One thing is clear: Providers need to start planning for the value-based system that is evolving from the volume-based system of the past. You can start by addressing five key implications of a lower-payment, lower-volume environment:

• Move from managing operating costs to redesigning your organization’s overall cost structure
• Consider your market position to assess whether horizontal integration can achieve economies of scale and vertical integration can provide more seamless care transitions
• Recognize that all providers will be held responsible for cost and quality outcomes and create a culture that supports re-engineering care delivery
• Prepare for a payment system that links a growing portion of revenue to quality, despite the challenges of measuring it
• Be ready to provide increased transparency of cost and quality data; as patients pay a greater share of the cost of healthcare, expect them to use data and act like more traditional consumers

As I wrote last May, transitions are difficult to manage, but others have blazed a trail for us to follow.  Deciding where to start is often, in retrospect, less important than beginning with an issue about which clinical champions feel strongly and allowing the process of act, learn, and adapt to manifest.  One area that can be a win for physicians, nurses, patients, and hospital leaders is improving patient handoffs and decreasing preventable readmissions.

In  “Embracing Complexity,” in Better Communication For Better Care: Mastering Physician-Administrator Collaboration, I wrote that face-to-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. 

Sensemaking is part of the Baldrige journey.  It describes the critical role leaders play in interpreting and explaining disruptive marketplace changes and framing what is required for successful healthcare delivery.  It gives us a way to understand and frame healthcare complexity, view our organizations as part of a holistic system of care,  and provide potential and hope for sustainable improvement.

What do you think?

• In bracing for an uncertain future, can we view change as an opportunity to improve rather than as a threat
• Can we overcome past perceived insults to build a safe environment for reflection and learning
• How have you benefited from the cycle of acting, learning, and adapting

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

Kenneth H. Cohn

© 2012, 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.

©2012 Healthcare Collaboration. All Rights Reserved.

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

During a recent ACHE faculty conference call, we brainstormed about US healthcare issues in 2011 that are likely to have an impact in 2012, including:

1) Revenue-Expense considerations:

• The growth of medical tourism and support from payers for its continuation and expansion
• Increasing community pressure to take away hospitals’ tax-exempt status
• Implications of the green movement on renovation and new facility construction, increasing initial expense but offering the possibility of decreased maintenance costs in the future

2) Computers and the Internet:

• Approaching deadlines for meaningful use compliance
• The role of health information exchanges in sharing data
• The impact of the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey on patients’ perceptions and market behavior
• The ICD-9 to ICD-10 conversion deadline of October 1, 2013
• Robotics
• Virtual physician extenders, such as e-ICUs
• Social media and the need to monitor online communication in real time
• The challenges of maintaining patient privacy and sizeable fines for lack of compliance

3) Innovation and Complexity:

• Personalized medicine- diagnostic and therapeutic implications
• Decreased spare capacity, resulting in shortages when manufacturing capacity becomes constrained, for example, drug shortages
• The blurring of clinical and administrative functions, requiring ongoing education for providers to recognize the system implications of their daily clinical routines as we become more clinically integrated
• The political polarity affecting healthcare delivery reform

Conclusion Regarding US Healthcare Issues in 2011

 Regardless of the decision of the Supreme Court regarding the individual mandate, healthcare professionals will experience increasing pressure to provide more interdependent, coordinated, and cost-effective care for two reasons: our current level of spending is unsustainable, and it is the right thing to do for patients and their families, something that we wish for our loved ones who need care.

• What do you think
• Which issues do you think will be our greatest concerns in 2012
• What issues have I left out that merit consideration

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

Best wishes for a happy and productive new year, and please contact me any time that I can be of continuing service to you as you cope with multiple priorities at the same time. 

Kenneth H. Cohn

© 2012, 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.

©2012 Healthcare Collaboration. All Rights Reserved.

US Healthcare Issues in 2011 is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Ken on Twitter, Facebook or Google+.

I stayed transfixed in front of the TV set where I was staying when I was not seeing patients, learning about the families coping without their loved ones.  I saw a program about the health effects of the dust at the ground zero site and the number of responders who now struggle to breathe.

I wrote a letter to an MBA-school classmate whose brother perished 10 years ago in the World Trade Center attack, saying that the heroes were not only those who lost their lives, but also the families and friends who moved forward one footstep at a time to rebuild their lives.

I think about the former stockbroker who is now a banker and carries his World Trade Center ID with him, so that every time he begins to feel sorry for himself, he can remind himself of the thousands of people who would give anything to have his “problems.”

As I spoke with others about their reactions to what they experienced over the weekend, I believe that we put aside our differences and came together as a proud, mature nation.  It gives me hope.

