The Patient Patient

Have you ever thought about the definition of the word "patient?”  Because I am such a geek, I actually looked it up and this is what I found;

adjective: patient - able to accept or tolerate delays, problems, or suffering without becoming annoyed or anxious

noun: patient - a person receiving or registered to receive medical treatment.

The definition of the adjective made me laugh and then get uncomfortable because I am sure the origin of the word came from people having to wait to see their doctor! 

So here is my question to you - do specific terms/words or labels really matter?

Within the adults with disability movement, there has been a lot of debate, discussion, and change based on the "terms" The Association for Retarded Citizens is now the ARC. Instead of "disabled people" or "the disabled," people with disabilities have asked us to put the "person" first and not their disability.

Within the medical field, a discussion has begun about what it means to call someone "our patient."

Research has shown that how we live, what we eat, how we treat our bodies actually can influence our health outcomes to a greater extent then our DNA. Scientists will argue over how much, but the impact is there and I have seen numbers as high as 90% - as what you do to yourself vs. the genes you are given.

So if that is true, shouldn't the language being used in healthcare empower people to take control of their own health? Not to "accept or tolerate delays," as the definition of “patient” describes; but to proactively take control of their health and their bodies. The words we use and how we encourage people to activity participate in their care is a huge issue in pediatrics. When we talk about the patient - sometimes the best treatment is purely engaging the family in the care of their child. How are we "partnering" with parents and what are we doing?

Our efforts in patient and family centered care has been about developing that partnership. Finding ways to share clinical information and then providing a plan of care that will help the parent be part of the best outcome for their child. There is often much work that must be done outside our walls to get these amazing outcomes that have been achieved. You have inspired the families to dream of what is possible and be willing to put in the work to achieve, sometimes the impossible.   

You have heard me talk about the next wave of consumerism in healthcare. My parents wait for hours to see their doctors and hang on their every word. Conversely, I won’t wait 10 minutes and after the appointment I immediately go to the internet to check their diagnosis or treatment.  Think about how the use of technology is going to change the delivery of care. In the adult world, people now want the concierge service, access their physicians whenever they need them and they pay big bucks to do it. Telemedicine is not only being used in far away places to bring in specialists, but it is also being used on a "regular" basis for follow up visits and for people who are willing to pay for access.

I share all of this to ask you to think about how we might begin to meet the needs of the children who come to us seeking an enhanced experience and outcome.

Think about how the language we use impacts how families partner with us and also look for areas we should change right now - to make the rest of the world catch up to us.

While I don't know what the future looks like for healthcare, I know one thing for sure - it will be different than it is today. The need for quality outcomes combined with technology and the pressure to be much more efficient is definitely going to cause change. The only question is will we be driving that change or chasing others? The decision is ours.

Sharing Your Voice

Last week I was in Washington for the public policy council of the Children's Hospital Association. We heard from national experts giving their thoughts about what was going to happen with the Supreme Court on their ruling of the Healthcare Law, and the outlook of the Presidential campaign. While the experts offered many different views, what struck me was one common theme.

All agreed that regardless of who is elected President, or who controls the Congress, the federal deficit will be addressed in 2013. Cuts will be made in all federal programs and they will be severe. No if’s, and’s, or but’s about it - severe cost cutting will happen. This means that Medicaid, the program so many of our children rely on will be cut. The question is not if it will be cut - but by how much.

Staff from Congress came to speak to us. They reminded us that when Medicaid was created, it was intended to support the healthcare needs of the poor - not what it has evolved into, it is now the program covering the massive long term care expenses for the elderly. (In NJ most of the $6 billion spent in Medicaid is spent on the elderly in nursing homes.) They said we must be able to have an honest, thoughtful conversation about how to restructure the program or else the program will be cut irrationally, and arbitrarily.

My gut wrenched. It is time to sit down and be an adult. Not just an advocate who says, “you can’t cut me; go look somewhere else,” but instead asking for real solutions.

It took me immediately back to what we have been talking about over the last 2 years. I have told you that we are not going to get paid anymore in reimbursements. The president of the American Hospital Association said last week when he spoke at a private meeting of NJ Hospital CEO's, "What you get paid today, is the most you will ever be paid. You have to do more with less, and if you don’t figure it out, someone else will."

This wasn’t news to me, and shouldn’t be to you because it’s something I’ve been discussing over and over again. But just like a recent conversation I had with a staffer who shared their concerns, “How do we have the courage to put ideas and real changes on the table that might hurt for a short time, but protect our entire program for years to come?”

