer Satisfaction” group may be a bellwether.  With so many hospitals being required to make “across the board” cuts in the past year, it does not come as a surprise that patients are less than satisfied with their care.

The leading hospitals, however, are not going for across the board cuts.  They are looking at more difficult, but more lasting and effective, transformations of clinical care.  Joan Moss, RN, MSN, Senior Vice President, Sg2, on June 21, 2010, commented on the blog (registration required to read entire posting) that the average proportion of costs that will need to be taken out by facilities may be 14% to 20% in order for facilities to reduce their direct costs to maintain current profitability at Medicare rates.   Using consultant-supplied full-time equivalent (FTE) ratios, Moss estimates that across-the-board workforce reductions might shave perhaps 5% off of the expense base. Over time, the headcount creeps back into the organization. Moss sees that what is different this time is the magnitude of the reductions faced and, therefore, how we must go about making them.

Moss outlined several approaches to making changes.  She included:

• imaging appropriateness criteria at Massachusetts General,
• fast-track asthma lounge at Highland Hospital in CA,
• remote monitoring of heart patients at Inova in VA, and
• repurposing an acute care facility at Henry Ford Health System (MI). 

Moss has it right, and documents leading edge hospitals.   The unintended consequences of across the board cuts includes creating disgruntled employees, and lower patient satisfaction scores.  Though it’s far more difficult to reengineer services rather than simply enforcing  an “everybody take 10% off their budget” directive, the results will be longer lasting.  These organizations will succeed in the long term under the health reform pay-for-performance standards.

I’m interested in hearing innovative approaches that hospitals have done to save costs. Feel free to post them here!