Cabo overlooking Sea of Cortez

Cabo Sunset

The next day was equally memorable, with a sunset cruise around the tip of the peninsula and a close-up view of Los Arcos (The Arches).  

Los Arcos, Cabo, Mexico

Cabo Sunrise

I fell into rhythm with the days, going to bed much earlier than usual and rising before 6 AM to catch the sunrise.  The 3-hour time change and the switch to daylight standard time were not an issue.  

One morning, as my wife slept, I worked on the initial draft of the ACHE self-study course for my new book, Getting It Done: Lifelines from the Field, which Health Administration Press will publish, spring 2011.  It is too early to know which 3 chapters will be selected for additional review from the case presentations that deal with slaying sepsis, preparing for disaster, overcoming rural healthcare challenges, building a system-wide culture of safety, and engaging physicians in collaborative supply cost management, ED call, breaking down silos, transforming the OR culture, addressing disruptive behavior, and adopting electronic health records, to name a few of the 16 chapters.

However, I am certain that the accompanying article for the course will be “Cultural Transformation from the Ground Up: Being Part of Something Larger than Yourself,” a chapter that I wrote in Ignite Your Business: Transform Your World,  published by Celebrity Press, October 15, 2010.  This chapter summarizes the journey of a reluctant physician champion who leveraged his clinical credibility to transform the culture of his hospital, improving revenues and collections, cutting expenses, and improving clinical outcomes.  The first three of the ten steps that he recommends for building a culture of collaboration from the ground up are:

• Engage your top performers, regardless of irascibility; hospital leaders need to reframe physician anger as pain rather than criticism, understanding that process is a lifelong journey
• Have ground rules to which the group commits, such as building on others’ ideas, refraining from personal criticism, sharing responsibility for deadlines, developing win-win solutions, and respecting confidentiality
• Focus both on workplace pains that lead to suboptimal outcomes and past successes where people overcame obstacles to achieve outstanding results

I think that it was no accident that, during my week of vacation, I received four  invitations to speak in the upcoming months on:

• engaging physicians to deal with mergers
• decreasing readmissions
• dealing with the challenges of end-of-life care
• moving beyond satisfaction surveys

As I wrote in Collaborative Gnosticism, my mentor Lee Kaiser and my coach Kelly O’Neil believe that we attract the outcomes into which we put our thought and energy.

I leave you with one counterintuitive proposition: 

• Are you willing to escape your workplace to attract the outcomes that you desire?

As always, I welcome your input to improve healthcare collaboration. 

Kenneth H. Cohn 

© 2010, all rights reserved 

Disclosure: 

I have not received any compensation for writing this content.

©2012 Healthcare Collaboration. All Rights Reserved.

Collaborative Attraction is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Ken on Twitter, Facebook or Google+.

In An Interview with Stuart Altman, this distinguished healthcare economist mentioned Altman’s Law, that  advocacy groups seek to preserve the status quo rather than adopt another plan that might disadvantage their interests.

January 21, 2010, in Citizens United v. Federal Election Commission, the Supreme Court voted 5-4 to remove limits on contributions from corporations and unions for “electioneering communication.”  Hailed by some as a victory for the First Amendment right of free speech, to at least one skeptical surgeon, it means that free speech just became more expensive, as limitless contributions pour in to influence 535 votes.

Kudos to David Harlow for getting it right in his commentary, Holy Mackarel: Scott Brown, Health Reform Redux and What Can (Should) Happen Next: “it is time to think about other avenues towards the improvement of the health care system in this country.”  Reform efforts will go on while Congress is embroiled in partisan gridlock.  As David mentioned, states have become the learning laboratories.

Medicare demonstration grants in Colorado, New Mexico, Oklahoma, and Texas continue to investigate the merits of value-based purchasing of healthcare services.  Patient-centered medical home projects, as described in Engaging Physicians to Adopt Healthcare Information Technology, represent a continuous, proactive, consumer-directed approach to care coordination.