©2012 Healthcare Collaboration. All Rights Reserved.

Saluting Our 9/11 Heroes is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Ken on Twitter, Facebook or Google+.

This is a note that Carl Taylor dashed off to me at 7 AM, concerned about my whereabouts on my return from covering a surgeon’s practice in Maine on Monday, September 29.
Carl is Assistant Dean of the University of South Alabama College of Medicine and
Director of the National Center for Disaster Medical Response.  He is also the author of Chapter 2, Disaster Planning, in Getting It Done. 

The following is what he has titled a “Random To Do To List For Hurricane Irene”:

1. If my office is damaged where will I relocate? Consider the hospital. Most fraud and abuse laws and other barriers are waived temporarily and at least some hospitals can create mini-offices for displaced physicians.

2. This is a late-in-the-month storm, so you should consider contacting patients scheduled for next week and see them now if you can. In addition, those patients needing prescription refills should be encouraged to get them refilled today, as pharmacies may not be open or capable of delivery next week.

3. Consider how you will make payroll next week if the banks are closed or your office is closed. Consider also cash advances even if you make electronic payroll payments since when the power goes out, we become a cash society again.

4. If you evacuate, how will you contact your staff to let them know when to return?

5. If you evacuate, have you secured your office and remotely backed up your electronic data?

6. If you volunteer to work in a hospital, ask how decisions will be made if resources are scarce. What we know is when hospitals go on generator power, some things may not work: among them air conditioning, information systems, CT, MRI and PET scanners. Medical care must be rendered, but without these commonly used and relied upon tools. If the water supply is compromised, drinking water is fairly easy to replace but sterilization becomes problematic. Have a plan (in Haiti, vodka worked well). Temperatures will rise in operating rooms, often causing walls to literally sweat from excess humidity; this can impact the use of other tools requiring power even if red plugs are working. Expect to see a number of puncture wounds, lacerations and closed head injuries from debris. Expect also by day 2 or 3 to see a rise in respiratory ailments of all kinds. Hurricanes like tornadoes put a lot of stuff in the air. The important thing is to make sure that your judgment under challenging conditions is supported.

7. Transportation will be challenged, so expect gasoline shortages for some time. Establish a relationship with either a gasoline station or fuel supplier to provide fuel. Anticipate that ambulances will be in short supply or not operational due to flat tires or fuel issues.

8. Talk to your suppliers. Fortunately since Katrina, many suppliers have gotten very good at disaster supply chain management.

9. Tell your patients or at least your answering service how to contact you if you evacuate. For patients who are in a shelter without their health security card and have limited knowledge about their conditions or medications, the primary care physician or designee may be a source of valued advice.

10. Contact health plans; since they have the data and the ability to operate 24×7, they could serve in a knowledge capacity.

11. Medically fragile patients going to a shelter should be told to inquire as to the location of a medical needs shelter rather than a general shelter, and to check the rules for admission. Many shelters require the patient to bring a caregiver with them. Expect power for durble medical equipment (DME), and limited medical professional staffing, but tell them to be self-supporting where possible. Unfortunately for the frail elderly, their caregiver is often also frail and elderly. Begin discharge planning now. Your patients should be encouraged to think about moving in with family, friends or other loved ones for a time if their permanent residence is damaged or destroyed.

12. For dialysis patients, chemotherapy patients and others who rely on a regular scheduled interaction with their health system, today is the day to contact that provider and understand their back-up plan. Find alternate centers.

13. Lastly plan to communicate. Have an air card, become fluent in text messaging since SMS seems to work under even austere conditions. Even if you are staying to help in the impacted area, consider an office manager or family member relocating outside the area to serve as your communication back-up.

©2012 Healthcare Collaboration. All Rights Reserved.

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

Ideally, branding creates a right-brain, visceral connection with listeners.  The trust I had in Mark’s insight, wit, and ability to deliver knowledge in the face of uncertainty created that visceral connection.

In an era of ratings-driven TV personas, Mark was authentic, clearly comfortable in his own skin.  If  legacy emanates from leveraging knowledge, wisdom,and experience to make a difference in people’s lives, Mark has left a lasting legacy.

As always, I welcome your input to improve healthcare collaboration.  Let Mark’s sudden passing rekindle a desire in all of us to tackle stretch goals as a reminder that none of us know how long we have left on this planet.

Kenneth H. Cohn

© 2011, 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.

©2012 Healthcare Collaboration. All Rights Reserved.

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

“Heck no,” I replied. “It is changing way too fast for anyone to feel like an expert.  The word ‘Facilitator’ appears after my name,  to clarify my role as someone who brings data for group discussion rather than someone who acts as the sage on the stage.”