I thought about examples of changes we made personally or professionally and wondered if we had the benefit of hindsight, we might have personally done things differently. There is no argument that whether you call what we have been through since the crash of the stock market in 2008 a recession or a depression, we know that 1 in 10 people are unemployed and the numbers of those underemployed are 1 in 19. People are hurting. Some have lost their homes, or are working two jobs. Some of you have shared the challenges your spouses and family members have faced and are still facing. Your children have moved home or you are helping support other loved ones who have fallen on hard times.

At some level, we knew that the "good times" couldn't last forever - right? Our houses were worth twice what we paid for them, by doing no additional improvements; we were getting salary increases every year, even though we were losing money and we were consuming. Consuming products and stuff (iPad’s, computers, houses …who would ever pay more than $50 for a purse in 2000?). We were buying bigger houses and as a people, Americans were running up huge debt. And then it happened. The bottom fell out. What would you have done differently if you knew then what you know now?

And that is how I am looking at the conversation last week in Washington. The experts tell us “it” is coming. Congressional staffers, off the record have said, you have to give us something to restructure the programs you depend on or you are going to end up having people who don’t understand what you do as well as you do, restructuring the program for you. I am now talking to my colleagues about putting tough questions out there and trying to give them the hard medicine but at least we can prepare for how to live with it.

That is what the 100 day work outs are about and why we continue to ask you for your ideas on restructuring our business and becoming more efficient. We have to change. We will not get paid any more for the services we deliver, and in some cases we will get HALF of what we get today. We can be mad that we are in this financial time or we can use this time before the cuts happen, to figure it out and be ready.

If you don’t engage in this process and give ideas to your supervisors and directors, then the cuts will come and we may not make the "best" decisions, or the ones you think we should but I am asking you now - get engaged.

Even if it is in other departments - often it is hard to see how to change when you are in the middle of it. Right, that is why we go to personal trainers or counselors, we need people to help us think through and work through. We hired consultants who helped us get started on the 100 day work out process, but now it is on us. What should we do? How can we make changes? We had this discussion during the employee meetings but most of the conversation was about doing more, spending more money, which is ok but it does not get us ready for what is certainly coming.

So I ask you - what is that our senior leadership is not doing that we can do better to get you engaged in this process, of putting real ideas on the table for significant change? Because it is coming, and changes have to be made. If you want to be part of what the change looks like, now is the time.

You have a voice in this. Make it heard.

Cultural Change

Last week I had a chance to spend a week with people from all different countries, and industries, for a course on managing change. While the framework of the basics was the same as we all know – I did learn you have to have a specific vision about where you want to take your company and do a thorough implementation plan and then check the execution. Implementing a change in the operations of the organization and implementing cultural change is tremendously different. I am preparing to share my conference experience in a clinical rounds presentation soon but this experience made me think about each of you and how you have managed a "cultural" change in your life.

In our personal lives, “cultural change” would be something that is a permanent immersion or approach to a different way of life. For example, a “culture change” could include becoming a vegetarian, or adopting a new healthy lifestyle or maybe moving to a new part of the country. Of course having children and getting married mark changes as well.

If I had to name just one cultural change in my personal life, I would say it was adjusting to being divorced. It wasn’t just not being married anymore, it was really learning how to be comfortable in my own "skin." That means being alone and not just filling time, but really learn to be thankful for the time I had alone and finding ways to embrace the change. Like most things in our lives, I was resistant at first and gradually began accepting this new way to live - not just a way of life - but a way to live. So as always, I am interested in what cultural change you have made in your life and how you adopted it.

You can be anonymous! I truly believe sharing some of your personal experiences or best practices are helpful for your friends and colleagues and they may certainly apply at work too.

Talks of Hospital Mergers Begin

Yesterday, five North Jersey hospitals announced plans to sell, explore a merger, and seek a new buyer to help solidify their existence in this turbulent health care market. Children’s Specialized nor our partner RWJ were among them. Take a breath.

We knew this was coming.

Is Children’s Specialized talking with other health systems or hospitals about mergers or acquisitions? As a member of the Robert Wood Johnson Health System, we stand strong under their powerful umbrella of services. The system is in constant state of conversations with many because of their strong market position. We provide such specialized care that our services will always be unique and the talk of us “merging” with another pediatric rehabilitation hospital is non-existent. We have a 120 year history of providing services for children with special needs and we will see it through for another 100 years.