In My Inadvertent Oncology Fellowship: Why I Remain Optimistic About Healthcare, I concurred with fellow Massachusetts surgeon Dr. Atul Gawande, that healthcare reform embodies an iterative journey, where we test different hypotheses in our learning laboratories, because no one has sufficient knowledge to assert that one way of delivering care will work for all our citizens. Dr. Gawande concluded in Testing, Testing:

But if we’re willing to accept an arduous, messy, and continuous process, we can come to grips with a problem even of this immensity. We’ve done it before.

As I mentioned in “Embracing Complexity,” in Better Communication For Better Care: Mastering Physician-Administrator Collaboration, face-face conversations are the only sustainable way that people can deal with complex situations in which predictability is diminished, experience does not guarantee success, and relationships are key. 

Complexity facilitates interest group politics, as members on all sides struggle to convey their message in 30 seconds or less.  In Collaborative Sensemaking, I described the critical role that healthcare leaders must play in interpreting and explaining disruptive marketplace changes and framing what is required for successful healthcare delivery.

Finally, I thank my mentor, Lee Kaiser, who in Collaborative Gnosticism, wrote:

Most people and most organizations see themselves at the center of the universe, which leads to egocentric, self-interested approaches that facilitate exploiting others for competitive advantage, hardly a sustainable approach to differentiation and the service of others… There is no economic, social, or political solution to the current healthcare crisis.  Spirituality, based on abundance, collaboration, and sharing provides the only solution because it makes problems disappear.

As always, I welcome your input to improve healthcare collaboration, even if sometimes I feel (to paraphrase Churchill) that we embrace it only after we have exhausted all other alternatives.

Kenneth H. Cohn

© 2010, all rights reserved

Disclosure:

I have not received any compensation for writing this content.  I have no material connection to the brands, topics and/or products that are mentioned herein.  David Harlow is a friend, colleague, and coauthor with me of Field-tested Strategies for Physician Recruitment and Contracting.  Please check out his HealthBlawg.

©2012 Healthcare Collaboration. All Rights Reserved.

A Massachusetts Surgeon Weighs in on the Meaning of Scott Brown’s Senate Victory: Post 81 is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Ken on Twitter, Facebook or Google+.

 So, I asked respected thought leaders what they were doing and what was working.  I ended with the following question:

• If you could be granted three wishes, what would you request?

Their responses fell into several thought-provoking clusters:

• Regarding healthcare reform, over one third wished for a more efficient system that decreased red tape and made it easier for people to collaborate inside and outside their organizations.  Such collaboration included sharing information about outcomes and improvement programs that worked as well as aligning incentives, so that we have a system of interdependent parts rather than a collection of cottage industries.  In Collaborative Conversations, I wrote that the challenge of any meaningful healthcare reform efforts is the extent to which they engage healthcare professionals to make a difference in patients’ and families’ lives.
• The above response tied into to their wish for a nationwide information network that would help providers and organizations be more accountable for outcomes and help them integrate care throughout the inpatient/outpatient continuum.  As one respondent wrote, “Know more, act prudently, measure outcomes.”
• Physician staffing also entered into their responses, especially primary care providers and orthopedic surgeons.  As I mentioned in Field-tested Strategies for Physician Recruitment and Contracting, not only are patients aging and their care needs becoming more complex, but health care providers are aging along with them, and younger physicians tend to have different expectations about work-life balance than colleagues who were born before 1965. Of the physicians practicing in 2005, 36% were at least 55 years old and over 15% were at least 65 (Cohn KH. Harlow DC. Journal of Healthcare Management. 2009; 54(3):151-158).
• Several participants wished for patients to become more cognizant of their role in improving healthcare outcomes, specifically regarding nutrition, exercise, and safe decisionmaking related to seatbelt use, alcohol, and protective barriers in those who have multiple partners. As noted in Collaborative Business, here is an area where insurance companies and large corporations are providing innovative incentives, such as a 24-hour help line, exercise facilities, smoking cessation programs, cancer screening, diabetic education, and trans-fat free cafeterias.
• One person wished for targeted management and leadership training.  As I wrote in Collaborative Leadership Development, summarizing Growing Leaders in Healthcare by Brett D. Lee and James W. Herring, 85% of Fortune 500 companies sponsor formalized internal leadership development programs, but only 21% of US hospitals have formal processes for identifying and developing candidates for leadership positions.
• Another wished for an intellectually stimulating environment in which to work.  In Collaborative Listening, I mentioned Brian Wong’s survey of over 1,500 practicing physicians, where meaningful work that makes a difference in patients’ lives ranked as the top priority.
• Finally, about 10% of respondents made ”spiritual” wishes to restore a sense of mission, purpose, and professionalism, reconnect with the reasons they initially chose healthcare careers, and have the courage and wisdom to make correct decisions in difficult economic times.  Not only did they seek incentives to encourage cooperation and sharing, they also sought an abundance rather than a scarcity mentality to confront our current challenges.  In Collaborative Gnosticism, my mentor, Lee Kaiser, stated that most people and  organizations see themselves at the center of the universe, which leads to egocentric, self-interested approaches that facilitate exploiting others for competitive advantage, hardly a sustainable approach to the service of others. He maintains that there is no economic, social, or political solution to the current healthcare crisis.  Spirituality, based on abundance, collaboration, and sharing provides the only solution because it makes problems disappear.