With that purpose in mind, I traveled to Connecticut last week to speak to a group of physicians, hospital administrators, and Board members on Making Sense of Healthcare Reform: Moving Forward in the Face of Uncertainty. The Vice-President of the Medical Staff invited me to help him dispel myths, like “Healthcare reform will be overturned, it will only apply to Medicare,  and it will take decades before disruptive change comes to this part of the state.”

I divided my talk into three parts:

• Historical context: In 1943, facing union-led strikes during a period of wartime wage and price controls, Congress and the Internal Revenue Service agreed to allow companies to provide healthcare benefits to employees as a tax-free benefit that companies could expense as a tax deduction; so began our healthcare non-system
• Organizational implications: As I mentioned in Collaborative Culture, most physicians enjoy bottom-up processes more than top-down edicts. They have told me that they much prefer being inspired to being supervised. The only way that I know to develop a common culture is to allow physicians to play a role in shaping it.  A few physician champions can transform a culture once they see that they are making their time count and that they are making a difference in their patients’  lives.
• Personal implications: I believe that disruptive change calls for personal reinvention; unfortunately, the pathways that are so clear for becoming a physician are anything but transparent when it comes to transitioning; as my mentor, Dr.Paul Batalden, said, “Change feels like failure when we are in the middle of it,” which can lead to feelings of isolation and despair

Two questions from the audience remain with me:

1) From the Board Chair: “What should be the role of the Board in supporting healthcare reform?”
I replied that the Board should be a convener of respectful conversations among members of the medical staff, hospital leadership, and the community.  In complex times, communication based on active listening can help us act, learn, and adapt.

2) From an orthopedic surgeon: “How can we avoid reinventing the wheel?  There has to be a model out there that works, and people like you need to tell us what doesn’t work.”
I empathized with his feeling that nobody wants to relive the difficult situations of the previous century occasioned by capitation and reengineering.  I also mentioned that orthopedists in the 40 states where I have worked have told me, “When you have been to one hospital, you have been to one hospital.”  Physicians with whom I have collaborated have preferred being active participants to having change imposed upon them.  Healthcare reform involves an iterative journey, in which we accept setbacks in order to move forward.  Learning is never failure.

Personal Implications of Healthcare Reform

The Collaboration Multiplier

I believe that we are in an exciting phase.  The changes that we are making now may have implications for decades.  We need to feel that we are not alone, that collaboration can improve clinical and financial outcomes, and that a spirit of inquiry rather than advocacy can guide us in the face of uncertainty.  As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

© 2011, all rights reserved

Disclosure:

Although I was paid to speak on “Making Sense of Healthcare Reform: Moving Forward in the Face of Uncertainty,” I have not received any compensation for writing this blog post. I have no material connection to the brands, topics and/or products that are mentioned herein.

©2012 Healthcare Collaboration. All Rights Reserved.

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

It was a poignant reminder that campuses shield students from some of life’s pressures, so that they can focus on curricular and extra-curricular activities.  The word campus originally meant a flat place or field before becoming known as the grounds, buildings, and faculty of a division of a university that is administratively joined to the rest of the university.

Having been part of trauma resuscitations in the past, I thought of all the people who are affected by the event, in addition to students like my daughter who find it difficult to study now, as they try to make sense of this tragedy, including the:

• family who lost a child with such promise
• family of the assailant who is now in custody
• doctors, nurses, and paramedics associated with the world-class academic medicial center where the student was brought emergently
• students at the fraternity house dealing with the question, “What could I have done to de-escalate the situation ?”
• university administrators discussing, “What techniques and tools could we have taught students to prevent this tragedy?”
• other university officials throughout the US who are pondering similar questions, troubled by, “There but for the grace of God, go I.”

In International Collaboration, I mused on The Last Judgment,  in which Michaelangelo painted the Vatican Master of Ceremonies, Biagio da Cesena, as Minos, gatekeeper of the underworld, after da Cesena commented that Michaelangelo’s art belonged in a bar rather than in the Sistine Chapel.  It reminded me of how carried away that we can be in our personal hostilities and made me wonder what might result if physicians and hospital leaders used art to convey their feelings.

Tragedies like the one at my daughter’s college jar us out of the past or future and force us to deal with present-day realities.  As I noted in Collaborative Leadership, when I reviewed the recently published Quicksilver: A Revolutionary Way to Lead the Many and the Few- Beginning with You , the word “quicksilver” is a synonym for mercury and a metaphor for suddenness and unpredictability.