What does this mean for you? Change is happening all around us and the best way we can remain in the forefront of this evolution is to remain vigilant at responding to doctors and hospitals who want us to care for their kids, improve our processes, cut expenses and continue to improve the quality of our care. Even if our services are so unique, we still are a “health care service provider” and we are faced with the same challenges as all hospitals. Our reimbursement rates are decreasing, our federal and state funding is diminishing and the funding we do receive will be based on the quality of the service we provide and patient satisfaction.

Below is an article that was in today’s Star-Ledger detailing the news about the mergers.

I will continue to share this information with you and give you an opportunity to ask questions. Please don’t hesitate to contact me or your supervisor.

We will discuss this further as we pick up another round of our employee meetings. Keep an eye on the intranet for a schedule. Meetings to begin in late February.

- Amy

Star-Ledger/NJ.com - Thursday, February 02, 2012, 7:35 AM

Big hospital merger plans part of dizzying day for N.J. medical industry
By Susan K. Livio and Seth Augenstein/The Star-Ledger

It was a dizzying day for the hospital industry Wednesday, as executives from five North Jersey hospitals announced plans to sell, explore a merger, and seek a new buyer to shore up their stake in the state’s competitively "harsh" health care market.

Industry experts said even more sales and consolidations were looming as hospitals brace for the financial consequences of the federal health care reform law — insuring more people while cutting costs — which will take effect in two years.
Kerry McKean Kelly, a spokeswoman for the New Jersey Hospitals Association, said health care reform was driving a lot of the discussions about consolidation and partnerships. "There might be a single payment for an ‘episode of care’ that would be divided between home health aides, physicians, nursing homes, hospitals," she said.

In addition, she said New Jersey’s "harsh marketplace," with high costs and limited reimbursements, was also forcing hospitals to rethink their business model.
The state Department of Health and Senior Services must approve any hospital sale or merger.

According to Wednesday's announcements:
• Hackensack University Medical Center and its investment partner, LHP Hospital Group, announced the purchase of Mountainside Hospital in Glen Ridge for $190 million — $160 million more than owners Merit Health Systems paid in 2007. Hackensack and LHP are already awaiting state approval to reopen Pascack Valley Hospital in Westwood.

• Ascension Health Care Network of St. Louis, Mo, the nation’s largest Catholic hospital system, confirmed that it is talking to St. Mary’s Medical Center in Passaic and St. Joseph’s Regional Medical Center in Paterson, for the "potential creation of a new Catholic health care system in New Jersey," a spokesman for Ascension, Joe Orlando, said.

• Prime Healthcare of California dropped its bid to buy Christ Hospital in Jersey City. "Christ Hospital must now work through very difficult financial challenges, and it remains to be seen if there is another viable way forward," said Peter Kelly, the hospital’s president and chief executive.

• St. Luke’s Hospital and Health Network announced it would add Warren Hospital in Phillipsburg to its roster of facilities in of Lehigh Valley, Pa., with plans of reviving maternity services and investing up to $6 million in its intensive care unit.

Industry insiders also expect an announcement soon regarding Barnabas Health, the state’s biggest hospital chain, which has held lengthy talks with the University of Medicine and Dentistry of New Jersey over University Hospital.

The two said in a statement that they were pursuing an affiliation, but that any change would "preserve the clinical, academic and research alignment between The University Hospital and the UMDNJ New Jersey Medical School." Industry observers have said this simply means Barnabas Health would run University Hospital.

The new owners of Mountainside told employees there would be no layoffs, and that services would be expanded if the state Department of Health and Senior Services approved the sale.

"There will be no impact to staff at all — everyone will be hired for the same positions and same salary,’’ a spokeswoman for the hospital group, Pat Ball, said. "There are no plans to discontinue services."

The collapse of talks involving the purchase of Christ Hospital by Prime Healthcare — which is under investigation in California — was welcome news for the nurses’ union, which publicly fought the sale

"This welcome withdrawal of Prime Healthcare from its intended purchase of our community hospital represents a new opportunity to protect access to quality health care for our patients and residents," said Ann Twomey, president of the Health Professionals and Allied Employees.

Ascension’s arrival would preserve the dwindling presence of Catholic hospitals in the state, said Donald Malafronte of the Urban Health Institute. "St. Mary’s has been marketed around for awhile," he said, while St. Joseph’s is carrying a lot of debt.