 What do you think?

• Despite the strident debate over healthcare that we are witnessing in the news media, do we largely agree on the rationale for improving our clinical and financial outcomes
• If we agree on the why and and the what, can the how become a lifelong  iterative journey
• What three wishes would you like granted

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

Addendum: Anyone wishing to take the aforementioned survey and have your responses mentioned in my upcoming column, please copy the questions below, paste them into your e-mail program, and send your responses to ken.cohn@healthcarecollaboration.com by September 11, 2009.  Thank you for your input:

• How are you and your organization doing in these difficult economic times?
• What are your greatest concerns?
• What strategies have you found to be the most useful in dealing with your concerns?
• What strategies have not proven to be helpful?
• If you could be granted three wishes, what would you request?

© 2009, all rights reserved

©2012 Healthcare Collaboration. All Rights Reserved.

Collaborative Wishes: Post 75 is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Ken on Twitter, Facebook or Google+.

Gnosticism refers to knowledge, recognition, and wisdom.  In Peeling the Onion, Lee refers to gnostics as fellow mountain climbers who come from different backgrounds but are climbing the mountain together and providing assistance to fellow travelers as needed, i.e. collaborating.

In I Am Beside Myself, he postulates that most people and most organizations see themselves at the center of the universe, which leads to egocentric, self-interested approaches that facilitate exploiting others for competitive advantage, hardly a sustainable approach to differentiation and the service of others.

Lee maintains that there is no economic, social, or political solution to the current healthcare crisis.  Spirituality, based on abundance, collaboration, and sharing provides the only solution because it makes problems disappear.

I don’t expect all of you to follow Lee like the Pied Piper.  In Junk in Your Life, he maintains that we develop strength by pushing against something.  Resistance builds strength and resilience. 

In It Will Hit the Fan, he notes, “Folks you know and associate with on a regular basis may be unable to reconcile your choices with their inaccurate image of who you are. At the very least, you will be asked to justify yourself. At the worst you may be threatened and intimidated.  You should not act in a way that encourages confrontation. However, you should not back away from it either. You do not have to apologize for who you are … Give a simple answer to your accusers and get on with your life.”

“The old control game of threat, intimidation, hurt and silence will become familiar to you as you go about your world work. You have a unique destiny to pursue. Following this destiny often cuts across the vested interests of people you know, like, or love. So, you must either fold your cards or continue to play out your hand in the game of life. If you seek to maintain harmony at any cost – the cost will be your failure to progress on the pathway of Light. So, expect that sooner or later it will hit the fan and you will have to make a choice to retreat or go forward.”

What do you think:

• Do you find Lee’s writing stimulating and unsettling
• Who is at the center of your universe
• Have you found yourself confronted
• How do we move forward to improve care for our communities

As always, I welcome your thoughts.

 Kenneth H. Cohn
 

©2012 Healthcare Collaboration. All Rights Reserved.

Collaborative Gnosticism is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Ken on Twitter, Facebook or Google+.