When I was undergoing chemotherapy for lymphoma, a physician”s phrase comforted me: mope, cope, and hope.  I hope that, as in Tucson, we relearn the power of our words to heal.  As the President of the University wrote:

At times like this, it is important to remember that as a community we are dedicated to each other’s well-being, and we are stronger together when we support one another, especially in difficult times.

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

Kenneth H. Cohn

© 2011, 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.

©2012 Healthcare Collaboration. All Rights Reserved.

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

Getting It Done will provide case insights from  leading organizations on topics ranging from slaying sepsis to dealing with disruptive practitioners, ED call-pay solutions, and preparing for disaster, to name just a quarter of the topics.  As far as I know, it represents the first time that a practicing surgeon has teamed up with a hospital COO to edit a book.  Now onto the review

Dr. Sanjay Gupta gave the keynote lecture at my alma mater University of Rochester’s Meliora Weekend  October 16, 2010.  I enjoyed his warm, authentic story-telling style as much as insights like:

I learned that hopes, dreams and aspirations are spread evenly throughout the world…

So, I bought his book, Chasing Life, which I thoroughly enjoyed.  With each page that I turned, I visualized myself appearing smarter in front of patients when asked for advice:

• Hara hachi bu: An Okinawan expression for pushing away from the table when one is 80% satiated (p.20); Okinawans have one of the longest life-spans in the world
• Tatyana Pozdnyakova who won the LA marathon in 2004 at age 49: “My age is very high, but my head is strong.  It is not about your body.  It is discipline.” (p.80)
• Inadequate sleep decreases leptin production (an appetite suppressant) and increases ghrelin (an appetite stimulant), suggesting a link between sleep deprivation and obesity (p. 161)
• An estimated 1.4 million Americans start smoking each year, half under age 18 (p.161)
• An estimated 20.8 million Americans are diabetic; approximately 30% undiagnosed; over 1/3 of insulin-dependent diabetics who started a low-fat, vegetarian diet were able to stop taking insulin (p. 168-171)
• The death of a spouse increases the risk of death of  his or her partner within the next 2 years by 17% for women and 21% for men (p.182)
• The brain scans of people who meditate show less aging than comparable people who don’t (p. 195)

These are just a few of the well-reported insights in this entertaining book; reading it is a painless growth experience.

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.  I have no material connection to the brands, topics and/or products that are mentioned herein.

©2012 Healthcare Collaboration. All Rights Reserved.

Collaborative Intelligence: A Brief Review of Dr. Sanjay Gupta’s Chasing Life is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Ken on Twitter, Facebook or Google+.

• Continue to educate patients and their families that lifestyle decisions (for example, affecting diet, exercise, smoking, and seat belts) account for 40 percent of their quantity and quality of life, whereas healthcare interventions account for only 10 percent
• Decrease readmissions: In Collaborate for Success, Waterbury Hospital decreased readmissions due to failure to take medications as prescribed from two patients per month to nearly zero, with one call to recently discharged patients. As Dr. Cusano summarized, “We realized that patients who were getting calls were close to 100 percent on doing the right things.” A phone call within 48 hours of discharge and assessment shortly after admission of patients’ likely discharge needs are at the top of Maureen Bisognano’s ten-point checklist of What Can Be Done to Reduce Rehospitalization.
• Improve recruitment and retention: Gaps in coverage are costly to practice administrators and patient outcomes. In The Lifelong Iterative Process of Physician Retention, a healthcare system improved its annual retention rate from 90 percent to 100 percent by teaching established physicians how to mentor recently hired physicians.
• Foster healthy competition: In Better Communication for Better Care, the director of a cardiac catheterization laboratory brought the procedure times and outcomes for his six-person group to within one standard deviation in four months by telling physicians that if they could not come to consensus on how to limit variation and improve financial and clinical outcomes within six months, he would post the results for each cardiologist on a bulletin board in the catheterization lounge in full view of the entire staff. As a cardiologist explained, “None of us wanted to be an outlier except on the positive side.”

I believe that we earn the trust of patients and their families because we keep our promises.  Transparency is a bridge to trust.  As I quoted Dorn and Marcus in A call to action for healthcare executives:

When our patients face a frightening procedure or a discouraging diagnosis, we comfort them by offering a course of action to give them a sense of hope, and with it, a future. This formula is what good medicine is about, and it is time we do the same for ourselves and for our profession.

Change in and of itself can be exciting as we envision something new and being a part of making it happen.

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 from anyone’s political action fund. Although I remain passionate about healthcare collaboration, I have no material connection to the brands, topics and/or products that are mentioned herein.

©2012 Healthcare Collaboration. All Rights Reserved.

Collaborative Politics: The Essence of Trust is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Ken on Twitter, Facebook or Google+.