Sharing the Changes of Healthcare

There are times when the healthcare industry is in an uproar and I may only share information with you sporadically. Partly because maybe I am trying to not make you worry or maybe it is because I assume if I am hearing these things, you are hearing them too. This year we did not make the Best Places to work from Modern Healthcare. From the comments on the Modern Healthcare Survey, it is clear that we need to do a better job of communicating what is going on in our hospital industry. So here it goes - Here are some of major changes that have happened in the 2010 in the hospital industry that have affected many hospital employees and people who receive care.

RWJ Rahway in July of this year reduced management’s salary by 10% across the board and all other employees by 5%. They took back a week of vacation from all management employees and have stopped the hospitals contribution to the 403B plan.

RWJ Hamilton and St. Peter's Hospital in New Brunswick were forced to lay off 200 employees each or not fill positions that were currently open due to their decreased census. St. Barnabas announced the sale of all of their long term care services, impacting 600 employees.

Many hospitals throughout the state have frozen wages and have stopped any contribution to their 403 B plans.

State employees had to agree to seven furlough days, (meaning they can’t work, nor will they get paid for that day) In addition, a new law requires an increase in their health benefits contribution.

Beginning January1, Medicare will reduce its payments to NJ acute care hospitals by $1 BILLION a year, each year, for the next 10 years.

Economists say that the recession is over, but the financial growth may never reach the levels of before September 2008.

The State of the NJ is facing a $12 BILLION loss in 2011. The Governor has committed that he will not raise taxes and this loss is after his difficult reductions made in last year’s budget.

So why do I tell you all of this? There will be more hard times ahead for the State of NJ and for all of the healthcare industry. Besides continuing to deliver high quality care and make wise management decisions, we must continue to distinguish ourselves with our positive culture, delivery of high quality care and your commitment to our children and their families. It is being able to live our values each and every day, even though there may be chaos and tumult going on all around us. As much as we can, this Senior Leadership team is going to work hard to mitigate the pressures of the outside world but we are going to need to make changes in order to do that.

In 2010 we began an effort to systematically review every thing we do - every process, every contract, every thing to ask our selves are we doing this in the most efficient way for our families and our staff? There have been great things that have come out of that review, and we have uncovered many opportunities to make more improvements. That work will be part of what we do each and every day - not a one time project. It is much like the changes we have made in reference to quality improvement. This process is not to make “more” money for the organization but knowing that our reimbursement is going to be flat or reduced, we need to make sure we have money to continue to meet increased salaries, health insurance and reward employees for your superior work.

So what does this all mean for you? It means that the work that we have done to date, improving the quality of care we give, including our families in helping solve problems, being focused on becoming the most efficient organization we can be, all are a strong foundation for the challenges that we will face. I am absolutely confident that we will come out the other side of these challenges an even stronger organization, more resolute on doing all that we need to for our kids.

What I need from you are your thoughts on how best to engage all of you in this constant change that is going on. I truly want you focused on continuing to do great work but I know you need a context to understand why we are doing the things we are doing. Please give me your suggestions on how best to connect with you and make sure we are doing the best job possible to align all of our goals with the realities that we are facing.

The Impact of Change

Many of you have received the recent news about the 2010 budget changes. I thought I would blog and give you a chance to ask questions anonymously or just offer a place to vent.

I want you to know that none of these decisions were easy and we sincerely regret that some of these decisions may impact you negatively. During the recent employee meetings, you consistently told me that it was most important to protect people's jobs and health benefits. The goal our senior leadership team decided from the very first discussion was to make sure that we had no lay offs, wanting no one to be out on the street during these tough economic times. In addition, we wanted to make sure our kids still have access to the services they so desperately need.

This was one of the most challenging situations we have ever faced. I know everyone on the team has had many sleepless nights contemplating the “what if we did this…” In the end, we accomplished our goal - no lay offs and our kids are receiving their services.

Even with the things we are doing, there is still great uncertainty in the world around us. The State of New Jersey is facing an $8 billion deficit. The Governor Elect has said that under no terms will he raise taxes. That means that all of our funding from the State, 50% of the children we serve, are at risk of funding cuts or elimination. We are still struggling to make sure that we can protect our kids in the federal health care reform. As you know from our employee meetings, the Senate bill doesn't yet have the language in it that would make sure our kids on Medicaid still have the same benefits as they do today.

We will be posting a memo on our intranet with all the details about the upcoming changes. Please take a look at this for reference and hopefully this will clear up any confusion.

Please post any questions. I’d love to clear up any rumors or ease concerns.

I thank you for your continued hard work and dedication to our children.

Amy