US Navy Commissioning Oath

The oath of office that he took reads:

 I solemnly swear that I will support and defend the Constitution of the United States against all enemies foreign and domestic; that I will bear true faith and allegiance to the same; that I take this obligation freely, without any mental reservation or purpose of evasion; and that I will well and faithfully discharge the office upon which I am about to enter. So help me God.

My son is living his passion to become a naval aviator.

Well-meaning friends have asked me if I am concerned for his safety. They point to the hazards of an aircraft carrier, where approximately 65,000 pound fully armed aircraft accelerate from 0 to over 150 mph in 3 seconds, launched by catapults, whose controls are set by 20-somethings with an average of 2-3 years experience. And then, there are the landings on a slippery flight deck bobbing up and down, with only four arresting wires to halt the plane.

Knowing that arguing would be futile, I respond, “Sure, any parent would be concerned for his child’s safety. One never stops being a parent.”

But deep down, I feel secure because aircraft carriers embody the five principles of high reliability organizations:

• Preoccupation with failure: focusing on predicting and eliminating catastrophes rather than reacting to them
• Commitment to resilience: assuming that systems can fail in unanticipated ways and learning to contain errors quickly by discussing and practicing responses to systems failures and near misses
• Deference to expertise: de-emphasizing hierarchy to gain input from people with the greatest knowledge relevant to the issue at hand
• Reluctance to simplify: accepting that work is complex and that failures are multi-factorial
• Sensitivity to operations: understanding how processes really work and paying attention to a broad range of factors, such as distractions, availability of needed supplies and personnel, and length of time people have been on duty

Why is healthcare generally not as reliable as aviation? 

As Jack Barker and I discussed in Collaborate for Success!, aviation utilizes organizations such as the Federal Aviation Administration (FAA) to develop and enforce regulations and the National Transportation Safety Board (NTSB) to investigate accidents. Furthermore, aviation has a mechanism through the Aviation Safety Reporting System (ASRS) to report near misses and errors that impact safety. Widespread use of medical guidelines and a process for reporting all medical errors that is not subject to legal discovery are in their infancy.  Healthcare professionals face difficult transitions changing their status from craftsmen to people that value safety and interchangeability.  Distinguishing between iatrogenic injury and complications due to disease often is a judgment journey.

One hospital system journey that gives me hope is the Sentara Safety Initiative which began in 2002 when hospital leaders became frustrated with the pace of change.  Dr. Yates, VP and medical director for clinical effectiveness, wrote that the missing piece was a stronger organizational culture focused on patient safety.  A group of 14 physicians and 2 nurses developed 5 behavior-based expectations (BBEs):

• Pay attention to detail: using the mnemonic SAFE (Stop, Analyze, Focus, Evaluate) to focus attention on the task at hand and decrease skill-based errors
• Communicate clearly, using clarifying questions and repeating back orders
• Have a questioning attitude, empowering healthcare professionals to stop actions when unsure about their safety
• Handoff effectively, using the 5P checklist to ensure successful transfers (Patient/ Project, Plan, Purpose, Problems, Precautions)
• Never leave your wingman, using peer checking and coaching when appropriate

To convert expectations into organizational habits, supervisors provide everyday feedback on BBEs which serve as core competencies on performance reviews. Managers use walk rounds to reinforce safety culture behaviors and make sure that shift-change reports, handoff reports, and pre-procedure briefings are handled appropriately. As in aviation, staff receive encouragement and recognition for reporting near misses and unsafe events. Meeting patient safety goals is a criterion for medical staff reappointment.

Hospital leaders use a system call Real-time Behavior Based Monitoring to monitor overall performance. One quarter of variable executive compensation is linked to achieving safety goals, as is one half of the annual employee gainsharing bonus.

In 2 ½ years, Sentara decreased ventilator-associated pneumonia 84% and device-associated bloodstream infections 63% (Yates GR et al. 2004. Sentara Norfolk General Hospital: accelerating improvement by focusing on building a culture of safety. Joint Commission Journal on Quality and Safety 30: 434-542.). They experienced a 50% reduction in events of harm per 10,000 adjusted patient days system-wide (McCarthy D, Blumenthal D. Committed to Safety. Commonwealth Fund pub. no. 923; 2006:17:165-200).

Sentara has shown that they can enhance culture change by embedding tactical safety improvement projects in a larger organizational strategy. They have promoted a virtuous cycle of organizational culture driving behaviors which drive improved outcomes that reinforce the safety culture and improve reliability.

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. I have no material connection to the brands, topics and/or products that are mentioned herein.

©2012 Healthcare Collaboration. All Rights Reserved.

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